Inappropriate imaging utilization in Texas: Geographic variation and predictive factors

Objective::Describe and understand regional differences and associated multilevel factors (patient, provider and regional) to inappropriate utilization of advance imaging tests in the privately insured population of Texas. Methods: We analyzed Blue Cross Blue Shield of Texas claims dataset to study the advance imaging utilization during 2008-2010 in the PPO/PPO+ plans. We used three of CMS "Hospital Outpatient Quality Reporting" imaging efficiency measures. These included ordering MRI for low back pain without prior conservative management (OP-8) and utilization of combined with and without contrast abdominal CT (OP-10) and thorax CT (OP-11). Means and variation by hospital referral regions (HRR) in Texas were measured and a multilevel logistic regression for being a provider with high values for any the three OP measures was used in the analysis. We also analyzed OP-8 at the individual level. A multilevel logistic regression was used to identify predictive factors for having an inappropriate MRI for low back pain. Results: Mean OP-8 for Texas providers was 37.89%, OP-10 was 29.94% and OP-11 was 9.24%. Variation was higher for CT measure. And certain HRRs were consistently above the mean. Hospital providers had higher odds of high OP-8 values (OP-8: OR, 1.34; CI, 1.12-1.60) but had smaller odds of having high OP-10 and OP-11 values (OP-10: OR, 0.15; CI, 0.12-0.18; OP-11: OR, 0.43; CI, 0.34-0.53). Providers with the highest volume of imaging studies performed, were less likely to have high OP-8 measures (OP-8: OR, 0.58; CI, 0.48-0.70) but more likely to perform combined thoracic CT scans (OP-11: OR, 1.62; CI, 1.34-1.95). Males had higher odds of inappropriate MRI (OR, 1.21; CI, 1.16-1.26). Pattern of care in the six months prior to the MRI event was significantly associated with having an inappropriate MRI. Conclusion::We identified a significant variation in advance imaging utilization across Texas. Type of facility was associated with measure performance, but the associations differ according to the type of study. Last, certain individual characteristics such as gender, age and pattern of care were found to be predictors of inappropriate MRIs.^

Organizational Capability of Local Societies in Rural Development: A Comparative Study of Microfinance Organizations in Thailand and the Philippines

The importance of organizing local people for development work is widely recognized. Both governmental and non-governmental agencies have implemented various projects that have needed and encouraged collective action by people. Often, however, such projects malfunction after the outside agencies retreat from the project site, suggesting that making organizations is not the same as making a system of making organizations. The latter is essential to make rural organizations self-reliant and sustainable. This paper assumes that such a system exists in local societies and focuses on the capacity of local societies for creating and managing organizations for development. It reveals that (1) such capability differs according to the locality, (2) the difference depends on the structure of the organizations that coordinate people's social relations, and (3) the local administrative bodies define, at least partly, the organizational capability of local societies. We compare two rural societies, one in Thailand and the other in the Philippines, which show clear contrasts in both the form of microfinance organizations and the way of making these organizations.

Publicness and Taken-for-granted Knowledge: A Case Study of Communal Land Formation in Rural Thailand

The lack of public-mindedness can cause problems in the social order of people’s daily lives, such as the tragedy of the commons and the problem of free riders. Some scholars such as Habermas assert that communicative rationality is the solution, expecting that individuals will communicate with each other to reach a consensus without being bounded by aspects of social background. Other scholars advocate the revitalization of traditional community culture. These arguments, however, are not based on reality. By using the case of communal land formation in rural Thailand, the author shows that collective action is neither a revival of tradition nor a result of communication free from social constraints. Rather, cooperation emerges because the people rationally respond to their present needs and have built, through daily social interactions, taken-for-granted knowledge about how they should behave for cooperation.

China's inter-regional spillover of carbon emissions and domestic supply chains

In this study, we apply the inter-regional input–output model to explain the relationship between China’s inter-regional spillover of CO2 emissions and domestic supply chains for 2002 and 2007. Based on this model, we propose alternative indicators such as the trade in CO2 emissions, CO2 emissions in trade, regional trade balances, and comparative advantage of CO2 emissions. The empirical results not only reveal the nature and significance of inter-regional environmental spillover within China’s domestic regions but also demonstrate how CO2 emissions are created and distributed across regions via domestic production networks. The main finding shows that a region’s CO2 emissions depend on not only its intra-regional production technique, energy use efficiency but also its position and participation degree in domestic and global supply chains.

TELEVISÃO REGIONAL E REDE NACIONAL:UM ESTUDO DE CASO DE EMISSORAS AFILIADAS DA REDE BANDEIRANTES DE TV

A aceleração do processo de globalização da mídia em todo o mundo trouxe como contrapartida um crescente interesse pela mídia regional. Para se examinar esse processo no Brasil, buscou-se analisar como a programação regional de cinco emissoras regionais afiliadas a uma rede nacional de televisão e localizadas no Norte, Nordeste, Centro-Oeste, Sudeste e Sul se articula com a programação nacional. A Rede Bandeirantes de Televisão foi escolhida por estar presente em todo o país e atingir um grande número de domicílios. O método utilizado é o qualitativo, de caráter descritivo e optou-se pelo estudo de caso múltiplo, com o objetivo de se obter uma perspectiva comparada da programação das emissoras regionais estudadas. A principal conclusão é que, apesar da pequena produção regional, com ênfase na informação (telejornal e entrevista) pode-se constatar, em algumas regiões, o interesse da audiência por programas voltados para a cultura regional.(AU)

TELEVISÃO REGIONAL E REDE NACIONAL:UM ESTUDO DE CASO DE EMISSORAS AFILIADAS DA REDE BANDEIRANTES DE TV

A aceleração do processo de globalização da mídia em todo o mundo trouxe como contrapartida um crescente interesse pela mídia regional. Para se examinar esse processo no Brasil, buscou-se analisar como a programação regional de cinco emissoras regionais afiliadas a uma rede nacional de televisão e localizadas no Norte, Nordeste, Centro-Oeste, Sudeste e Sul se articula com a programação nacional. A Rede Bandeirantes de Televisão foi escolhida por estar presente em todo o país e atingir um grande número de domicílios. O método utilizado é o qualitativo, de caráter descritivo e optou-se pelo estudo de caso múltiplo, com o objetivo de se obter uma perspectiva comparada da programação das emissoras regionais estudadas. A principal conclusão é que, apesar da pequena produção regional, com ênfase na informação (telejornal e entrevista) pode-se constatar, em algumas regiões, o interesse da audiência por programas voltados para a cultura regional.(AU)

Excavated housing in Crevillente (Spain). Constructive and typologycal study

Underground architecture has sheltered man for many centuries, but the current need to emphasize the bioclimatic approach makes the study of excavated housing essential. This traditional construction is a part of the collective human living experience but also a reference in using the natural conditions of each region through simple proposals based on ground thermal inertia. The aim of this paper is to show the typological evolution of the excavated dwelling in Crevillente, in southeast Spain, compared to other worldwide architectural proposals or urban solutions. To show their adaptation to the regional geography and to comprehend both formal and material characteristics of these simple typologies, which do not need extra energy contribution for interior conditioning. This work is part of the doctoral thesis of the author.

Transferability of Regional Permafrost Disturbance Susceptibility Modelling Using Generalized Linear and Generalized Additive Models

To effectively assess and mitigate risk of permafrost disturbance, disturbance-p rone areas can be predicted through the application of susceptibility models. In this study we developed regional susceptibility models for permafrost disturbances using a field disturbance inventory to test the transferability of the model to a broader region in the Canadian High Arctic. Resulting maps of susceptibility were then used to explore the effect of terrain variables on the occurrence of disturbances within this region. To account for a large range of landscape charac- teristics, the model was calibrated using two locations: Sabine Peninsula, Melville Island, NU, and Fosheim Pen- insula, Ellesmere Island, NU. Spatial patterns of disturbance were predicted with a generalized linear model (GLM) and generalized additive model (GAM), each calibrated using disturbed and randomized undisturbed lo- cations from both locations and GIS-derived terrain predictor variables including slope, potential incoming solar radiation, wetness index, topographic position index, elevation, and distance to water. Each model was validated for the Sabine and Fosheim Peninsulas using independent data sets while the transferability of the model to an independent site was assessed at Cape Bounty, Melville Island, NU. The regional GLM and GAM validated well for both calibration sites (Sabine and Fosheim) with the area under the receiver operating curves (AUROC) N 0.79. Both models were applied directly to Cape Bounty without calibration and validated equally with AUROC's of 0.76; however, each model predicted disturbed and undisturbed samples differently. Addition- ally, the sensitivity of the transferred model was assessed using data sets with different sample sizes. Results in- dicated that models based on larger sample sizes transferred more consistently and captured the variability within the terrain attributes in the respective study areas. Terrain attributes associated with the initiation of dis- turbances were similar regardless of the location. Disturbances commonly occurred on slopes between 4 and 15°, below Holocene marine limit, and in areas with low potential incoming solar radiation

Regional health governance: a comparative perspective on EU and ASEAN. EU Centre in Singapore Policy Brief No. 4, June 2012

Globalisation has led to new health challenges for the 21st Century. These challenges have transnational implications and involve a large range of actors and stakeholders. National governments no longer hold the sole responsibility for the health of their people. These changes in health trends have led to the rise of Global Health Governance as a theoretical notion for health policy-making. The Southeast Asian region is particularly prone to public health threats and it is for this reason that this brief looks at the potential of the Association of Southeast Asian Nations (ASEAN) as a regional organisation to take a lead in health cooperation. Through a comparative study between the regional mechanisms for health cooperation of the European Union (EU) and ASEAN, we look at how ASEAN could maximise its potential as a global health actor. Regional institutions and a network of civil society organisations are crucial in relaying global initiatives for health, and ensuring their effective implementation at the national level. While the EU benefits from higher degrees of integration and involvement in the sector of health policy making, ASEAN’s role as a regional body for health governance will depend both on greater horizontal and vertical regional integration through enhanced regional mechanisms and a wider matrix of cooperation.

Recursos hídricos superficiais vs subterrâneos na Várzea da Nazaré : implicações na qualidade da água

Tese de doutoramento, Geologia (Hidrogeologia), Universidade de Lisboa, Faculdade de Ciências, 2016

Federation without federalism. Relations between Moscow and the regions. OSW Study 49/2014

The regions of the Russian Federation are immensely diverse economically and geographically as well as when it comes to their national identity, civic awareness and political activity. We are in fact dealing with a ‘multi-speed Russia’: along with the post-industrial regions with their higher living standards and a need for pluralism in politics, there are poverty-stricken, inertial regions, dependent on subsidies from the centre. As a result of the policy of centralisation pursued by the Kremlin since 2000, the autonomy of the regions has been reduced fundamentally. This has affected the performance of the regional elites and made it difficult for the regions to use their natural advantages (such as resources or location) to their benefit. One of the effects of this policy has been the constantly decreasing number of the donor regions. The current model promotes the role of the region as a passive supplicant, for whom it is easier to seek support from the central government, offering loyalty in exchange, than to implement complex systemic reforms that would contribute to long-term development. Moscow’s control (political, economic and administrative) over the regions is currently so thorough that it contradicts the formally existing federal form of government in Russia.

Perspectives in Resource Management and Climate Change Adaptation in the Southern and Eastern Mediterranean. MEDPRO Policy Paper No. 6, March 2013

This policy paper focuses on the sustainable management of some key natural resources in southern and eastern Mediterranean countries (SEMCs) under climate change and anthropogenic pressures. In a business-as-usual and even more so in a failed cooperation scenario, water resources, ecosystems and biodiversity in the region are under stress, with negative consequences for agriculture, food security, tourism and development. However, proper adaptation strategies are shown to be effective in reconciling resource conservation with GDP, trade and population growth. These need be implemented in different ways: technological, institutional, behavioural; and at different levels: regional, national and international. There is ample room for fruitful cooperation between the EU and SEMCs in this area, which can take the form of EU direct financial and technical support when resources in SEMCs are scarce, and of multilateral and bilateral cooperation programmes to improve resource efficiency. The EU could also take on the role of coordinating these different bilateral actions and, at the same time, support SEMCs to establish a structured programme focused on the communication and dissemination of emerging best practices.

Evaluation of an index of biotic integrity : temporal variability and regional application in the midwest /

Mode of access: Internet.

Study of older child restraint/booster seat fit and NASS injury analysis. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Regional location of production of major field crops at alternative demand and price levels, 1975; a linear programing analysis,

Issued in cooperation with Iowa State University of Science and Technology, Agriculture and Home Economics Experiment Station, and the Center for Agricultural and Economic Development.