Explaining Fiscal Balances with a Simultaneous Equation Model of Revenue and Expenditure : A Case Study of Swiss Cantons Using Panel Data

Empirical literature on the analysis of the efficiency of measures for reducing persistent government deficits has mainly focused on the direct explanation of deficit. By contrast, this paper aims at modeling government revenue and expenditure within a simultaneous framework and deriving the fiscal balance (surplus or deficit) equation as the difference between the two variables. This setting enables one to not only judge how relevant the explanatory variables are in explaining the fiscal balance but also understand their impact on revenue and/or expenditure. Our empirical results, obtained by using a panel data set on Swiss Cantons for the period 1980-2002, confirm the relevance of the approach followed here, by providing unambiguous evidence of a simultaneous relationship between revenue and expenditure. They also reveal strong dynamic components in revenue, expenditure, and fiscal balance. Among the significant determinants of public fiscal balance we not only find the usual business cycle elements, but also and more importantly institutional factors such as the number of administrative units, and the ease with which people can resort to political (direct democracy) instruments, such as public initiatives and referendum.

Estimation de la fonction rénale par l'equation MDRD: intérêt et limites pour l'adaptation des doses de médicaments [Renal function estimation by MDRD equation: interest and limitations for drug dosing].

The MDRD (Modification of diet in renal disease) equation enables glomerular filtration rate (GFR) estimation from serum creatinine only. Thus, the laboratory can report an estimated GFR (eGFR) with each serum creatinine assessment, increasing therefore the recognition of renal failure. Predictive performance of MDRD equation is better for GFR < 60 ml/min/1,73 m2. A normal or near-normal renal function is often underestimated by this equation. Overall, MDRD provides more reliable estimations of renal function than the Cockcroft-Gault (C-G) formula, but both lack precision. MDRD is not superior to C-G for drug dosing. Being adjusted to 1,73 m2, MDRD eGFR has to be back adjusted to the patient's body surface area for drug dosing. Besides, C-G has the advantage of a greater simplicity and a longer use.

Further insights on the French WISC-IV factor structure through Bayesian structural equation modeling

The interpretation of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) is based on a 4-factor model, which is only partially compatible with the mainstream Cattell-Horn-Carroll (CHC) model of intelligence measurement. The structure of cognitive batteries is frequently analyzed via exploratory factor analysis and/or confirmatory factor analysis. With classical confirmatory factor analysis, almost all crossloadings between latent variables and measures are fixed to zero in order to allow the model to be identified. However, inappropriate zero cross-loadings can contribute to poor model fit, distorted factors, and biased factor correlations; most important, they do not necessarily faithfully reflect theory. To deal with these methodological and theoretical limitations, we used a new statistical approach, Bayesian structural equation modeling (BSEM), among a sample of 249 French-speaking Swiss children (8-12 years). With BSEM, zero-fixed cross-loadings between latent variables and measures are replaced by approximate zeros, based on informative, small-variance priors. Results indicated that a direct hierarchical CHC-based model with 5 factors plus a general intelligence factor better represented the structure of the WISC-IV than did the 4-factor structure and the higher order models. Because a direct hierarchical CHC model was more adequate, it was concluded that the general factor should be considered as a breadth rather than a superordinate factor. Because it was possible for us to estimate the influence of each of the latent variables on the 15 subtest scores, BSEM allowed improvement of the understanding of the structure of intelligence tests and the clinical interpretation of the subtest scores.

Adult native septic arthritis: 10 years in review in order to establish local guidelines on empiric antibiotic therapy.

Objective: Antibiotic stewardship includes development of practice guidelines incorporating local microbiology and resistance patterns. In case of septic arthritis (SA), addition of vancomycin to the empiric therapy and broad-spectrum antibiotherapy in some clinical settings are subjects of discussion. Our objective was to review the local epidemiology of native septic arthritis in adults, in order to establish local guidelines for empiric therapy. Methods: Retrospective study based on positive synovial fluid cultures and hospital discharge diagnoses of SA obtained from 1999 to 2008 in patients _16 years. Medical records were reviewed to assess the diagnosis and complete relevant clinical information. Results: During this ten-year period, we identified 233 SA on native joints in 231 patients. 107 episodes (46%) were obtained through positive synovial fluid cultures, and 126 episodes (54%) through the discharge diagnosis. 147 SA (63%) were large joint infections (LJI). 35 SA (15%) occurred in intravenous drug users. Preexisting arthropathy was present in 51% of cases. 42% of patients with small joint infection (SJI) were diabetic, vs. 23% with LJI (p = 0.003). When available, synovial fluid direct examination was positive in 35% of cases. Etiologic agents are reported in the table. Five of the 11 MRSA SA (45%) occurred in known carriers. SJI were more frequently polymicrobial (24% vs. 1%, p<0.001). For LJI, an empiric treatment with amoxicillin/clavulanate (A/C) would have been appropriate in 85% of cases. MRSA (8 cases) and tuberculous (7 cases) arthritis would have been the most frequently untreated pathogens. Addition of vancomycin to A/C in MRSA carriers would rise the adequacy to 87%. In contrast, A/C would cover only 75% of SJI (82% if restricted to non-diabetic patients). MRSA (3 cases) and P. aeruginosa (9 cases, 7 monomicrobial) would be the main untreated pathogens. An anti-pseudomonal penicillin would have been appropriate in 94% of cases of SJI (P = 0.002 vs. A/C, p = 0.19 if diabetic patients not included). Conclusions: Treatment with A/C seems adequate for empiric coverage of LJI in our setting. Broad-spectrum antibiotherapy was significantly superior for SJI in diabetic patients, due to different causative bacteria. In an area of low MRSA incidence, our results do not justify a systematic empiric therapy for MRSA, which should be considered in a known carrier.

Ingénieur pédagogique et démarche projet : facteurs clés de succès pour l'intégration des technologies dans la pratique enseignante?

Résumé: Les gouvernements des pays occidentaux ont dépensé des sommes importantes pour faciliter l'intégration des technologies de l'information et de la communication dans l'enseignement espérant trouver une solution économique à l'épineuse équation que l'on pourrait résumer par la célèbre formule " faire plus et mieux avec moins ". Cependant force est de constater que, malgré ces efforts et la très nette amélioration de la qualité de service des infrastructures, cet objectif est loin d'être atteint. Si nous pensons qu'il est illusoire d'attendre et d'espérer que la technologie peut et va, à elle seule, résoudre les problèmes de qualité de l'enseignement, nous croyons néanmoins qu'elle peut contribuer à améliorer les conditions d'apprentissage et participer de la réflexion pédagogique que tout enseignant devrait conduire avant de dispenser ses enseignements. Dans cette optique, et convaincu que la formation à distance offre des avantages non négligeables à condition de penser " autrement " l'enseignement, nous nous sommes intéressé à la problématique du développement de ce type d'applications qui se situent à la frontière entre les sciences didactiques, les sciences cognitives, et l'informatique. Ainsi, et afin de proposer une solution réaliste et simple permettant de faciliter le développement, la mise-à-jour, l'insertion et la pérennisation des applications de formation à distance, nous nous sommes impliqué dans des projets concrets. Au fil de notre expérience de terrain nous avons fait le constat que (i)la qualité des modules de formation flexible et à distance reste encore très décevante, entre autres parce que la valeur ajoutée que peut apporter l'utilisation des technologies n'est, à notre avis, pas suffisamment exploitée et que (ii)pour réussir tout projet doit, outre le fait d'apporter une réponse utile à un besoin réel, être conduit efficacement avec le soutien d'un " champion ". Dans l'idée de proposer une démarche de gestion de projet adaptée aux besoins de la formation flexible et à distance, nous nous sommes tout d'abord penché sur les caractéristiques de ce type de projet. Nous avons ensuite analysé les méthodologies de projet existantes dans l'espoir de pouvoir utiliser l'une, l'autre ou un panachage adéquat de celles qui seraient les plus proches de nos besoins. Nous avons ensuite, de manière empirique et par itérations successives, défini une démarche pragmatique de gestion de projet et contribué à l'élaboration de fiches d'aide à la décision facilitant sa mise en oeuvre. Nous décrivons certains de ses acteurs en insistant particulièrement sur l'ingénieur pédagogique que nous considérons comme l'un des facteurs clé de succès de notre démarche et dont la vocation est de l'orchestrer. Enfin, nous avons validé a posteriori notre démarche en revenant sur le déroulement de quatre projets de FFD auxquels nous avons participé et qui sont représentatifs des projets que l'on peut rencontrer dans le milieu universitaire. En conclusion nous pensons que la mise en oeuvre de notre démarche, accompagnée de la mise à disposition de fiches d'aide à la décision informatisées, constitue un atout important et devrait permettre notamment de mesurer plus aisément les impacts réels des technologies (i) sur l'évolution de la pratique des enseignants, (ii) sur l'organisation et (iii) sur la qualité de l'enseignement. Notre démarche peut aussi servir de tremplin à la mise en place d'une démarche qualité propre à la FFD. D'autres recherches liées à la réelle flexibilisation des apprentissages et aux apports des technologies pour les apprenants pourront alors être conduites sur la base de métriques qui restent à définir. Abstract: Western countries have spent substantial amount of monies to facilitate the integration of the Information and Communication Technologies (ICT) into Education hoping to find a solution to the touchy equation that can be summarized by the famous statement "do more and better with less". Despite these efforts, and notwithstanding the real improvements due to the undeniable betterment of the infrastructure and of the quality of service, this goal is far from reached. Although we think it illusive to expect technology, all by itself, to solve our economical and educational problems, we firmly take the view that it can greatly contribute not only to ameliorate learning conditions but participate to rethinking the pedagogical approach as well. Every member of our community could hence take advantage of this opportunity to reflect upon his or her strategy. In this framework, and convinced that integrating ICT into education opens a number of very interesting avenues provided we think teaching "out of the box", we got ourself interested in courseware development positioned at the intersection of didactics and pedagogical sciences, cognitive sciences and computing. Hence, and hoping to bring a realistic and simple solution that could help develop, update, integrate and sustain courseware we got involved in concrete projects. As ze gained field experience we noticed that (i)The quality of courseware is still disappointing, amongst others, because the added value that the technology can bring is not made the most of, as it could or should be and (ii)A project requires, besides bringing a useful answer to a real problem, to be efficiently managed and be "championed". Having in mind to propose a pragmatic and practical project management approach we first looked into open and distance learning characteristics. We then analyzed existing methodologies in the hope of being able to utilize one or the other or a combination to best fit our needs. In an empiric manner and proceeding by successive iterations and refinements, we defined a simple methodology and contributed to build descriptive "cards" attached to each of its phases to help decision making. We describe the different actors involved in the process insisting specifically on the pedagogical engineer, viewed as an orchestra conductor, whom we consider to be critical to ensure the success of our approach. Last but not least, we have validated a posteriori our methodology by reviewing four of the projects we participated to and that we think emblematic of the university reality. We believe that the implementation of our methodology, along with the availability of computerized cards to help project managers to take decisions, could constitute a great asset and contribute to measure the technologies' real impacts on (i) the evolution of teaching practices (ii) the organization and (iii) the quality of pedagogical approaches. Our methodology could hence be of use to help put in place an open and distance learning quality assessment. Research on the impact of technologies to learning adaptability and flexibilization could rely on adequate metrics.

Increased risk of cardiovascular disease (CVD) with age in HIV-positive men : a comparison of the D:A:D CVD risk equation and general population CVD risk equations

OBJECTIVES: The aim of the study was to statistically model the relative increased risk of cardiovascular disease (CVD) per year older in Data collection on Adverse events of anti-HIV Drugs (D:A:D) and to compare this with the relative increased risk of CVD per year older in general population risk equations. METHODS: We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI or invasive coronary procedure) and CVD (CHD or stroke). We fitted a number of parametric age effects, adjusting for known risk factors and antiretroviral therapy (ART) use. The best-fitting age effect was determined using the Akaike information criterion. We compared the ageing effect from D:A:D with that from the general population risk equations: the Framingham Heart Study, CUORE and ASSIGN risk scores. RESULTS: A total of 24 323 men were included in analyses. Crude MI, CHD and CVD event rates per 1000 person-years increased from 2.29, 3.11 and 3.65 in those aged 40-45 years to 6.53, 11.91 and 15.89 in those aged 60-65 years, respectively. The best-fitting models included inverse age for MI and age + age(2) for CHD and CVD. In D:A:D there was a slowly accelerating increased risk of CHD and CVD per year older, which appeared to be only modest yet was consistently raised compared with the risk in the general population. The relative risk of MI with age was not different between D:A:D and the general population. CONCLUSIONS: We found only limited evidence of accelerating increased risk of CVD with age in D:A:D compared with the general population. The absolute risk of CVD associated with HIV infection remains uncertain.