Spesa pubblica in Sanità, Istruzione e Ricerca: efficienza, efficacia e determinanti

La ricerca intende analizzare l’efficacia della spesa pubblica, l’efficienza e le loro determinanti nei settori della Sanità, dell’Istruzione e della Ricerca per 33 paesi dell’area OCSE. L’analisi ha un duplice obiettivo: da un lato un confronto cross country e dall’altro un confronto temporale, prendendo in considerazione il periodo che va dal 1992 al 2011. Il tema della valutazione dell’efficacia e dell’efficienza della spesa pubblica è molto attuale, soprattutto in Europa, sia perché essa incide di quasi il 50% sul PIL, sia a causa della crisi finanziaria del 2008 che ha spinto i governi ad una riduzione dei bugdet e ad un loro uso più oculato. La scelta di concentrare il lavoro di analisi nei settori della Sanità, dell’Istruzione e della Ricerca e Sviluppo deriva da un lato dalla loro peculiarità di attività orientate al cliente (scuole, ospedali, tribunali) dall’altro dal ruolo strategico che essi rappresentano per lo sviluppo economico di un paese. Il lavoro è articolato in tre sezioni: 1. Rassegna dei principali strumenti metodologici utilizzati in letteratura per la misurazione della performance e dell’efficienza della spesa pubblica nei tre settori. 2. Valutazione e confronto dell’efficienza e della performance della spesa pubblica dal punto di vista sia temporale sia cross-country attraverso la costruzione di indicatori di performance e di efficienza della spesa pubblica (per approfondire l'indice dell'efficienza ho applicato la tecnica DEA "bootstrap output oriented" con indicatori di output ed input non simultanei mentre l’evoluzione dell’efficienza tra i periodi 2011-2002 e 2001-1992 è stata analizzata attraverso il calcolo dell’indice di Malmquist). 3. Analisi delle variabili esogene che influenzano l’efficienza della spesa pubblica nei settori Salute, Istruzione e Ricerca e Sviluppo attraverso una regressione Tobit avente come variabile dipendente i punteggi di efficienza DEA output oriented e come variabili esogene alcuni indicatori scelti tra quelli presenti in letteratura: l’Indicatore delle condizioni socioeconomiche delle famiglie (costruito e applicato da OCSE PISA per valutare l’impatto del background familiare nelle performance dell’apprendimento), l’Indicatore di fiducia nel sistema legislativo del paese, l’Indicatore di tutela dei diritti di proprietà, l’Indicatore delle azioni di controllo della corruzione, l’Indicatore di efficacia delle azioni di governo, l’Indicatore della qualità dei regolamenti, il PIL pro-capite. Da questo lavoro emergono risultati interessanti: non sempre alla quantità di risorse impiegate corrisponde il livello massimo di performance raggiungibile. I risultati della DEA evidenziano la media dei punteggi di efficienza corretti di 0,712 e quindi, impiegando la stessa quantità di risorse, si produrrebbe un potenziale miglioramento dell’output generato di circa il 29%. Svezia, Giappone, Finlandia e Germania risultano i paesi più efficienti, più vicini alla frontiera, mentre Slovacchia, Portogallo e Ungheria sono più distanti dalla frontiera con una misura di inefficienza di circa il 40%. Per quanto riguarda il confronto tra l’efficienza della spesa pubblica nei tre settori tra i periodi 1992-2001 e 2002-2011, l’indice di Malmquist mostra risultati interessanti: i paesi che hanno migliorato il loro livello di efficienza sono quelli dell’Est come l’Estonia, la Slovacchia, la Lituania mentre Paesi Bassi, Belgio e Stati Uniti hanno peggiorato la loro posizione. I paesi che risultano efficienti nella DEA come Finlandia, Germania e Svezia sono rimasti sostanzialmente fermi con un indice di Malmquist vicino al valore uno. In conclusione, i risultati della Tobit contengono indicazioni importanti per orientare le scelte dei Governi. Dall’analisi effettuata emerge che la fiducia nelle leggi, la lotta di contrasto alla corruzione, l’efficacia del governo, la tutela dei diritti di proprietà, le condizioni socioeconomiche delle famiglie degli studenti OECD PISA, influenzano positivamente l’efficienza della spesa pubblica nei tre settori indagati. Oltre alla spending review, per aumentare l’efficienza e migliorare la performance della spesa pubblica nei tre settori, è indispensabile per gli Stati la capacità di realizzare delle riforme che siano in grado di garantire il corretto funzionamento delle istituzioni.

ANALISANDO A RELAÇÃO DOS VOLUMES DE EXPORTAÇÃO E DE IMPORTAÇÃO, PIB, TAXAS DE CÂMBIO E INFLAÇÃO NO PERÍODO DE 2004 A 2014.

Esta dissertação visa deslumbrar uma análise macroeconômica do Brasil, especialmente no que se refere à relação dos índices mensais dos volumes das exportações e das importações com os volumes mensais do PIB, da Taxa SELIC e as Taxas de Câmbio, conforme dados coletados no período de janeiro de 2004 a dezembro de 2014, através de pesquisa literária referente aos históricos sobre cada conceito envolvido no âmbito da macroeconomia das varáveis estudadas. Foi realizado um estudo de caso embasado em dados de sites governamentais, no período delimitado, empregando-se o método de regressão linear, com base na Teoria da correlação de Pearson, demonstrando os resultados obtidos no período do estudo para as varáveis estudadas. Desta maneira, conseguiu-se estudar e analisar como as variáveis dependentes (resposta): volume das exportações e volume das importações estão relacionadas com as varáveis independentes (explicativas): PIB, Taxa Selic e taxa de Câmbio. Os resultados apurados no presente estudo permitem identificar que existe correlação moderada e negativa, quando analisadas a Taxa Selic e a Taxa de Câmbio com os volumes das exportações e das importações, enquanto o PIB apresenta correlação forte e positiva na análise com os volumes das exportações e das importações. Palavras-

People, technology, processes and risk knowledge sharing

The present global economic crisis creates doubts about the good use of accumulated experience and knowledge in managing risk in financial services. Typically, risk management practice does not use knowledge management (KM) to improve and to develop new answers to the threats. A key reason is that it is not clear how to break down the “organizational silos” view of risk management (RM) that is commonly taken. As a result, there has been relatively little work on finding the relationships between RM and KM. We have been doing research for the last couple of years on the identification of relationships between these two disciplines. At ECKM 2007 we presented a general review of the literature(s) and some hypotheses for starting research on KM and its relationship to the perceived value of enterprise risk management. This article presents findings based on our preliminary analyses, concentrating on those factors affecting the perceived quality of risk knowledge sharing. These come from a questionnaire survey of RM employees in organisations in the financial services sector, which yielded 121 responses. We have included five explanatory variables for the perceived quality of risk knowledge sharing. These comprised two variables relating to people (organizational capacity for work coordination and perceived quality of communication among groups), one relating to process (perceived quality of risk control) and two related to technology (web channel functionality and RM information system functionality). Our findings so far are that four of these five variables have a significant positive association with the perceived quality of risk knowledge sharing: contrary to expectations, web channel functionality did not have a significant association. Indeed, in some of our exploratory regression studies its coefficient (although not significant) was negative. In stepwise regression, the variable organizational capacity for work coordination accounted for by far the largest part of the variation in the dependent variable perceived quality of risk knowledge sharing. The “people” variables thus appear to have the greatest influence on the perceived quality of risk knowledge sharing, even in a sector that relies heavily on technology and on quantitative approaches to decision making. We have also found similar results with the dependent variable perceived value of Enterprise Risk Management (ERM) implementation.

Statnote 27: Principal components analysis (PCA)

In Statnotes 24 and 25, multiple linear regression, a statistical method that examines the relationship between a single dependent variable (Y) and two or more independent variables (X), was described. The principle objective of such an analysis was to determine which of the X variables had a significant influence on Y and to construct an equation that predicts Y from the X variables. ‘Principal components analysis’ (PCA) and ‘factor analysis’ (FA) are also methods of examining the relationships between different variables but they differ from multiple regression in that no distinction is made between the dependent and independent variables, all variables being essentially treated the same. Originally, PCA and FA were regarded as distinct methods but in recent times they have been combined into a single analysis, PCA often being the first stage of a FA. The basic objective of a PCA/FA is to examine the relationships between the variables or the ‘structure’ of the variables and to determine whether these relationships can be explained by a smaller number of ‘factors’. This statnote describes the use of PCA/FA in the analysis of the differences between the DNA profiles of different MRSA strains introduced in Statnote 26.

Remote sensing applications to flood hydrology in Belize

The research compares the usefullness of four remote sensing information sources, these being LANDSAT photographic prints, LANDSAT computer compatible tapes, Metric Camera and SIR-A photographic prints. These sources provide evaluations of the catchment characteristics of the Belize and Sibun river basins in Central America. Map evaluations at 1:250,000 scale are compared to the results of the same scale, remotely sensed information sources. The values of catchment characteristics for both maps and LANDSAT prints are used in multiple regression analysis, providing flood flow formulae, after investigations to provide a suitable dependent variable discharge series are made for short term records. The use of all remotely sensed information sources in providing evaluations of catchment characteristics is discussed. LANDSAT prints and computer compatible tapes of a post flood scene are used to estimate flood distributions and volumes. These are compared to values obtained from unit hydrograph analysis, using the dependent discharge series and evaluate the probable losses from the Belize river to the floodplain, thereby assessing the accuracy of LANDSAT estimates. Information relating to flood behaviour is discussed in terms of basic image presentation as well as image processing. A cost analysis of the purchase and use of all materials is provided. Conclusions of the research indicate that LANDSAT print material may provide information suitable for regression analysis at levels of accuracy as great as those of topographic maps, that the differing information sources are uniquely applicable and that accurate estimates of flood volumes may be determined even by post flood imagery.

Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study

BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.

Provision of primary care to patients with chronic cough in the community pharmacy setting

BACKGROUND: Community pharmacies are at the forefront of primary care providers and have an important role in the referral of patients to a medical practitioner for review when necessary. Chronic cough is a common disorder in the community and requires medical assessment. The proficiency of community pharmacy staff to refer patients with chronic cough is currently unknown. OBJECTIVE: To assess the ability of community pharmacy staff to recognize and medically refer patients with a chronic nonproductive cough. METHODS: Following ethics approval, a simulated patient study of 156 community pharmacies in Perth, Western Australia, was conducted over a 3-month period. Simulated patients presented to the pharmacy requesting treatment for a cough. The simulated patient required a referral based on a designated scenario. Demographic details, assessment questions, and advice provided were recorded by the simulated patient immediately postvisit. A logistic regression analysis was performed, with referral for medical assessment as the dependent variable. RESULTS: Of the 155 community pharmacies included in the analysis, 38% provided appropriate medical referral. Cough suppressants were provided as therapy in 72% of all visits. Predictors of medical referral were assessment of symptom duration, medical history, current medications being taken, frequency of reliever use, and the position of the pharmacy staff member conducting the consultation. A third of community pharmacies provided appropriate primary care by recommending medical referral advice to patients with chronic cough. The majority of pharmacy staff members acquired information from the patient that suggested a need for medical referral, yet did not provide referral advice. CONCLUSIONS: Appropriate medical referral is more likely when adequate assessment is undertaken and when a pharmacist is directly involved in the consultation. This highlights the need for pharmacies to ensure that processes are in place for patients to access the pharmacist.

Factors preventing myopia progression with orthokeratology correction

PURPOSE: To examine which baseline measurements constitute predictive factors for axial length growth over 2 years in children wearing orthokeratology contact lenses (OK) and single-vision spectacles (SV). METHODS: Sixty-one children were prospectively assigned to wear either OK (n = 31) or SV (n = 30) for 2 years. The primary outcome measure (dependent variable) was axial length change at 2 years relative to baseline. Other measurements (independent variables) were age, age of myopia onset, gender, myopia progression 2 years before baseline and baseline myopia, anterior chamber depth, corneal power and shape (p value), and iris and pupil diameters as well as parental refraction. The contribution of all independent variables to the 2-year change in axial length was assessed using univariate and multivariate regression analyses. RESULTS: After univariate analyses, smaller increases in axial length were found in the OK group compared to the SV group in children who were older, had earlier onset of myopia, were female, had lower rate of myopia progression before baseline, had less myopia at baseline, had longer anterior chamber depth, had greater corneal power, had more prolate corneal shape, had larger iris diameter, had larger pupil sizes, and had lower levels of parental myopia (all p < 0.05). In multivariate analyses, older age and greater corneal power were associated with smaller increases in axial length in the OK group (both p < 0.05), whereas in SV wearers, smaller iris diameter was associated with smaller increases in axial length (p = 0.021). CONCLUSIONS: Orthokeratology is a successful treatment option in controlling axial elongation compared to SV in children of older age, had earlier onset of myopia, were female, had lower rate of myopia progression before baseline, had lower myopia at baseline, had longer anterior chamber depth, had greater corneal power, had more prolate corneal shape, had larger iris and pupil diameters, and had lower levels of parental myopia. © American Academy of Optometry.

The goal-dependent automaticity of drinking habits

In recent treatments of habitual social behaviour, habits are conceptualized as a form of goal-directed automatic behaviour that are mentally represented as goal-action links. Three experiments tested this conceptualization in the context of students' drinking (alcohol consumption)habits. Participants were randomly assigned to conditions where either a goal related to drinking behaviour (socializing) was activated, or an unrelated goal was activated. In addition, participants' drinking habits were measured. The dependent variable in Experiments 1 and 2 was readiness to drink, operationalized by speed of responding to the action concept 'drinking' in a verb verification task. Experiment 3 used the uptake of a voucher to measure drinking behaviour. Findings supported the view that when habits are established, simply activating a goal related to the focal behaviour automatically elicits that behaviour. These findings are consistent with a goal-dependent conception of habit. Possibilities for interventions designed to attenuate undesirable habitual behaviours are considered.

Theoretical Hyperbolic Model of a Partial Agonism: Explicit Formulas for Affinity, Efficacy and Amplification

The quantitative analysis of receptor-mediated effect is based on experimental concentration-response data in which the independent variable, the concentration of a receptor ligand, is linked with a dependent variable, the biological response. The steps between the drug–receptor interaction and the subsequent biological effect are to some extent unknown. The shape of the fitting curve of the experimental data may give some in-sights into the nature of the concentration–receptor–response (C-R-R) mechanism. It can be evaluated by non-linear regression analysis of the experimental data points of the independent and dependent variables, which could be considered as a history of the interaction between the drug and receptors. However, this information is not enough to evaluate such important parameters of the mechanism as the dissociation constant (affinity) and efficacy. There are two ways to provide more detailed information about the C-R-R mechanism: (i) an experimental way for obtaining data with new or

Factors predicting recommendations for civil commitment of sexually violent predators under Florida's Jimmy Ryce Act

This study investigated the factors considered by forensic examiners when evaluating sexually violent predators (SVP) for civil commitment under Florida's “Jimmy Ryce Act.” The project was funded by a pre-doctoral research grant awarded by the Association for the Treatment of Sexual Abusers (ATSA). ^ This study proposed two specific research questions. First, what is the direct relationship between actuarial risk assessment scores and recommendations for sex offender civil commitment? Second, which other variables are likely to influence SVP commitment decisions, and to what degree? The purpose of the study was to determine if risk assessment practices are evidence-based, and whether offenders selected for commitment meet statutory criteria. ^ The purposive sample of 450 SVPs was drawn from the population of sex offenders evaluated for civil commitment in Florida between July 1, 2000 and June 30, 2001. Data were extracted from SVP evaluations provided by the Florida Department of Children and Families. Using multivariate logistic regression, this correlational research design examined the relationship between the dependent variable, commitment decision, and several sets of independent variables. The independent variables were derived from a review of the literature, and were grouped conceptually according to their degree of correlation with sex offense recidivism. Independent variables included diagnoses, actuarial risk assessment scores, empirically validated static and dynamic risk factors, consensus based risk factors, evaluator characteristics, and demographics. This study investigated the degree to which the identified variables predicted civil commitment decisions. ^ Logistic regression results revealed that the statistically significant predictors of recommendations for sex offender civil commitment were actuarial risk assessment scores, diagnoses of Pedophilia and Paraphilia NOS, psychopathy, younger age of victim, and non-minority race. Discriminant function analysis confirmed that these variables correctly predicted commitment decisions in 90% of cases. ^ It appears that civil commitment evaluators in Florida used empirically-based assessment procedures, and did not make decisions that were heavily influenced by extraneous factors. SVPs recommended for commitment consistently met the criteria set forth by the U.S. Supreme Court in Hendricks v. Kansas (1997): they suffered from a mental abnormality predisposing them to sexual violence, and risk assessment determined that they were likely to reoffend. ^

Financial aid and the persistence of associate of arts graduates transferring to a senior university

This study examined the effects of financial aid on the persistence of associate of arts graduates transferring to a senior university in one of four consecutive fall semesters (1998-2001). Situated in an international metropolitan area in the southeastern United States, the institution where the study was conducted is a large public research university identified as a Hispanic Serving Institution. Archival databases served as the source of information on the academic and social background of the 4,669 participants in the study. Data from institutional financial aid records were pooled with the data in the student administrative system.^ For purposes of this study, persistence was defined as ongoing progress until completing the baccalaureate degree. Student social background variables used in the study were gender, ethnicity, age, and income, with GPA and part-time or full-time enrollment status being the academic variables. Amount and type of aid, including grants, loans, scholarships, and work study were incorporated in the models to determine the effect of financial aid on the persistence of these transfer students. Because the dependent variable persistence had three possible outcomes (graduated, still enrolled, dropped out) multinomial logistic regression was the appropriate technique for analyzing the data; four multinomial models were employed in the analysis.^ Findings suggest that grants awarded based on the financial need of students and loans were effective in encouraging the persistence of students, but scholarships and work study were not effective.^

Organizational culture, organizational climate, and collaborative capacity for planning

The objective of this study was to investigate the relationship of organizational culture and organizational climate on participant perceptions of collaborative capacity for planning, within the context of the Florida School Readiness Coalitions (FSRCs). Three hypotheses were proposed for study: First, that organizational culture would be correlated to organizational climate; second, that organizational culture would be correlated to collaborative capacity for planning; and the third that organizational climate would be correlated to collaborative capacity for planning. ^ A cross-sectional survey research design was used to obtain data from participants in 25 Florida School Readiness Coalitions. Pearson product-moment correlations were used to examine the association between the dependent variable, collaborative capacity for planning, and the independent variables, organizational culture and climate. Bivariate analyses revealed a significant level of association for five culture indicators to collaborative capacity for planning: motivation, interpersonal, service, supportive and individualistic indicators, and four climate indicators: cooperation, job satisfaction, organizational commitment, and role clarity. Findings suggest (a) a constructive culture and positive climate were present within the FSRCs during the period of study and (b) participants perceived that the collaborative capacity for planning existed. Hierarchical multiple regression, controlling for effects of participant demographics, were used to examine the degree to which organizational culture and climate predict collaborative capacity. The culture indicators, supportive and individualistic, and the climate indicator job satisfaction accounted for 46% of the variance in collaborative capacity for planning. No other indicators of the independent variables demonstrated significance. The findings suggests that (a) culture and climate should be studied together, (b) culture and climate are two constructs that may provide knowledge about the way community groups work together, and (c) the collaborative capacity of groups planning services such as the FSRCs may benefit through consideration of how culture and climate affect service planners' relationships, communication, and ability to achieve a mission or goal. Culture and climate may offer social workers new information about internal factors affecting the collaborative process. Further investigation of these constructs with other types of groups is warranted. ^

Development and validation of an instrument to predict online student success using faculty perceptions

Distance learning is growing and transforming educational institutions. The increasing use of distance learning by higher education institutions and particularly community colleges coupled with the higher level of student attrition in online courses than in traditional classrooms suggests that increased attention should be paid to factors that affect online student course completion. The purpose of the study was to develop and validate an instrument to predict community college online student course completion based on faculty perceptions, yielding a prediction model of online course completion rates. Social Presence and Media Richness theories were used to develop a theoretically-driven measure of online course completion. This research study involved surveying 311 community college faculty who taught at least one online course in the past 2 years. Email addresses of participating faculty were provided by two south Florida community colleges. Each participant was contacted through email, and a link to an Internet survey was given. The survey response rate was 63% (192 out of 303 available questionnaires). Data were analyzed through factor analysis, alpha reliability, and multiple regression. The exploratory factor analysis using principal component analysis with varimax rotation yielded a four-factor solution that accounted for 48.8% of the variance. Consistent with Social Presence theory, the factors with their percent of variance in parentheses were: immediacy (21.2%), technological immediacy (11.0%), online communication and interactivity (10.3%), and intimacy (6.3%). Internal consistency of the four factors was calculated using Cronbach's alpha (1951) with reliability coefficients ranging between .680 and .828. Multiple regression analysis yielded a model that significantly predicted 11% of the variance of the dependent variable, the percentage of student who completed the online course. As indicated in the literature (Johnson & Keil, 2002; Newberry, 2002), Media Richness theory appears to be closely related to Social Presence theory. However, elements from this theory did not emerge in the factor analysis.

Cognitive and noncognitive variables that predict Florida community college radiography program graduates' success on the Registry

This study examined the predictive merits of selected cognitive and noncognitive variables on the national Registry exam pass rate using 2008 graduates (n = 175) from community college radiography programs in Florida. The independent variables included two GPAs, final grades in five radiography courses, self-efficacy, and social support. The dependent variable was the first-attempt results on the national Registry exam. The design was a retrospective predictive study that relied on academic data collected from participants using the self-report method and on perceptions of students' success on the national Registry exam collected through a questionnaire developed and piloted in the study. All independent variables except self-efficacy and social support correlated with success on the national Registry exam ( p < .01) using the Pearson Product-Moment Correlation analysis. The strongest predictor of the national Registry exam success was the end-of-program GPA, r = .550, p < .001. The GPAs and scores for self-efficacy and social support were entered into a logistic regression analysis to produce a prediction model. The end-of-program GPA (p = .015) emerged as a significant variable. This model predicted 44% of the students who failed the national Registry exam and 97.3% of those who passed, explaining 45.8% of the variance. A second model included the final grades for the radiography courses, self efficacy, and social support. Three courses significantly predicted national Registry exam success; Radiographic Exposures, p < .001; Radiologic Physics, p = .014; and Radiation Safety & Protection, p = .044, explaining 56.8% of the variance. This model predicted 64% of the students who failed the national Registry exam and 96% of those who passed. The findings support the use of in-program data as accurate predictors of success on the national Registry exam.