Using small area estimation and geographic information systems technology to target health services for the uninsured

The three articles that comprise this dissertation describe how small area estimation and geographic information systems (GIS) technologies can be integrated to provide useful information about the number of uninsured and where they are located. Comprehensive data about the numbers and characteristics of the uninsured are typically only available from surveys. Utilization and administrative data are poor proxies from which to develop this information. Those who cannot access services are unlikely to be fully captured, either by health care provider utilization data or by state and local administrative data. In the absence of direct measures, a well-developed estimation of the local uninsured count or rate can prove valuable when assessing the unmet health service needs of this population. However, the fact that these are “estimates” increases the chances that results will be rejected or, at best, treated with suspicion. The visual impact and spatial analysis capabilities afforded by geographic information systems (GIS) technology can strengthen the likelihood of acceptance of area estimates by those most likely to benefit from the information, including health planners and policy makers. ^ The first article describes how uninsured estimates are currently being performed in the Houston metropolitan region. It details the synthetic model used to calculate numbers and percentages of uninsured, and how the resulting estimates are integrated into a GIS. The second article compares the estimation method of the first article with one currently used by the Texas State Data Center to estimate numbers of uninsured for all Texas counties. Estimates are developed for census tracts in Harris County, using both models with the same data sets. The results are statistically compared. The third article describes a new, revised synthetic method that is being tested to provide uninsured estimates at sub-county levels for eight counties in the Houston metropolitan area. It is being designed to replicate the same categorical results provided by a current U.S. Census Bureau estimation method. The estimates calculated by this revised model are compared to the most recent U.S. Census Bureau estimates, using the same areas and population categories. ^

Endemic tuberculosis, the homeless, and public transportation: A merging of geographical information systems surveillance and the Houston Tuberculosis Initiative Surveillance project

To reach the goals established by the Institute of Medicine (IOM) and the Centers for Disease Control's (CDC) STOP TB USA, measures must be taken to curtail a future peak in Tuberculosis (TB) incidence and speed the currently stagnant rate of TB elimination. Both efforts will require, at minimum, the consideration and understanding of the third dimension of TB transmission: the location-based spread of an airborne pathogen among persons known and unknown to each other. This consideration will require an elucidation of the areas within the U.S. that have endemic TB. The Houston Tuberculosis Initiative (HTI) was a population-based active surveillance of confirmed Houston/Harris County TB cases from 1995–2004. Strengths in this dataset include the molecular characterization of laboratory confirmed cases, the collection of geographic locations (including home addresses) frequented by cases, and the HTI time period that parallels a decline in TB incidence in the United States (U.S.). The HTI dataset was used in this secondary data analysis to implement a GIS analysis of TB cases, the locations frequented by cases, and their association with risk factors associated with TB transmission. ^ This study reports, for the first time, the incidence of TB among the homeless in Houston, Texas. The homeless are an at-risk population for TB disease, yet they are also a population whose TB incidence has been unknown and unreported due to their non-enumeration. The first section of this dissertation identifies local areas in Houston with endemic TB disease. Many Houston TB cases who reported living in these endemic areas also share the TB risk factor of current or recent homelessness. Merging the 2004–2005 Houston enumeration of the homeless with historical HTI surveillance data of TB cases in Houston enabled this first-time report of TB risk among the homeless in Houston. The homeless were more likely to be US-born, belong to a genotypic cluster, and belong to a cluster of a larger size. The calculated average incidence among homeless persons was 411/100,000, compared to 9.5/100,000 among housed. These alarming rates are not driven by a co-infection but by social determinants. The unsheltered persons were hospitalized more days and required more follow-up time by staff than those who reported a steady housing situation. The homeless are a specific example of the increased targeting of prevention dollars that could occur if TB rates were reported for specific areas with known health disparities rather than as a generalized rate normalized over a diverse population. ^ It has been estimated that 27% of Houstonians use public transportation. The city layout allows bus routes to run like veins connecting even the most diverse of populations within the metropolitan area. Secondary data analysis of frequent bus use (defined as riding a route weekly) among TB cases was assessed for its relationship with known TB risk factors. The spatial distribution of genotypic clusters associated with bus use was assessed, along with the reported routes and epidemiologic-links among cases belonging to the identified clusters. ^ TB cases who reported frequent bus use were more likely to have demographic and social risk factors associated with poverty, immune suppression and health disparities. An equal proportion of bus riders and non-bus riders were cultured for Mycobacterium tuberculosis, yet 75% of bus riders were genotypically clustered, indicating recent transmission, compared to 56% of non-bus riders (OR=2.4, 95%CI(2.0, 2.8), p<0.001). Bus riders had a mean cluster size of 50.14 vs. 28.9 (p<0.001). Second order spatial analysis of clustered fingerprint 2 (n=122), a Beijing family cluster, revealed geographic clustering among cases based on their report of bus use. Univariate and multivariate analysis of routes reported by cases belonging to these clusters found that 10 of the 14 clusters were associated with use. Individual Metro routes, including one route servicing the local hospitals, were found to be risk factors for belonging to a cluster shown to be endemic in Houston. The routes themselves geographically connect the census tracts previously identified as having endemic TB. 78% (15/23) of Houston Metro routes investigated had one or more print groups reporting frequent use for every HTI study year. We present data on three specific but clonally related print groups and show that bus-use is clustered in time by route and is the only known link between cases in one of the three prints: print 22. (Abstract shortened by UMI.)^

Correlation of tuberculosis and human immunodeficiency virus in Harris County, Texas from 2009 through 2010 using Geographic Information Systems

A population based ecological study was conducted to identify areas with a high number of TB and HIV new diagnoses in Harris County, Texas from 2009 through 2010 by applying Geographic Information Systems to determine whether distinguished spatial patterns exist at the census tract level through the use of exploratory mapping. As of 2010, Texas has the fourth highest occurrence of new diagnoses of HIV/AIDS and TB.[31] The Texas Department of State Health Services (DSHS) has identified HIV infected persons as a high risk population for TB in Harris County.[29] In order to explore this relationship further, GIS was utilized to identify spatial trends. ^ The specific aims were to map TB and HIV new diagnoses rates and spatially identify hotspots and high value clusters at the census tract level. The potential association between HIV and TB was analyzed using spatial autocorrelation and linear regression analysis. The spatial statistics used were ArcGIS 9.3 Hotspot Analysis and Cluster and Outlier Analysis. Spatial autocorrelation was determined through Global Moran's I and linear regression analysis. ^ Hotspots and clusters of TB and HIV are located within the same spatial areas of Harris County. The areas with high value clusters and hotspots for each infection are located within the central downtown area of the city of Houston. There is an additional hotspot area of TB located directly north of I-10 and a hotspot area of HIV northeast of Interstate 610. ^ The Moran's I Index of 0.17 (Z score = 3.6 standard deviations, p-value = 0.01) suggests that TB is statistically clustered with a less than 1% chance that this pattern is due to random chance. However, there were a high number of features with no neighbors which may invalidate the statistical properties of the test. Linear regression analysis indicated that HIV new diagnoses rates (β=−0.006, SE=0.147, p=0.970) and census tracts (β=0.000, SE=0.000, p=0.866) were not significant predictors of TB new diagnoses rates. ^ Mapping products indicate that census tracts with overlapping hotspots and high value clusters of TB and HIV should be a targeted focus for prevention efforts, most particularly within central Harris County. While the statistical association was not confirmed, evidence suggests that there is a relationship between HIV and TB within this two year period.^

A Model-Based Monitoring Architecture for Heterogeneous Enterprise Services and Information Systems

Runtime management of distributed information systems is a complex and costly activity. One of the main challenges that must be addressed is obtaining a complete and updated view of all the managed runtime resources. This article presents a monitoring architecture for heterogeneous and distributed information systems. It is composed of two elements: an information model and an agent infrastructure. The model negates the complexity and variability of these systems and enables the abstraction over non-relevant details. The infrastructure uses this information model to monitor and manage the modeled environment, performing and detecting changes in execution time. The agents infrastructure is further detailed and its components and the relationships between them are explained. Moreover, the proposal is validated through a set of agents that instrument the JEE Glassfish application server, paying special attention to support distributed configuration scenarios.

Knowledge Management and Information Systems based on Workflow Technology

Knowledge management is critical for the success of virtual communities, especially in the case of distributed working groups. A representative example of this scenario is the distributed software development, where it is necessary an optimal coordination to avoid common problems such as duplicated work. In this paper the feasibility of using the workflow technology as a knowledge management system is discussed, and a practical use case is presented. This use case is an information system that has been deployed within a banking environment. It combines common workflow technology with a new conception of the interaction among participants through the extension of existing definition languages.

Managing Industrial Simulator Visual Databases Using Geographic Information Systems

Geographic Information Systems are developed to handle enormous volumes of data and are equipped with numerous functionalities intended to capture, store, edit, organise, process and analyse or represent the geographically referenced information. On the other hand, industrial simulators for driver training are real-time applications that require a virtual environment, either geospecific, geogeneric or a combination of the two, over which the simulation programs will be run. In the final instance, this environment constitutes a geographic location with its specific characteristics of geometry, appearance, functionality, topography, etc. The set of elements that enables the virtual simulation environment to be created and in which the simulator user can move, is usually called the Visual Database (VDB). The main idea behind the work being developed approaches a topic that is of major interest in the field of industrial training simulators, which is the problem of analysing, structuring and describing the virtual environments to be used in large driving simulators. This paper sets out a methodology that uses the capabilities and benefits of Geographic Information Systems for organising, optimising and managing the visual Database of the simulator and for generally enhancing the quality and performance of the simulator.

Real time passenger information systems and quality of bus services

One of the main problems in urban areas is the steady growth in car ownership and traffic levels. Therefore, the challenge of sustainability is focused on a shift of the demand for mobility from cars to collective means of transport. For this end, buses are a key element of the public transport systems. In this respect Real Time Passenger Information (RTPI) systems help citizens change their travel behaviour towards more sustainable transport modes. This paper provides an assessment methodology which evaluates how RTPI systems improve the quality of bus services in two European cities, Madrid and Bremerhaven. In the case of Madrid, bus punctuality has increased by 3%. Regarding the travellers perception, Madrid raised its quality of service by 6% while Bremerhaven increased by 13%. On the other hand, the users ́ perception of Public Transport (PT) image increased by 14%.

Optical systems design using the SMS method and optimizations

Resumen El diseño de sistemas ópticos, entendido como un arte por algunos, como una ciencia por otros, se ha realizado durante siglos. Desde los egipcios hasta nuestros días los sistemas de formación de imagen han ido evolucionando así como las técnicas de diseño asociadas. Sin embargo ha sido en los últimos 50 años cuando las técnicas de diseño han experimentado su mayor desarrollo y evolución, debido, en parte, a la aparición de nuevas técnicas de fabricación y al desarrollo de ordenadores cada vez más potentes que han permitido el cálculo y análisis del trazado de rayos a través de los sistemas ópticos de forma rápida y eficiente. Esto ha propiciado que el diseño de sistemas ópticos evolucione desde los diseños desarrollados únicamente a partir de la óptica paraxial hasta lo modernos diseños realizados mediante la utilización de diferentes técnicas de optimización multiparamétrica. El principal problema con el que se encuentra el diseñador es que las diferentes técnicas de optimización necesitan partir de un diseño inicial el cual puede fijar las posibles soluciones. Dicho de otra forma, si el punto de inicio está lejos del mínimo global, o diseño óptimo para las condiciones establecidas, el diseño final puede ser un mínimo local cerca del punto de inicio y lejos del mínimo global. Este tipo de problemática ha llevado al desarrollo de sistemas globales de optimización que cada vez sean menos sensibles al punto de inicio de la optimización. Aunque si bien es cierto que es posible obtener buenos diseños a partir de este tipo de técnicas, se requiere de muchos intentos hasta llegar a la solución deseada, habiendo un entorno de incertidumbre durante todo el proceso, puesto que no está asegurado el que se llegue a la solución óptima. El método de las Superficies Múltiples Simultaneas (SMS), que nació como una herramienta de cálculo de concentradores anidólicos, se ha demostrado como una herramienta también capaz utilizarse para el diseño de sistemas ópticos formadores de imagen, aunque hasta la fecha se ha utilizado para el diseño puntual de sistemas de formación de imagen. Esta tesis tiene por objeto presentar el SMS como un método que puede ser utilizado de forma general para el diseño de cualquier sistema óptico de focal fija o v afocal con un aumento definido así como una herramienta que puede industrializarse para ayudar al diseñador a afrontar de forma sencilla el diseño de sistemas ópticos complejos. Esta tesis está estructurada en cinco capítulos: El capítulo 1, es un capítulo de fundamentos donde se presentan los conceptos fundamentales necesarios para que el lector, aunque no posea una gran base en óptica formadora de imagen, pueda entender los planteamientos y resultados que se presentan en el resto de capítulos El capitulo 2 aborda el problema de la optimización de sistemas ópticos, donde se presenta el método SMS como una herramienta idónea para obtener un punto de partida para el proceso de optimización. Mediante un ejemplo aplicado se demuestra la importancia del punto de partida utilizado en la solución final encontrada. Además en este capítulo se presentan diferentes técnicas que permiten la interpolación y optimización de las superficies obtenidas a partir de la aplicación del SMS. Aunque en esta tesis se trabajará únicamente utilizando el SMS2D, se presenta además un método para la interpolación y optimización de las nubes de puntos obtenidas a partir del SMS3D basado en funciones de base radial (RBF). En el capítulo 3 se presenta el diseño, fabricación y medidas de un objetivo catadióptrico panorámico diseñado para trabajar en la banda del infrarrojo lejano (8-12 μm) para aplicaciones de vigilancia perimetral. El objetivo presentado se diseña utilizando el método SMS para tres frentes de onda de entrada utilizando cuatro superficies. La potencia del método de diseño utilizado se hace evidente en la sencillez con la que este complejo sistema se diseña. Las imágenes presentadas demuestran cómo el prototipo desarrollado cumple a la perfección su propósito. El capítulo 4 aborda el problema del diseño de sistemas ópticos ultra compactos, se introduce el concepto de sistemas multicanal, como aquellos sistemas ópticos compuestos por una serie de canales que trabajan en paralelo. Este tipo de sistemas resultan particularmente idóneos para él diseño de sistemas afocales. Se presentan estrategias de diseño para sistemas multicanal tanto monocromáticos como policromáticos. Utilizando la novedosa técnica de diseño que en este capítulo se presenta el diseño de un telescopio de seis aumentos y medio. En el capítulo 5 se presenta una generalización del método SMS para rayos meridianos. En este capítulo se presenta el algoritmo que debe utilizarse para el diseño de cualquier sistema óptico de focal fija. La denominada optimización fase 1 se vi introduce en el algoritmo presentado de forma que mediante el cambio de las condiciones iníciales del diseño SMS que, aunque el diseño se realice para rayos meridianos, los rayos skew tengan un comportamiento similar. Para probar la potencia del algoritmo desarrollado se presenta un conjunto de diseños con diferente número de superficies. La estabilidad y potencia del algoritmo se hace evidente al conseguirse por primera vez el diseño de un sistema de seis superficies diseñado por SMS. vii Abstract The design of optical systems, considered an art by some and a science by others, has been developed for centuries. Imaging optical systems have been evolving since Ancient Egyptian times, as have design techniques. Nevertheless, the most important developments in design techniques have taken place over the past 50 years, in part due to the advances in manufacturing techniques and the development of increasingly powerful computers, which have enabled the fast and efficient calculation and analysis of ray tracing through optical systems. This has led to the design of optical systems evolving from designs developed solely from paraxial optics to modern designs created by using different multiparametric optimization techniques. The main problem the designer faces is that the different optimization techniques require an initial design which can set possible solutions as a starting point. In other words, if the starting point is far from the global minimum or optimal design for the set conditions, the final design may be a local minimum close to the starting point and far from the global minimum. This type of problem has led to the development of global optimization systems which are increasingly less sensitive to the starting point of the optimization process. Even though it is possible to obtain good designs from these types of techniques, many attempts are necessary to reach the desired solution. This is because of the uncertain environment due to the fact that there is no guarantee that the optimal solution will be obtained. The Simultaneous Multiple Surfaces (SMS) method, designed as a tool to calculate anidolic concentrators, has also proved useful for the design of image-forming optical systems, although until now it has occasionally been used for the design of imaging systems. This thesis aims to present the SMS method as a technique that can be used in general for the design of any optical system, whether with a fixed focal or an afocal with a defined magnification, and also as a tool that can be commercialized to help designers in the design of complex optical systems. The thesis is divided into five chapters. Chapter 1 establishes the basics by presenting the fundamental concepts which the reader needs to acquire, even if he/she doesn‟t have extensive knowledge in the field viii of image-forming optics, in order to understand the steps taken and the results obtained in the following chapters. Chapter 2 addresses the problem of optimizing optical systems. Here the SMS method is presented as an ideal tool to obtain a starting point for the optimization process. The importance of the starting point for the final solution is demonstrated through an example. Additionally, this chapter introduces various techniques for the interpolation and optimization of the surfaces obtained through the application of the SMS method. Even though in this thesis only the SMS2D method is used, we present a method for the interpolation and optimization of clouds of points obtained though the SMS3D method, based on radial basis functions (RBF). Chapter 3 presents the design, manufacturing and measurement processes of a catadioptric panoramic lens designed to work in the Long Wavelength Infrared (LWIR) (8-12 microns) for perimeter surveillance applications. The lens presented is designed by using the SMS method for three input wavefronts using four surfaces. The powerfulness of the design method used is revealed through the ease with which this complex system is designed. The images presented show how the prototype perfectly fulfills its purpose. Chapter 4 addresses the problem of designing ultra-compact optical systems. The concept of multi-channel systems, such as optical systems composed of a series of channels that work in parallel, is introduced. Such systems are especially suitable for the design of afocal systems. We present design strategies for multichannel systems, both monochromatic and polychromatic. A telescope designed with a magnification of six-and-a-half through the innovative technique exposed in this chapter is presented. Chapter 5 presents a generalization of the SMS method for meridian rays. The algorithm to be used for the design of any fixed focal optics is revealed. The optimization known as phase 1 optimization is inserted into the algorithm so that, by changing the initial conditions of the SMS design, the skew rays have a similar behavior, despite the design being carried out for meridian rays. To test the power of the developed algorithm, a set of designs with a different number of surfaces is presented. The stability and strength of the algorithm become apparent when the first design of a system with six surfaces if obtained through the SMS method.

A fuzzy approach to risk analysis in information systems

Assets are interrelated in risk analysis methodologies for information systems promoted by international standards. This means that an attack on one asset can be propagated through the network and threaten an organization's most valuable assets. It is necessary to valuate all assets, the direct and indirect asset dependencies, as well as the probability of threats and the resulting asset degradation. These methodologies do not, however, consider uncertain valuations and use precise values on different scales, usually percentages. Linguistic terms are used by the experts to represent assets values, dependencies and frequency and asset degradation associated with possible threats. Computations are based on the trapezoidal fuzzy numbers associated with these linguistic terms.

A fuzzy extension of MAGERIT methodology for risk analysis in information systems

We propose a fuzzy approach to deal with risk analysis for information systems. We extend MAGERIT methodology that valuates the asset dependencies to a fuzzy framework adding fuzzy linguistic terms to valuate the different elements (terminal asset values, asset dependencies as well as the probability of threats and the resulting asset degradation) in risk analysis. Computations are based on the trapezoidal fuzzy numbers associated with these linguistic terms and, finally, the results of these operations are translated into a linguistic term by means of a similarity function.

Quality of bus services performance: benefits of real time passenger information systems

One of the main problems in urban areas is the steady growth in car ownership and traffic levels. Therefore, the challenge of sustainability is focused on a shift of the demand for mobility from cars to collective means of transport. For this purpose, buses are a key element of the public transport systems. In this respect Real Time Passenger Information (RTPI) systems help people change their travel behaviour towards more sustainable transport modes. This paper provides an assessment methodology which evaluates how RTPI systems improve the quality of bus services performance in two European cities, Madrid and Bremerhaven. In the case of Madrid, bus punctuality has increased by 3%. Regarding the travellers perception, Madrid raised its quality of service by 6% while Bremerhaven increased by 13%. On the other hand, the users¿ perception of Public Transport (PT) image increased by 14%.

Two risky and costly end-user related taboos when developing information systems: qualifications and accountability

This work highlights two critical taboos in organizations: 1)taking for granted the quality of certain capabilities and attitudes of the end-user representatives (EUR) in information systems development projects (ISDP), and 2) the EUR´s inherent accountability for losses in IS investments. These issues are neither addressed by theory nor research when assessing success/ failure. A triangulation approach was applied to combine quantitative and qualitative methods, having convergent results and showing that in problematic cases, paradoxically, the origin of IS rejection by end users (EU) points towards the EUR themselves. It has been evaluated to what extent some EUR factors impacted a macro ISDP involving an enterprise resource planning (ERP) package, ranking the ‘knowledge of the EUR’ as the main latent variable. The results validate some issues found throughout decades of praxis, confirming that when not properly managed the EUR role by itself has a direct relationship with IS rejection and significant losses in IS investments.

A Fuzzy approach based on dynamic programming and metaheuristics for selecting safeguards for risk management for information systems

In this paper we focus on the selection of safeguards in a fuzzy risk analysis and management methodology for information systems (IS). Assets are connected by dependency relationships, and a failure of one asset may affect other assets. After computing impact and risk indicators associated with previously identified threats, we identify and apply safeguards to reduce risks in the IS by minimizing the transmission probabilities of failures throughout the asset network. However, as safeguards have associated costs, the aim is to select the safeguards that minimize costs while keeping the risk within acceptable levels. To do this, we propose a dynamic programming-based method that incorporates simulated annealing to tackle optimizations problems.

Inter-organizational information systems adoption for service innovation in building sector

The building sector has experienced a significant decline in recent years in Spain and Europe as a result of the financial crisis that began in 2007. This drop accompanies a low penetration of information and communication technologies in inter-organizational oriented business processes. The market decrease is causing a slowdown in the building sector, where only flexible small and medium enterprises (SMEs) survive thanks to specialization and innovation in services, which allow them to face new market demands. Inter-organizational information systems (IOISs) support innovation in services, and are thus a strategic tool for SMEs to obtain competitive advantage. Because of the inherent complexity of IOIS adoption, this research extends Kurnia and Johnston's (2000) theoretical model of IOIS adoption with an empirical model of IOIS characterization. The resultant model identifies the factors influencing IOIS adoption in SMEs in the building sector, to promote further service innovation for competitive and collaborative advantages. An empirical longitudinal study over six consecutive years using data from Spanish SMEs in the building sector validates the model, using the partial least squares technique and analyzing temporal stability. The main findings of this research are the four ways an IOIS might contribute to service innovation in the building sector. Namely: a) improving client interfaces and the link between service providers and end users; b) defining a specific market where SMEs can develop new service concepts; c) enhancing the service delivery system in traditional customer?supplier relationships; and d) introducing information and communication technologies and tools to improve information management.

The use of geographic information systems for the optimal location of biomass power plants in the Madrid Community (Spain)

This article has been extracted from the results of a thesis entitled “Potential bioelectricity production of the Madrid Community Agricultural Regions based on rye and triticale biomass.” The aim was, first, to quantify the potential of rye (Secale Cereale L.) and triticale ( Triticosecale Aestivum L.) biomass in each of the Madrid Community agricultural regions, and second, to locate the most suitable areas for the installation of power plants using biomass. At least 17,339.9 t d.m. of rye and triticale would be required to satisfy the biomass needs of a 2.2 MW power plant, (considering an efficiency of 21.5%, 8,000 expected operating hours/year and a biomass LCP of 4,060 kcal/kg for both crops), and 2,577 ha would be used (which represent 2.79% of the Madrid Community fallow dry land surface). Biomass yields that could be achieved in Madrid Community using 50% of the fallow dry land surface (46,150 ha representing 5.75% of the Community area), based on rye and triticale crops, are estimated at 84,855, 74,906, 70,109, 50,791, 13,481, and 943 t annually for the Campiña, Vegas, Sur Occidental, Área Metropolitana, Lozoya-Somosierra, and Guadarrama regions. The latter represents a bioelectricity potential of 10.77, 9.5, 8.9, 6.44, 1.71, and 0.12 MW, respectively.