Ohio Insurance Report. Exhibit of Business

Title varies: 1885,1888,1922-23,1942-66, Annual Report of the Superintendent of Insurance (varies slightly); 1921, Summary of the Standing of All Companies Authorized to Do Business in Ohio; 1967, Annual Report of the Director of Insurance

Answers to frequently asked questions from Civil Service annuitants about retirement and insurance /

"May 1983."

The interesting narrative of the life of Olaudah Equiano; or Gustavus Vassa, the African. /

Text continuous (despite pagination).

Lifetime cover in private insurance markets

In the last few decades, private health insurance rates have declined in many countries. In countries and states with community rating, a major cause is adverse selection. In order to address age-based adverse selection, Australia has recently begun a novel approach which imposes stiff penalties for buying private insurance later in life, when expected costs are higher. In this paper, we analyze Australiarsquos Lifetime Cover in the context of a modified version of the Rothschild-Stiglitz insurance model (Rothschild and Stiglitz, 1976). We allow empirically-based probabilities to increase by age for low-risk types. The model highlights the shortcomings of the Australian plan. Based on empirically-based probabilities of illness, we predict that Lifetime Cover will not arrest adverse selection. The model has many policy implications for government regulation encouraging long-term health coverage.

The effect of life expectancy on fertility, saving, schooling and economic growth: theory and evidence

We construct a simple growth model where agents with uncertain survival choose schooling time, life-cycle consumption and the number of children. We show that rising longevity reduces fertility but raises saving, schooling time and the growth rate at a diminishing rate. Cross-section analyses using data from 76 countries support these propositions: life expectancy has a significant positive effect on the saving rate, secondary school enrollment and growth but a significant negative effect on fertility. Through sensitivity analyses, the effect on the saving rate is inconclusive, while the effects on the other variables are robust and consistent. These estimated effects are decreasing in life expectancy. Copyright The editors of the Scandinavian Journal of Economics 2005.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

Adaptive agents in changing environments, the role of modularity

We explored the role of modularity as a means to improve evolvability in populations of adaptive agents. We performed two sets of artificial life experiments. In the first, the adaptive agents were neural networks controlling the behavior of simulated garbage collecting robots, where modularity referred to the networks architectural organization and evolvability to the capacity of the population to adapt to environmental changes measured by the agents performance. In the second, the agents were programs that control the changes in network's synaptic weights (learning algorithms), the modules were emerged clusters of symbols with a well defined function and evolvability was measured through the level of symbol diversity across programs. We found that the presence of modularity (either imposed by construction or as an emergent property in a favorable environment) is strongly correlated to the presence of very fit agents adapting effectively to environmental changes. In the case of learning algorithms we also observed that character diversity and modularity are also strongly correlated quantities. © 2014 Springer Science+Business Media New York.

Self-adaptive probabilistic roadmap generation for intelligent virtual agents

Agents inhabiting large scale environments are faced with the problem of generating maps by which they can navigate. One solution to this problem is to use probabilistic roadmaps which rely on selecting and connecting a set of points that describe the interconnectivity of free space. However, the time required to generate these maps can be prohibitive, and agents do not typically know the environment in advance. In this paper we show that the optimal combination of different point selection methods used to create the map is dependent on the environment, no point selection method dominates. This motivates a novel self-adaptive approach for an agent to combine several point selection methods. The success rate of our approach is comparable to the state of the art and the generation cost is substantially reduced. Self-adaptation therefore enables a more efficient use of the agent's resources. Results are presented for both a set of archetypal scenarios and large scale virtual environments based in Second Life, representing real locations in London.

Parametrikus nyugdíjreformok és életciklus-munkakínálat (Parametric pension reforms and life-cycle labour supply)

A társadalombiztosítási nyugdíjrendszer finanszírozása pusztán a demográfiai folyamatok következtében is jelentős terhet ró majd a költségvetésére, amin a különböző parametrikus és paradigmatikus nyugdíjreformok enyhíthetnek. A reformok azonban hosszú távon olyan viselkedési, munkakínálati reakciókat válthatnak ki, amelyek alapvetően változtatják meg a költségvetési hatásokat. Az 1999 és 2009 között Magyarországon megfigyelhető átlagos munka- és nyugdíjkorprofilok bemutatása után arra tettünk kísérletet, hogy mikroökonómiai alapon határozzuk meg néhány alapvető parametrikus nyugdíjreformnak a férfiak életciklus-munkakínálatára gyakorolt hatását. A modell paramétereit a magyar gazdaság 1999 és 2009 közötti jellemzőinek megfelelően kalibráltuk. Eredményeink szerint a helyettesítési ráta csökkentése, a nyugdíjkorhatár emelése és a svájci indexálás árindexálásra cserélése összességében számottevően növeli az egyes képzettségi csoportok munkakínálatát, s a fiatalabb korosztályok javára csoportosítja át az életciklus-munkakínálatot, míg a nyugdíj kiszámításához figyelembe vett évek számának megváltoztatása nem hoz jelentős aggregált hatást, és nem jár a munkakínálat korcsoportok közötti átcsoportosításával. ____ Financing the social-security pension system will weigh heavily on the government budget in developed countries, merely through the projected demographic processes. The burden could be eased by various parametric and paradigmatic pension reforms, but in the long run such reforms may trigger behavioural, labour-supply responses, which may alter the budgetary effects fundamentally. Having described the average work and pension profiles in Hungary between 1999 and 2009, the authors use a microeconomic approach in an attempt to assess the effect of certain parametric pension reforms on the life-cycle labour supply of males. The parameters for the model were calibrated for the characteristics of the Hungarian economy. The results show that decreasing the replacement rate, increasing the retirement age and replacing Swiss indexation of pensions by price indexation cause a considerable increase in the labour supply of all education-level groups, whereas changing the number of years considered in computing pensions does not have a significant aggregate effect. While introducing price indexation increases the labour supply of all cohorts by the same amount, the other reforms reallocate the life-cycle labour supply, mainly towards younger age-groups.

Quality of life and application of the transtheoretical model to diabetes self -management behaviors in older adults with type 2 diabetes

One in five adults 65 years and older has diabetes. Coping with diabetes is a lifelong task, and much of the responsibility for managing the disease falls upon the individual. Reports of non-adherence to recommended treatments are high. Understanding the additive impact of diabetes on quality of life issues is important. The purpose of this study was to investigate the quality of life and diabetes self-management behaviors in ethnically diverse older adults with type 2 diabetes. The SF-12v2 was used to measure physical and mental health quality of life. Scores were compared to general, age sub-groups, and diabetes-specific norms. The Transtheoretical Model (TTM) was applied to assess perceived versus actual behavior for three diabetes self-management tasks: dietary management, medication management, and blood glucose self-monitoring. Dietary intake and hemoglobin A1c values were measured as outcome variables. Utilizing a cross-sectional research design, participants were recruited from Elderly Nutrition Program congregate meal sites (n = 148, mean age 75). ^ Results showed that mean scores of the SF-12v2 were significantly lower in the study sample than the general norms for physical health (p < .001), mental health (p < .01), age sub-group norms (p < .05), and diabetes-specific norms for physical health (p < .001). A multiple regression analysis found that adherence to an exercise plan was significantly associated with better physical health (p < .001). Transtheoretical Model multiple regression analyses explained 68% of the variance for % Kcal from fat, 41% for fiber, 70% for % Kcal from carbohydrate, and 7% for hemoglobin A 1c values. Significant associations were found between TTM stage of change and dietary fiber intake (p < .01). Other significant associations related to diet included gender (p < .01), ethnicity (p < .05), employment (p < .05), type of insurance (p < .05), adherence to an exercise plan (p < .05), number of doctor visits/year ( p < .01), and physical health (p < .05). Significant associations were found between hemoglobin A1c values and age ( p < .05), being non-Hispanic Black (p < .01), income (p < .01), and eye problems (p < .05). ^ The study highlights the importance of the beneficial effects of exercise on quality of life issues. Furthermore, application of the Transtheoretical Model in conjunction with an assessment of dietary intake may be valuable in helping individuals make lifestyle changes. ^

From Wovoka to Wounded Knee: deprivation of Sioux traditional life and the massacre of Wounded Knee in 1890

The purpose of this thesis is to explore deprivation experienced by the nineteenth century Sioux who suffered the loss of traditional lands, economic independence, buffalo, tribal customs, and religion. After years of reservation life, starvation, and deprivation at the hands of the U.S. government, white settlers, and reservation agents, the Sioux anxiously sought out a Paiute Indian Messiah named Wovoka whose message of a new Indian world spread rapidly throughout the Dakotas. The use of extensive historical and religious documents, as well as primary sources, will argue that the extent of desperation experienced by the Sioux drove them to accept the Ghost Dance as a substitute for the Sun Dance, the center of their traditional religious complex. With its hope of the resurrection of dead Indians, return of the buffalo, and renewal of the earth, it was immediately adopted leading ultimately to the massacre at Wounded Knee in 1890 and the passing of Wovoka's religion into history.

Universalização do acesso à saúde e regulação dos planos privados de assistência à saúde: a atuação regulatória da ANS como instrumento de harmonia contratual e viabilização do papel suplementar da iniciativa privada na efetivação do direito social à saúde

While essential to human nature, health and life have been protected since ancient times by various areas of knowledge, particularly by the Law, given its dynamics within the regulation of social interactions. In Brazil, health has been granted major importance by the Federal Constitution of 1988, which, disrupting the dictatorial authoritarianism, inaugurating a Social State and focusing on the values of freedom and human dignity, raises health to the condition of a social right, marked predominantly by an obligational bias directed, primarily, to the State, through the enforcement of public policies. Although, given the limitation of the State action to the reserve for contingencies, it turns clear that an universalizing access to public health is impossible, seen that the high cost of medical provisions hinders the State to meet all the health needs of the rightholders. As a result of the inefficiency of the State, the effort of the Constituent Assembly of 1988 in creating a hybrid health system becomes nuclear, which, marked by the possibility of exploration of healthcare by the private initiative, assigns to the private enterprise a key role in supplementing the public health system, especially through the offer of health insurance plans. At this point, however, it becomes clear that health provisions rendered by the private agents are not unlimited, which involves discussions about services and procedures that should be excluded from the contractual coverage, for purposes of sectoral balance, situation which draws the indispensability of deliberations between Fundamental Rights on one hand, related to the protection of health and life, and contractual principles on the other hand, connected to the primacy of private autonomy. At this point, the importance of the regulation undertaken by the ANS, Brazilian National Health Agency, appears primordial, which, by means of its seized broad functions, considerable autonomy and technical discretion, has conditions to implement an effective control towards the harmonization of the regulatory triangle, the stability and development of the supplementary health system and, consequently, towards the universalization of the right to health, within constitutional contours. According to this, the present essay, resorting to a broad legislative, doctrinal and jurisprudential study, concludes that economic regulation over the private healthcare sector, when legitimately undertaken, provides progress and stability to the intervening segment and, besides, turns healthcare universalization feasible, in a way that it can not be replaced efficiently by any other State function.

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy): Consensus Validation

Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriate medications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensus survey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinical pharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.
Methods: STOPPFrail criteria was initially created by the authors based on clinical
experience and appraisal of the available literature. Criteria were organised according to physiological system. Each criterion was accompanied by an explanation. Panellists ranked their agreement with each criterion on a 5-point Likert scale and invited to provide written feedback. Criteria with a median Likert response of 4/5 (agree/strongly agree) and a 25th centile of ≥4 were included in the final criteria.
Results: Three Delphi rounds were required. All panellists completed all rounds. Thirty criteria were proposed for inclusion; 26 were accepted. No new criteria were added. The first two criteria suggest deprescribing medications with no indication or where compliance is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers for hypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antagonists, anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, bone anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal antiinflammatories, corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers, muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics. Anticoagulants and anti-depressants were excluded. Despite incorporation of panellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remained inconclusive.
Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad consensus, to be potentially inappropriate in frailer older patients with limited life expectancy. STOPPFrail may assist in deprescribing medications in these patients.

Cyber Enigmas? Passive Detection and Pedagogical Agents: Can Students Spot the fake?

This paper presents a study that was undertaken to examine human interaction with a pedagogical agent and the passive and active detection of such agents within a synchronous, online environment. A pedagogical agent is a software application which can provide a human like interaction using a natural language interface. These may be familiar from the smartphone interfaces such as ‘Siri’ or ‘Cortana’, or the virtual online assistants found on some websites, such as ‘Anna’ on the Ikea website. Pedagogical agents are characters on the computer screen with embodied life-like behaviours such as speech, emotions, locomotion, gestures, and movements of the head, the eye, or other parts of the body. The passive detection test is where participants are not primed to the potential presence of a pedagogical agent within the online environment. The active detection test is where participants are primed to the potential presence of a pedagogical agent. The purpose of the study was to examine how people passively detected pedagogical agents that were presenting themselves as humans in an online environment. In order to locate the pedagogical agent in a realistic higher education online environment, problem-based learning online was used. Problem-based learning online provides a focus for discussions and participation, without creating too much artificiality. The findings indicated that the ways in which students positioned the agent tended to influence the interaction between them. One of the key findings was that since the agent was focussed mainly on the pedagogical task this may have hampered interaction with the students, however some of its non-task dialogue did improve students' perceptions of the autonomous agents’ ability to interact with them. It is suggested that future studies explore the differences between the relationships and interactions of learner and pedagogical agent within authentic situations, in order to understand if students' interactions are different between real and virtual mentors in an online setting.

Updating Beliefs: Are economic agents inspired by rational action or according to ones hopes and fears?.

The purpose of this investigationwas to simulate a real life scenarioand explore the way economicagents update their beliefs. Do theyupdate according to what theyhope? Or do they update inspired byrational behavior?We mimicked the environment whicha recently high school graduate faceswhen entering college to see how astudent updates his beliefs in regardsto his classroom position. We examinedhow economic agents envisagethemselves through and through collegeand see if they update their beliefsabout a hypothesis A in the lightof new evidence B, or if they updatetheir beliefs subject to what theychoose they hope. In this sense weexplored the possibility of setting asidethe neoclassical assumption thatagents are anything more than hyperrational naïve optimizers acting on perfect (and in some cases, limited information)in order to turn back to anolder tradition in economic theory, thatis agents are recognizably human.