Risk Adjustment

In Pakistan Mutual Funds were introduced in 1962, when the public offering of National Investment (Unit) Trust (NIT) was introduced which is an open-end mutual fund. In 1966 another fund that is Investment Corporation of Pakistan (ICP) was establishment. ICP subsequently offered a series of closed-end mutual funds. Up to early 1990s, twenty six (26) closed-end ICP mutual funds had been floated by Investment Corporation of Pakistan. After considering the option of restructuring the corporation, government decided to wind up ICP in June, 2000. In 2002, the Government started Privatisation of the Investment Corporation of Pakistan. 25 Out of 26 closed-end funds of ICP were split into two lots. There had been a competitive bidding for the privatisation of funds. Management Right of Lot-A comprising 12 funds was acquired by ABAMCO Limited. Out of these 12, the first 9 funds were merged into a single closed-end fund and that was named as ABAMCO Capital Fund, except 4th ICP mutual fund as ...

This study examines the conditional relationship between beta and return for stocks traded on S&P 500 for the period from July 2001 to June 2011. The portfolios formed based on the Book value per share and betas using monthly data. A novel approach for capturing time variation in betas whose pattern is treated as a function of market returns is developed and presented. The estimated coefficients of a nonlinear regression constitute the basis of creating a two factor model. Our results indicate that the proposed specification surpasses alternative models in explaining the cross-section of returns.

We analyze monthly returns on an equally weighted index of eighteen to twenty-three equity (real property) real estate investment trusts (REITs) that were traded on major stock exchanges over the 1973-87 period. We employ a multifactor Arbitrage Pricing Model using prespecified macroeconomic factors. We also test whether equity REIT returns are related to changes in the discount on closed-end stock funds, which seems plausible given the closed-end nature of REITs. Three factors, and the percentage change in the discount on closed-end stock funds, consistently drive equity REIT returns: unexpected inflation and changes in the risk and term structures of interest rates. The impacts of these variables on equity REIT returns is around 60% of the impacts on corporate stock returns generally. As expected, the impacts are greater for more heavily levered REITs than for less levered REITs. Real estate, at least as measured by the return performance of equity REITs, is less risky than stocks generally, but does not offer a superior risk-adjusted return and is not a hedge against unexpected inflation.

The magnitude of the effect of government-sponsored enterprise purchases on primary mortgage market rates has been a difficult research question with differing data and competing methodologies producing varying results. Here we present a new approach using loan level data and controlling for credit risk differentials between conforming and nonconforming loans. Our method also addresses econometric problems of endogeneity and sample selection bias. We find that conforming loans have yield spreads about 5.5% lower compared to other loans on a risk-adjusted basis. This is lower than previous estimates appearing in the literature.

We analyze monthly returns on an equally weighted index of eighteen to twenty‐three equity (real property) real estate investment trusts (REITs) that were traded on major stock exchanges over the 1973–87 period. We employ a multifactor Arbitrage Pricing Model using prespecified macroeconomic factors. We also test whether equity REIT returns are related to changes in the discount on closed‐end stock funds, which seems plausible given the closed‐end nature of REITs.Three factors, and the percentage change in the discount on closed‐end stock funds, consistently drive equity REIT returns: unexpected inflation and changes in the risk and term structures of interest rates. The impacts of these variables on equity REIT returns is around 60% of the impacts on corporate stock returns generally. As expected, the impacts are greater for more heavily levered REITs than for less levered REITs. Real estate, at least as measured by the return performance of equity REITs, is less risky than stocks ...

In hematopoietic cell transplantation (HCT), current risk adjustment strategies are based on clinical and disease-related variables. Although patient-reported outcomes (PROs) predict mortality in multiple cancers, they have been less well studied within HCT. Improvements in risk adjustment strategies in HCT would inform patient selection, patient counseling, and quality reporting. The objective of the current study was to determine whether pre-HCT PROs, in particular physical health, predict survival among patients undergoing autologous or allogeneic transplantation. In this secondary analysis, the authors studied pre-HCT PROs that were reported by 336 allogeneic and 310 autologous HCT recipients enrolled in the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902 protocol, a study with broad representation of patients who underwent transplantation in the United States. Among allogeneic HCT recipients, the pre-HCT Medical Outcomes Study Short Form-36 Health Survey (SF-...

Background: Surgical readmissions will be targeted for reimbursement cuts in the near future. We sought to understand differences between hospitals with high and low readmission rates in a statewide surgical collaborative to identify potential quality improvement targets. We studied 5,181 patients undergoing laparoscopic or open colectomy at 24 hospitals participating in the Michigan Surgical Quality Collaborative between May 2007 and Jan 2011. We first calculated hospital risk-adjusted 30-day readmission rates. We then compared reasons for readmission, risk-adjusted complication rates, risk-adjusted inpatient length of stay and composite process compliance across readmission rate quartiles. Results: Hospitals with the lowest 30-day readmission rates averaged 5.1%, compared to 10.3% in hospitals with the highest rates (p<0.01). Despite wide variability in readmission rates, reasons for readmission were similar between hospitals. Compared to hospitals with low readmission rates, hospitals with high readmission rates had higher risk-adjusted complication rates (29% vs. 22%, p=0.03), but similar median length of stay (5.5 days vs. 5.6, p=0.61). While measures to reduce complications were associated with lower surgical site infection rates, they were not associated with reduced overall complication or readmission rates. There was wide variation in complication rates among hospitals with similar readmission rates. There is wide variation in hospital readmission rates after colectomy that correlates with overall complication rates. However, the wide variation in complication rates among hospitals with similar readmission rates suggests that hospital complication rates explain little of their readmission rates. Preventing readmissions after colectomy in hospitals with high readmission rates will require more attention to different care processes currently unmeasured in many clinical registries as well as complication prevention.

Objectives: To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design: We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting: Twenty-two regional NICUs in California.

Total knee arthroplasty (TKA) is a well-established procedure for managing advanced knee osteoarthritis, providing significant pain relief and functional improvement [1]. However, despite its success, postoperative complications and hospital readmissions remain a concern [2,3]. This mini review focuses on the causes and risk factors associated with readmission after TKA, highlighting findings from recent literature, including our retrospective study. The primary reasons for readmission include surgical site infections, wound complications, thromboembolic events, and medical comorbidities [4,5]. Understanding these factors is crucial for developing strategies to minimize readmission rates and improve patient outcomes.

Hip replacement (HR) operations are increasing. Short term mortality is an indicator of quality; few studies include risk adjustment models to predict HR outcomes. We evaluated in-hospital and 30-day mortality in hospitalized patients for HR and compared the performance of two risk adjustment algorithms. A retrospective cohort study on hospital discharge records of patients undergoing HR from 2000 to 2005 in Tuscany Region, Italy, applied All-Patient Refined Diagnosis Related Groups (APR-DRG) and Elixhauser Index (EI) risk adjustment models to predict outcomes. Logistic regression was used to analyse the performance of the two models; C statistic (C) was used to define their discriminating ability. 25 850 hospital discharge records were studied. In-hospital and 30-day crude mortality were 1.3% and 3%, respectively. Female gender was a significant (p &lt; 0.001) protective factor under both models and had the following Odds Ratios (OR): 0.64 for in-hospital and 0.51 for 30-day mortal...

Wstęp: W rzetelnej ocenie wyników leczenia należy brać pod uwagę różnorodność leczonej populacji pacjentów. Bez uwzględnienia tych danych analizowanie, a tym bardziej porównywanie, wyników jest obarczone dużym, nieakceptowalnym błędem. Do analizy śmiertelności po leczeniu wad wrodzonych serca w okresie 16 lat zastosowaliśmy cztery narzędzia do stratyfikacji ich złożoności: Aristotle Basic Complexity Score (ABC Score), Risk Adjustment for Congenital Heart Surgery-1 Categories (RACHS-1 Categories),

This paper analyses the stable distributional approach for portfolio optimisation. We consider a portfolio optimization problem under the assumption of normal (Gaussian) and stable (non-Gaussian) distributed asset returns. We compare the results of portfolio allocations in normal and stable cases.

Risk-adjusted stock ranking criteria applicable when stock returns are not normally distributed are able to generate more profitable momentum strategies than those based on usual cumulative or total return criterion. These alternative risk-return ratio criteria conform to properties of coherent risk measures and, in different form, capture the risk of the tail distribution. Replacing the cumulative return by the risk-adjusted criterion, we also utilize the ratio as the objective function in the portfolio optimization problem and obtain optimal risky winner and loser portfolios. Our results are robust to transaction costs for both equal-weighted and optimized-weighted strategies. In particular, our alternative ratios outperform the cumulative return and the Sharpe ratio across all strategies measured by total realized return and independent performance measures over the observed period.

In this paper we are looking for answers: are domestic companies operating in small market economies such as the Baltics with little or no direct foreign involvement also at risk, taking into account that our companies mainly as a mean of exchange are using euro. The aim of this study is to examine the foreign exchange rate exposure of domestic corporations in the Baltic States. The study shows that companies in the Baltic States tend not to manage their foreign exchange risk properly and some of the companies are thus exposed to significant losses due to fluctuations in currency exchange rates. The VaR estimates are proposed and evaluated as a method to measure the position that is necessary to hedge.

The authors are grateful to two anonymous reviewers as well as to Philip Girard and the editorial board of this journal for helpful comments. Responsibility rests solely with the authors. 1. 5754 Sefer HaChukim 156. 2. A.C. Enthoven, "The History and Principles of Managed Competition" (1993) 12 Health Aff. (Supplement) 25. See A.C. Enthoven, Theory and Practice of Managed Competition in Health Care Finance (Amsterdam: North Holland, 1988).

comments, which helped me improve the quality of my research papers. I would like to offer my special thanks to Huasheng Gao and Stephen Dimmock for their professional guidance and selfless help during the first two years of my PhD study. My gratitude goes out as well to Jun-Koo Kang, Angie Low, Chishen Wei, Hangjiang Zhang and all the other faculty members in the division of Banking and Finance, Nanyang Business School for their coursework teaching and comments during the brown-bag seminars. In addition, I am indebted to my fellow PhD candidates in Nanyang Business School who helped make my research life enjoyable and stimulating. Lastly, I would like to express my sincere appreciation to my parents who raised me and supported me in all my pursuits throughout my life. I would not have made it this far without them. And I also want to thank all my close friends for their friendship and warm company along the way. I would like to thank my beloved wife for her constant love and her faith in me through all those hard times.

for discussions on this research project. We thank the representatives of Dodge & Cox Funds and Goldman Sachs Asset Management for sharing with us their investment decision making process. The authors acknowledge nancial support from the Social Sciences and Humanities Research Council (SSHRC).

This paper utilizes a new data set from AllianceBernstein that, unlike other corporate governance data, has country-level and monthly-updated firm-level governance ratings for 22 emerging markets countries for almost a five year period. With these data we examine the relationship of firm-level and country-level corporate governance on firm valuation, dividend payout, internal firm performance and other issues. We find a number of interesting results that have implications for corporations, investors and policymakers. First, we find there is a positive and significant relation between firm-level and country-level corporate governance ratings and market valuation. Second, we find this relation between governance and market valuation is non-linear. Specifically, top-rated firms and firms in toprated countries have significantly better market valuations than other firms, but there is little significant difference in the market valuation between intermediate rated and low rated firms. Third, we find firmlevel governance impacts market valuation differently depending on the degree of country governance where the firm is located. Indeed, in countries with weak country-level governance, we find that improvements in firm-level governance can actually lead to significantly lower market valuations. Fourth, since we have firm-level corporate governance ratings on a monthly basis, we examine the effects of changes in corporate governance at the firm level over the specific window of time when the corporate governance ratings have changed. This type of test allows us to overcome the issue of whether better governance causes better valuations, or whether firms with better valuations endogenously choose better governance. Using this test we find some evidence that improvements in corporate governance do cause higher valuations, higher returns on equity, and more efficient usage of capital. Fifth, in an examination of what country-level governance issues influence firm-level governance, we find that the governance stance on corporate governance and equity culture and the political, social, and environmental climate of the country are both positively and significantly related to firm-level governance. Although causation is difficult to determine, this result suggests that a country that is concerned with human rights and environmental issues creates a positive example that corporations seem follow in their firm-level governance. Sixth, in an out-sample analysis of the predictive ability of the governance ratings, we find that firms located in countries with high countrylevel governance ratings did in fact predict significantly better future risk-adjusted stock return performance. On the other hand, we find that firm-level corporate governance ratings themselves are weaker predictors of future risk-adjusted stock return performance.

Along with anthracyclines, taxanes are the most active cytotoxics in breast cancer (BC). Balancing efficacy against toxicity in older patients with reduced physiological reserves and significant comorbidities is both important and difficult. This is especially so given the under-representation of elderly patients in major trials and a consequent lack of evidence for drug, dose and schedule. However, BC is frequent in elderly women, who are a growing proportion of the population. Careful consideration of their care is therefore imperative. Treatment that can cure or extend the duration and quality of life should not be restricted by age, but needs to be tailored to the circumstances of elderly patients. In adjuvant use, taxane toxicity in older women is greater than in their younger counterparts, limiting its sequential combination with anthracyclines for high-risk disease unless patients are in very good health. More frequently taxanes are used alone (weekly paclitaxel, three-weekly...

NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Design Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Results Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality ( p<0.001) and improved survival ( p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, p<2.2×10 -6 ) and an improvement in survival ( p<10 -19 ; 5-year difference: 3.8% (41.0%-44.8%)) comparing high participation for ≥4 years with 0 years. Conclusions There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation.

Hiperconsumidor; Utilizacio ´n de servicios sanitarios; Complejidad casuı ´stica; Ajuste de riesgos Resumen Objetivo: Identificar pacientes hiperconsumidores de farmacia en atencio ´n primaria, describir las diferencias epidemiolo ´gicas entre pacientes normoconsumidores e hiperconsumidores e investigar la capacidad explicativa del sistema de ajuste de riesgos ACG (Adjusted Clinical Groups) sobre la variabilidad del gasto farmace ´utico para ambos grupos de pacientes. Disen ˜o: Estudio observacional retrospectivo. Emplazamiento: 23 centros de salud de Arago ´n, Baleares y Catalun ˜a. Participantes: Se incluyeron 286.450 pacientes atendidos al menos una vez en 2005. Mediciones: Se analizaron variables demogra ´ficas, de consumo farmace ´utico y de casuı ´stica (ACG s 7.1). Se identificaron pacientes hiperconsumidores a partir del rango intercuartı ´lico. Se construyo ´un modelo de regresio ´n lineal, para conocer la capacidad explicativa del ACG sobre el consumo farmace ´utico. El mismo modelo se aplico ´para la estratificacio ´n segu ´n variables del profesional, centro de salud y comunidad auto ´noma. Resultados: Uno de cada 10 pacientes se clasifico ´como hiperconsumidor. Este grupo fue el causante del 60% del gasto farmace ´utico. Se trata de pacientes con 26,3 an ˜os ma ´s y con mayor comorbilidad que los pacientes normoconsumidores. La capacidad explicativa del ACG sobre el gasto farmace ´utico fue llamativamente inferior para el grupo de hiperconsumidores (3 frente a 26% en pacientes normoconsumidores). Conclusiones: Han de investigarse las causas que provocan la falta de adaptacio ´n de los ACG al grupo de pacientes hiperconsumidores. Puede que haya circunstancias sociales que influyen sobre la situacio ´n clı ´nica de estos pacientes. O, ma ´s probablemente, el me ´todo

OBJECTIVEConcurrent surgeries, also known as “running two rooms” or simultaneous/overlapping operations, have recently come under intense scrutiny. The goal of this study was to evaluate the operative time and outcomes of concurrent versus nonconcurrent vascular neurosurgical procedures.METHODSThe authors retrospectively reviewed 1219 procedures performed by 1 vascular neurosurgeon from 2012 to 2015 at the University of California, San Francisco. Data were collected on patient age, sex, severity of illness, risk of mortality, American Society of Anesthesiologists (ASA) status, procedure type, admission type, insurance, transfer source, procedure time, presence of resident or fellow in operating room (OR), number of co-surgeons, estimated blood loss (EBL), concurrent vs nonconcurrent case, severe sepsis, acute respiratory failure, postoperative stroke causing neurological deficit, unplanned return to OR, 30-day mortality, and 30-day unplanned readmission. For aneurysm clipping cases,...

Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes. We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, P<0.001) and higher mortality (0.26% vs. 0.05%, P = 0.01). The lowest quartile of skill was also associated with longer operations (137 minutes vs. 98 minutes, P<0.001) and higher rates of reoperation (3.4% vs. 1.6%, P = 0.01) and readmission (6.3% vs. 2.7%) (P<0.001). The technical skill of practicing bariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency.

Background: The optimal treatment of high-risk PE with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high-risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS™ acoustic pulse thrombolysis. Method: From April 2016 to June 2020, 29 patients with high-risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 ± 9.2 years. Twelve (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after the presentation. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality. Results: Twenty-two patients survived to hospital discharge, with a mean ICU stay of 9.9 ± 1.6 days (range, 7 to 22 days) and mean ...

Objectives: Patients with thoracic outlet syndrome (TOS) complain of many subjective symptoms that are difficult to measure and quantify. In this study we have tried to assess the weakness (muscle strength) and fatigue (endurance) of these patients with an objective measurement method, isokinetic muscle testing. Methods: Twenty three TOS patients and 15 age matched healthy controls were enrolled in the study. Detailed histories of the patients were taken and the patients underwent complete physical examinations. Cervical radiographies, Doppler ultrasonography, electromyography, and isokinetic measurements were carried out. The isokinetic measurements were carried using the Biodex System 3 dynamometer during concentric shoulder flexions and extensions at velocities of 60˚/s, 180˚/s, and 240˚/s. Results: Although the muscle strengths of both groups seemed to be similar, the fatigue ratios of TOS patients at 60˚/s and 180˚/s were found to be higher compared with those of healthy controls (p = 0.029, p = 0.007). Conclusions: TOS patients were found to have muscular performance similar to controls, but their upper extremities developed fatigue more easily than those of healthy individuals.

Aims  Although heart disease and stroke are the underlying causes of death in most people with diabetes, vascular risk modification targets are frequently not met. This study examined whether vascular risk‐modifying medication utilization for diabetic patients differed among physician specialties.Methods  A population‐based study using administrative data from 105 715 people aged ≥ 65 years with newly diagnosed diabetes in Ontario between 1994 and 2001. The receipt of antihypertensive and lipid‐lowering drugs was compared between patients who had regular care from endocrinologists, internists/geriatricians and family physicians. Hierarchical logistic regression adjusted for patient‐level differences, physician‐level differences and patient clustering within physicians.Results  Only two‐thirds of patients received antihypertensive drugs and about one‐quarter received lipid‐lowering drugs. Compared with patients of family physicians, the adjusted odds ratios for antihypertensive drug ...

Diabet. Med. 29, 1134–1141 (2012)Aims  There are limited validated methods to ascertain comorbidities for risk adjustment in ambulatory populations of patients with diabetes using administrative health‐care databases. The objective was to examine the ability of the Johns Hopkins’ Aggregated Diagnosis Groups to predict mortality in population‐based ambulatory samples of both incident and prevalent subjects with diabetes.Methods  Retrospective cohorts constructed using population‐based administrative data. The incident cohort consisted of all 346 297 subjects diagnosed with diabetes between 1April 2004 and 31 March 2008. The prevalent cohort consisted of all 879 849 subjects with pre‐existing diabetes on 1 January, 2007. The outcome was death within 1 year of the subject’s index date.Results  A logistic regression model consisting of age, sex and indicator variables for 22 of the 32 Johns Hopkins’ Aggregated Diagnosis Group categories had excellent discrimination for predicting mortal...

Segment diversification is a common strategy applied by hotel companies. According to previous research on the modern portfolio theory, a company can reduce risks and thus increase its value with more diversified operations. Such reasoning can certainly apply to the hotel industry in terms of its segment strategy. However, the findings are inconclusive. In particular, other literature argues for more concentrated rather than diversified operations. This study therefore examines the impacts of segment diversification on companies&#39; risk-adjusted performances among publicly traded US hotels. The results suggest that a moderate segment diversification strategy maximizes a company&#39;s risk-adjusted performance.

Of critical concern to hospitals today is the prevention of postoperative (surgical site) infections that often result in increased lengths of stays for patients, increased resource demands and costs, loss of public trust and lawsuits, and needless pain and suffering for patients and their families. While all surgical patients have the potential to develop a postoperative infection, the main challenge is to identify key risk factors (both patient centered and operational) through an electronic early-warning system to reduce the likelihood of a postoperative infection from occurring. Currently, most postoperative infection risk prevention practices encompass limited use of informatics technologies or do not maximize the potential benefits. In addition, from a research perspective, there has been more focus on extrapolating electronically housed data (eg, from progress notes, operative notes, laboratory, pharmacy, radiology) retrospectively to describe poor patient outcomes for benchm...

BackgroundIdentification of risk factors for perioperative complications helps in the prognostication. We wanted to determine whether Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth‐POSSUM (P‐POSSUM) can be used in patients undergoing head and neck oncosurgery.MethodsWe conducted a retrospective analysis of 1265 patients after they had major head and neck oncosurgeries. Demographic, surgical and outcome data was collected. We separately analyzed data for patients who had undergone cancer surgery for oral cavity, pharynx, and larynx. We calculated the POSSUM and P‐POSSUM scores.ResultsPOSSUM scoring system had moderate discrimination (AUC = 0.61) and good calibration (P = .36) for the entire study cohort and in the subgroup. Since there were no deaths in the entire cohort, we were not able to check predictive ability of the scores, for mortality.ConclusionsWe found that POSSUM had moderate discrimination and good calib...

Background: The aim of this study was to investigate differences in HIV disease progression in patients infected with HIV subtype B with a GPGR motif in the V3 loop region (B-GPGR) versus the Brazilian subtype B variant with a GWGR motif (B'-GWGR). Materials and Methods: Patients were enrolled in an ongoing cohort study at the University of SBo Paulo Dermatology Clinic in Sao Paulo, Brazil. V3 serology was performed by enzyme immunoassay with peptides representing two HIV subtype B strains, MN and SF2, and two Brazilian variant B'-GWGR strains. The incidence of AIDSdefining events was calculated, and Cox proportional hazards regression was used to estimate adjusted risk ratios. Results: Of the samples from 114 patients studied, 23 (20%) were classified as B'-GWGR motif, and 91 (80%) as B-GPGR motif. Patients with T CD4+ cell counts less than 200 cells/mm3 or 200-400 cells/mm3 experienced an increased incidence of AIDS-defining events compared with patients who entered the cohort withT CD4' cell counts greater than 400 cells/mm3. In a proportional hazard model including age, gender, T CD4' cell count at entry into the cohort, and V3 serology, GWGR reactivity was associated with a decreased hazard rate for presenting an AIDSdefining condition during follow-up. Three patients in the group with GPGR serology died after experiencing an AIDS-defining event. None of the patients with GWGR serology died during follow-up. Discussion: Survival analysis showed that patients infected with the Brazilian subtype B variant with a GWGR motif in the V3 loop had lower risk, adjusted for initial CD4' cell count, of AIDS-defining events than patients infected with subtype B-GPGR strains.

Established tests for asymmetric information in insurance markets are examined. The most commonly used, that information is symmetric if high and low cover contracts have the same loss rate, is inconsistent with standard assumptions that imply that under symmetric information, all contracts o¤er full-cover. Incomplete cover and symmetric information can be reconciled if there are claim-processing costs, but now existing tests fare badly, partly due to the divergence between marginal and average selection e¤ects. Ignoring the nature of loading factors may cause recent studies to mismeasure the welfare costs of asymmetric information but these problems are remedial. Economists' fascination with insurance markets is mostly due to the theoretical possibility that their functioning is impaired by asymmetric information. A substantial empirical literature, surveyed by Cohen and Seigelman (2010), seeks to determine whether this is a problem in practice. In the view of many, adverse selection justi…es major market interventions; "That problem [adverse selection] is not an abstraction invented by economists to justify trampling individual liberties. As experience in most countries around the world has con…rmed, it is a profound source of market failure that renders unregulated insurance markets a catastrophically ine¤ ective way of providing access to health care.

Adverse selection famously leads to the crowding out of socially beneficial trades. We show that even more trades may be simultaneously crowded in. The reason is that, in the absence of complete unravelling, "lemons" fetch more under adverse selection. It is demonstrated how these "bad" trades occur in insurance, credit and used-car markets, and some policy implications are discussed.

Recent evidence suggests that all asset returns are predictable to some extent with excess returns on real estate relatively easier to forecast. This raises the issue of whether we can successfully exploit this level of predictability using various market timing strategies to realize superior performance over a buy-and-hold strategy. We find that the level of predictability associated with real estate leads to moderate success in market timing, although this is not necessarily the case for the other asset classes examined in general. Besides this, real estate stocks typically have higher trading profits and higher mean risk-adjusted excess returns when compared to small stocks as well as large stocks and bonds even though most real estate stocks are small stocks.

To determine the relationship of Apgar scores, gestational age and neonatal risk mortality scores to health-related quality of life (HRQoL) for infants at the age of 8 months treated after birth in neonatal intensive care unit (NICU). All surviving infants treated in two-third level NICUs in Rijeka, Croatia (from August 2013 to August 2014) were included in this prospective, cross-sectional study. For all neonates, the Score for Neonatal Acute Physiology (SNAP), SNAP with Perinatal Extension (SNAP-PE) and their simplified modifications (SNAP II and SNAP-PE II) were calculated. At the corrected age of 8 months, the Pediatric Quality of Life Questionnaire (PedsQL)-infant scale-was completed by parents of surviving infants. Multiple regression analysis was performed in order to assess the value of neonatal risk mortality scores, Apgar scores and gestational age as possible predictors of HRQoL, measured by questionnaire score. A strong correlation has been found between SNAP and 5-min A...

We study the initial returns and long-run performance of a unique sample of thrifts that have recently converted from mutual to stock form. In addition to a full claim on all IPO proceeds, new investors in a converted thrift also receive a claim on all pre-conversion market value at no cost. Thus, the average firm in our sample has a degree of underpricing automatically built into its offer price. We find that after removing the large initial returns, cumulative excess returns for the firms in our sample are positive for 12 months after the IPO. Beginning in the second year after the IPO, the average firm in our sample undergoes a significant price correction that lasts approximately 18 months and which produces negative cumulative abnormal returns for up to 5 years post-issue. Differences in risk-adjusted returns also indicate negative long-run returns, with poor performance concentrated in the second and third years following the IPO. The return differences are most pronounced among the small thrifts in our sample, and are broadly consistent with investor overreaction at the time of the IPO that continues for 6-12 months before prices begin reverting back to fundamental value.

We examine the timing ability of mutual fund investors using cash flow data at the individual fund level. Over 1991-2004 equity fund investor timing decisions reduce fund investor average returns by 1.56% annually. Underperformance due to poor timing is greater in load funds and funds with relatively large risk-adjusted returns. In particular, the magnitude of investor underperformance due to poor timing largely offsets the risk-adjusted alpha gains offered by good-performing funds. Investors in both actively managed funds and index funds exhibit poor investment timing. We demonstrate that our empirical results are consistent with investor return-chasing behavior.

Purpose: The primary objective of this grant was to increase our knowledge and understanding of the patient safety issues and value of health information technology (HIT) in rural hospitals. The project focused primarily on Iowa's 89 rural hospitals. We created advisory groups of rural hospital staff, interviewed rural hospital key informants, conducted surveys on patient safety issues and HIT capacity, analyzed Iowa and national hospital discharge data to identify patient safety performance issues, and reviewed and compiled the literature on HIT. Results: A number of rurally-relevant patient safety issues were identified along with several key factors related to poor performance. Analyses characterized the use of HIT in rural hospital, barriers to such use, and approaches to enhancing HIT, especially in Critical Access Hospitals (CAH). We formed the Iowa CAH HIT Interest Group and created decision-making toolkits to provide HIT solutions that were appropriate for CAHs and assist CAHs in making HIT investment decisions. During the timeframe of the grant, 17 peer-reviewed papers were published, 27 presentations were made, and toolkits were constructed and evaluated.

Background: Case mix adjustment is a pre-requisite for valid measurement of healthcare performance and socioeconomic status (SES) is important to account for. Lack of information on individual-level SES has led to investigations into using a proxy for SES based on patient area of residence. The objective of this study was to use neighbourhood SES for case mix adjustment of performance indicators in total hip replacement (THR) in Sweden, and to compare with use of individual SES. Methods: Data from patient administrative systems and the Swedish Hip Arthroplasty Register were extracted for all patients undergoing THR in four Swedish regions. For each subject, individual data and neighbourhood data on country of birth, educational level, and income were provided by Statistics Sweden. Three variables were selected for analysis of performance; EQ-5D, hip pain and length of stay (LoS). In addition to socioeconomic information, several important clinical characteristics were used as case mix factors. Regression analysis was used to study each variable's impact on the three outcome variables and model fit was evaluated using mean squared error. Results: A total of 27,121 patients operated between 2010 and 2016 were included in the study. Both educational level and income were higher when based on neighbourhood information than individual information, while proportion born in Sweden was similar. Higher SES was generally found to be associated with better outcomes and lower LoS, albeit with certain differences between the different measures of SES. The predictive ability of the models was increased when adding information on SES to the clinical characteristics. The increase in predictive ability was higher for individual SES compared to neighbourhood SES. When analysing performance for the two providers with most diverging case mix in terms of SES, the inclusion of SES altered the relative performance using individual as well as neighbourhood SES.

Volume XXXIII January 2017 Abstract Over a long period of time, stocks with low beta have cons istent ly outperformed their h igh beta counterparts across developed and emerging markets alike. We explore the presence of low beta anomaly and its robustness after controlling for size, value and momentum factors in the Indian stock markets. We have chosen the universe of past and present constituent stocks of the Nifty 500 index in our study for the period 2001 to 2014. We study relative riskadjusted performance and portfolio characteristics of three different zero-cost, long-short beta arbitrage strategies including beta neutral and negative net beta version of strategies. We find all the beta arbitrage strategies deliver superior risk adjusted performance in the Indian markets, though of different magnitude, with a clear tilt away from the value factor and towards the momentum factor. However, we don&#39;t find any tilt towards size factor. Our study provides the framework for choosi...

The study aims to obtain the mean relative weights (MRWs) of the cost of care through the retrospective application of the adjusted clinical groups (ACGs) in several primary health care (PHC) centres in Catalonia (Spain) in routine clinical practice. Methods This is a retrospective study based on computerized medical records. All patients attended by 13 PHC teams in 2008 were included. The principle measurements were: demographic variables (age and sex), dependent variables (number of diagnoses and total costs), and case-mix or co-morbidity variables (International Classification of Primary Care). The costs model for each patient was established by differentiating the fix costs from the variable costs. In the bivariate analysis, the Student's t, analysis of variance, chi-squared, Pearson's linear correlation and Mann-Whitney-Wilcoxon tests were used. In order to compare the MRW of the present study with those of the United States (US), the concordance [intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC)] and the correlation (coefficient of determination: R 2 ) were measured. Results The total number of patients studied was 227 235, and the frequentation was 5.9 visits/habitant/year) and with a mean diagnoses number of 4.5 (3.2). The distribution of costs was €148.7 million, of which 29.1% were fixed costs. The mean total cost per patient/year was €654.2 (851.7), which was considered to be the reference MRW. Relationship between study-MRW and US-MRW: ICC was 0.40 [confidential interval (CI) 95%: 0.21-0.60] and the CCC was 0.42 (CI 95%: 0.35-0.49). The correlation between the US MRW and the MRW of the present study can be seen; the adjusted R 2 value is 0.691. The explanatory power of the ACG classification was 36.9% for the total costs. The R 2 of the total cost without considering outliers was 56.9%. Conclusions The methodology has been shown appropriate for promoting the calculation of the MRW for each category of the classification. The results provide a possible practical application in PHC clinical management.