Trading between perceived risks and benefits related to biosimilar biological treatment in Crohn’s disease; discrete choice experiment among gastroenterologists

Objective: The objective of the study is to explore preferences of gastroenterologists for biosimilar drugs in Crohn’s Disease and reveal trade-offs between the perceived risks and benefits related to biosimilar drugs. Method: Discrete choice experiment was carried out involving 51 Hungarian gastroenterologists in May, 2014. The following attributes were used to describe hypothetical choice sets: 1) type of the treatment (biosimilar/originator) 2) severity of disease 3) availability of continuous medicine supply 4) frequency of the efficacy check-ups. Multinomial logit model was used to differentiate between three attitude types: 1) always opting for the originator 2) willing to consider biosimilar for biological-naïve patients only 3) willing to consider biosimilar treatment for both types of patients. Conditional logit model was used to estimate the probabilities of choosing a given profile. Results: Men, senior consultants, working in IBD center and treating more patients are more likely to willing to consider biosimilar for biological-naïve patients only. Treatment type (originator/biosimilar) was the most important determinant of choice for patients already treated with biologicals, and the availability of continuous medicine supply in the case biological-naïve patients. The probabilities of choosing the biosimilar with all the benefits offered over the originator under current reimbursement conditions are 89% vs 11% for new patients, and 44% vs 56% for patients already treated with biological. Conclusions: Gastroenterologists were willing to trade between perceived risks and benefits of biosimilars. The continuous medical supply would be one of the major benefits of biosimilars. However, benefits offered in the scenarios do not compensate for the change from the originator to the biosimilar treatment of patients already treated with biologicals.

A novel neural network based system for assessing risks associated with information technology security breaches

Security remains a top priority for organizations as their information systems continue to be plagued by security breaches. This dissertation developed a unique approach to assess the security risks associated with information systems based on dynamic neural network architecture. The risks that are considered encompass the production computing environment and the client machine environment. The risks are established as metrics that define how susceptible each of the computing environments is to security breaches. ^ The merit of the approach developed in this dissertation is based on the design and implementation of Artificial Neural Networks to assess the risks in the computing and client machine environments. The datasets that were utilized in the implementation and validation of the model were obtained from business organizations using a web survey tool hosted by Microsoft. This site was designed as a host site for anonymous surveys that were devised specifically as part of this dissertation. Microsoft customers can login to the website and submit their responses to the questionnaire. ^ This work asserted that security in information systems is not dependent exclusively on technology but rather on the triumvirate people, process and technology. The questionnaire and consequently the developed neural network architecture accounted for all three key factors that impact information systems security. ^ As part of the study, a methodology on how to develop, train and validate such a predictive model was devised and successfully deployed. This methodology prescribed how to determine the optimal topology, activation function, and associated parameters for this security based scenario. The assessment of the effects of security breaches to the information systems has traditionally been post-mortem whereas this dissertation provided a predictive solution where organizations can determine how susceptible their environments are to security breaches in a proactive way. ^

Variables affecting the success of older applicants for employment in a public organization: An age -cued cognitive model of administrative decision-making

The dissertation takes a multivariate approach to answer the question of how applicant age, after controlling for other variables, affects employment success in a public organization. In addition to applicant age, there are five other categories of variables examined: organization/applicant variables describing the relationship of the applicant to the organization; organization/position variables describing the target position as it relates to the organization; episodic variables such as applicant age relative to the ages of competing applicants; economic variables relating to the salary needs of older applicants; and cognitive variables that may affect the decision maker's evaluation of the applicant. ^ An exploratory phase of research employs archival data from approximately 500 decisions made in the past three years to hire or promote applicants for positions in one public health administration organization. A logit regression model is employed to examine the probability that the variables modify the effect of applicant age on employment success. A confirmatory phase of the dissertation is a controlled experiment in which hiring decision makers from the same public organization perform a simulated hiring decision exercise to evaluate hypothetical applicants of similar qualifications but of different ages. The responses of the decision makers to a series of bipolar adjective scales add support to the cognitive component of the theoretical model of the hiring decision. A final section contains information gathered from interviews with key informants. ^ Applicant age has tended to have a curvilinear relationship with employment success. For some positions, the mean age of the applicants most likely to succeed varies with the values of the five groups of moderating variables. The research contributes not only to the practice of public personnel administration, but is useful in examining larger public policy issues associated with an aging workforce. ^

Is socioeconomic position early in life associated with physical activity during adulthood following the accumulation of risk model with additive effects?

L'activité physique améliore la santé, mais seulement 4.8% des Canadiens atteignent le niveau recommandé. La position socio-économique est un des déterminants de l'activité physique les plus importants. Elle est associée à l’activité physique de manière transversale à l’adolescence et à l’âge adulte. Cette thèse a tenté de déterminer s'il y a une association à long terme entre la position socio-économique au début du parcours de vie et l’activité physique à l’âge adulte. S'il y en avait une, un deuxième objectif était de déterminer quel modèle théorique en épidémiologie des parcours de vie décrivait le mieux sa forme. Cette thèse comprend trois articles: une recension systématique et deux recherches originales. Dans la recension systématique, des recherches ont été faites dans Medline et EMBASE pour trouver les études ayant mesuré la position socio-économique avant l'âge de 18 ans et l'activité physique à ≥18 ans. Dans les deux recherches originales, la modélisation par équations structurelles a été utilisée pour comparer trois modèles alternatifs en épidémiologie des parcours de vie: le modèle d’accumulation de risque avec effets additifs, le modèle d’accumulation de risque avec effet déclenché et le modèle de période critique. Ces modèles ont été comparés dans deux cohortes prospectives représentatives à l'échelle nationale: la 1970 British birth cohort (n=16,571; première recherche) et l’Enquête longitudinale nationale sur les enfants et les jeunes (n=16,903; deuxième recherche). Dans la recension systématique, 10 619 articles ont été passés en revue par deux chercheurs indépendants et 42 ont été retenus. Pour le résultat «activité physique» (tous types et mesures confondus), une association significative avec la position socio-économique durant l’enfance fut trouvée dans 26/42 études (61,9%). Quand seulement l’activité physique durant les loisirs a été considérée, une association significative fut trouvée dans 21/31 études (67,7%). Dans un sous-échantillon de 21 études ayant une méthodologie plus forte, les proportions d’études ayant trouvé une association furent plus hautes : 15/21 (71,4%) pour tous les types et toutes les mesures d’activité physique et 12/15 (80%) pour l’activité physique de loisir seulement. Dans notre première recherche originale sur les données de la British birth cohort, pour la classe sociale, nous avons trouvé que le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux chez les hommes et les femmes pour l’activité physique de loisir, au travail et durant les transports. Dans notre deuxième recherche originale sur les données canadiennes sur l'activité physique de loisir, nous avons trouvé que chez les hommes, le modèle de période critique s’est ajusté le mieux aux données pour le niveau d’éducation et le revenu, alors que chez les femmes, le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux pour le revenu, tandis que le niveau d’éducation ne s’est ajusté à aucun des modèles testés. En conclusion, notre recension systématique indique que la position socio-économique au début du parcours de vie est associée à la pratique d'activité physique à l'âge adulte. Les résultats de nos deux recherches originales suggèrent un patron d’associations le mieux représenté par le modèle d’accumulation de risque avec effets additifs.

Holocene experiment with coupled atmosphere-ocean-model ECHAM5/MPI-OM

Changes in the Earth's orbit lead to changes in the seasonal and meridional distribution of insolation. We quantify the influence of orbitally induced changes on the seasonal temperature cycle in a transient simulation of the last 6000 years - from the mid-Holocene to today - using a coupled atmosphere-ocean general circulation model (ECHAM5/MPI-OM) including a land surface model (JSBACH). The seasonal temperature cycle responds directly to the insolation changes almost everywhere. In the Northern Hemisphere, its amplitude decreases according to an increase in winter insolation and a decrease in summer insolation. In the Southern Hemisphere, the opposite is true. Over the Arctic Ocean, decreasing summer insolation leads to an increase in sea-ice cover. The insulating effect of sea ice between the ocean and the atmosphere leads to decreasing heat flux and favors more "continental" conditions over the Arctic Ocean in winter, resulting in strongly decreasing temperatures. Consequently, there are two competing effects: the direct response to insolation changes and a sea-ice insulation effect. The sea-ice insulation effect is stronger, and thus an increase in the amplitude of the seasonal temperature cycle over the Arctic Ocean occurs. This increase is strongest over the Barents Shelf and influences the temperature response over northern Europe. We compare our modeled seasonal temperatures over Europe to paleo reconstructions. We find better agreements in winter temperatures than in summer temperatures and better agreements in northern Europe than in southern Europe, since the model does not reproduce the southern European Holocene summer cooling inferred from the paleo reconstructions. The temperature reconstructions for northern Europe support the notion of the influence of the sea-ice insulation effect on the evolution of the seasonal temperature cycle.

Model based integration of management systems (MSs) – case study

Abstract Purpose – The purpose of this paper is to present a case study regarding the deployment of a previously developed model for the integration of management systems (MSs). The case study is developed at a manufacturing site of an international enterprise. The implementation of this model in a real business environment is aimed at assessing its feasibility. Design/methodology/approach – The presented case study takes into account different management systems standards (MSSs) progressively implemented, along the years, independently. The implementation of the model was supported by the results obtained from an investigation performed according to a structured diagnosis that was conducted to collect information related to the organizational situation of the enterprise. Findings – The main findings are as follows: a robust integrated management system (IMS), objectively more lean, structured and manageable was found to be feasible; this study provided an holistic view of the enterprise’s global management; clarifications of job descriptions and boundaries of action and responsibilities were achieved; greater efficiency in the use of resources was attained; more coordinated management of the three pillars of sustainability – environmental, economic and social, as well as risks, providing confidence and added value to the company and interested parties was achieved. Originality/value – This case study is pioneering in Portugal in respect to the implementation, at the level of an industrial organization, of the model previously developed for the integration of individualized MSs. The case study provides new insights regarding the implementation of IMSs including the rationalization of several resources and elimination of several types of organizational waste leveraging gains of efficiency. Due to its intrinsic characteristics, the model is able to support, progressively, new or revised MSSs according to the principles of annex SL (normative) – proposals for MSSs – of the International Organization for Standardization and the International Electrotechnical Commission, that the industrial organization can adopt beyond the current ones.

Evaluating Risks of Dam-Reservoir Systems Using Efficient Importance Sampling

The occurrence frequency of failure events serve as critical indexes representing the safety status of dam-reservoir systems. Although overtopping is the most common failure mode with significant consequences, this type of event, in most cases, has a small probability. Estimation of such rare event risks for dam-reservoir systems with crude Monte Carlo (CMC) simulation techniques requires a prohibitively large number of trials, where significant computational resources are required to reach the satisfied estimation results. Otherwise, estimation of the disturbances would not be accurate enough. In order to reduce the computation expenses and improve the risk estimation efficiency, an importance sampling (IS) based simulation approach is proposed in this dissertation to address the overtopping risks of dam-reservoir systems. Deliverables of this study mainly include the following five aspects: 1) the reservoir inflow hydrograph model; 2) the dam-reservoir system operation model; 3) the CMC simulation framework; 4) the IS-based Monte Carlo (ISMC) simulation framework; and 5) the overtopping risk estimation comparison of both CMC and ISMC simulation. In a broader sense, this study meets the following three expectations: 1) to address the natural stochastic characteristics of the dam-reservoir system, such as the reservoir inflow rate; 2) to build up the fundamental CMC and ISMC simulation frameworks of the dam-reservoir system in order to estimate the overtopping risks; and 3) to compare the simulation results and the computational performance in order to demonstrate the ISMC simulation advantages. The estimation results of overtopping probability could be used to guide the future dam safety investigations and studies, and to supplement the conventional analyses in decision making on the dam-reservoir system improvements. At the same time, the proposed methodology of ISMC simulation is reasonably robust and proved to improve the overtopping risk estimation. The more accurate estimation, the smaller variance, and the reduced CPU time, expand the application of Monte Carlo (MC) technique on evaluating rare event risks for infrastructures.

Oil spill environmental risk assessment of stationary sources in offshore zones (Innovating a mathematical model)

Nowadays, risks arising from the rapid development of oil and gas industries are significantly increasing. As a result, one of the main concerns of either industrial or environmental managers is the identification and assessment of such risks in order to develop and maintain appropriate proactive measures. Oil spill from stationary sources in offshore zones is one of the accidents resulting in several adverse impacts on marine ecosystems. Considering a site's current situation and relevant requirements and standards, risk assessment process is not only capable of recognizing the probable causes of accidents but also of estimating the probability of occurrence and the severity of consequences. In this way, results of risk assessment would help managers and decision makers create and employ proper control methods. Most of the represented models for risk assessment of oil spills are achieved on the basis of accurate data bases and analysis of historical data, but unfortunately such data bases are not accessible in most of the zones, especially in developing countries, or else they are newly established and not applicable yet. This issue reveals the necessity of using Expert Systems and Fuzzy Set Theory. By using such systems it will be possible to formulize the specialty and experience of several experts and specialists who have been working in petroliferous areas for several years. On the other hand, in developing countries often the damages to environment and environmental resources are not considered as risk assessment priorities and they are approximately under-estimated. For this reason, the proposed model in this research is specially addressing the environmental risk of oil spills from stationary sources in offshore zones.

Universities and Welfare States Coping with Permanent Financial Austerity: Pressures on (Competing) Public Institutions

A chapter linking universities and welfare states to permanent financial austerity can take a shorter or a longer historical perspective. This chapter looks further back (to the postwar expansion of European welfare states) to better understand future transformations of both public institutions. Their long-term sustainability problems did not start with the financial crisis of 2008 but have been growing since the 1970s (Schäfer and Streeck 2013; Bonoli and Natali 2012; Hay and Wincott 2012). Financial austerity is not a post-crisis phenomenon. As a concept, it was used in welfare state research at least a decade earlier, although it does not seem to have been used in higher education studies until recently. Two quotations bring us to the heart of the matter: welfare states and universities are currently changing under adverse financial conditions caused by an array of interrelating and mutually reinforcing forces and their long-term financial sustainability is at stake across Europe. The welfare state is a “particular trademark of the European social model” (Svallfors 2012: 1), “the jewel in the crown” and a “fundamental part of what Europe stands for” (Giddens 2006: 14), as are tuition-free universities, the cornerstone of intergenerational social mobility in Continental Europe. The past trajectories of major types of welfare states and of universities in Europe tend to go hand in hand: first vastly expanding following the Second World War, and especially in the 1960s and 1970s, and then being in the state of permanent resource-driven and legitimacy-based “crisis” in the last two decades. Welfare states and universities, two critically important public institutions, seem to be under heavy attacks from the public, the media and politicians. Their long-term sustainability is being questioned, and solutions to their (real and perceived) problems are being sought at global, European, and national levels.

A risk model with an observer in a Markov environment

We consider a spectrally-negative Markov additive process as a model of a risk process in a random environment. Following recent interest in alternative ruin concepts, we assume that ruin occurs when an independent Poissonian observer sees the process as negative, where the observation rate may depend on the state of the environment. Using an approximation argument and spectral theory, we establish an explicit formula for the resulting survival probabilities in this general setting. We also discuss an efficient evaluation of the involved quantities and provide a numerical illustration.

A Governance Reference Model for Virtual Enterprises

Part 2: Behaviour and Coordination

Application of a Bivariate Probit Model to Investigate the Intended Evacuation from Hurricane

With evidence of increasing hurricane risks in Georgia Coastal Area (GCA) and Virginia in the U.S. Southeast and elsewhere, understanding intended evacuation behavior is becoming more and more important for community planners. My research investigates intended evacuation behavior due to hurricane risks, a behavioral survey of the six counties in GCA under the direction of two social scientists with extensive experience in survey research related to citizen and household response to emergencies and disasters. Respondents gave answers whether they would evacuate under both voluntary and mandatory evacuation orders. Bivariate probit models are used to investigate the subjective belief structure of whether or not the respondents are concerned about the hurricane, and the intended probability of evacuating as a function of risk perception, and a lot of demographic and socioeconomic variables (e.g., gender, military, age, length of residence, owning vehicles).

Introducing a pilot data collection model for real-time evaluation of data redundancy

In order to reduce serious health incidents, individuals with high risks need to be identified as early as possible so that effective intervention and preventive care can be provided. This requires regular and efficient assessments of risk within communities that are the first point of contacts for individuals. Clinical Decision Support Systems CDSSs have been developed to help with the task of risk assessment, however such systems and their underpinning classification models are tailored towards those with clinical expertise. Communities where regular risk assessments are required lack such expertise. This paper presents the continuation of GRiST research team efforts to disseminate clinical expertise to communities. Based on our earlier published findings, this paper introduces the framework and skeleton for a data collection and risk classification model that evaluates data redundancy in real-time, detects the risk-informative data and guides the risk assessors towards collecting those data. By doing so, it enables non-experts within the communities to conduct reliable Mental Health risk triage.

Defending the 'public interest': an assessment of competing actor representations of 'solutions' to growing natural resource deficiencies.

This paper applies a SRT framework to the study of two case studies, namely the recent campaign of opposition to the legalization of hydraulic fracking in the State of New York and the more ongoing debate on land leasing in Africa. In relation to both campaigns, the analysis accounts for the arguments of a major financial institution and industry representatives who stress the safe and value-adding dimensions of these practices, as well as the views of opponents who refute the validity of industry's position and point to the unacceptable risks posed to the community, health and the environment. In spite of a number of obvious differences between these two case studies, not least differences arising from contrasting socio-economic and geo-political settings, there were also some notable similarities. First, was a tendency amongst protesters in both cases to formulate their role as contemporaries in a historically extended struggle for democratic justice. All perceived of themselves as guardians of their community's right to resist a corporate 'invasion' of their territories, like their forefathers and mothers before them. A theme of colonialism was explored in both settings through various identity and thematic anchoring devices that deliberately evoked shared understandings and historical memories of exploitation and human suffering. The evocation of powerful symbols of identity through visual narratives of protest further reinforced the cultural comprehensibility of opponents' message of protest in both contexts.

Quantifying the roles of competing static gears: comparative selectivity of longlines and monofilament gill nets in a multi-species fishery of the Algarve (southern Portugal)

Fishing trials with monofilament gill nets and longlines using small hooks were carried out in Algarve waters (southern Portugal) over a one-year period. Four hook sizes of "Mustad" brand, round bent, flatted sea hooks (Quality 2316 DT, numbers 15, 13, 12 and 11) and four mesh sizes of 25, 30, 35 and 40 mm (bar length) monofilament gill nets were used. Commercially valuable sea breams dominated the longline catches while small pelagics were relatively more important in the gill nets. Significant differences in the catch size frequency distributions of the two gears were found for all the most important species caught by both gears (Boops boops, Diplodus bellottii, Diplodus vulgaris, Pagellus acarne, Pagellus erythrinus, Spondyiosoma cantharus, Scomber japonicus and Scorpaena notata), with longlines catching larger fish and a wider size range than nets. Whereas longline catch size frequency distributions for most species for the different hook sizes were generally highly overlapped, suggesting little or no differences in size selectivity, gill net catch size frequency distributions clearly showed size selection. A variety of models were fitted to the gill net and hook data using the SELECT method, while the parameters of the logistic model were estimated by maximum likelihood for the longline data. The bi-normal model gave the best fits for most of the species caught with gill nets, while the logistic model adequately described hook selectivity. The results of this study show that the two static gears compete for many of the same species and have different impacts in terms of catch composition and size selectivity. This information will I;e useful for the improved management of these small-scale fisheries in which many different gears compete for scarce resources.