Endeavors Update, Iowa Medicaid Enterprise, January 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Changes in the risk of death after HIV seroconversion compared with mortality in the general population.

CONTEXT: Mortality among human immunodeficiency virus (HIV)-infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population. OBJECTIVE: To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population. DESIGN, SETTING, AND POPULATION: Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006. MAIN OUTCOME MEASURE: Excess mortality among HIV-infected individuals compared with that of the general uninfected population. RESULTS: Of 16,534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31,302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14,703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years). CONCLUSIONS: Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens.

Endeavors Update, Iowa Medicaid Enterprise, February 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, April 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, May 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, July 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Modeling the Emergence of Social Structure from a Phylogenetic Point of View

Based on provious (Hemelrijk 1998; Puga-González, Hildenbrant & Hemelrijk 2009), we have developed an agent-based model and software, called A-KinGDom, which allows us to simulate the emergence of the social structure in a group of non-human primates. The model includes dominance and affiliative interactions and incorporate s two main innovations (preliminary dominance interactions and a kinship factor), which allow us to define four different attack and affiliative strategies. In accordance with these strategies, we compared the data obtained under four simulation conditions with the results obtained in a provious study (Dolado & Beltran 2012) involving empirical observations of a captive group of mangabeys (Cercocebus torquatus)

Senescence rates are determined by ranking on the fast-slow life-history continuum.

Comparative analyses of survival senescence by using life tables have identified generalizations including the observation that mammals senesce faster than similar-sized birds. These generalizations have been challenged because of limitations of life-table approaches and the growing appreciation that senescence is more than an increasing probability of death. Without using life tables, we examine senescence rates in annual individual fitness using 20 individual-based data sets of terrestrial vertebrates with contrasting life histories and body size. We find that senescence is widespread in the wild and equally likely to occur in survival and reproduction. Additionally, mammals senesce faster than birds because they have a faster life history for a given body size. By allowing us to disentangle the effects of two major fitness components our methods allow an assessment of the robustness of the prevalent life-table approach. Focusing on one aspect of life history - survival or recruitment - can provide reliable information on overall senescence.

Social inequalities of functioning and perceived health in Switzerland: a representative cross-sectional analysis.

Many people worldwide live with a disability, i.e. limitations in functioning. The prevalence is expected to increase due to demographic change and the growing importance of non-communicable disease and injury. To date, many epidemiological studies have used simple dichotomous measures of disability, even though the WHO's International Classification of Functioning, Disability, and Health (ICF) provides a multi-dimensional framework of functioning. We aimed to examine associations of socio-economic status (SES) and social integration in 3 core domains of functioning (impairment, pain, limitations in activity and participation) and perceived health. We conducted a secondary analysis of representative cross-sectional data of the Swiss Health Survey 2007 including 10,336 female and 8,424 male Swiss residents aged 15 or more. Guided by a theoretical ICF-based model, 4 mixed effects Poisson regressions were fitted in order to explain functioning and perceived health by indicators of SES and social integration. Analyses were stratified by age groups (15-30, 31-54, ≥55 years). In all age groups, SES and social integration were significantly associated with functional and perceived health. Among the functional domains, impairment and pain were closely related, and both were associated with limitations in activity and participation. SES, social integration and functioning were related to perceived health. We found pronounced social inequalities in functioning and perceived health, supporting our theoretical model. Social factors play a significant role in the experience of health, even in a wealthy country such as Switzerland. These findings await confirmation in other, particularly lower resourced settings.

Normalisation et dimension culturelle des délocalisations de services : les cas du Maroc et de l'Inde

Cette thèse explore le rôle de la normalisation technique dans les délocalisations de services en Inde et au Maroc. La recherche appréhende le phénomène en opposant explicitement ou implicitement deux modèles. Un modèle serviciel dans lequel les activités de services sont difficilement délocalisables parce que non-mesurables ; un modèle industriel qui articule des activités de services mesurables par les normes techniques et susceptibles d'être délocalisés dans les pays du Sud à bas salaires. Notre thèse s'interroge sur la manière dont les relations Nord-Sud peuvent s'appréhender au sein de cette dichotomie et propose une réflexion épistémologique sur les représentations culturelles induites au sein de ce cadrage. A partir d'une perspective qui combine les apports de l'économie politique culturelle, la sociologie économique et les études postcoloniales au sein de l'économie politique internationale, elle mobilise trois catégories (la normalisation technique, l'imaginaire économique, la qualité). Ces catégories nous permettent de suggérer la centralité des enjeux de pouvoirs dans la définition de ce que sont les activités de services. L'analyse empirique suggère que les délocalisations de services au Maroc et en Inde expriment des réalités plus poreuses et plus dynamiques que la dichotomie entre modèle serviciel et modèle industriel laisse entendre. Elle met en évidence la capacité d'agir des acteurs des pays du Sud et suggère que les normes techniques ont une fonction politique à travers leurs fonctions de mesure. Abstract This thesis explores the role of technical standards in offshore outsourcing in India and Morocco. Current research captures the phenomenon while opposing explicitly or implicitly two models of production. A service-based model in which service activities are difficult to relocate because they are non-measurable; an industrial model that articulates service activities measured with technical standards and that may be outsourced to developing countries with low wages. Our thesis questions how North-South relations can be grasped within this dichotomy and offers an epistemologica! reflection on cultural representations induced within this framework. From a perspective that combines the contributions of cultural political economy, economic sociology and postcolonial studies in international political economy, it mobilizes three categories (technical standardization, the economic imaginary and quality). These categories allow us to suggest the centrality of power issues in the definition of service activities. The empirical analysis suggests that offshoring of services in Morocco and India express more porous and dynamic realities than the dichotomy suggested between a service model and an industrial model. It highlights the ability of the actors to act in the South and suggests that technical standards have a political function through their measurement functions.

The JAK/STAT3 Pathway Is a Common Inducer of Astrocyte Reactivity in Alzheimer's and Huntington's Diseases.

Astrocyte reactivity is a hallmark of neurodegenerative diseases (ND), but its effects on disease outcomes remain highly debated. Elucidation of the signaling cascades inducing reactivity in astrocytes during ND would help characterize the function of these cells and identify novel molecular targets to modulate disease progression. The Janus kinase/signal transducer and activator of transcription 3 (JAK/STAT3) pathway is associated with reactive astrocytes in models of acute injury, but it is unknown whether this pathway is directly responsible for astrocyte reactivity in progressive pathological conditions such as ND. In this study, we examined whether the JAK/STAT3 pathway promotes astrocyte reactivity in several animal models of ND. The JAK/STAT3 pathway was activated in reactive astrocytes in two transgenic mouse models of Alzheimer's disease and in a mouse and a nonhuman primate lentiviral vector-based model of Huntington's disease (HD). To determine whether this cascade was instrumental for astrocyte reactivity, we used a lentiviral vector that specifically targets astrocytes in vivo to overexpress the endogenous inhibitor of the JAK/STAT3 pathway [suppressor of cytokine signaling 3 (SOCS3)]. SOCS3 significantly inhibited this pathway in astrocytes, prevented astrocyte reactivity, and decreased microglial activation in models of both diseases. Inhibition of the JAK/STAT3 pathway within reactive astrocytes also increased the number of huntingtin aggregates, a neuropathological hallmark of HD, but did not influence neuronal death. Our data demonstrate that the JAK/STAT3 pathway is a common mediator of astrocyte reactivity that is highly conserved between disease states, species, and brain regions. This universal signaling cascade represents a potent target to study the role of reactive astrocytes in ND.

Toimitusketjun kehittäminen prosessiteollisuudessa

Diplomityön tavoitteena oli erään prosessiteollisuuden yrityksen toimitusketjun kehittäminen pääasiakkaan toimitusten osalta. Ongelmana olivat epäoptimaalinen tuotannon lajinvaihto ja toimitusketjun jakelutoimintojen tehottomuus asiakkaan tilausmäärien huonon ennustettavuuden vuoksi. Työssä keskityttiin tuotannon lajinvaihto- ja jakelutoimintoihin sekä niiden kustannusten määrittämiseen toimintolaskennan avulla. Päätavoitteena oli mallintaa Excel-pohjainen työkalu, joka soveltuu tuotannon lajinvaihdon, kuljetusten ja jakeluvarastoinnin karkeasuunnitteluun tarpeiden ja kapasiteetin yhteensovittamiseksi sekä em. kustannusten määrittämiseksi. Työkalua voidaan käyttää myös analysointityökaluna simuloimalla kustannuksia eri toimintavaihtoehdoilla ja tarkastelemalla kustannusten suhdetta toisiinsa. Työkalun avulla laskettiin tuotantotiheyden, kuljetuseräkoon ja tuotantoerien lukumäärän kustannusvaikutukset. Edellytyksenä työkalun käytölle suunnittelussa ja analysoinnissa ovat viikkokohtaiset kysyntäennusteet, joiden saamiseksi ehdotetaan yhteistyön kehittämistä asiakkaan kanssa. Työkalua voidaan jatkossa käyttää myös apuna erään tietojärjestelmän syöttötietojen määrittelyssä.

Activity patterns and foraging behaviour of Audouin's gulls at the Ebro Delta, NW Mediterranean.

Twenty Audouin´s gulls, Larus audouinii, breeding in the Ebro Delta (NW Mediterranean) were radio-tracked in 1998 to study their foraging behaviour and activity patterns. Some detrimental effects of tagging on the breeding success of the birds were detected, especially when both members of the pair were tagged. The results were actually constrained by the low number of locations due to natural breeding failure and failure in tag emission, as well as the adverse effect of tagging. However, through a combination of aircraft surveys at sea and a fixed station for automatic tracking of the presence of the birds at the colony, novel individual-based information of home ranges and activity patterns was obtained. Trawler fishing activity seemed to influence both the foraging range and habitat use: while trawlers operated, gulls overlapped their fishing grounds with vessels, probably to scavenge on discards. Very few locations were obtained during a trawling moratorium period, although they were all recorded in coastal bays and terrestrial habitats. During the trawling activity period, gulls ranged over a minimum convex polygon area of 2900 km2. Gulls were tracked up to 40 km from the colony, but some individuals were observed beyond 150 km while still breeding. Arrivals and departures from the colony were in accordance with the trawling timetable. However, most birds also showed some nocturnal foraging activity, probably linked to active fishing of clupeoids (following diel migrations) or to the exploitation of purse-seine fishing activity. Foraging trips lasted on average 15 hours: males performed significantly shorter trips than females, which spent more time outside the colony. The proportion of nocturnal time involved in the foraging trips was the same for males and females, but whilst all males initiated their trips both during the day and at night, some females only initiated their trips during the day. Hatching success was found to be related to foraging effort by males. Gulls spent on average ca. 38% of their time budget outside the nesting territory, representing the time devoted mainly to flying, foraging and other activities.

Pankkien vakavaraisuussäännöstön uudistus

Tutkielman tavoitteena on kuvata pankkien vakavaraisuusuudistuksen eri osa-alueita. Tarkempi analyysi rajautuu uudistuksen tuomiin muutoksiin luotto- ja operatiivisen riskin pääomavaateissa. Tutkielman empiirisen osuuden tavoitteena on perehtyä vakavaraisuussäännöstön uudistusten vaikutuksiin Nordeassa. Tutkimusmetodologiaksi on valittu normatiivinen tutkimusote. Lisäksi tutkielma sisältää deskriptiivisiä ja positivistisia osia. Lähdeaineisto koostuu Baselin pankkivalvontakomitean ja Suomen Pankin julkaisemista tutkimuksista ja dokumenteista sekä alan julkaisuissa ilmestyneistä artikkeleista. Pankkien vakavaraisuussäännöstöuudistuksen tavoitteena on lisätä rahoitusmarkkinoiden vakautta. Sääntelyn kautta pyritään turvaamaan pankkien varojen riittävyys suhteessa niiden riskien ottoon. Vakavaraisuussäännöstön uudistus muodostuu kolmesta pilarista: (1) minimipääomavaatimuksista, (2) pankkivalvonnan vahvistamisesta ja (3) markkinakurin hyödyntämisestä luottolaitosten toiminnan julkistamisvaatimuksia lisäämällä. Pankkivalvonnan harmonisoinnista vallitsee kansainvälinen yhteisymmärrys, mutta ennen kuin Basel II voi astua voimaan on useita ongelmia ratkaisematta. Baselin vakavaraisuuskehikko ei ole ainut lähitulevaisuudessa pankkitoimialaa koetteleva uudistus. Kansainväliset tilinpäätösstandardit; International Accounting Standards ja erityisesti IAS 39 sekä International Financial Reporting Standards, lyhyemmin IFRS tulevat muuttamaan merkittävästi pankkien tilinpäätöskäyttäytymistä. Epäselvää on vielä kuitenkin tukevatko uudistukset toisiaan ja missä määrin pankkien tulosvolatiliteetin odotetaan kasvavan. Tutkielmassa pohditaan vakavaraisuussäännöstön uudistuksen hyötyjä kansainvälisen kilpailuneutraliteetin osalta, sillä Yhdysvalloissa uudistus koskee vain suurimpia pankkeja. Tutkielmassa paneudutaan lisäksi uudistuksen mahdolliseen talouden syklejä voimistavaan vaikutukseen ja tarkastellaan parannusehdotuksia prosyklisyyden hillitsemiseksi. Yksi vakavaraisuusuudistuksen tärkeimmistä tehtävistä on luoda pankeille kannustin kehittää omia riskienhallinta malleja. Kannustin ongelma on pyritty ratkaisemaan vapaampien sisäisten mallien menetelmien avulla. Ongelmaa ei ole pystytty kuitenkaan ratkaisemaan aivan täysin, sillä luottoriskien osalta pankkien lainaportfolioiden rakenne määrittää sen, hyötyvätkö pankit siirtymisestä sisäisten mallien menetelmän käyttöön. Tutkielma sisältää myös Nordean arvion vakavaraisuusuudistuksen vaikutuksista pankkitoimialaan.

Estimating the Ontogenetic Status of an Enantiornithine Bird from the Lower Barremian of El Montsec, Central Pyrenees, Spain.

An Enantiornithes specimen from El Montsec was initially described as an immature individual based upon qualitative traits such as its relatively large orbit and overall proportions of the skull and the postcranium. In this study we re-evaluate the precise determination of the ontogenetic stage of this individual, establishing a cross-talk among taphonomic, anatomic, and morphometric data. The exceptional preservation of the specimen has allowed pondering ontogenetic influence versus preservational bias in features like the external patterns of bone surfaces, instead of being aprioristically considered due to taphonomic alterations only. The rough texture of the periosteal bone associated with pores in the distal, proximal and mid-shaft areas of the humeral shaft, indicates a subadult stage when compared with long bones of modern birds. Forelimb proportions of embryo and juvenile Enanthiornithes are equivalent to those of adult individuals of other taxa within this clade, though this is not a reliable criterion for establishing a precise ontogenetic stage. The El Montsec specimen may be attributed a close adulthood, yet only if growth regimes in Enantiornithes are considered equivalent to those in Neornithes birds.