Modelling and estimating models of physician labour supply and productivity

Ma thèse s’intéresse aux politiques de santé conçues pour encourager l’offre de services de santé. L’accessibilité aux services de santé est un problème majeur qui mine le système de santé de la plupart des pays industrialisés. Au Québec, le temps médian d’attente entre une recommandation du médecin généraliste et un rendez-vous avec un médecin spécialiste était de 7,3 semaines en 2012, contre 2,9 semaines en 1993, et ceci malgré l’augmentation du nombre de médecins sur cette même période. Pour les décideurs politiques observant l’augmentation du temps d’attente pour des soins de santé, il est important de comprendre la structure de l’offre de travail des médecins et comment celle-ci affecte l’offre des services de santé. Dans ce contexte, je considère deux principales politiques. En premier lieu, j’estime comment les médecins réagissent aux incitatifs monétaires et j’utilise les paramètres estimés pour examiner comment les politiques de compensation peuvent être utilisées pour déterminer l’offre de services de santé de court terme. En second lieu, j’examine comment la productivité des médecins est affectée par leur expérience, à travers le mécanisme du "learning-by-doing", et j’utilise les paramètres estimés pour trouver le nombre de médecins inexpérimentés que l’on doit recruter pour remplacer un médecin expérimenté qui va à la retraite afin de garder l’offre des services de santé constant. Ma thèse développe et applique des méthodes économique et statistique afin de mesurer la réaction des médecins face aux incitatifs monétaires et estimer leur profil de productivité (en mesurant la variation de la productivité des médecins tout le long de leur carrière) en utilisant à la fois des données de panel sur les médecins québécois, provenant d’enquêtes et de l’administration. Les données contiennent des informations sur l’offre de travail de chaque médecin, les différents types de services offerts ainsi que leurs prix. Ces données couvrent une période pendant laquelle le gouvernement du Québec a changé les prix relatifs des services de santé. J’ai utilisé une approche basée sur la modélisation pour développer et estimer un modèle structurel d’offre de travail en permettant au médecin d’être multitâche. Dans mon modèle les médecins choisissent le nombre d’heures travaillées ainsi que l’allocation de ces heures à travers les différents services offerts, de plus les prix des services leurs sont imposés par le gouvernement. Le modèle génère une équation de revenu qui dépend des heures travaillées et d’un indice de prix représentant le rendement marginal des heures travaillées lorsque celles-ci sont allouées de façon optimale à travers les différents services. L’indice de prix dépend des prix des services offerts et des paramètres de la technologie de production des services qui déterminent comment les médecins réagissent aux changements des prix relatifs. J’ai appliqué le modèle aux données de panel sur la rémunération des médecins au Québec fusionnées à celles sur l’utilisation du temps de ces mêmes médecins. J’utilise le modèle pour examiner deux dimensions de l’offre des services de santé. En premierlieu, j’analyse l’utilisation des incitatifs monétaires pour amener les médecins à modifier leur production des différents services. Bien que les études antérieures ont souvent cherché à comparer le comportement des médecins à travers les différents systèmes de compensation,il y a relativement peu d’informations sur comment les médecins réagissent aux changementsdes prix des services de santé. Des débats actuels dans les milieux de politiques de santé au Canada se sont intéressés à l’importance des effets de revenu dans la détermination de la réponse des médecins face à l’augmentation des prix des services de santé. Mon travail contribue à alimenter ce débat en identifiant et en estimant les effets de substitution et de revenu résultant des changements des prix relatifs des services de santé. En second lieu, j’analyse comment l’expérience affecte la productivité des médecins. Cela a une importante implication sur le recrutement des médecins afin de satisfaire la demande croissante due à une population vieillissante, en particulier lorsque les médecins les plus expérimentés (les plus productifs) vont à la retraite. Dans le premier essai, j’ai estimé la fonction de revenu conditionnellement aux heures travaillées, en utilisant la méthode des variables instrumentales afin de contrôler pour une éventuelle endogeneité des heures travaillées. Comme instruments j’ai utilisé les variables indicatrices des âges des médecins, le taux marginal de taxation, le rendement sur le marché boursier, le carré et le cube de ce rendement. Je montre que cela donne la borne inférieure de l’élasticité-prix direct, permettant ainsi de tester si les médecins réagissent aux incitatifs monétaires. Les résultats montrent que les bornes inférieures des élasticités-prix de l’offre de services sont significativement positives, suggérant que les médecins répondent aux incitatifs. Un changement des prix relatifs conduit les médecins à allouer plus d’heures de travail au service dont le prix a augmenté. Dans le deuxième essai, j’estime le modèle en entier, de façon inconditionnelle aux heures travaillées, en analysant les variations des heures travaillées par les médecins, le volume des services offerts et le revenu des médecins. Pour ce faire, j’ai utilisé l’estimateur de la méthode des moments simulés. Les résultats montrent que les élasticités-prix direct de substitution sont élevées et significativement positives, représentant une tendance des médecins à accroitre le volume du service dont le prix a connu la plus forte augmentation. Les élasticitésprix croisées de substitution sont également élevées mais négatives. Par ailleurs, il existe un effet de revenu associé à l’augmentation des tarifs. J’ai utilisé les paramètres estimés du modèle structurel pour simuler une hausse générale de prix des services de 32%. Les résultats montrent que les médecins devraient réduire le nombre total d’heures travaillées (élasticité moyenne de -0,02) ainsi que les heures cliniques travaillées (élasticité moyenne de -0.07). Ils devraient aussi réduire le volume de services offerts (élasticité moyenne de -0.05). Troisièmement, j’ai exploité le lien naturel existant entre le revenu d’un médecin payé à l’acte et sa productivité afin d’établir le profil de productivité des médecins. Pour ce faire, j’ai modifié la spécification du modèle pour prendre en compte la relation entre la productivité d’un médecin et son expérience. J’estime l’équation de revenu en utilisant des données de panel asymétrique et en corrigeant le caractère non-aléatoire des observations manquantes à l’aide d’un modèle de sélection. Les résultats suggèrent que le profil de productivité est une fonction croissante et concave de l’expérience. Par ailleurs, ce profil est robuste à l’utilisation de l’expérience effective (la quantité de service produit) comme variable de contrôle et aussi à la suppression d’hypothèse paramétrique. De plus, si l’expérience du médecin augmente d’une année, il augmente la production de services de 1003 dollar CAN. J’ai utilisé les paramètres estimés du modèle pour calculer le ratio de remplacement : le nombre de médecins inexpérimentés qu’il faut pour remplacer un médecin expérimenté. Ce ratio de remplacement est de 1,2.

Essays on Machine Learning and Hedonic Models

Thesis (Ph.D.)--University of Washington, 2016-08

Monitoring Infection Risk for Air and Soil Borne Fungal Plant Pathogens using Antibody and DNA Techniques and Mathematical Models describing Environmental Parameters

Economic losses resulting from disease development can be reduced by accurate and early detection of plant pathogens. Early detection can provide the grower with useful information on optimal crop rotation patterns, varietal selections, appropriate control measures, harvest date and post harvest handling. Classical methods for the isolation of pathogens are commonly used only after disease symptoms. This frequently results in a delay in application of control measures at potentially important periods in crop production. This paper describes the application of both antibody and DNA based systems to monitor infection risk of air and soil borne fungal pathogens and the use of this information with mathematical models describing risk of disease associated with environmental parameters.

Integrated indicator framework and methodology for monitoring and assessment of hazardous substances and their effects in the marine environment

Many maritime countries in Europe have implemented marine environmental monitoring programmes which include the measurement of chemical contaminants and related biological effects. How best to integrate data obtained in these two types of monitoring into meaningful assessments has been the subject of recent efforts by the International Council for Exploration of the Sea (ICES) Expert Groups. Work within these groups has concentrated on defining a core set of chemical and biological endpoints that can be used across maritime areas, defining confounding factors, supporting parameters and protocols for measurement. The framework comprised markers for concentrations of, exposure to and effects from, contaminants. Most importantly, assessment criteria for biological effect measurements have been set and the framework suggests how these measurements can be used in an integrated manner alongside contaminant measurements in biota, sediments and potentially water. Output from this process resulted in OSPAR Commission (www.ospar.org) guidelines that were adopted in 2012 on a trial basis for a period of 3 years. The developed assessment framework can furthermore provide a suitable approach for the assessment of Good Environmental Status (GES) for Descriptor 8 of the European Union (EU) Marine Strategy Framework Directive (MSFD).

Efficient Secure Computation for Real-world Settings and Security Models

Secure computation involves multiple parties computing a common function while keeping their inputs private, and is a growing field of cryptography due to its potential for maintaining privacy guarantees in real-world applications. However, current secure computation protocols are not yet efficient enough to be used in practice. We argue that this is due to much of the research effort being focused on generality rather than specificity. Namely, current research tends to focus on constructing and improving protocols for the strongest notions of security or for an arbitrary number of parties. However, in real-world deployments, these security notions are often too strong, or the number of parties running a protocol would be smaller. In this thesis we make several steps towards bridging the efficiency gap of secure computation by focusing on constructing efficient protocols for specific real-world settings and security models. In particular, we make the following four contributions: - We show an efficient (when amortized over multiple runs) maliciously secure two-party secure computation (2PC) protocol in the multiple-execution setting, where the same function is computed multiple times by the same pair of parties. - We improve the efficiency of 2PC protocols in the publicly verifiable covert security model, where a party can cheat with some probability but if it gets caught then the honest party obtains a certificate proving that the given party cheated. - We show how to optimize existing 2PC protocols when the function to be computed includes predicate checks on its inputs. - We demonstrate an efficient maliciously secure protocol in the three-party setting.

Multiple solutions and numerical analysis to the dynamic and stationary models coupling a delayed energy balance model involving latent heat and discontinuous albedo with a deep ocean

We study a climatologically important interaction of two of the main components of the geophysical system by adding an energy balance model for the averaged atmospheric temperature as dynamic boundary condition to a diagnostic ocean model having an additional spatial dimension. In this work, we give deeper insight than previous papers in the literature, mainly with respect to the 1990 pioneering model by Watts and Morantine. We are taking into consideration the latent heat for the two phase ocean as well as a possible delayed term. Non-uniqueness for the initial boundary value problem, uniqueness under a non-degeneracy condition and the existence of multiple stationary solutions are proved here. These multiplicity results suggest that an S-shaped bifurcation diagram should be expected to occur in this class of models generalizing previous energy balance models. The numerical method applied to the model is based on a finite volume scheme with nonlinear weighted essentially non-oscillatory reconstruction and Runge–Kutta total variation diminishing for time integration.

Development of Planning And Evaluation Models For Superstreets

Despite the extensive implementation of Superstreets on congested arterials, reliable methodologies for such designs remain unavailable. The purpose of this research is to fill the information gap by offering reliable tools to assist traffic professionals in the design of Superstreets with and without signal control. The entire tool developed in this thesis consists of three models. The first model is used to determine the minimum U-turn offset length for an Un-signalized Superstreet, given the arterial headway distribution of the traffic flows and the distribution of critical gaps among drivers. The second model is designed to estimate the queue size and its variation on each critical link in a signalized Superstreet, based on the given signal plan and the range of observed volumes. Recognizing that the operational performance of a Superstreet cannot be achieved without an effective signal plan, the third model is developed to produce a signal optimization method that can generate progression offsets for heavy arterial flows moving into and out of such an intersection design.

Integrated pest management and the (un)sustainable use of pesticides

Doutoramento em Engenharia Agronómica - Instituto Superior de Agronomia - UL

Licochalcone A exerts antitumor activity in bladder cancer cell lines and mice models

Purpose: To investigate the effect of licochalcone A (LA) on the inhibition of cell proliferation and ERK1/2 phosphorylation in bladder carcinoma cell lines. Methods: Cell viability was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide (MTT) assay. Dye-binding method was used to examine the concentration of proteins. Lymphocytes were extracted from mice and after surface staining were subjected to BD fixation and permeabilization for intracellular staining. Flow cytometry was used to measure cellular fluorescence. Results: MTT results revealed a significant decrease in the proliferation of UM-UC-3, J82 and HT-1197 cell lines on treatment with LA. LA also induced reduction in phosphorylation of ERK1/2 in all three carcinoma cell lines. In the mouse model, licochalcone A treatment via intraperitoneal (ip) administration induced a significant decrease in the level of regulatory T cells (Tregs). Comparison of the mouse interferon-α (IFN-α)-treated and LA-treated groups revealed that LA treatment caused enhancement of cytotoxic T lymphocyte (CTL) activity similar to that of IFN-α. Administration of UM-UC-3 cells in C3H/HeN mice resulted in marked reduction in the counts for splenocytes and CD4+ CD25+ Foxp3+ T (regulatory T cells) cell proportion in LA-treated mice compared to untreated control group. Conclusion: Licochalcone A may be of therapeutic importance for the prevention of bladder carcinoma. However, studies are required to ascertain the compound’s usefulness in this regard.

Combining multispecies home range and distribution models aids assessment of MPA effectiveness

Marine protected areas (MPAs) are today's most important tools for the spatial management and conservation of marine species. Yet, the true protection that they provide to individual fish is unknown, leading to uncertainty associated with MPA effectiveness. In this study, conducted in a recently established coastal MPA in Portugal, we combined the results of individual home range estimation and population distribution models for 3 species of commercial importance and contrasting life histories to infer (1) the size of suitable areas where they would be fully protected and (2) the vulnerability to fishing mortality of each species. Results show that the relationship between MPA size and effective protection is strongly modulated by both the species' home range and the distribution of suitable habitat inside and outside the MPA. This approach provides a better insight into the true potential of MPAs in effectively protecting marine species, since it can reveal the size and location of the areas where protection is most effective and a clear, quantitative estimation of the vulnerability to fishing throughout an entire MPA.

Occurrence and abundance models of threatened plant species: Applications to mitigate the impact of hydroelectric power dams

Species occurrence and abundance models are important tools that can be used in biodiversity conservation, and can be applied to predict or plan actions needed to mitigate the environmental impacts of hydropower dams. In this study our objectives were: (i) to model the occurrence and abundance of threatened plant species, (ii) to verify the relationship between predicted occurrence and true abundance, and (iii) to assess whether models based on abundance are more effective in predicting species occurrence than those based on presence–absence data. Individual representatives of nine species were counted within 388 randomly georeferenced plots (10 m × 50 m) around the Barra Grande hydropower dam reservoir in southern Brazil. We modelled their relationship with 15 environmental variables using both occurrence (Generalised Linear Models) and abundance data (Hurdle and Zero-Inflated models). Overall, occurrence models were more accurate than abundance models. For all species, observed abundance was significantly, although not strongly, correlated with the probability of occurrence. This correlation lost significance when zero-abundance (absence) sites were excluded from analysis, but only when this entailed a substantial drop in sample size. The same occurred when analysing relationships between abundance and probability of occurrence from previously published studies on a range of different species, suggesting that future studies could potentially use probability of occurrence as an approximate indicator of abundance when the latter is not possible to obtain. This possibility might, however, depend on life history traits of the species in question, with some traits favouring a relationship between occurrence and abundance. Reconstructing species abundance patterns from occurrence could be an important tool for conservation planning and the management of threatened species, allowing scientists to indicate the best areas for collection and reintroduction of plant germplasm or choose conservation areas most likely to maintain viable populations.

A Review of the Arcuate Structures in the Iberian Variscides; Constraints and Genetical Models

In the Iberian Variscides several first order arcuate structures have been considered. In spite of being highly studied their characterization, formation mechanisms and even existence is still debatable. Themain Ibero-Armorican Arc (IAA) is essentially defined by a predominantNW–SE trend in the Iberian branch and an E–Wtrend in the Brittany one. However, in northern Spain it presents a 180° rotation, sometimes known as the Cantabrian Arc (CA). The relation between both arcs is controversial, being considered either as a single arc due to one tectonic event, or as the result of a polyphasic process. According to the last assumption, there is a later arcuate structure (CA), overlapping a previousmajor one (IAA). Whatever themodels, they must be able to explain the presence of a Variscan sinistral transpression in Iberia and a dextral one in Armorica, and a deformation spanning from the Devonian to the Upper Carboniferous. Another arcuate structure, in continuity with the CA, the Central-Iberian Arc (CIA) was recently proposed mainly based upon on magnetic anomalies, geometry of major folds and Ordovician paleocurrents. The critical review of the structural, stratigraphic and geophysical data supports both the IAA and the CA, but as independent structures. However, the presence of a CIA is highly questionable and could not be supported. The complex strain pattern of the IAA and the CA could be explained by a Devonian — Carboniferous polyphasic indentation of a Gondwana promontory. In thismodel the CA is essentially a thin-skinned arc,while the IAA has a more complex and longer evolution that has led to a thick-skinned first order structure. Nevertheless, both arcs are essentially the result of a lithospheric bending process during the Iberian Variscides.

Inversion of ambient seismic noise HVSR to evaluate velocity and structural models of the Lower Tagus Basin, Portugal

During its history, several significant earthquakes have shaken the Lower Tagus Valley (Portugal). These earthquakes were destructive; some strong earthquakes were produced by large ruptures in offshore structures located southwest of the Portuguese coastline, and other moderate earthquakes were produced by local faults. In recent years, several studies have successfully obtained strong-ground motion syntheses for the Lower Tagus Valley using the finite difference method. To confirm the velocity model of this sedimentary basin obtained from geophysical and geological data, we analysed the ambient seismic noise measurements by applying the horizontal to vertical spectral ratio (HVSR) method. This study reveals the dependence of the frequency and amplitude of the low-frequency (HVSR) peaks (0.2–2 Hz) on the sediment thickness. We have obtained the depth of the Cenozoic basement along a profile transversal to the basin by the inversion of these ratios, imposing constraints from seismic reflection, boreholes, seismic sounding and gravimetric and magnetic potentials. This technique enables us to improve the existing three-dimensional model of the Lower Tagus Valley structure. The improved model will be decisive for the improvement of strong motion predictions in the earthquake hazard analysis of this highly populated basin. The methodology discussed can be applied to any other sedimentary basin.

Comparison of Photovoltaic panel’s standard and simplified models

Shockley diode equation is basic for single diode model equation, which is overly used for characterizing the photovoltaic cell output and behavior. In the standard equation, it includes series resistance (Rs) and shunt resistance (Rsh) with different types of parameters. Maximum simulation and modeling work done previously, related to single diode photovoltaic cell used this equation. However, there is another form of the standard equation which has not included Series Resistance (Rs) and Shunt Resistance (Rsh) yet, as the Shunt Resistance is much bigger than the load resistance and the load resistance is much bigger than the Series Resistance. For this phenomena, very small power loss occurs within a photovoltaic cell. This research focuses on the comparison of two forms of basic Shockley diode equation. This analysis describes a deep understanding of the photovoltaic cell, as well as gives understanding about Series Resistance (Rs) and Shunt Resistance (Rsh) behavior in the Photovoltaic cell. For making estimation of a real time photovoltaic system, faster calculation is needed. The equation without Series Resistance and Shunt Resistance is appropriate for the real time environment. Error function for both Series resistance (Rs) and Shunt resistances (Rsh) have been analyzed which shows that the total system is not affected by this two parameters' behavior.