Data-Driven vs Consensus Diagnosis of MCI: Enhanced Sensitivity for Detection of Clinical, Biomarker, and Neuropathologic Outcomes

Objective:Given prior work demonstrating that mild cognitive impairment (MCI) can be empirically differentiated into meaningful cognitive subtypes, we applied actuarial methods to comprehensive neuropsychological data from the University of California San Diego (UCSD) Alzheimer’s Disease Research Center (ADRC) in order to identify cognitive subgroups within nondemented ADRC participants, and to examine cognitive, biomarker, and neuropathological trajectories.Methods:Cluster analysis was performed on baseline neuropsychological data (n=738; mean age=71.8). Survival analysis examined progression to dementia (mean follow-up=5.9 years). CSF AD biomarker status and neuropathological findings at follow-up were examined in a subset with available data.Results:Five clusters were identified: “optimal” cognitively normal (CN; n=130) with above-average cognition, “typical” CN (n=204) with average cognition, non-amnestic MCI (naMCI; n=104), amnestic MCI (aMCI; n=216), and mixed MCI (mMCI; n=84). Progression to dementia differed across MCI subtypes (mMCI>aMCI>naMCI), with the mMCI group demonstrating the highest rate of CSF biomarker positivity and AD pathology at autopsy. Actuarial methods classified 29.5% more of the sample with MCI and outperformed consensus diagnoses in capturing those who had abnormal biomarkers, progressed to dementia, or had AD pathology at autopsy.Conclusions:We identified subtypes of MCI and CN with differing cognitive profiles, clinical outcomes, CSF AD biomarkers, and neuropathological findings over more than 10 years of follow-up. Results demonstrate that actuarial methods produce reliable cognitive phenotypes, with data from a subset suggesting unique biological and neuropathological signatures. Findings indicate that data-driven algorithms enhance diagnostic sensitivity relative to consensus diagnosis for identifying older adults at risk for cognitive decline.

Role of actuarial accounting in enhancing banks performance

This study aims to shed light on the significance of actuarial science in the banking sector from an accounting point of, And try to find out of the role he plays of actuarial accountant in the Sudanese banking sector and added value that he can add especially In light of a local economy which suffers from violent economic fluctuations that cast a shadow over on. financial stability, and the extent of its ability and contribution to the effectiveness of performance. The study found that Actuaries are active in banking roles despite the weakness of the actuaries who work in the banking sectors in sudan, The study also showed there's a direct relationship between economic fluctuation risks and financial crises need to adopt actuarial accounting methods, also, they have a major role to play to supports the improvement of the quality of financial reporting. The Study recommended necessity of educating decision- makers in the banking sector on the importance of actuarial science and actuarial accountants, who play a key role through actuarial methods that effectively contribute to the bank's ability to overcome economic fluctuations and financial crises.

The Use and Usability of Decision-Making Theory in Child Welfare Policy and Practice

The aim of this chapter is to clarify how decision-making processes within the context of child welfare and child protection could be improved by decision-making theories (i.e., Decision-Making Ecology [DME] and decisional conflict model), with specific interest in methods intended to support practitioners based on these theories, in particular methods of structured decision-making and actuarial methods. Existing studies indicate that structured decision-making methods have a limited effect on the decision-making process, as well as on the reliability and validity of the judgments and choices made by professionals in cases of suspected child abuse and neglect. Actuarial methods may be more precise in making valid judgments but may ignore factors relevant to decisions concerning treatment and intervention. The DME framework reveals that other factors—in addition to rationally weighing information and arguing—influence the decision-making process and outcomes. Especially the influence of decision-maker factors seems to be ignored in structured decision-making methods. Although systematic methods and instruments do have some value, several additional options are available that take decision-maker factors more into account. This chapter discusses the potentials of critical thinking, team decision-making, systematic feedback, and shared decision-making.

Exposure–response assessment of cancer mortality in styrene-exposed boatbuilders

ObjectivesTo improve exposure estimates and reexamine exposure–response relationships between cumulative styrene exposure and cancer mortality in a previously studied cohort of US boatbuilders exposed between 1959 and 1978 and followed through 2016.MethodsCumulative styrene exposure was estimated from work assignments and air-sampling data. Exposure–response relationships between styrene and select cancers were examined in Cox proportional hazards models matched on attained age, sex, race, birth cohort and employment duration. Models adjusted for socioeconomic status (SES). Exposures were lagged 10 years or by a period maximising the likelihood. HRs included 95% profile-likelihood CIs. Actuarial methods were used to estimate the styrene exposure corresponding to 10-4 extra lifetime risk.ResultsThe cohort (n= 5163) contributed 201 951 person-years. Exposures were right-skewed, with mean and median of 31 and 5.7 ppm-years, respectively. Positive, monotonic exposure–response associations were evident for leukaemia (HR at 50 ppm-years styrene = 1.46; 95% CI 1.04 to 1.97) and bladder cancer (HR at 50 ppm-years styrene =1.64; 95% CI 1.14 to 2.33). There was no evidence of confounding by SES. A working lifetime exposure to 0.05 ppm styrene corresponded to one extra leukaemia death per 10 000 workers.ConclusionsThe study contributes evidence of exposure–response associations between cumulative styrene exposure and cancer. Simple risk projections at current exposure levels indicate a need for formal risk assessment. Future recommendations on worker protection would benefit from additional research clarifying cancer risks from styrene exposure.

Narzędzia szacowania ryzyka powrotu do przestępstwa. Niezbędny instrument postępowania wykonawczego

The aim of the study is to discuss the most important problems related to the assess-ment of the level of risk of recidivism, taking into account actuarial methods, psycho-metric methods, and idiographic clinical trials. The point is to show tools that are intended not only to predict criminal behavior, but also to be an indicator of effective interventions aimed at social reintegration of convicts and thus a permanent form of preventing recid-ivism. These instruments are of particular importance for controlling crimes committed under the influence of sexual preference disorders.

Neuropsychological Contributions to the Diagnosis of Mild Cognitive Impairment Associated With Alzheimer’s Disease

Mild cognitive impairment (MCI) has long been conceptualized as a transitional stage between normal aging and Alzheimer’s disease (AD) and other dementia subtypes, thus providing a potential window for early intervention in at-risk older adults. Nonetheless, effective intervention requires accurate identification of prodromal dementia, and the criteria for MCI have undergone significant evolution over the last 30 years to improve diagnostic sensitivity and specificity. There is increasing recognition of heterogeneous neuropsychological presentations in MCI. When traditional diagnostic criteria for the diagnosis of MCI have been applied a body of research employing statistical algorithms consistently demonstrated the existences of 3 to 4 unique MCI subtypes. Importantly, one subgroup that has emerged across studies involves a sizeable minority of participants that are cognitively normal on comprehensive neuropsychological assessment. These false-positives have highlighted the susceptibility of traditional Petersen/Winblad MCI criteria to diagnostic errors and demonstrated the need for developing of neuropsychological paradigms for MCI classification, and a new set of comprehensive MCI criteria using actuarial methods has been proposed. Accumulating evidence indicates that these comprehensive criteria pose an advantage over conventional criteria in the accurate identification of prodromal dementia and capture the neuropsychological and biological heterogeneity of MCI. Future research should expand on early work examining the association between empirical MCI subtypes and biological, neuroimaging, and genetic markers of AD.

CONCEPTUAL APPROACHES TO USING THE RESULTS OF GENETIC RESEARCH IN THE FIELD OF PERSONAL INSURANCE

The availability and high information content of the results of genetic research require the legislator to decide on the limits of their use in various spheres of public life, including when concluding insurance contracts. Targeted genome sequencing is more appropriate for insurance purposes, although for de novo mutations, disease detection is only possible when exomic sequencing is performed. The research made it possible to conclude that there is a need for regulatory regulation of the use of genetic research results in the implementation of personal insurance. At the same time, we should proceed from: a differentiated approach to diagnostic and predictive tests, extending restrictions only to the latter; the possibility of regulating these relations at the level of self-regulationwhile controlling key positions by the Central Bank of the Russian Federation as the regulator of the insurance market; the permissibility of the use of genetic testing results in the sphere of voluntary personal insurance in case of a contract for the amount above the established limits; the necessity of refutation is a family history in order to develop a more favorable terms of insurance with the appropriate will of the insured; the feasibility of establishing a Biobank data including the purpose of ensuring the access of insurers to the impersonal statistical information. At the same time, it is true that in many aspects the lack of access to genetic data is fully compensated for by traditional actuarial methods.

Model of Rice Farm Insurance to Reduce Losses Due to Harvest Failure

The rice farm insurance is one of micro insurance, which is intended for paddy fields. Its use is to reduce or minimize the losses suffered by farmers due to crop failure. In this article various things are related to rice farming insurance and specifically highlight rice farming insurance in Indonesia from the actuarial side. There are several actuarial methods that can be used to determine the amount of rice farming insurance premiums. Calculation of premiums is based on expectations of losses and losses of extreme events. The premium calculation used is: pure premium method, and method of level of coverage. Based on the results of the discussion, it shows that the actuarial fair premium determined in the range of IDR 179,000 to IDR 268,000. Thus, the official premium of rice farming insurance is IDR 180,000, is the minimum premium for agricultural insurance programs in Indonesia.

Funding Defined Benefit pension schemes: an integrated risk management approach

The last 12 years have seen the evolution of a new funding regime under the supervision of the Pensions Regulator. Over this period, there has been significant turbulence in financial markets, including record low interest rates. This paper takes a critical look at the development of funding approaches and methodologies over this period. It analyses the Pensions Regulator guidance and how scheme specific actuarial methods have emerged since the move away from the Minimum Funding Requirement in 2001 and the introduction of the Scheme Specific Funding Requirements in 2005. It asks whether these new methodologies have been successful from the perspective of members, trustees, employers and shareholders. At a time when actuarial valuation methodologies have faced considerable criticism, this paper aims to propose a pension funding methodology which is fit for purpose and also reflects the latest guidance from the Pensions Regulator on integrated risk management.