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In this paper, we extend the concept of mutual exclusivity proposed by [Dhaene, J. & Denuit, M. (1999). The safest dependence structure among risks.Insurance: Mathematics and Economics25, 11–21] to its tail counterpart and baptize this new dependency structure as tail mutual exclusivity. Probability levels are first specified for each component of the random vector. Under this dependency structure, at most one exceedance over the corresponding Value-at-Risks (VaRs) is possible, the other components being zero in such a case. No condition is imposed when all components stay below the VaRs. Several properties of this new negative dependence concept are derived. We show that this dependence structure gives rise to the smallest value of Tail-VaR (TVaR) of a sum of risks within a given Fréchet space, provided that the probability level of the TVaR is close enough to one. [ABSTRACT FROM PUBLISHER]

This article investigates optimal reinsurance treaties minimizing an insurer’s risk-adjusted liability, which encompasses a risk margin quantified by distortion risk measures. Via the introduction of a transparent cost-benefit argument, we extend the results in Cui et al. [Cui, W., Yang, J. & Wu, L. (2013). Optimal reinsurance minimizing the distortion risk measure under general reinsurance premium principles.Insurance: Mathematics and Economics53, 74–85] and provide full characterizations on the set of optimal reinsurance treaties within the class of non-decreasing, 1-Lipschitz functions. Unlike conventional studies, our results address the issue of (non-)uniqueness of optimal solutions and indicate that ceded loss functions beyond the traditional insurance layers can be optimal in some cases. The usefulness of our novel cost-benefit approach is further demonstrated by readily solving the dual problem of minimizing the reinsurance premium while maintaining the risk-adjusted liability below a fixed tolerance level. [ABSTRACT FROM PUBLISHER]

In this paper we show that under appropriate moment conditions, the supermodular ordered random vectorsandwith equal expected utilities (or distorted expectations) of the sumsandfor an appropriate utility (or distortion) function, must necessarily be equal in distribution, that is. The results in this paper can be considered as generalizations of some recent results on comonotonicity, where necessary conditions related to the distribution ofare presented for the random vectorto be comonotonic. [ABSTRACT FROM AUTHOR]

In this paper, we consider the jump-diffusion risk model with proportional reinsurance and stock price process following the constant elasticity of variance model. Compared with the geometric Brownian motion model, the advantage of the constant elasticity of variance model is that the volatility has correlation with the risky asset price, and thus, it can explain the empirical bias exhibited by the Black and Scholes model, such as volatility smile. Here, we study the optimal investment-reinsurance problem of maximizing the expected exponential utility of terminal wealth. By using techniques of stochastic control theory, we are able to derive the explicit expressions for the optimal strategy and value function. Numerical examples are presented to show the impact of model parameters on the optimal strategies. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Comonotonicity has proved to be a powerful and useful tool in financial economics and actuarial science. Jouini and Napp [Decision in Economics and Finance 27(2) (2004), 153-166] generalized it to a new concept called conditional comonotonicity. While preserving the advantage of being analytically tractable, the extra freedom of the choice of the conditioning map or sigma-field makes this new concept more flexible than the classical concept of comonotonicity. This article serves to provide a systemic overview, together with some of its applications, of this relatively new notion. [ABSTRACT FROM AUTHOR]

The regulations for driving fitness of people using drugs with potential influence on driving capability are embodied in the 'Regelingeisengeschiktheid 2000' (REG2000). The Health Council of the Netherlands (HCN) adviced to design more strict regulations for professional drivers. This advice has not yet been approved by the minister due to implementation complexity. The HCN recommends to follow the by the KNMP formulated advices when using category II psychostimulants or category III antidepressants, benzodiazepines, antipsychotics, antihistamines, anti-epileptics or opioids. The KNMP advices for driving participation are broadly available via the public websites www.apotheek.nl and www.rijveiligmetmedicijnen.nl. Both websites are written in accessible language level. The HCN advices to enhance scientific research concerning influence on driving fitness before approving a drug, to use standard procedures to prevent ad hoc decisions concerning driving fitness and the use of checklists for doctors when preparing driving fitness attests.

Objectives: Pharmacogenetic panel-based testing represents a new model for precision medicine. A sufficiently powered prospective study assessing the (cost-)effectiveness of a panel-based pharmacogenomics approach to guide pharmacotherapy is lacking. Therefore, the Ubiquitous Pharmacogenomics Consortium initiated the PREemptive Pharmacogenomic testing for prevention of Adverse drug Reactions (PREPARE) study. Here, we provide an overview of considerations made to mitigate multiple methodological challenges that emerged during the design., Methods: An evaluation of considerations made when designing the PREPARE study across six domains: study aims and design, primary endpoint definition and collection of adverse drug events, inclusion and exclusion criteria, target population, pharmacogenomics intervention strategy, and statistical analyses., Results: Challenges and respective solutions included: (1) defining and operationalizing a composite primary endpoint enabling measurement of the anticipated effect, by including only severe, causal, and drug genotype-associated adverse drug reactions; (2) avoiding overrepresentation of frequently prescribed drugs within the patient sample while maintaining external validity, by capping drugs of enrolment; (3) designing the pharmacogenomics intervention strategy to be applicable across ethnicities and healthcare settings; and (4) designing a statistical analysis plan to avoid dilution of effect by initially excluding patients without a gene-drug interaction in a gatekeeping analysis., Conclusion: Our design considerations will enable quantification of the collective clinical utility of a panel of pharmacogenomics-markers within one trial as a proof-of-concept for pharmacogenomics-guided pharmacotherapy across multiple actionable gene-drug interactions. These considerations may prove useful to other investigators aiming to generate evidence for precision medicine.

Introduction: In the Netherlands, a Central Medication Incidents Registration (CMR) system is operational. To prevent recurrence of reported medication incidents the CMR sends medication incident alerts with recommendations. It is up to the healthcare workers whether or not to implement the recommendations in clinical practice, which may lead to variations in degrees of uptake of the recommendations., Objective: The aim of this study was to explore the degree of self-reported uptake of the recommendations and to identify potential determinants associated with successful uptake., Design: This is a cross-sectional study conducted within a convenience sample of 33 Dutch hospital pharmacies. The study was carried out from April 2009 to September 2010., Measurements: Three alerts were selected for the study: administration of methotrexate in a dosage of once a day instead of once a week, administration of undiluted potassium-sodium-phosphate concentrate, and administration of glucose 50% instead of 5%. The primary outcome was the degree of self-reported uptake of the specific recommendations and the associations of the degree of uptake with several potential determinants., Results: Twenty-one hospitals (63.6%) had adopted all recommendations about methotrexate. A quarter of the hospitals (24.2%) had adopted all recommendations related to potassium-sodium-phosphate concentrate. For the alert about glucose 50%, none of the hospitals had implemented all the recommendations. No statistically significant associations between potential determinants and the degree of uptake were found., Conclusions: This study is the first to investigate the degree of uptake of the recommendations of three different CMR alerts. The alerts varied in the degrees of self-reported uptake of the recommendations, with the methotrexate alert having the highest degree of uptake. No significant associations with potential determinants were found.