論文

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. In the context of an insurance portfolio which provides dividend income for the insurance company’s shareholders, an important problem in risk theory is how the premium income will be paid to the shareholders as dividends according to a barrier strategy until the next claim occurs whenever the surplus attains the level of ‘barrier’. In this paper, we are concerned with the estimation of optimal dividend barrier, defined as the level of the barrier that maximizes the expected discounted dividends until ruin, under the widely used compound Poisson model as the aggregate claims process. We propose a semi-parametric statistical procedure for estimation of the optimal dividend barrier, which is critically needed in applications. We first construct a consistent estimator of the objective function that is complexly related to the expected discounted dividends and then the estimated optimal dividend barrier as the minimizer of the estimated objective function. In theory, we show that the constructed estimator of the optimal dividend barrier is statistically consistent. Numerical experiments by both simulated and real data analyses demonstrate that the proposed estimators work reasonably well with an appropriate size of samples.

© 2020 The American Association for Thoracic Surgery Objective: To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. Methods: A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency thoracic aortic surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. Results: A total of 12,004 patients underwent emergency thoracic aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. Conclusions: No significant association was found between surgical mortality and prehospital transfer distance in emergency thoracic aortic surgery cases. Suspected cases of acute thoracic aortic syndrome may be transferred safely to distant high-volume hospitals.