Information bias and lifetime mortality risks of radiation-induced cancer

Additive and multiplicative models of relative risk were used to measure the effect of cancer misclassification and DS86 random errors on lifetime risk projections in the Life Span Study (LSS) of Hiroshima and Nagasaki atomic bomb survivors. The true number of cancer deaths in each stratum of the cancer mortality cross-classification was estimated using sufficient statistics from the EM algorithm. Average survivor doses in the strata were corrected for DS86 random error ($\sigma$ = 0.45) by use of reduction factors. Poisson regression was used to model the corrected and uncorrected mortality rates with covariates for age at-time-of-bombing, age at-time-of-death and gender. Excess risks were in good agreement with risks in RERF Report 11 (Part 2) and the BEIR-V report. Bias due to DS86 random error typically ranged from $-$15% to $-$30% for both sexes, and all sites and models. The total bias, including diagnostic misclassification, of excess risk of nonleukemia for exposure to 1 Sv from age 18 to 65 under the non-constant relative projection model was $-$37.1% for males and $-$23.3% for females. Total excess risks of leukemia under the relative projection model were biased $-$27.1% for males and $-$43.4% for females. Thus, nonleukemia risks for 1 Sv from ages 18 to 85 (DRREF = 2) increased from 1.91%/Sv to 2.68%/Sv among males and from 3.23%/Sv to 4.02%/Sv among females. Leukemia excess risks increased from 0.87%/Sv to 1.10%/Sv among males and from 0.73%/Sv to 1.04%/Sv among females. Bias was dependent on the gender, site, correction method, exposure profile and projection model considered. Future studies that use LSS data for U.S. nuclear workers may be downwardly biased if lifetime risk projections are not adjusted for random and systematic errors. (Supported by U.S. NRC Grant NRC-04-091-02.) ^

Effect of primary care availability and health insurance coverage on risk and cost of Preventable Hospitalizations in Harris County

Preventable Hospitalizations (PHs) are hospitalizations that can be avoided with appropriate and timely care in the ambulatory setting and hence are closely associated with primary care access in a community. Increased primary care availability and health insurance coverage may increase primary care access, and consequently may be significantly associated with risks and costs of PHs. Objective. To estimate the risk and cost of preventable hospitalizations (PHs); to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs, first alone and then simultaneously; and finally, to estimate the impact of expansions in primary care availability and health insurance coverage on the burden of PHs among non-elderly adult residents of Harris County. Methods. The study population was residents of Harris County, age 18 to 64, who had at least one hospital discharge in a Texas hospital in 2008. The primary independent variables were availability of primary care physicians, availability of primary care safety net clinics and health insurance coverage. The primary dependent variables were PHs and associated hospitalization costs. The Texas Health Care Information Collection (THCIC) Inpatient Discharge data was used to obtain information on the number and costs of PHs in the study population. Risk of PHs in the study population, as well as average and total costs of PHs were calculated. Multivariable logistic regression models and two-step Heckman regression models with log-transformed costs were used to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs respectively, while controlling for individual predisposing, enabling and need characteristics. Predicted PH risk and cost were used to calculate the predicted burden of PHs in the study population and the impact of expansions in primary care availability and health insurance coverage on the predicted burden. Results. In 2008, hospitalized non-elderly adults in Harris County had 11,313 PHs and a corresponding PH risk of 8.02%. Congestive heart failure was the most common PH. PHs imposed a total economic burden of $84 billion at an average of $7,449 per PH. Higher primary care safety net availability was significantly associated with the lower risk of PHs in the final risk model, but only in the uninsured. A unit increase in safety net availability led to a 23% decline in PH odds in the uninsured, compared to only a 4% decline in the insured. Higher primary care physician availability was associated with increased PH costs in the final cost model (β=0.0020; p<0.05). Lack of health insurance coverage increased the risk of PH, with the uninsured having 30% higher odds of PHs (OR=1.299; p<0.05), but reduced the cost of a PH by 7% (β=-0.0668; p<0.05). Expansions in primary care availability and health insurance coverage were associated with a reduction of about $1.6 million in PH burden at the highest level of expansion. Conclusions. Availability of primary care resources and health insurance coverage in hospitalized non-elderly adults in Harris County are significantly associated with the risk and costs of PHs. Expansions in these primary care access factors can be expected to produce significant reductions in the burden of PHs in Harris County.^

Assessing and applying evidence-based interventions at the community level in India as a model policy to reduce neonatal mortality rates in Nigeria

Background. The United Nations' Millennium Development Goal (MDG) 4 aims for a two-thirds reduction in death rates for children under the age of five by 2015. The greatest risk of death is in the first week of life, yet most of these deaths can be prevented by such simple interventions as improved hygiene, exclusive breastfeeding, and thermal care. The percentage of deaths in Nigeria that occur in the first month of life make up 28% of all deaths under five years, a statistic that has remained unchanged despite various child health policies. This paper will address the challenges of reducing the neonatal mortality rate in Nigeria by examining the literature regarding efficacy of home-based, newborn care interventions and policies that have been implemented successfully in India. ^ Methods. I compared similarities and differences between India and Nigeria using qualitative descriptions and available quantitative data of various health indicators. The analysis included identifying policy-related factors and community approaches contributing to India's newborn survival rates. Databases and reference lists of articles were searched for randomized controlled trials of community health worker interventions shown to reduce neonatal mortality rates. ^ Results. While it appears that Nigeria spends more money than India on health per capita ($136 vs. $132, respectively) and as percent GDP (5.8% vs. 4.2%, respectively), it still lags behind India in its neonatal, infant, and under five mortality rates (40 vs. 32 deaths/1000 live births, 88 vs. 48 deaths/1000 live births, 143 vs. 63 deaths/1000 live births, respectively). Both countries have comparably low numbers of healthcare providers. Unlike their counterparts in Nigeria, Indian community health workers receive training on how to deliver postnatal care in the home setting and are monetarily compensated. Gender-related power differences still play a role in the societal structure of both countries. A search of randomized controlled trials of home-based newborn care strategies yielded three relevant articles. Community health workers trained to educate mothers and provide a preventive package of interventions involving clean cord care, thermal care, breastfeeding promotion, and danger sign recognition during multiple postnatal visits in rural India, Bangladesh, and Pakistan reduced neonatal mortality rates by 54%, 34%, and 15–20%, respectively. ^ Conclusion. Access to advanced technology is not necessary to reduce neonatal mortality rates in resource-limited countries. To address the urgency of neonatal mortality, countries with weak health systems need to start at the community level and invest in cost-effective, evidence-based newborn care interventions that utilize available human resources. While more randomized controlled studies are urgently needed, the current available evidence of models of postnatal care provision demonstrates that home-based care and health education provided by community health workers can reduce neonatal mortality rates in the immediate future.^

Health outcomes, quality improvement and cost-effectiveness of the Community Diabetes Education (CoDE) program: Results of a randomized controlled trial

The objectives of this dissertation were to evaluate health outcomes, quality improvement measures, and the long-term cost-effectiveness and impact on diabetes-related microvascular and macrovascular complications of a community health worker-led culturally tailored diabetes education and management intervention provided to uninsured Mexican Americans in an urban faith-based clinic. A prospective, randomized controlled repeated measures design was employed to compare the intervention effects between: (1) an intervention group (n=90) that participated in the Community Diabetes Education (CoDE) program along with usual medical care; and (2) a wait-listed comparison group (n=90) that received only usual medical care. Changes in hemoglobin A1c (HbA1c) and secondary outcomes (lipid status, blood pressure and body mass index) were assessed using linear mixed-models and an intention-to-treat approach. The CoDE group experienced greater reduction in HbA1c (-1.6%, p<.001) than the control group (-.9%, p<.001) over the 12 month study period. After adjusting for group-by-time interaction, antidiabetic medication use at baseline, changes made to the antidiabetic regime over the study period, duration of diabetes and baseline HbA1c, a statistically significant intervention effect on HbA1c (-.7%, p=.02) was observed for CoDE participants. Process and outcome quality measures were evaluated using multiple mixed-effects logistic regression models. Assessment of quality indicators revealed that the CoDE intervention group was significantly more likely to have received a dilated retinal examination than the control group, and 53% achieved a HbA1c below 7% compared with 38% of control group subjects. Long-term cost-effectiveness and impact on diabetes-related health outcomes were estimated through simulation modeling using the rigorously validated Archimedes Model. Over a 20 year time horizon, CoDE participants were forecasted to have less proliferative diabetic retinopathy, fewer foot ulcers, and reduced numbers of foot amputations than control group subjects who received usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life-year gained was estimated for CoDE intervention participants over the same time period. The results from the three areas of program evaluation: impact on short-term health outcomes, quantification of improvement in quality of diabetes care, and projection of long-term cost-effectiveness and impact on diabetes-related health outcomes provide evidence that a community health worker can be a valuable resource to reduce diabetes disparities for uninsured Mexican Americans. This evidence supports formal integration of community health workers as members of the diabetes care team.^

Prioritization of Policies: A Prototype Model of a Flowchart Method

This paper builds a prototype model of how to prioritize policies by using a flowchart. We presented the following six steps to decide priorities of policies: Step 1 is to attain the social subsistence level (primary education, health care, and food sufficiency); Step 2 is to attain macroeconomic stability; Step 3 is to liberalize the economy by structural adjustment programs; Step 4 is capacity building specific to a growth strategy by facilitating sufficient infrastructure (physical infrastructure and institutions); Step 5 is to initiate a growth strategy; and Step 6 is to narrow income inequalities. We illustrated the effectiveness of our "flowchart method" in case studies of Morocco, Laos, Vietnam, and China. The first priority of reforms in Morocco was given to social sectors of primary education and health care, particularly in the rural areas at Step 1. Laos should not put much emphasis on growth strategy before educational reform, attainment of macroeconomic stability, and institutional capacity building at Steps 1, 2, and 3. Vietnam can focus on reforming the state-run enterprises and developing the stock markets at Step 5 of growth strategies. We found that we should apply our flowchart method to China not nation-wide but province-wide.

Financial Policies and Dynamic Game Simulation in Poland and Hungary

Recently, steady economic growth rates have been kept in Poland and Hungary. Money supplies are growing rather rapidly in these economies. In large, exchange rates have trends of depreciation. Then, exports and prices show the steady growth rates. It can be thought that per capita GDPs are in the same level and development stages are similar in these two countries. It is assumed that these two economies have the same export market and export goods are competing in it. If one country has an expansion of monetary policy, price increase and interest rate decrease. Then, exchange rate decrease. Exports and GDP will increase through this phenomenon. At the same time, this expanded monetary policy affects another country through the trade. This mutual relationship between two countries can be expressed by the Nash-equilibrium in the Game theory. In this paper, macro-econometric models of Polish and Hungarian economies are built and the Nash- equilibrium is introduced into them.

Cost Reduction Effects of "pseudo FTAs" in Asia -Application of a price model based on a multilateral I/O table-

This paper examines the repercussion effects on the production cost of industries in Asian countries when some countries eliminate tariffs and import commodity taxes on all imports. This kind of analysis is related in some sense to that measuring the effects of FTAs on economies, and thus may be considered as an analysis of “pseudo FTAs.” Examining a number of combinations of “pseudo FTAs” between China, Japan, and ASEAN, it is found that the case of China plus Japan plus ASEAN is the most effective “pseudo FTA” of the combinations in terms of production cost reduction. The method is a form of price model based on the Asian International Input-Output Table. Almost no studies on price models related to multilateral I/O tables have been implemented thus far.

Neutrality in the choice of number of firms or level of fixed costs in calibrating an Armington-Krugman-Melitz encompassing module for applied general equilibrium models

This paper shows how an Armington-Krugman-Melitz encompassing module based on Dixon and Rimmer (2012) can be calibrated, and clarifies the choice of initial levels for two kinds of number of firms, or parameter values for two kinds of fixed costs, that enter a Melitz-type specification can be set freely to any preferred value, just as the cases we derive quantities from given value data assuming some of the initial prices to be unity. In consequence, only one kind of additional information, which is on the shape parameter related to productivity, just is required in order to incorporate Melitz-type monopolistic competition and heterogeneous firms into a standard applied general equilibrium model. To be a Krugman-type, nothing is needed. This enables model builders in applied economics to fully enjoy the featured properties of the theoretical models invented by Krugman (1980) and Melitz (2003) in practical policy simulations at low cost.

Is FTA/EPA effective for a developing country to attract FDI? : simulation analysis based on an extended knowledge-capital model

To prepare an answer to the question of how a developing country can attract FDI, this paper explored the factors and policies that may help bring FDI into a developing country by utilizing an extended version of the knowledge-capital model. With a special focus on the effects of FTAs/EPAs between market countries and developing countries, simulations with the model revealed the following: (1) Although FTA/EPA generally ends to increase FDI to a developing country, the possibility of improving welfare through increased demand for skilled and unskilled labor becomes higher as the size of the country declines; (2) Because the additional implementation of cost-saving policies to reduce firm-type/trade-link specific fixed costs ends to depreciate the price of skilled labor by saving its input, a developing country, which is extremely scarce in skilled labor, is better off avoiding the additional option; (3) If a country hopes to enjoy larger welfare gains with EPA, efforts to increase skilled labor in the country, such as investing in education, may be beneficial.

University-industry technology transfer models: an empirical analysis

The aim of this paper is to contribute to the understanding of the underlying factors in the process of transferring technology from university to industry. Findings point to strategic importance of critical factors as the definition of common objectives, cooperation, motivation, and the elimination of technical and legal barriers. These challenges must have implications in the incorporation of cooperative aspects of research projects in the design of public innovation policies.

Reduced order adaptive models for systems of PDEs using POD

In this work we propose a method to accelerate time dependent numerical solvers of systems of PDEs that require a high cost in computational time and memory. The method is based on the combined use of such numerical solver with a proper orthogonal decomposition, from which we identify modes, a Galerkin projection (that provides a reduced system of equations) and the integration of the reduced system, studying the evolution of the modal amplitudes. We integrate the reduced model until our a priori error estimator indicates that our approximation in not accurate. At this point we use again our original numerical code in a short time interval to adapt the POD manifold and continue then with the integration of the reduced model. Application will be made to two model problems: the Ginzburg-Landau equation in transient chaos conditions and the two-dimensional pulsating cavity problem, which describes the motion of liquid in a box whose upper wall is moving back and forth in a quasi-periodic fashion. Finally, we will discuss a way of improving the performance of the method using experimental data or information from numerical simulations

Evolución y crisis de la región metropolitana de Madrid 1985-2007. Análisis de las diversas perspectivas para la transformación del gobierno urbano: una revisión crítica del planeamiento

La Región Metropolitana de Madrid (RMM) ha sufrido una gran transformación urbana en el periodo 1985-2007, en el cual ha crecido la población, ha crecido fuertemente el cuerpo físico, pero sobre todo han crecido su coste y su consumo, lo que supone que se ha vuelto más insostenible. Para tratar de comprender esta evolución asimétrica se ensayan sucesivos modelos que tratan de explicar la transformación de la realidad a través de la articulación de las formas de poder y sus políticas asociadas dentro del contexto local-metropolitano. Si se compara la transformación urbana en el periodo 1985-2007 respecto a la registrada durante el desarrollismo previo al presente periodo democrático, se encuentran similitudes, como el amplio consumo de suelo, pero el modelo desarrollista se inscribe en otras lógicas y tiene otros parámetros de contexto y es congruente ya que las últimas décadas del Régimen Franquista se caracterizan por un importantísimo aumento poblacional que se correspondía con el fuerte crecimiento industrial de la RMM. Esa congruencia relativa se pierde en el periodo estudiado, a pesar de que en 1985, se aprueba el Plan General de Ordenación Urbana de Madrid centrado en la ciudad existente y con un crecimiento contenido, y que puede considerarse un modelo abortado. Tras numerosas transformaciones políticas, económicas, sociales y urbanísticas se llega a una situación opuesta a la prevista en el citado Plan. Más de veinte años después, en 2007, se presentan no solo síntomas de agotamiento del modelo finalmente adoptado, sino su quiebra dramática tanto en su dimensión inmobiliario-financiera como del espacio del bienestar. Es precisamente la supresión de los mecanismos de regulación lo que ha caracterizado la evolución de los modelos urbanos, en correspondencia con la desregulación de las actividades económicas y de los flujos de capital propios del modelo "neoliberal". La actual crisis financiera internacional, en especial en algunos países periféricos europeos como España, ha demostrado cómo las políticas económicas que se han llevado a cabo, fuera de toda regulación, han resultado insostenibles. Pero no se trata solo de una crisis económica. En el caso español, de todas las dimensiones de la crisis, destaca la dimensión urbana, o el auge y caída del ciclo inmobiliario, debido a la urbanización intensiva del territorio en relación con el circuito secundario de la acumulación capitalista, habiendo tenido especial incidencia en algunos territorios como la RMM. En la Región Metropolitana de Madrid la situación actual es de crisis urbana, causada principalmente por el divorcio entre las necesidades y la producción de ciudad, pues no se ha basado el crecimiento en la creación de nuevos hogares, u otras cuestiones demográficas, sino en la acumulación de capital a través del crecimiento de la ciudad. Además, dicho crecimiento está conformado por una expansión urbana descontrolada, con mayores requerimientos energéticos que el modelo compacto y complejo tradicional, lo que unido a la escala de los procesos, supone un sistema urbano progresivamente ineficiente. El caso de la RMM resulta paradigmático, ya que la región ha desempeñado un papel como laboratorio de nuevas formas de gobierno y planificación que han dado un mayor protagonismo al espacio, que ha entrado en las dinámicas centrales principalmente por el apoyo al crecimiento físico, a la vez que han confluido circunstancias específicas, como un nuevo impulso al centralismo, lo que ha potenciado ciertas políticas, como considerar la ciudad como motor de crecimiento económico y de competitividad en el concierto europeo y mundial de ciudades. El estudio del papel de la planificación y sus crisis en la sucesión de los modelos, muestra su función nuclear en la propia constitución de estos —es parte fundamental de su aparato de regulación— y su valor no solo para poder entender el periodo, sino para poder proyectar otro futuro urbano. Este enfoque conduce a establecer la relación del planeamiento con las diferentes crisis económicas en el periodo de estudio lo que permite diferenciar tres momentos de dicha relación: la planificación urbanística austera bajo la influencia de la crisis fordista, la salida de la crisis a través de la imposición de un modelo urbano basado en el sobreproducción de espacio urbano, y la entrada en una crisis inmobiliaria y de financiarización en relación a la adopción de un modelo multidimensionalmente insostenible. El análisis de este periodo es la base para apuntar perspectivas que permitan transformar el gobierno urbano hacia un modelo urbano más deseable, o mejor aún, otros futuros posibles, que se enmarcan dentro de la alternativa principal que supone la sostenibilidad. Madrid's Metropolitan Region (MMR) has undergone a major urban transformation in the period 1985-2007, where the population has grown up, the built environment has grown strongly, but mostly its cost and consumption have grown, which means that it has become unsustainable. To try to understand this evolution successive asymmetric models are tested in order to explain the transformation of reality through the articulation of forms of power and its associated policies in that localmetropolitan context. Comparing the urban transformation in the period 1985-2007 to the existing during developmentalism in the current predemocratic period, both have similarities in terms of land consumption, but the previous developmentalism model is part of another logics and has got other context parameters. It is consistent since the last decades of the Franco Regime was characterized by an important population increase that corresponded to strong industrial growth of the MMR. This relative consistency is lost during the study period, although in 1985, with the approval of the Master Plan of Madrid that was focused on the existing city, with a limited growth, and it may be considered an interrupted model. After numerous political, economic, social and urban changes, there is the opposite situation to that foresight under that Plan. Over twenty years later, in 2007, there are not only signs of exhaustion of the model which was finally adopted, but also its dramatic collapse in both real estate and financial dimension of space as well. The urban transformation under analysis has relaunched the hegemony of the sectors that rule the growth of the Madrid's Metropolitan Region and it is supported by decision making and financing of the different administrations with the passivity of the social stakeholders and citizens. This has meant the removal of regulatory mechanisms that have characterized the evolution of urban models, corresponding to the deregulation of economic activities and capital flows according to "neoliberal" model. The current international financial crisis, especially in some European peripheral countries like Spain, has shown how economic policies that have been carried out, without any regulation, have proven unsustainable. But it is not only an economic crisis. In the Spanish case, of all the dimensions of the crisis, it is the urban dimension that is highlighted, or the rise and fall of real estate cycle, due to intensive urbanization of the territory in relation to the secondary circuit of capital accumulation, having had a particular impact in some territories such as the Madrid's Metropolitan Region. In Madrid's Metropolitan Region there is the current situation of urban crisis, mainly caused by the divorce between needs and the city (space) production, because no growth has been based on creating new homes, or other demographic issues, but in the capital accumulation through growth of the city. Furthermore, this growth is made up of urban sprawl, with higher energy requirements than the traditional compact and complex one, which together with the scale of processes, is increasingly an inefficient urban system. The case of Madrid's Metropolitan Region is paradigmatic, since the region has played a role as a laboratory for new forms of governance and planning have given a greater role to space, which has entered the core dynamics supported mainly by physical growth, while specific circumstances have come together as a new impulse to centralization. This has promoted policies such as considering the city as an engine of economic growth and competitiveness in the international and the European hierarchy of cities. The study of the role of planning and crisis in the succession of models, shows its nuclear role in the constitution of these models is a fundamental part of its regulatory apparatus- and also its value not only to understand the period, but to anticipate to other urban future. This approach leads to establish the relationship of planning with the various crises in the study period, allowing three different moments of that relationship: the austere urban planning under the influence of Fordist crisis, the output of the crisis through imposition of an urban model based on the overproduction of urban space, and entry into a housing crisis and financialisation in relation to the adoption of a multi-dimensionally unsustainable model. The analysis of this period is the basis for targeting prospects that translate urban governance towards a more desirable urban model, or better yet, other possible futures, which are part of the main alternative that is sustainability.

Multiobjective optimization applied to structural sizing of low cost university-class microsatellite projects

In recent years, there has been continuing interest in the participation of university research groups in space technology studies by means of their own microsatellites. The involvement in such projects has some inherent challenges, such as limited budget and facilities. Also, due to the fact that the main objective of these projects is for educational purposes, usually there are uncertainties regarding their in orbit mission and scientific payloads at the early phases of the project. On the other hand, there are predetermined limitations for their mass and volume budgets owing to the fact that most of them are launched as an auxiliary payload in which the launch cost is reduced considerably. The satellite structure subsystem is the one which is most affected by the launcher constraints. This can affect different aspects, including dimensions, strength and frequency requirements. In this paper, the main focus is on developing a structural design sizing tool containing not only the primary structures properties as variables but also the system level variables such as payload mass budget and satellite total mass and dimensions. This approach enables the design team to obtain better insight into the design in an extended design envelope. The structural design sizing tool is based on analytical structural design formulas and appropriate assumptions including both static and dynamic models of the satellite. Finally, a Genetic Algorithm (GA) multiobjective optimization is applied to the design space. The result is a Pareto-optimal based on two objectives, minimum satellite total mass and maximum payload mass budget, which gives a useful insight to the design team at the early phases of the design.