Performance tiers: Implementing comparative effectiveness analysis in the health care setting through operations research and spatial methods

This dissertation develops and tests a comparative effectiveness methodology utilizing a novel approach to the application of Data Envelopment Analysis (DEA) in health studies. The concept of performance tiers (PerT) is introduced as terminology to express a relative risk class for individuals within a peer group and the PerT calculation is implemented with operations research (DEA) and spatial algorithms. The analysis results in the discrimination of the individual data observations into a relative risk classification by the DEA-PerT methodology. The performance of two distance measures, kNN (k-nearest neighbor) and Mahalanobis, was subsequently tested to classify new entrants into the appropriate tier. The methods were applied to subject data for the 14 year old cohort in the Project HeartBeat! study.^ The concepts presented herein represent a paradigm shift in the potential for public health applications to identify and respond to individual health status. The resultant classification scheme provides descriptive, and potentially prescriptive, guidance to assess and implement treatments and strategies to improve the delivery and performance of health systems. ^

SOCIO-ENVIRONMENTAL FACTORS ASSOCIATED WITH THE DISTRIBUTION OF DRACUNCULUS MEDINENSIS (GUINEA WORM DISEASE) AND SUGGESTED METHODS FOR CONTROL, IBARAPA, NIGERIA, 1982 (AFRICA)

A population-based cross-sectional survey of socio-environmental factors associated with the prevalence of Dracunculus medinensis (guinea worm disease) was conducted in Idere, a rural agricultural community in Ibarapa, Oyo state, Nigeria, during 1982.^ The epidemiologic data were collected by household interview of all 501 households. The environmental data were collected by analysis of water samples collected from all domestic water sources and rainfall records.^ The specific objectives of this research were to: (a) Describe the prevalence of guinea worm disease in Idere during 1982 by age, sex, area of residence, drinking water source, religion and weekly amount of money spent by the household to collect potable drinking water. (b) Compare the characteristics of cases with non-cases of guinea worm in order to identify factors associated with high risk of infection. (c) Investigate domestic water sources for the distribution of Cyclops. (d) Determine the extent of potable water shortage with a view to identifying factors responsible for such shortage in the community. (e) Describe the effects of guinea worm on school attendance during 1980/1982 school years by class and location of school from piped water supply.^ The findings of this research indicate that during 1982, 31.8 percent of Idere's 6,527 residents experienced guinea worm infection, with higher prevalence of infection recorded in males in their most productive years and females in their teenage years. The role of sex and age to risk of higher infection rate was explained in the context of water related exposure and water intake due to dehydration from physical occupational actitives of subgroups.^ Potable water available to residents was considerably below the minimum recommended by WHO for tropical climates, with sixty-eight percent of water needs of the residents coming from unprotected surface water which harbour Cyclops, the obligatory intermediate host of Dracunculus medinensis. An association was found between periods of relative high density of Cyclops in domestic water and rainfall.^ Impact of guinea worm infection on educational activities was considerable and its implications were discussed, including the implications of the research findings in relation to control of guinea worm disease in Ibarapa. ^

Comparison of machine learning approaches and statistical methods for estimation of airborne chemical exposures

Accurate quantitative estimation of exposure using retrospective data has been one of the most challenging tasks in the exposure assessment field. To improve these estimates, some models have been developed using published exposure databases with their corresponding exposure determinants. These models are designed to be applied to reported exposure determinants obtained from study subjects or exposure levels assigned by an industrial hygienist, so quantitative exposure estimates can be obtained. ^ In an effort to improve the prediction accuracy and generalizability of these models, and taking into account that the limitations encountered in previous studies might be due to limitations in the applicability of traditional statistical methods and concepts, the use of computer science- derived data analysis methods, predominantly machine learning approaches, were proposed and explored in this study. ^ The goal of this study was to develop a set of models using decision trees/ensemble and neural networks methods to predict occupational outcomes based on literature-derived databases, and compare, using cross-validation and data splitting techniques, the resulting prediction capacity to that of traditional regression models. Two cases were addressed: the categorical case, where the exposure level was measured as an exposure rating following the American Industrial Hygiene Association guidelines and the continuous case, where the result of the exposure is expressed as a concentration value. Previously developed literature-based exposure databases for 1,1,1 trichloroethane, methylene dichloride and, trichloroethylene were used. ^ When compared to regression estimations, results showed better accuracy of decision trees/ensemble techniques for the categorical case while neural networks were better for estimation of continuous exposure values. Overrepresentation of classes and overfitting were the main causes for poor neural network performance and accuracy. Estimations based on literature-based databases using machine learning techniques might provide an advantage when they are applied to other methodologies that combine `expert inputs' with current exposure measurements, like the Bayesian Decision Analysis tool. The use of machine learning techniques to more accurately estimate exposures from literature-based exposure databases might represent the starting point for the independence from the expert judgment.^

Phosphorus and Potassium Rates and Placement Methods for Corn and Soybean Managed with No-till or Tillage

No-till management for corn and soybean results in little or no incorporation of crop residues and fertilizer with soil. Subsurface banding phosphorus (P) and potassium (K) fertilizers with planter attachments could be more effective than broadcast fertilization, because in no-till with broadcast fertilizer, both nutrients accumulate at or near the soil surface. A long-term study was initiated in 1994 at the ISU Northwest Research Farm to evaluate P and K fertilizer placement for corn and soybean managed with no-till and chiselplow tillage.

An environmental magnetic study, sedimentological and numerical methods around Tauranga Harbour, New Zealand

Magnetic iron minerals are widespread and indicative sediment constituents in estuarine, coastal and shelf systems. We combine environmental magnetic, sedimentological and numerical methods to identify magnetite-enriched placer-like zones in a complex coastal system and delineate their formation mechanisms. Magnetic susceptibility and remanence measurements on 245 surficial sediment samples collected in and around Tauranga Harbour, the largest barrier-enclosed tidal estuary of New Zealand, reveal several discrete enrichment zones controlled by local hydrodynamic conditions. Active magnetite enrichment takes place in tidal channels, which feed into two coast-parallel nearshore magnetite-enriched belts centered at water depths of 6-10 m and 10-20 m. A close correlation between magnetite content and magnetic grain size was found, where higher susceptibility values are associated within coarser magnetic crystal sizes. Two key mechanisms for magnetite enrichment are identified. First, tide-induced residual currents primarily enable magnetite enrichment within the estuarine channel network. A coast-parallel, fine sand magnetite enrichment belt in water depths of less than 10 m along the barrier island has a strong decrease in magnetite content away from the southern tidal inlet and is apparently related to active coast-parallel transport combined with mobilizing surf zone processes. A second, less pronounced, but more uniform magnetite enrichment belt at 10-20 m water depth is composed of non-mobile, medium-coarse-grained relict sands, which have been reworked during post-glacial sea level transgression. We demonstrate the potential of magnetic methods to reveal and differentiate coastal magnetite enrichment patterns and investigate their formative mechanisms.

Complete and efficient methods for supporting side effects in independent/restricted and-parallelism

It has been shown that it is possible to exploit Independent/Restricted And-parallelism in logic programs while retaining the conventional "don't know" semantics of such programs. In particular, it is possible to parallelize pure Prolog programs while maintaining the semantics of the language. However, when builtin side-effects (such as write or assert) appear in the program, if an identical observable behaviour to that of sequential Prolog implementations is to be preserved, such side-effects have to be properly sequenced. Previously proposed solutions to this problem are either incomplete (lacking, for example, backtracking semantics) or they force sequentialization of significant portions of the execution graph which could otherwise run in parallel. In this paper a series of side-effect synchronization methods are proposed which incur lower overhead and allow more parallelism than those previously proposed. Most importantly, and unlike previous proposals, they have well-defined backward execution behaviour and require only a small modification to a given (And-parallel) Prolog implementation.

Applications of image-based, multi-view stereo reconstruction methods = (Aplicaciones de los métodos de reconstrucción estéreo multivista)

These slides present several 3-D reconstruction methods to obtain the geometric structure of a scene that is viewed by multiple cameras. We focus on the combination of the geometric modeling in the image formation process with the use of standard optimization tools to estimate the characteristic parameters that describe the geometry of the 3-D scene. In particular, linear, non-linear and robust methods to estimate the monocular and epipolar geometry are introduced as cornerstones to generate 3-D reconstructions with multiple cameras. Some examples of systems that use this constructive strategy are Bundler, PhotoSynth, VideoSurfing, etc., which are able to obtain 3-D reconstructions with several hundreds or thousands of cameras. En esta presentación se tratan varios métodos de reconstrucción 3-D para la obtención de la estructura geométrica de una escena que es visualizada por varias cámaras. Se enfatiza la combinación de modelado geométrico del proceso de formación de la imagen con el uso de herramientas estándar de optimización para estimar los parámetros característicos que describen la geometría de la escena 3-D. En concreto, se presentan métodos de estimación lineales, no lineales y robustos de las geometrías monocular y epipolar como punto de partida para generar reconstrucciones con tres o más cámaras. Algunos ejemplos de sistemas que utilizan este enfoque constructivo son Bundler, PhotoSynth, VideoSurfing, etc., los cuales, en la práctica pueden llegar a reconstruir una escena con varios cientos o miles de cámaras.

Anticorrelation between Ion Acceleration and Nonlinear Coherent Structures from Laser-Underdense Plasma Interaction

In laser-plasma experiments, we observed that ion acceleration from the Coulomb explosion of the plasma channel bored by the laser, is prevented when multiple plasma instabilities such as filamentation and hosing, and nonlinear coherent structures (vortices/post-solitons) appear in the wake of an ultrashort laser pulse. The tailoring of the longitudinal plasma density ramp allows us to control the onset of these insabilities. We deduced that the laser pulse is depleted into these structures in our conditions, when a plasma at about 10% of the critical density exhibits a gradient on the order of 250 {\mu}m (gaussian fit), thus hindering the acceleration. A promising experimental setup with a long pulse is demonstrated enabling the excitation of an isolated coherent structure for polarimetric measurements and, in further perspectives, parametric studies of ion plasma acceleration efficiency.

Estimation of a probability in inverse binomial sampling under normalized linear-linear and inverse-linear loss

Sequential estimation of the success probability p in inverse binomial sampling is considered in this paper. For any estimator pˆ , its quality is measured by the risk associated with normalized loss functions of linear-linear or inverse-linear form. These functions are possibly asymmetric, with arbitrary slope parameters a and b for pˆ

and pˆ>p , respectively. Interest in these functions is motivated by their significance and potential uses, which are briefly discussed. Estimators are given for which the risk has an asymptotic value as p→0, and which guarantee that, for any p∈(0,1), the risk is lower than its asymptotic value. This allows selecting the required number of successes, r, to meet a prescribed quality irrespective of the unknown p. In addition, the proposed estimators are shown to be approximately minimax when a/b does not deviate too much from 1, and asymptotically minimax as r→∞ when a=b.

Comparing linear and non linear wind flow models

Assessing wind conditions on complex terrain has become a hard task as terrain complexity increases. That is why there is a need to extrapolate in a reliable manner some wind parameters that determine wind farms viability such as annual average wind speed at all hub heights as well as turbulence intensities. The development of these tasks began in the early 90´s with the widely used linear model WAsP and WAsP Engineering especially designed for simple terrain with remarkable results on them but not so good on complex orographies. Simultaneously non-linearized Navier Stokes solvers have been rapidly developed in the last decade through CFD (Computational Fluid Dynamics) codes allowing simulating atmospheric boundary layer flows over steep complex terrain more accurately reducing uncertainties. This paper describes the features of these models by validating them through meteorological masts installed in a highly complex terrain. The study compares the results of the mentioned models in terms of wind speed and turbulence intensity.

Estimation of a probability in inverse binomial sampling under normalized linear-linear and inverse-linear loss

Sequential estimation of the success probability $p$ in inverse binomial sampling is considered in this paper. For any estimator $\hatvap$, its quality is measured by the risk associated with normalized loss functions of linear-linear or inverse-linear form. These functions are possibly asymmetric, with arbitrary slope parameters $a$ and $b$ for $\hatvap < p$ and $\hatvap > p$ respectively. Interest in these functions is motivated by their significance and potential uses, which are briefly discussed. Estimators are given for which the risk has an asymptotic value as $p \rightarrow 0$, and which guarantee that, for any $p \in (0,1)$, the risk is lower than its asymptotic value. This allows selecting the required number of successes, $\nnum$, to meet a prescribed quality irrespective of the unknown $p$. In addition, the proposed estimators are shown to be approximately minimax when $a/b$ does not deviate too much from $1$, and asymptotically minimax as $\nnum \rightarrow \infty$ when $a=b$.

The application of inverse-dispersion and gradient methods to estimate ammonia emissions from a penguin colony.

Penguin colonies represent some of the most concentrated sources of ammonia emissions to the atmosphere in the world. The ammonia emitted into the atmosphere can have a large influence on the nitrogen cycling of ecosystems near the colonies. However, despite the ecological importance of the emissions, no measurements of ammonia emissions from penguin colonies have been made. The objective of this work was to determine the ammonia emission rate of a penguin colony using inverse-dispersion modelling and gradient methods. We measured meteorological variables and mean atmospheric concentrations of ammonia at seven locations near a colony of Adélie penguins in Antarctica to provide input data for inverse-dispersion modelling. Three different atmospheric dispersion models (ADMS, LADD and a Lagrangian stochastic model) were used to provide a robust emission estimate. The Lagrangian stochastic model was applied both in ‘forwards’ and ‘backwards’ mode to compare the difference between the two approaches. In addition, the aerodynamic gradient method was applied using vertical profiles of mean ammonia concentrations measured near the centre of the colony. The emission estimates derived from the simulations of the three dispersion models and the aerodynamic gradient method agreed quite well, giving a mean emission of 1.1 g ammonia per breeding pair per day (95% confidence interval: 0.4–2.5 g ammonia per breeding pair per day). This emission rate represents a volatilisation of 1.9% of the estimated nitrogen excretion of the penguins, which agrees well with that estimated from a temperature-dependent bioenergetics model. We found that, in this study, the Lagrangian stochastic model seemed to give more reliable emission estimates in ‘forwards’ mode than in ‘backwards’ mode due to the assumptions made.

Advances in global instability computations: from incompressible to hypersonic flow

Esta tesis constituye un gran avance en el conocimiento del estudio y análisis de inestabilidades hidrodinámicas desde un punto de vista físico y teórico, como consecuencia de haber desarrollado innovadoras técnicas para la resolución computacional eficiente y precisa de la parte principal del espectro correspondiente a los problemas de autovalores (EVP) multidimensionales que gobiernan la inestabilidad de flujos con dos o tres direcciones espaciales inhomogéneas, denominados problemas de estabilidad global lineal. En el contexto del trabajo de desarrollo de herramientas computacionales presentado en la tesis, la discretización mediante métodos de diferencias finitas estables de alto orden de los EVP bidimensionales y tridimensionales que se derivan de las ecuaciones de Navier-Stokes linealizadas sobre flujos con dos o tres direcciones espaciales inhomogéneas, ha permitido una aceleración de cuatro órdenes de magnitud en su resolución. Esta mejora de eficiencia numérica se ha conseguido gracias al hecho de que usando estos esquemas de diferencias finitas, técnicas eficientes de resolución de problemas lineales son utilizables, explotando el alto nivel de dispersión o alto número de elementos nulos en las matrices involucradas en los problemas tratados. Como más notable consecuencia cabe destacar que la resolución de EVPs multidimensionales de inestabilidad global, que hasta la fecha necesitaban de superordenadores, se ha podido realizar en ordenadores de sobremesa. Además de la solución de problemas de estabilidad global lineal, el mencionado desarrollo numérico facilitó la extensión de las ecuaciones de estabilidad parabolizadas (PSE) lineales y no lineales para analizar la inestabilidad de flujos que dependen fuertemente en dos direcciones espaciales y suavemente en la tercera con las ecuaciones de estabilidad parabolizadas tridimensionales (PSE-3D). Precisamente la capacidad de extensión del novedoso algoritmo PSE-3D para el estudio de interacciones no lineales de los modos de estabilidad, desarrollado íntegramente en esta tesis, permite la predicción de transición en flujos complejos de gran interés industrial y por lo tanto extiende el concepto clásico de PSE, el cuál ha sido empleado exitosamente durante las pasadas tres décadas en el mismo contexto para problemas de capa límite bidimensional. Típicos ejemplos de flujos incompresibles se han analizado en este trabajo sin la necesidad de recurrir a restrictivas presuposiciones usadas en el pasado. Se han estudiado problemas vorticales como es el caso de un vórtice aislado o sistemas de vórtices simulando la estela de alas, en los que la homogeneidad axial no se impone y así se puede considerar la difusión viscosa del flujo. Además, se ha estudiado el chorro giratorio turbulento, cuya inestabilidad se utiliza para mejorar las características de funcionamiento de combustores. En la tesis se abarcan adicionalmente problemas de flujos compresibles. Se presenta el estudio de inestabilidad de flujos de borde de ataque a diferentes velocidades de vuelo. También se analiza la estela formada por un elemento rugoso aislado en capa límite supersónica e hipersónica, mostrando excelentes comparaciones con resultados obtenidos mediante simulación numérica directa. Finalmente, nuevas inestabilidades se han identificado en el flujo hipersónico a Mach 7 alrededor de un cono elíptico que modela el vehículo de pruebas en vuelo HIFiRE-5. Los resultados comparan favorablemente con experimentos en vuelo, lo que subraya aún más el potencial de las metodologías de análisis de estabilidad desarrolladas en esta tesis. ABSTRACT The present thesis constitutes a step forward in advancing the frontiers of knowledge of fluid flow instability from a physical point of view, as a consequence of having been successful in developing groundbreaking methodologies for the efficient and accurate computation of the leading part of the spectrum pertinent to multi-dimensional eigenvalue problems (EVP) governing instability of flows with two or three inhomogeneous spatial directions. In the context of the numerical work presented in this thesis, the discretization of the spatial operator resulting from linearization of the Navier-Stokes equations around flows with two or three inhomogeneous spatial directions by variable-high-order stable finite-difference methods has permitted a speedup of four orders of magnitude in the solution of the corresponding two- and three-dimensional EVPs. This improvement of numerical performance has been achieved thanks to the high-sparsity level offered by the high-order finite-difference schemes employed for the discretization of the operators. This permitted use of efficient sparse linear algebra techniques without sacrificing accuracy and, consequently, solutions being obtained on typical workstations, as opposed to the previously employed supercomputers. Besides solution of the two- and three-dimensional EVPs of global linear instability, this development paved the way for the extension of the (linear and nonlinear) Parabolized Stability Equations (PSE) to analyze instability of flows which depend in a strongly-coupled inhomogeneous manner on two spatial directions and weakly on the third. Precisely the extensibility of the novel PSE-3D algorithm developed in the framework of the present thesis to study nonlinear flow instability permits transition prediction in flows of industrial interest, thus extending the classic PSE concept which has been successfully employed in the same context to boundary-layer type of flows over the last three decades. Typical examples of incompressible flows, the instability of which was analyzed in the present thesis without the need to resort to the restrictive assumptions used in the past, range from isolated vortices, and systems thereof, in which axial homogeneity is relaxed to consider viscous diffusion, as well as turbulent swirling jets, the instability of which is exploited in order to improve flame-holding properties of combustors. The instability of compressible subsonic and supersonic leading edge flows has been solved, and the wake of an isolated roughness element in a supersonic and hypersonic boundary-layer has also been analyzed with respect to its instability: excellent agreement with direct numerical simulation results has been obtained in all cases. Finally, instability analysis of Mach number 7 ow around an elliptic cone modeling the HIFiRE-5 flight test vehicle has unraveled flow instabilities near the minor-axis centerline, results comparing favorably with flight test predictions.