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.

Finite element modeling of straightening of thin-walled seamless tubes of austenitic stainless steel

During this thesis work a coupled thermo-mechanical finite element model (FEM) was builtto simulate hot rolling in the blooming mill at Sandvik Materials Technology (SMT) inSandviken. The blooming mill is the first in a long line of processes that continuously or ingotcast ingots are subjected to before becoming finished products. The aim of this thesis work was twofold. The first was to create a parameterized finiteelement (FE) model of the blooming mill. The commercial FE software package MSCMarc/Mentat was used to create this model and the programing language Python was used toparameterize it. Second, two different pass schedules (A and B) were studied and comparedusing the model. The two pass series were evaluated with focus on their ability to healcentreline porosity, i.e. to close voids in the centre of the ingot. This evaluation was made by studying the hydrostatic stress (σm), the von Mises stress (σeq)and the plastic strain (εp) in the centre of the ingot. From these parameters the stress triaxiality(Tx) and the hydrostatic integration parameter (Gm) were calculated for each pass in bothseries using two different transportation times (30 and 150 s) from the furnace. The relationbetween Gm and an analytical parameter (Δ) was also studied. This parameter is the ratiobetween the mean height of the ingot and the contact length between the rolls and the ingot,which is useful as a rule of thumb to determine the homogeneity or penetration of strain for aspecific pass. The pass series designed with fewer passes (B), many with greater reduction, was shown toachieve better void closure theoretically. It was also shown that a temperature gradient, whichis the result of a longer holding time between the furnace and the blooming mill leads toimproved void closure.

Production planning, pricing and market coordination for news vendor problem with price dependent demand

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

Computational approaches and tools for modeling biomass pyrolysis

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

Passivity Framework for Modeling, Composing and Mitigating Cyber Attacks

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

Assessing the resilience of water supply systems in Oman

Water systems in the Sultanate of Oman are inevitably exposed to varied threats and hazards due to both natural and man-made hazards. Natural disasters, especially tropical cyclone Gonu in 2007, cause immense damage to water supply systems in Oman. At the same time water loss from leaks is a major operational problem. This research developed an integrated approach to identify and rank the risks to the water sources, transmission pipelines and distribution networks in Oman and suggests appropriate mitigation measures. The system resilience was evaluated and an emergency response plan for the water supplies developed. The methodology involved mining the data held by the water supply utility for risk and resilience determination and operational data to support calculations of non-revenue water. Risk factors were identified, ranked and scored at a stakeholder workshop and the operational information required was principally gathered from interviews. Finally, an emergency response plan was developed by evaluating the risk and resilience factors. The risk analysis and assessment used a Coarse Risk Analysis (CRA) approach and risk scores were generated using a simple risk matrix based on WHO recommendations. The likelihoods and consequences of a wide range of hazardous events were identified through a key workshop and subsequent questionnaires. The thesis proposes a method of translating the detailed risk evaluations into resilience scores through a methodology used in transportation networks. A water audit indicated that the percentage of NRW in Oman is greater than 35% which is similar to other Gulf countries but high internationally. The principal strategy for managing NRW used in the research was the AWWA water audit method which includes free to use software and was found to be easy to apply in Oman. The research showed that risks to the main desalination processes can be controlled but the risk due to feed water quality might remain high even after implementing mitigation measures because the intake is close to an oil port with a significant risk of oil contamination and algal blooms. The most severe risks to transmission mains were found to be associated with pipe rather than pump failure. The systems in Oman were found to be moderately resilient, the resilience of desalination plants reasonably high but the transmission mains and pumping stations are very vulnerable. The integrated strategy developed in this study has a wide applicability, particularly in the Gulf area, which may have risks from exceptional events and will be experiencing NRW. Other developing countries may also experience such risks but with different magnitudes and the risk evaluation tables could provide a useful format for further work.

Solar coronal jets: observations, theory, and modeling

Coronal jets represent important manifestations of ubiquitous solar transients, which may be the source of significant mass and energy input to the upper solar atmosphere and the solar wind. While the energy involved in a jet-like event is smaller than that of “nominal” solar flares and coronal mass ejections (CMEs), jets share many common properties with these phenomena, in particular, the explosive magnetically driven dynamics. Studies of jets could, therefore, provide critical insight for understanding the larger, more complex drivers of the solar activity. On the other side of the size-spectrum, the study of jets could also supply important clues on the physics of transients close or at the limit of the current spatial resolution such as spicules. Furthermore, jet phenomena may hint to basic process for heating the corona and accelerating the solar wind; consequently their study gives us the opportunity to attack a broad range of solar-heliospheric problems.

Contribution à la planification tactique et opérationnelle du transport forestier

Cette thèse est une contribution à la modélisation, la planification et l’optimisation du transport pour l’approvisionnement en bois de forêt des industries de première transformation. Dans ce domaine, les aléas climatiques (mise au sol des bois par les tempêtes), sanitaires (attaques bactériologiques et fongiques des bois) et commerciaux (variabilité et exigence croissante des marchés) poussent les divers acteurs du secteur (entrepreneurs et exploitants forestiers, transporteurs) à revoir l’organisation de la filière logistique d’approvisionnement, afin d’améliorer la qualité de service (adéquation offre-demande) et de diminuer les coûts. L’objectif principal de cette thèse était de proposer un modèle de pilotage améliorant la performance du transport forestier, en respectant les contraintes et les pratiques du secteur. Les résultats établissent une démarche de planification hiérarchique des activités de transport à deux niveaux de décision, tactique et opérationnel. Au niveau tactique, une optimisation multi-périodes permet de répondre aux commandes en minimisant l’activité globale de transport, sous contrainte de capacité agrégée des moyens de transport accessibles. Ce niveau permet de mettre en œuvre des politiques de lissage de charge et d’organisation de sous-traitance ou de partenariats entre acteurs de transport. Au niveau opérationnel, les plans tactiques alloués à chaque transporteur sont désagrégés, pour permettre une optimisation des tournées des flottes, sous contrainte des capacités physiques de ces flottes. Les modèles d’optimisation de chaque niveau sont formalisés en programmation linéaire mixte avec variables binaires. L’applicabilité des modèles a été testée en utilisant un jeu de données industrielles en région Aquitaine et a montré des améliorations significatives d’exploitation des capacités de transport par rapport aux pratiques actuelles. Les modèles de décision ont été conçus pour s’adapter à tout contexte organisationnel, partenarial ou non : la production du plan tactique possède un caractère générique sans présomption de l’organisation, celle-ci étant prise en compte, dans un deuxième temps, au niveau de l’optimisation opérationnelle du plan de transport de chaque acteur.

Conversor de energia das ondas em energia elétrica com dispositivo de coluna de água oscilante: simulação numérica e estudo geométrico

Os oceanos representam um dos maiores recursos naturais, possuindo expressivo potencial energético, podendo suprir parte da demanda energética mundial. Nas últimas décadas, alguns dispositivos destinados à conversão da energia das ondas dos oceanos em energia elétrica têm sido estudados. No presente trabalho, o princípio de funcionamento do conversor do tipo Coluna de Água Oscilante, do inglês Oscillating Water Colum, (OWC) foi analisado numericamente. As ondas incidentes na câmara hidro-pneumática da OWC, causam um movimento alternado da coluna de água no interior da câmara, o qual produz um fluxo alternado de ar que passa pela chaminé. O ar passa e aciona uma turbina a qual transmite energia para um gerador elétrico. O objetivo do presente estudo foi investigar a influência de diferentes formas geométricas da câmara sobre o fluxo resultante de ar que passa pela turbina, que influencia no desempenho do dispositivo. Para isso, geometrias diferentes para o conversor foram analisadas empregando modelos computacionais 2D e 3D. Um modelo computacional desenvolvido nos softwares GAMBIT e FLUENT foi utilizado, em que o conversor OWC foi acoplado a um tanque de ondas. O método Volume of Fluid (VOF) e a teoria de 2ª ordem Stokes foram utilizados para gerar ondas regulares, permitindo uma interação mais realista entre o conversor, água, ar e OWC. O Método dos Volumes Finitos (MVF) foi utilizado para a discretização das equações governantes. Neste trabalho o Contructal Design (baseado na Teoria Constructal) foi aplicado pela primeira vez em estudos numéricos tridimensionais de OWC para fim de encontrar uma geometria que mais favorece o desempenho do dispositivo. A função objetivo foi a maximização da vazão mássica de ar que passa através da chaminé do dispositivo OWC, analisado através do método mínimos quadrados, do inglês Root Mean Square (RMS). Os resultados indicaram que a forma geométrica da câmara influencia na transformação da energia das ondas em energia elétrica. As geometrias das câmaras analisadas que apresentaram maior área da face de incidência das ondas (sendo altura constante), apresentaram também maior desempenho do conversor OWC. A melhor geometria, entre os casos desse estudo, ofereceu um ganho no desempenho do dispositivo em torno de 30% maior.

Development and Application of Predictive Models for Survival, Growth, and Death of Enteric Pathogens in Leafy Greens Supply Chain

Leafy greens are essential part of a healthy diet. Because of their health benefits, production and consumption of leafy greens has increased considerably in the U.S. in the last few decades. However, leafy greens are also associated with a large number of foodborne disease outbreaks in the last few years. The overall goal of this dissertation was to use the current knowledge of predictive models and available data to understand the growth, survival, and death of enteric pathogens in leafy greens at pre- and post-harvest levels. Temperature plays a major role in the growth and death of bacteria in foods. A growth-death model was developed for Salmonella and Listeria monocytogenes in leafy greens for varying temperature conditions typically encountered during supply chain. The developed growth-death models were validated using experimental dynamic time-temperature profiles available in the literature. Furthermore, these growth-death models for Salmonella and Listeria monocytogenes and a similar model for E. coli O157:H7 were used to predict the growth of these pathogens in leafy greens during transportation without temperature control. Refrigeration of leafy greens meets the purposes of increasing their shelf-life and mitigating the bacterial growth, but at the same time, storage of foods at lower temperature increases the storage cost. Nonlinear programming was used to optimize the storage temperature of leafy greens during supply chain while minimizing the storage cost and maintaining the desired levels of sensory quality and microbial safety. Most of the outbreaks associated with consumption of leafy greens contaminated with E. coli O157:H7 have occurred during July-November in the U.S. A dynamic system model consisting of subsystems and inputs (soil, irrigation, cattle, wildlife, and rainfall) simulating a farm in a major leafy greens producing area in California was developed. The model was simulated incorporating the events of planting, irrigation, harvesting, ground preparation for the new crop, contamination of soil and plants, and survival of E. coli O157:H7. The predictions of this system model are in agreement with the seasonality of outbreaks. This dissertation utilized the growth, survival, and death models of enteric pathogens in leafy greens during production and supply chain.

Modelo para formação dinâmica de rede de fornecedores em empresas estendidas

Supply chains have become an important focus for competitive advantage. The performance of a company increasingly depends on its ability to maintain effective and efficient relationships with its suppliers and customers. The extended enterprise (i.e. composed of several partners) needs to be dynamically formed in order to be agile and adaptable. According to the Digital Manufacturing paradigm, companies have to be able to quickly share and disseminate information regarding planning, designing and manufacturing of products. Additionally, they must be responsive to all technical and business determinants, as well as be assessed and certified for guaranteed performance. The current research intends to present a solution for the dynamic composition of the extended enterprise, formed to take advantage of market opportunities quickly and efficiently. A construction model was developed. This construction model consists of: information model, protocol model and process model. The information model has been defined based on the concepts of Supply Chain Operations Reference model (SCOR®). In this model is defined information for negotiating the participation of candidate companies in the dynamic establishment of a network for responding to a given demand for developing and manufacturing products, in seven steps as follows: request for information; request for qualification; alignment of strategy; request for proposal; request for quotation; compatibility of process; and compatibility of system. The protocol model has been elaborated and inspired in the OSI, this model provides a framework for linking customers and suppliers, indicates a sequence to be followed, in order to selecte companies to become suppliers. The process model has been implemented by means of process modeling according to the BPMN standard and, in turn, implemented as a web-based application that runs the process through its several steps, which uses forms to gather data. An application example in the context of the oil and gas industry is used for demonstrating the solution concept.

Informational lobbying in the European Union: Explaining information supply to the European Commission

Information supply is an important instrument through which interest groups can exert influence on political decisions. However, information supply to decision-makers varies extensively across interest groups. How can this be explained? Why do some interest groups provide more information than others? I argue that variation in information supply can largely be explained by organizational characteristics, more specifically the resources, the functional differentiation, the professionalization and the decentralization of interest groups. I test my theoretical expectations based on a large new dataset: Using multilevel modeling, I examine information supply to the European Commission across 56 policy issues and a wide range of interest groups by combining an analysis of consultation submissions with a survey conducted among interest groups.

Regional differences of outpatient physician supply as a theoretical economic and empirical generalized linear model

BACKGROUND: Regional differences in physician supply can be found in many health care systems, regardless of their organizational and financial structure. A theoretical model is developed for the physicians' decision on office allocation, covering demand-side factors and a consumption time function. METHODS: To test the propositions following the theoretical model, generalized linear models were estimated to explain differences in 412 German districts. Various factors found in the literature were included to control for physicians' regional preferences. RESULTS: Evidence in favor of the first three propositions of the theoretical model could be found. Specialists show a stronger association to higher populated districts than GPs. Although indicators for regional preferences are significantly correlated with physician density, their coefficients are not as high as population density. CONCLUSIONS: If regional disparities should be addressed by political actions, the focus should be to counteract those parameters representing physicians' preferences in over- and undersupplied regions.

The study of the impact of demand controlled ventilation in energy consumption of offices in Portuguese commercial buildings

Indoor Air 2016 - The 14th International Conference of Indoor Air Quality and Climate

Dynamic Programming Approaches for Estimating and Applying Large-scale Discrete Choice Models

People go through their life making all kinds of decisions, and some of these decisions affect their demand for transportation, for example, their choices of where to live and where to work, how and when to travel and which route to take. Transport related choices are typically time dependent and characterized by large number of alternatives that can be spatially correlated. This thesis deals with models that can be used to analyze and predict discrete choices in large-scale networks. The proposed models and methods are highly relevant for, but not limited to, transport applications. We model decisions as sequences of choices within the dynamic discrete choice framework, also known as parametric Markov decision processes. Such models are known to be difficult to estimate and to apply to make predictions because dynamic programming problems need to be solved in order to compute choice probabilities. In this thesis we show that it is possible to explore the network structure and the flexibility of dynamic programming so that the dynamic discrete choice modeling approach is not only useful to model time dependent choices, but also makes it easier to model large-scale static choices. The thesis consists of seven articles containing a number of models and methods for estimating, applying and testing large-scale discrete choice models. In the following we group the contributions under three themes: route choice modeling, large-scale multivariate extreme value (MEV) model estimation and nonlinear optimization algorithms. Five articles are related to route choice modeling. We propose different dynamic discrete choice models that allow paths to be correlated based on the MEV and mixed logit models. The resulting route choice models become expensive to estimate and we deal with this challenge by proposing innovative methods that allow to reduce the estimation cost. For example, we propose a decomposition method that not only opens up for possibility of mixing, but also speeds up the estimation for simple logit models, which has implications also for traffic simulation. Moreover, we compare the utility maximization and regret minimization decision rules, and we propose a misspecification test for logit-based route choice models. The second theme is related to the estimation of static discrete choice models with large choice sets. We establish that a class of MEV models can be reformulated as dynamic discrete choice models on the networks of correlation structures. These dynamic models can then be estimated quickly using dynamic programming techniques and an efficient nonlinear optimization algorithm. Finally, the third theme focuses on structured quasi-Newton techniques for estimating discrete choice models by maximum likelihood. We examine and adapt switching methods that can be easily integrated into usual optimization algorithms (line search and trust region) to accelerate the estimation process. The proposed dynamic discrete choice models and estimation methods can be used in various discrete choice applications. In the area of big data analytics, models that can deal with large choice sets and sequential choices are important. Our research can therefore be of interest in various demand analysis applications (predictive analytics) or can be integrated with optimization models (prescriptive analytics). Furthermore, our studies indicate the potential of dynamic programming techniques in this context, even for static models, which opens up a variety of future research directions.