An EM-based Semi-Parametric Mixture Model Approach to the Regression Analysis of Competing-Risks Data

We consider a mixture model approach to the regression analysis of competing-risks data. Attention is focused on inference concerning the effects of factors on both the probability of occurrence and the hazard rate conditional on each of the failure types. These two quantities are specified in the mixture model using the logistic model and the proportional hazards model, respectively. We propose a semi-parametric mixture method to estimate the logistic and regression coefficients jointly, whereby the component-baseline hazard functions are completely unspecified. Estimation is based on maximum likelihood on the basis of the full likelihood, implemented via an expectation-conditional maximization (ECM) algorithm. Simulation studies are performed to compare the performance of the proposed semi-parametric method with a fully parametric mixture approach. The results show that when the component-baseline hazard is monotonic increasing, the semi-parametric and fully parametric mixture approaches are comparable for mildly and moderately censored samples. When the component-baseline hazard is not monotonic increasing, the semi-parametric method consistently provides less biased estimates than a fully parametric approach and is comparable in efficiency in the estimation of the parameters for all levels of censoring. The methods are illustrated using a real data set of prostate cancer patients treated with different dosages of the drug diethylstilbestrol. Copyright (C) 2003 John Wiley Sons, Ltd.

A multifactor approach to the social discount rate

This work focuses on the appraisal of public and environmental projects and, more specifically, on the calculation of the social discount rate (SDR) for this kind of very long-term investment projects. As a rule, we can state that the instantaneous discount rate must be equal to the hazard rate of the public good or to the mortality rate of the population that the project is intended to. The hazard can be due to technical failures of the system, but, in this paper, we are going to consider different independent variables that can cause the hazard. That is, we are going to consider a multivariate hazard rate. In our empirical application, the Spanish forest surface will be the system and the forest fire will be the fail that can be caused by several factors. The aim of this work is to integrate the different variables that produce the fail in the calculation of the SDR from a multivariate hazard rate approach.

Creation of a web application for smart park system and parking prediction study for system integration

In the last few years, we have observed an exponential increasing of the information systems, and parking information is one more example of them. The needs of obtaining reliable and updated information of parking slots availability are very important in the goal of traffic reduction. Also parking slot prediction is a new topic that has already started to be applied. San Francisco in America and Santander in Spain are examples of such projects carried out to obtain this kind of information. The aim of this thesis is the study and evaluation of methodologies for parking slot prediction and the integration in a web application, where all kind of users will be able to know the current parking status and also future status according to parking model predictions. The source of the data is ancillary in this work but it needs to be understood anyway to understand the parking behaviour. Actually, there are many modelling techniques used for this purpose such as time series analysis, decision trees, neural networks and clustering. In this work, the author explains the best techniques at this work, analyzes the result and points out the advantages and disadvantages of each one. The model will learn the periodic and seasonal patterns of the parking status behaviour, and with this knowledge it can predict future status values given a date. The data used comes from the Smart Park Ontinyent and it is about parking occupancy status together with timestamps and it is stored in a database. After data acquisition, data analysis and pre-processing was needed for model implementations. The first test done was with the boosting ensemble classifier, employed over a set of decision trees, created with C5.0 algorithm from a set of training samples, to assign a prediction value to each object. In addition to the predictions, this work has got measurements error that indicates the reliability of the outcome predictions being correct. The second test was done using the function fitting seasonal exponential smoothing tbats model. Finally as the last test, it has been tried a model that is actually a combination of the previous two models, just to see the result of this combination. The results were quite good for all of them, having error averages of 6.2, 6.6 and 5.4 in vacancies predictions for the three models respectively. This means from a parking of 47 places a 10% average error in parking slot predictions. This result could be even better with longer data available. In order to make this kind of information visible and reachable from everyone having a device with internet connection, a web application was made for this purpose. Beside the data displaying, this application also offers different functions to improve the task of searching for parking. The new functions, apart from parking prediction, were: - Park distances from user location. It provides all the distances to user current location to the different parks in the city. - Geocoding. The service for matching a literal description or an address to a concrete location. - Geolocation. The service for positioning the user. - Parking list panel. This is not a service neither a function, is just a better visualization and better handling of the information.

Time Horizons And Smoothing In The Bank Of England’s Reaction Function: The Contrast Between The Standard GMM And Ex Ante Forecast Approaches

The monetary policy reaction function of the Bank of England is estimated by the standard GMM approach and the ex-ante forecast method developed by Goodhart (2005), with particular attention to the horizons for inflation and output at which each approach gives the best fit. The horizons for the ex-ante approach are much closer to what is implied by the Bank’s view of the transmission mechanism, while the GMM approach produces an implausibly slow adjustment of the interest rate, and suffers from a weak instruments problem. These findings suggest a strong preference for the ex-ante approach.

Time Horizons And Smoothing In The Bank Of England’s Reaction Function: The Contrast Between The Standard GMM And Ex Ante Forecast Approaches

The monetary policy reaction function of the Bank of England is estimated by the standard GMM approach and the ex-ante forecast method developed by Goodhart (2005), with particular attention to the horizons for inflation and output at which each approach gives the best fit. The horizons for the ex-ante approach are much closer to what is implied by the Bank’s view of the transmission mechanism, while the GMM approach produces an implausibly slow adjustment of the interest rate, and suffers from a weak instruments problem. These findings suggest a strong preference for the ex-ante approach.

Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index.

INTRODUCTION Recurrence risk in breast cancer varies throughout the follow-up time. We examined if these changes are related to the level of expression of the proliferation pathway and intrinsic subtypes. METHODS Expression of estrogen and progesterone receptor, Ki-67, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) was performed on tissue-microarrays constructed from a large and uniformly managed series of early breast cancer patients (N = 1,249). Subtype definitions by four biomarkers were as follows: luminal A (ER + and/or PR+, HER2-, Ki-67 <14), luminal B (ER + and/or PR+, HER2-, Ki-67 ≥14), HER2-enriched (any ER, any PR, HER2+, any Ki-67), triple-negative (ER-, PR-, HER2-, any Ki-67). Subtype definitions by six biomarkers were as follows: luminal A (ER + and/or PR+, HER2-, Ki-67 <14, any CK 5/6, any EGFR), luminal B (ER + and/or PR+, HER2-, Ki-67 ≥14, any CK 5/6, any EGFR), HER2-enriched (ER-, PR-, HER2+, any Ki-67, any CK 5/6, any EGFR), Luminal-HER2 (ER + and/or PR+, HER2+, any Ki-67, any CK 5/6, any EGFR), Basal-like (ER-, PR-, HER2-, any Ki-67, CK5/6+ and/or EGFR+), triple-negative nonbasal (ER-, PR-, HER2-, any Ki-67, CK 5/6-, EGFR-). Each four- or six-marker defined intrinsic subtype was divided in two groups, with Ki-67 <14% or with Ki-67 ≥14%. Recurrence hazard rate function was determined for each intrinsic subtype as a whole and according to Ki-67 value. RESULTS Luminal A displayed a slow risk increase, reaching its maximum after three years and then remained steady. Luminal B presented most of its relapses during the first five years. HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%. However a second peak occurred at 72 months but the risk magnitude was greater in Ki-67 <14%. Triple negative tumors with low proliferation rate display a smooth risk curve, but with Ki-67 ≥14% show sharp peak at nearly 18 months. CONCLUSIONS Each intrinsic subtype has a particular pattern of relapses over time which change depending on the level of activation of the proliferation pathway assessed by Ki-67. These findings could have clinical implications both on adjuvant treatment trial design and on the recommendations concerning the surveillance of patients.

Influence of gender on long-term prognosis of patients with chronic heart failure seen in heart failure clinics.

BACKGROUND Controversy exists concerning the influence of gender in the prognosis of patients with heart failure and no evidence is available from specific heart failure clinics. HYPOTHESIS Women with ambulatory heart failure are managed differently than men, although their prognosis might be better than men. METHODS AND RESULTS We analyzed the clinical characteristics, complementary test results, treatment, and prognosis in 4720 patients with chronic heart failure seen in 62 specialized clinics forming part of a multicenter registry during a mean follow-up of 40 months. The mean age was 65 +/- 12 years and 71% were men. The men were younger than the women and more often had a history of hyperlipidemia and ischemic heart disease. The men had a more advanced heart failure New York Heart Association (NYHA) functional class (III-IV) than the women and a greater frequency of systolic ventricular dysfunction. The men more often received treatment with beta-blockers, vasodilators, and antiplatelet aggregators as well as higher mean doses as compared with the women. The overall survival after the follow-up was similar for both genders, although the women had lower rates of survival free of admission for heart failure. CONCLUSIONS Despite the mortality of women and men with heart failure being similar, the rate of readmission for heart failure is greater in women in specialized heart failure clinics. These results may be associated with the pharmacological treatment differences observed.

Discriminant validity and test-retest reliability of a self-administered Internet-based questionnaire testing doctors' knowledge in evidence-based medicine.

Aims and objectives  This study aimed to determine the discriminant validity and the test-retest reliability of a questionnaire testing the impact of evidence-based medicine (EBM) training on doctors' knowledge and skills. Methods  Questionnaires were sent electronically to all doctors working as residents and chief residents in two French speaking hospital networks in Switzerland. Participants completed the questionnaire twice, within a 4-week interval. The discriminant validity was examined in comparing doctors' performance according to their reported EBM previous training. Proportion of agreement between both sessions of the questionnaire, Cohen's kappa and 'uniform kappa' determined its test-retest reliability. Results  The participation rate was 9.8%/7.1% to first/second session. Performance increased according to the level of doctors' previous training in EBM. The observed proportion of agreement between both sessions was over 70% for 14/19 questions, and the 'uniform kappa' was superior to 0.60 for 15/19 questions. Conclusion  The discriminant validity and test-retest reliability of the questionnaire were satisfying. The low participation rate did not prevent the study from achieving its aims.

Rules of origin : from analysis to reform

General Introduction This thesis can be divided into two main parts :the first one, corresponding to the first three chapters, studies Rules of Origin (RoOs) in Preferential Trade Agreements (PTAs); the second part -the fourth chapter- is concerned with Anti-Dumping (AD) measures. Despite wide-ranging preferential access granted to developing countries by industrial ones under North-South Trade Agreements -whether reciprocal, like the Europe Agreements (EAs) or NAFTA, or not, such as the GSP, AGOA, or EBA-, it has been claimed that the benefits from improved market access keep falling short of the full potential benefits. RoOs are largely regarded as a primary cause of the under-utilization of improved market access of PTAs. RoOs are the rules that determine the eligibility of goods to preferential treatment. Their economic justification is to prevent trade deflection, i.e. to prevent non-preferred exporters from using the tariff preferences. However, they are complex, cost raising and cumbersome, and can be manipulated by organised special interest groups. As a result, RoOs can restrain trade beyond what it is needed to prevent trade deflection and hence restrict market access in a statistically significant and quantitatively large proportion. Part l In order to further our understanding of the effects of RoOs in PTAs, the first chapter, written with Pr. Olivier Cadot, Celine Carrère and Pr. Jaime de Melo, describes and evaluates the RoOs governing EU and US PTAs. It draws on utilization-rate data for Mexican exports to the US in 2001 and on similar data for ACP exports to the EU in 2002. The paper makes two contributions. First, we construct an R-index of restrictiveness of RoOs along the lines first proposed by Estevadeordal (2000) for NAFTA, modifying it and extending it for the EU's single-list (SL). This synthetic R-index is then used to compare Roos under NAFTA and PANEURO. The two main findings of the chapter are as follows. First, it shows, in the case of PANEURO, that the R-index is useful to summarize how countries are differently affected by the same set of RoOs because of their different export baskets to the EU. Second, it is shown that the Rindex is a relatively reliable statistic in the sense that, subject to caveats, after controlling for the extent of tariff preference at the tariff-line level, it accounts for differences in utilization rates at the tariff line level. Finally, together with utilization rates, the index can be used to estimate total compliance costs of RoOs. The second chapter proposes a reform of preferential Roos with the aim of making them more transparent and less discriminatory. Such a reform would make preferential blocs more "cross-compatible" and would therefore facilitate cumulation. It would also contribute to move regionalism toward more openness and hence to make it more compatible with the multilateral trading system. It focuses on NAFTA, one of the most restrictive FTAs (see Estevadeordal and Suominen 2006), and proposes a way forward that is close in spirit to what the EU Commission is considering for the PANEURO system. In a nutshell, the idea is to replace the current array of RoOs by a single instrument- Maximum Foreign Content (MFC). An MFC is a conceptually clear and transparent instrument, like a tariff. Therefore changing all instruments into an MFC would bring improved transparency pretty much like the "tariffication" of NTBs. The methodology for this exercise is as follows: In step 1, I estimate the relationship between utilization rates, tariff preferences and RoOs. In step 2, I retrieve the estimates and invert the relationship to get a simulated MFC that gives, line by line, the same utilization rate as the old array of Roos. In step 3, I calculate the trade-weighted average of the simulated MFC across all lines to get an overall equivalent of the current system and explore the possibility of setting this unique instrument at a uniform rate across lines. This would have two advantages. First, like a uniform tariff, a uniform MFC would make it difficult for lobbies to manipulate the instrument at the margin. This argument is standard in the political-economy literature and has been used time and again in support of reductions in the variance of tariffs (together with standard welfare considerations). Second, uniformity across lines is the only way to eliminate the indirect source of discrimination alluded to earlier. Only if two countries face uniform RoOs and tariff preference will they face uniform incentives irrespective of their initial export structure. The result of this exercise is striking: the average simulated MFC is 25% of good value, a very low (i.e. restrictive) level, confirming Estevadeordal and Suominen's critical assessment of NAFTA's RoOs. Adopting a uniform MFC would imply a relaxation from the benchmark level for sectors like chemicals or textiles & apparel, and a stiffening for wood products, papers and base metals. Overall, however, the changes are not drastic, suggesting perhaps only moderate resistance to change from special interests. The third chapter of the thesis considers whether Europe Agreements of the EU, with the current sets of RoOs, could be the potential model for future EU-centered PTAs. First, I have studied and coded at the six-digit level of the Harmonised System (HS) .both the old RoOs -used before 1997- and the "Single list" Roos -used since 1997. Second, using a Constant Elasticity Transformation function where CEEC exporters smoothly mix sales between the EU and the rest of the world by comparing producer prices on each market, I have estimated the trade effects of the EU RoOs. The estimates suggest that much of the market access conferred by the EAs -outside sensitive sectors- was undone by the cost-raising effects of RoOs. The chapter also contains an analysis of the evolution of the CEECs' trade with the EU from post-communism to accession. Part II The last chapter of the thesis is concerned with anti-dumping, another trade-policy instrument having the effect of reducing market access. In 1995, the Uruguay Round introduced in the Anti-Dumping Agreement (ADA) a mandatory "sunset-review" clause (Article 11.3 ADA) under which anti-dumping measures should be reviewed no later than five years from their imposition and terminated unless there was a serious risk of resumption of injurious dumping. The last chapter, written with Pr. Olivier Cadot and Pr. Jaime de Melo, uses a new database on Anti-Dumping (AD) measures worldwide to assess whether the sunset-review agreement had any effect. The question we address is whether the WTO Agreement succeeded in imposing the discipline of a five-year cycle on AD measures and, ultimately, in curbing their length. Two methods are used; count data analysis and survival analysis. First, using Poisson and Negative Binomial regressions, the count of AD measures' revocations is regressed on (inter alia) the count of "initiations" lagged five years. The analysis yields a coefficient on measures' initiations lagged five years that is larger and more precisely estimated after the agreement than before, suggesting some effect. However the coefficient estimate is nowhere near the value that would give a one-for-one relationship between initiations and revocations after five years. We also find that (i) if the agreement affected EU AD practices, the effect went the wrong way, the five-year cycle being quantitatively weaker after the agreement than before; (ii) the agreement had no visible effect on the United States except for aone-time peak in 2000, suggesting a mopping-up of old cases. Second, the survival analysis of AD measures around the world suggests a shortening of their expected lifetime after the agreement, and this shortening effect (a downward shift in the survival function postagreement) was larger and more significant for measures targeted at WTO members than for those targeted at non-members (for which WTO disciplines do not bind), suggesting that compliance was de jure. A difference-in-differences Cox regression confirms this diagnosis: controlling for the countries imposing the measures, for the investigated countries and for the products' sector, we find a larger increase in the hazard rate of AD measures covered by the Agreement than for other measures.

Tasasähkön hyödyntämismahdollisuudet sähkönjakelussa

Tässä työssä on tutkittu tasasähkönsiirron tuomia mahdollisuuksia sähkönjakelussa, kun pienjännitedirektiivin pienjännitemäärittelyn soveltamista laajennetaan koskemaan vaihtojännitteen lisäksi myös tasajännitettä. Aiemmin tasasähköjärjestelmiä on käytetty ainoastaan sähköistymisen alkuaikoina 1900-luvun alussa. Viime vuosikymmeninä on sähkönjakelussa käytetty pelkästään vaihtosähköverkkoja, koska tehoelektronisten laitteiden korkea hintataso ja tekniset ominaisuudet ovat mahdollistaneet tasasähkön käytön vain suurjännitteellä. Suomalaisten sähkönkäyttö on lisääntynyt muutamalla prosenttiyksiköllä vuosittain ja kasvun taantumista ei ole odotettavissa lähiaikoina. Samaan aikaan yhteiskunta muuttuu jatkuvasti yhä riippuvaisemmaksi sähköstä ja odotukset toteutuvasta sähkönlaadusta ovat jatkuvasti korkeammat. Sähkönlaadun näkökulmasta ilmasto on tuonut aiempia suurempia haasteita sähkön toimitusvarmuudelle, kun myrskyjen aiheuttamat tuhot ovat olleet yhä entisiä suurempia. Toimitusvarmuuden parantamiseksi ovat muutamat vuosikymmenen alun rajut myrskyt johtaneet pohdintaan tulevien haasteiden hoitamiseksi ja edelleen uuden 3-portaiseen 20/1/0,4 kV vaihtosähköjärjestelmän kehittämiseen. Tasasähkönsiirron avulla halutaan tuoda käyttöön niitä hyötyjä, joita järjestelmän vaihdolla on saavutettavissa. Täysimääräisellä tasajännitteen hyödyntämisellä voidaan saavuttaa mm. aiempaa edullisempia investointivaihtoehtoja,parempi sähkönlaatu, parempi hajautetun tuotannon liitettävyys verkkoon ja erilaisten asiakaskohtaisten laitteiden helppo integroitavuus osaksi jakelujärjestelmää. Tämän työn puitteissa on pohdittu sekä teknisiä ratkaisuja että järjestelmän teknistaloudellista käyttöaluetta. Lisäksi on pyritty hahmottamaan eri tekijöiden vaikutuksia sähkönjakeluun.

Elinkaarikustannusten ja toimitusvarmuuden analysointi sähkönjakelun saneerausmenetelmille

Tässä työssä tutkitaan haja-asutusalueiden sähkönjakeluverkkojen kehittämistä. Kehityskohteiksi on valittu viisi tekniikkaa, 1000 V-järjestelmä, keskijännitejohtojen siirtäminen teiden varsille, PAS -johtojen käyttö, maakaapelointi sekä pylväskatkaisijan käyttö. Teoreettisen tarkastelun tavoitteena on määrittää reunaehdot tarkasteltavien tekniikoiden kannattavuudelle. Aiemmin keskijänniteverkko on rakennettu lähes poikkeuksetta avojohtona. Viime vuosien myrskyt sekä lumikuormat ovat häirinneet sähkönjakelua ja nostaneet painetta jakeluvarmuuden kasvattamiseksi. Tutkimuksessa haja-asutusalueiden sähkönjakeluverkon kehittämiseen etsitään teknillisesti sekä taloudellisesti kannattavia ratkaisumalleja. Kehittämisen tavoitteena on parantaa kuluttajien sähkön laatua ja toimitusvarmuutta. Tutkimuksessa käsitellään tarkasteltavia tekniikoita esimerkkikohteiden avulla, jotka on valittu Itä-Suomelle tyypillisiltä jakelualueilta. Kohteissa taloudellista kannattavuutta tutkitaan vertaamalla perinteistä saneeraamista tarkastelussa oleviin korvaaviin menetelmiin. Korvaavilla ratkaisuilla toimitusvarmuus paranee, mutta kannattavuus riippuu siirrettävästä tehosta, asiakasryhmien jakaumasta sekä saavutettavasta vikataajuuden muutoksesta.

Sähkönjakeluverkon käyttövarmuuden kehittäminen

Diplomityössä tutkitaan sähkönjakelun käyttövarmuutta parantavia investointeja ja menetelmiä. Lopputuloksena saadaan selville mitkä ratkaisut soveltuvat teknistaloudellisesti parhaiten Imatran Seudun Sähkön jakeluverkkoon. Menetelmien kannattavuutta on tutkittu ensisijaisesti keskeytyskustannussäästöjen näkökulmasta. Sähkönjakeluverkon käyttövarmuus on tullut nykyisessä yhteiskunnassa yhä tärkeämmäksi tekijäksi. Kaikki keskijänniteverkosta aiheutuneet keskeytykset on alettu ottaa tammikuusta 2008 lähtien huomioon verkkoliiketoiminnan kohtuullisen tuoton laskennassa. Toisaalta Suomen jakeluverkot ovat vanhoja, eikä niitä ole suunniteltu käyttövarmuuden kannalta. Tilannetta voidaan parantaa mm. lisäämällä verkkoon automaatiota sekä ottamalla käyttövarmuus huomioon saneerauksia suunniteltaessa. Sähkönjakeluverkon käyttövarmuuden parantaminen on pitkän aikavälin prosessi. Tutkittujen investointien kannattavuuksista on tehty herkkyysanalyysi, joka ottaa huomioon korkotason ja KAH-arvojen vaihtelut. Investointien todellista vaikutusta käyttövarmuuteen voidaan seurata vertaamalla tulevia vikatilastoja tässä työssä tehtyyn nykytilatutkimukseen.

Mäntsälän Sähkö Oy:n jakeluverkon kehittämissuunnitelma

Työn tavoitteena oli laatia Mäntsälän Sähkö Oy:n jakeluverkon kehittämissuunnitelma vuodelle 2020. Työn laadinta aloitettiin selvittämällä verkon nykytila ja käyttövarmuus korvaustilanteissa. Tämän jälkeen työssä paikannettiin alueet, joissa korvattavuuden parantaminen tai kuormituksien kasvaminen tulevaisuudessa edellyttää mittavia investointeja jakeluverkon käyttövarmuuden takaamiseksi. Työssä tarkastellaan yksityiskohtaisemmin Järvelän alueen käyttövarmuuden kehittämistä ja Hennan alueen kuormituksen kasvuun varautumista. Järvelän alueen käyttövarmuuden parantaminen edellyttää joko uutta sähköasemainvestointia tai 110 kV johdon rakentamista. Hennan alueen kuormituksen kasvu edellyttää, alueen kuormituksista riippuen, joko yhtä tai kahta uutta sähköasemainvestointia.

Keskijänniteverkon maakaapeloinnin kannattavuus

Tämän työn tavoitteena oli löytää tekijöitä jotka vaikuttavat keskijänniteverkon maakaapeloinnin kannattavuuteen. 1950–1970 luvuilla verkkoa rakennettiin halvimmalla mahdollisella tavalla, eikä sähkönjakelun luotettavuuteen kiinnitetty huomiota. Tämä tuo verkkoyhtiöille haasteen vanhoja verkkoja saneerattaessa, sillä keskeytyskustannusten arvostus on noussut merkittävään asemaan. Työssä tarkoituksena oli vertailla avojohdon sekä maakaapeloinnin elinkaarikustannuksia kahden erilaisen johtolähdön avulla. Toisella johtolähdöllä oli suuri julkinen kuorma ja toinen johtolähtö oli pitkä maaseutulähtö jolla esiintyi paljon vikoja. Työssä tarkastellaan myös sähkönjakeluverkon käyttövarmuutta ja maakaapeloinnin ominaisuuksia. Elinkaarikustannuksiin vaikuttavia tekijöitä olivat investointikustannukset, keskeytyskustannukset sekä ylläpitokustannukset. Tuloksista voidaan huomata, että keskeytyskustannuksilla voi olla joissain tapauksissa hyvinkin suuri vaikutus johtolähdön elinkaareen. Pitkillä ja pienitehoisilla johtolähdöillä keskeytyskustannusten merkitys pienenee, eikä kaapeloinnilla saavuteta yhtä suurta hyötyä kuin suuritehoisemmilla lähdöillä.

Renal dysfunction in patients with sickle cell anemia or sickle cell trait

Patients with sickle cell anemia (Hb SS) or sickle cell trait (Hb AS) may present several types of renal dysfunction; however, comparison of the prevalence of these abnormalities between these two groups and correlation with the duration of disease in a large number of patients have not been thoroughly investigated. In a cross-sectional study using immunoenzymometric assays to measure tubular proteinuria, microalbuminuria, measurement of creatinine clearance, urinary osmolality and analysis of urine sediment, we evaluated glomerular and tubular renal function in 106 adults and children with Hb SS (N = 66) or Hb AS (N = 40) with no renal failure (glomerular filtration rate (GFR) >85 ml/min). The percentage of individuals with microalbuminuria was higher among Hb SS than among Hb AS patients (30 vs 8%, P<0.0001). The prevalence of microhematuria was similar in both groups (26 vs 30%, respectively). Increased urinary levels of retinol-binding protein or ß2-microglobulin were detected in only 3 Hb SS and 2 Hb AS patients. Urinary osmolality was reduced in patients with Hb SS or with Hb AS; however, it was particularly evident in Hb SS patients older than 15 years (median = 393 mOsm/kg, range = 366-469) compared with Hb AS patients (median = 541 mOsm/kg, range = 406-722). Thus, in addition to the frequently reported early reduction of urinary osmolality and increased GFR, nondysmorphic hematuria was found in 26 and 30% of patients with Hb SS or Hb AS, respectively. Microalbuminuria is an important marker of glomerular injury in patients with Hb SS and may also be demonstrated in some Hb AS individuals. Significant proximal tubular dysfunction is not a common feature in Hb SS and Hb AS population at this stage of the disease (i.e., GFR >85 ml/min).