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Sample records for risk adjustment models

  1. Risk-adjusted performance evaluation in three academic thoracic surgery units using the Eurolung risk models.

    Science.gov (United States)

    Pompili, Cecilia; Shargall, Yaron; Decaluwe, Herbert; Moons, Johnny; Chari, Madhu; Brunelli, Alessandro

    2018-01-03

    The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality. This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 and 433 patients in Centre 3 who underwent anatomical lung resections were analysed. The Eurolung1 and Eurolung2 models were used to predict risk-adjusted cardiopulmonary morbidity and 30-day mortality rates. Observed and risk-adjusted outcomes were compared within each centre. The observed morbidity of Centre 1 was in line with the predicted morbidity (observed 21.1% vs predicted 22.7%, P = 0.31). Centre 2 performed better than expected (observed morbidity 20.2% vs predicted 26.7%, P models were successfully used as risk-adjusting instruments to internally audit the outcomes of 3 different centres, showing their applicability for future quality improvement initiatives. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?

    Science.gov (United States)

    Tsang, Victor T; Brown, Katherine L; Synnergren, Mats Johanssen; Kang, Nicholas; de Leval, Marc R; Gallivan, Steve; Utley, Martin

    2009-02-01

    Risk adjustment of outcomes in pediatric congenital heart surgery is challenging due to the great diversity in diagnoses and procedures. We have previously shown that variable life-adjusted display (VLAD) charts provide an effective graphic display of risk-adjusted outcomes in this specialty. A question arises as to whether the risk model used remains appropriate over time. We used a recently developed graphic technique to evaluate the performance of an existing risk model among those patients at a single center during 2000 to 2003 originally used in model development. We then compared the distribution of predicted risk among these patients with that among patients in 2004 to 2006. Finally, we constructed a VLAD chart of risk-adjusted outcomes for the latter period. Among 1083 patients between April 2000 and March 2003, the risk model performed well at predicted risks above 3%, underestimated mortality at 2% to 3% predicted risk, and overestimated mortality below 2% predicted risk. There was little difference in the distribution of predicted risk among these patients and among 903 patients between June 2004 and October 2006. Outcomes for the more recent period were appreciably better than those expected according to the risk model. This finding cannot be explained by any apparent bias in the risk model combined with changes in case-mix. Risk models can, and hopefully do, become out of date. There is scope for complacency in the risk-adjusted audit if the risk model used is not regularly recalibrated to reflect changing standards and expectations.

  3. Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

    Science.gov (United States)

    McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

    2016-08-01

    To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P ratio 3.30, P performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

  4. Conference Innovations in Derivatives Market : Fixed Income Modeling, Valuation Adjustments, Risk Management, and Regulation

    CERN Document Server

    Grbac, Zorana; Scherer, Matthias; Zagst, Rudi

    2016-01-01

    This book presents 20 peer-reviewed chapters on current aspects of derivatives markets and derivative pricing. The contributions, written by leading researchers in the field as well as experienced authors from the financial industry, present the state of the art in: • Modeling counterparty credit risk: credit valuation adjustment, debit valuation adjustment, funding valuation adjustment, and wrong way risk. • Pricing and hedging in fixed-income markets and multi-curve interest-rate modeling. • Recent developments concerning contingent convertible bonds, the measuring of basis spreads, and the modeling of implied correlations. The recent financial crisis has cast tremendous doubts on the classical view on derivative pricing. Now, counterparty credit risk and liquidity issues are integral aspects of a prudent valuation procedure and the reference interest rates are represented by a multitude of curves according to their different periods and maturities. A panel discussion included in the book (featuring D...

  5. Rational Multi-curve Models with Counterparty-risk Valuation Adjustments

    DEFF Research Database (Denmark)

    Crépey, Stéphane; Macrina, Andrea; Nguyen, Tuyet Mai

    2016-01-01

    We develop a multi-curve term structure set-up in which the modelling ingredients are expressed by rational functionals of Markov processes. We calibrate to London Interbank Offer Rate swaptions data and show that a rational two-factor log-normal multi-curve model is sufficient to match market da...... with regulatory obligations. In order to compute counterparty-risk valuation adjustments, such as credit valuation adjustment, we show how default intensity processes with rational form can be derived. We flesh out our study by applying the results to a basis swap contract....... with accuracy. We elucidate the relationship between the models developed and calibrated under a risk-neutral measure Q and their consistent equivalence class under the real-world probability measure P. The consistent P-pricing models are applied to compute the risk exposures which may be required to comply...

  6. Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer.

    Science.gov (United States)

    Fischer, C; Lingsma, H; Hardwick, R; Cromwell, D A; Steyerberg, E; Groene, O

    2016-01-01

    Outcomes for oesophagogastric cancer surgery are compared with the aim of benchmarking quality of care. Adjusting for patient characteristics is crucial to avoid biased comparisons between providers. The study objective was to develop a case-mix adjustment model for comparing 30- and 90-day mortality and anastomotic leakage rates after oesophagogastric cancer resections. The study reviewed existing models, considered expert opinion and examined audit data in order to select predictors that were consequently used to develop a case-mix adjustment model for the National Oesophago-Gastric Cancer Audit, covering England and Wales. Models were developed on patients undergoing surgical resection between April 2011 and March 2013 using logistic regression. Model calibration and discrimination was quantified using a bootstrap procedure. Most existing risk models for oesophagogastric resections were methodologically weak, outdated or based on detailed laboratory data that are not generally available. In 4882 patients with oesophagogastric cancer used for model development, 30- and 90-day mortality rates were 2·3 and 4·4 per cent respectively, and 6·2 per cent of patients developed an anastomotic leak. The internally validated models, based on predictors selected from the literature, showed moderate discrimination (area under the receiver operating characteristic (ROC) curve 0·646 for 30-day mortality, 0·664 for 90-day mortality and 0·587 for anastomotic leakage) and good calibration. Based on available data, three case-mix adjustment models for postoperative outcomes in patients undergoing curative surgery for oesophagogastric cancer were developed. These models should be used for risk adjustment when assessing hospital performance in the National Health Service, and tested in other large health systems. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  7. PACE and the Medicare+Choice risk-adjusted payment model.

    Science.gov (United States)

    Temkin-Greener, H; Meiners, M R; Gruenberg, L

    2001-01-01

    This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

  8. Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models.

    Science.gov (United States)

    Nicholl, Jon; Jacques, Richard M; Campbell, Michael J

    2013-10-29

    Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as "practically impossible", and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons.

  9. Improving Risk Adjustment for Mortality After Pediatric Cardiac Surgery: The UK PRAiS2 Model.

    Science.gov (United States)

    Rogers, Libby; Brown, Katherine L; Franklin, Rodney C; Ambler, Gareth; Anderson, David; Barron, David J; Crowe, Sonya; English, Kate; Stickley, John; Tibby, Shane; Tsang, Victor; Utley, Martin; Witter, Thomas; Pagel, Christina

    2017-07-01

    Partial Risk Adjustment in Surgery (PRAiS), a risk model for 30-day mortality after children's heart surgery, has been used by the UK National Congenital Heart Disease Audit to report expected risk-adjusted survival since 2013. This study aimed to improve the model by incorporating additional comorbidity and diagnostic information. The model development dataset was all procedures performed between 2009 and 2014 in all UK and Ireland congenital cardiac centers. The outcome measure was death within each 30-day surgical episode. Model development followed an iterative process of clinical discussion and development and assessment of models using logistic regression under 25 × 5 cross-validation. Performance was measured using Akaike information criterion, the area under the receiver-operating characteristic curve (AUC), and calibration. The final model was assessed in an external 2014 to 2015 validation dataset. The development dataset comprised 21,838 30-day surgical episodes, with 539 deaths (mortality, 2.5%). The validation dataset comprised 4,207 episodes, with 97 deaths (mortality, 2.3%). The updated risk model included 15 procedural, 11 diagnostic, and 4 comorbidity groupings, and nonlinear functions of age and weight. Performance under cross-validation was: median AUC of 0.83 (range, 0.82 to 0.83), median calibration slope and intercept of 0.92 (range, 0.64 to 1.25) and -0.23 (range, -1.08 to 0.85) respectively. In the validation dataset, the AUC was 0.86 (95% confidence interval [CI], 0.82 to 0.89), and the calibration slope and intercept were 1.01 (95% CI, 0.83 to 1.18) and 0.11 (95% CI, -0.45 to 0.67), respectively, showing excellent performance. A more sophisticated PRAiS2 risk model for UK use was developed with additional comorbidity and diagnostic information, alongside age and weight as nonlinear variables. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

    Science.gov (United States)

    Antioch, K M; Walsh, M K

    2002-01-01

    Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Probpayment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost Groups (DCGs) is a promising alternative classification system for capitation arrangements.

  11. Relevance of the c-statistic when evaluating risk-adjustment models in surgery.

    Science.gov (United States)

    Merkow, Ryan P; Hall, Bruce L; Cohen, Mark E; Dimick, Justin B; Wang, Edward; Chow, Warren B; Ko, Clifford Y; Bilimoria, Karl Y

    2012-05-01

    The measurement of hospital quality based on outcomes requires risk adjustment. The c-statistic is a popular tool used to judge model performance, but can be limited, particularly when evaluating specific operations in focused populations. Our objectives were to examine the interpretation and relevance of the c-statistic when used in models with increasingly similar case mix and to consider an alternative perspective on model calibration based on a graphical depiction of model fit. From the American College of Surgeons National Surgical Quality Improvement Program (2008-2009), patients were identified who underwent a general surgery procedure, and procedure groups were increasingly restricted: colorectal-all, colorectal-elective cases only, and colorectal-elective cancer cases only. Mortality and serious morbidity outcomes were evaluated using logistic regression-based risk adjustment, and model c-statistics and calibration curves were used to compare model performance. During the study period, 323,427 general, 47,605 colorectal-all, 39,860 colorectal-elective, and 21,680 colorectal cancer patients were studied. Mortality ranged from 1.0% in general surgery to 4.1% in the colorectal-all group, and serious morbidity ranged from 3.9% in general surgery to 12.4% in the colorectal-all procedural group. As case mix was restricted, c-statistics progressively declined from the general to the colorectal cancer surgery cohorts for both mortality and serious morbidity (mortality: 0.949 to 0.866; serious morbidity: 0.861 to 0.668). Calibration was evaluated graphically by examining predicted vs observed number of events over risk deciles. For both mortality and serious morbidity, there was no qualitative difference in calibration identified between the procedure groups. In the present study, we demonstrate how the c-statistic can become less informative and, in certain circumstances, can lead to incorrect model-based conclusions, as case mix is restricted and patients become

  12. The New York Sepsis Severity Score: Development of a Risk-Adjusted Severity Model for Sepsis.

    Science.gov (United States)

    Phillips, Gary S; Osborn, Tiffany M; Terry, Kathleen M; Gesten, Foster; Levy, Mitchell M; Lemeshow, Stanley

    2018-05-01

    In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. Retrospective evaluation of prospectively collected data. Data from 43,204 severe sepsis and septic shock patients from 179 hospitals across New York State were evaluated. Prospective data were submitted to a database from January 1, 2015, to December 31, 2015. None. Maximum likelihood logistic regression was used to estimate model coefficients used in the New York State risk model. The mortality probability was estimated using a logistic regression model. Variables to be included in the model were determined as part of the model-building process. Interactions between variables were included if they made clinical sense and if their p values were less than 0.05. Model development used a random sample of 90% of available patients and was validated using the remaining 10%. Hosmer-Lemeshow goodness of fit p values were considerably greater than 0.05, suggesting good calibration. Areas under the receiver operator curve in the developmental and validation subsets were 0.770 (95% CI, 0.765-0.775) and 0.773 (95% CI, 0.758-0.787), respectively, indicating good discrimination. Development and validation datasets had similar distributions of estimated mortality probabilities. Mortality increased with rising age, comorbidities, and lactate. The New York Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination. This sepsis-specific model provides an accurate, comprehensive method for standardized mortality comparison of adult

  13. A Comparative Study of CAPM and Seven Factors Risk Adjusted Return Model

    Directory of Open Access Journals (Sweden)

    Madiha Riaz Bhatti

    2014-12-01

    Full Text Available This study is a comparison and contrast of the predictive powers of two asset pricing models: CAPM and seven factor risk-return adjusted model, to explain the cross section of stock rate of returns in the financial sector listed at Karachi Stock Exchange (KSE. To test the models daily returns from January 2013 to February 2014 have been taken and the excess returns of portfolios are regressed on explanatory variables. The results of the tested models indicate that the models are valid and applicable in the financial market of Pakistan during the period under study, as the intercepts are not significantly different from zero. It is consequently established from the findings that all the explanatory variables explain the stock returns in the financial sector of KSE. In addition, the results of this study show that addition of more explanatory variables to the single factor CAPM results in reasonably high values of R2. These results provide substantial support to fund managers, investors and financial analysts in making investment decisions.

  14. A Proportional Hazards Regression Model for the Subdistribution with Covariates-adjusted Censoring Weight for Competing Risks Data

    DEFF Research Database (Denmark)

    He, Peng; Eriksson, Frank; Scheike, Thomas H.

    2016-01-01

    function by fitting the Cox model for the censoring distribution and using the predictive probability for each individual. Our simulation study shows that the covariate-adjusted weight estimator is basically unbiased when the censoring time depends on the covariates, and the covariate-adjusted weight......With competing risks data, one often needs to assess the treatment and covariate effects on the cumulative incidence function. Fine and Gray proposed a proportional hazards regression model for the subdistribution of a competing risk with the assumption that the censoring distribution...... and the covariates are independent. Covariate-dependent censoring sometimes occurs in medical studies. In this paper, we study the proportional hazards regression model for the subdistribution of a competing risk with proper adjustments for covariate-dependent censoring. We consider a covariate-adjusted weight...

  15. Risk adjustment model of credit life insurance using a genetic algorithm

    Science.gov (United States)

    Saputra, A.; Sukono; Rusyaman, E.

    2018-03-01

    In managing the risk of credit life insurance, insurance company should acknowledge the character of the risks to predict future losses. Risk characteristics can be learned in a claim distribution model. There are two standard approaches in designing the distribution model of claims over the insurance period i.e, collective risk model and individual risk model. In the collective risk model, the claim arises when risk occurs is called individual claim, accumulation of individual claim during a period of insurance is called an aggregate claim. The aggregate claim model may be formed by large model and a number of individual claims. How the measurement of insurance risk with the premium model approach and whether this approach is appropriate for estimating the potential losses occur in the future. In order to solve the problem Genetic Algorithm with Roulette Wheel Selection is used.

  16. Development and Validation of Perioperative Risk-Adjustment Models for Hip Fracture Repair, Total Hip Arthroplasty, and Total Knee Arthroplasty.

    Science.gov (United States)

    Schilling, Peter L; Bozic, Kevin J

    2016-01-06

    Comparing outcomes across providers requires risk-adjustment models that account for differences in case mix. The burden of data collection from the clinical record can make risk-adjusted outcomes difficult to measure. The purpose of this study was to develop risk-adjustment models for hip fracture repair (HFR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) that weigh adequacy of risk adjustment against data-collection burden. We used data from the American College of Surgeons National Surgical Quality Improvement Program to create derivation cohorts for HFR (n = 7000), THA (n = 17,336), and TKA (n = 28,661). We developed logistic regression models for each procedure using age, sex, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, laboratory values, and vital signs-based comorbidities as covariates, and validated the models with use of data from 2012. The derivation models' C-statistics for mortality were 80%, 81%, 75%, and 92% and for adverse events were 68%, 68%, 60%, and 70% for HFR, THA, TKA, and combined procedure cohorts. Age, sex, and ASA classification accounted for a large share of the explained variation in mortality (50%, 58%, 70%, and 67%) and adverse events (43%, 45%, 46%, and 68%). For THA and TKA, these three variables were nearly as predictive as models utilizing all covariates. HFR model discrimination improved with the addition of comorbidities and laboratory values; among the important covariates were functional status, low albumin, high creatinine, disseminated cancer, dyspnea, and body mass index. Model performance was similar in validation cohorts. Risk-adjustment models using data from health records demonstrated good discrimination and calibration for HFR, THA, and TKA. It is possible to provide adequate risk adjustment using only the most predictive variables commonly available within the clinical record. This finding helps to inform the trade-off between model performance and data

  17. A comparative evaluation of risk-adjustment models for benchmarking amputation-free survival after lower extremity bypass.

    Science.gov (United States)

    Simons, Jessica P; Goodney, Philip P; Flahive, Julie; Hoel, Andrew W; Hallett, John W; Kraiss, Larry W; Schanzer, Andres

    2016-04-01

    Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB). We used the national Society for Vascular Surgery Vascular Quality Initiative (VQI) database (2003-2012) to assess the performance of three previously validated risk-adjustment models for AFS. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), Finland National Vascular (FINNVASC) registry, and the modified Project of Ex-vivo vein graft Engineering via Transfection III (PREVENT III [mPIII]) risk scores were applied to the VQI cohort. A novel model for 1-year AFS was also derived using the VQI data set and externally validated using the PIII data set. The relative discrimination (Harrell c-index) and calibration (Hosmer-May goodness-of-fit test) of each model were compared. Among 7754 patients in the VQI who underwent LEB for critical limb ischemia, the AFS was 74% at 1 year. Each of the previously published models for AFS demonstrated similar discriminative performance: c-indices for BASIL, FINNVASC, mPIII were 0.66, 0.60, and 0.64, respectively. The novel VQI-derived model had improved discriminative ability with a c-index of 0.71 and appropriate generalizability on external validation with a c-index of 0.68. The model was well calibrated in both the VQI and PIII data sets (goodness of fit P = not significant). Currently available prediction models for AFS after LEB perform modestly when applied to national contemporary VQI data. Moreover, the performance of each model was inferior to that of the novel VQI-derived model

  18. Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study.

    Science.gov (United States)

    McLawhorn, Alexander S; Schairer, William W; Schwarzkopf, Ran; Halsey, David A; Iorio, Richard; Padgett, Douglas E

    2017-12-06

    For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database. Conversion and primary THA patients were matched 1:1 using propensity scores, based on preoperative covariates. Multivariable logistic regressions evaluated associations between conversion THA and 30-day outcomes. A total of 2018 conversions were matched to 2018 primaries. There were no differences in preoperative covariates. Conversions had longer operative times (148 vs 95 minutes, P reimbursement models shift toward bundled payment paradigms, conversion THA appears to be a procedure for which risk adjustment is appropriate. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Convexity Adjustments for ATS Models

    DEFF Research Database (Denmark)

    Murgoci, Agatha; Gaspar, Raquel M.

    . As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...

  20. Risk-adjusted econometric model to estimate postoperative costs: an additional instrument for monitoring performance after major lung resection.

    Science.gov (United States)

    Brunelli, Alessandro; Salati, Michele; Refai, Majed; Xiumé, Francesco; Rocco, Gaetano; Sabbatini, Armando

    2007-09-01

    The objectives of this study were to develop a risk-adjusted model to estimate individual postoperative costs after major lung resection and to use it for internal economic audit. Variable and fixed hospital costs were collected for 679 consecutive patients who underwent major lung resection from January 2000 through October 2006 at our unit. Several preoperative variables were used to develop a risk-adjusted econometric model from all patients operated on during the period 2000 through 2003 by a stepwise multiple regression analysis (validated by bootstrap). The model was then used to estimate the postoperative costs in the patients operated on during the 3 subsequent periods (years 2004, 2005, and 2006). Observed and predicted costs were then compared within each period by the Wilcoxon signed rank test. Multiple regression and bootstrap analysis yielded the following model predicting postoperative cost: 11,078 + 1340.3X (age > 70 years) + 1927.8X cardiac comorbidity - 95X ppoFEV1%. No differences between predicted and observed costs were noted in the first 2 periods analyzed (year 2004, $6188.40 vs $6241.40, P = .3; year 2005, $6308.60 vs $6483.60, P = .4), whereas in the most recent period (2006) observed costs were significantly lower than the predicted ones ($3457.30 vs $6162.70, P model may be used as a methodologic template for economic audit in our specialty and complement more traditional outcome measures in the assessment of performance.

  1. The HHS-HCC Risk Adjustment Model for Individual and Small

    Data.gov (United States)

    U.S. Department of Health & Human Services — Volume 4, Issue 3 of the Medicare and Medicaid Research Review includes three articles describing the Department of Health and Human Services (HHS) developed risk...

  2. 42 CFR 422.310 - Risk adjustment data.

    Science.gov (United States)

    2010-10-01

    ... that are used in the development and application of a risk adjustment payment model. (b) Data... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... risk adjustment factors used to adjust payments, as required under §§ 422.304(a) and (c). CMS also may...

  3. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

    Science.gov (United States)

    Brunelli, Alessandro; Tentzeris, Vasileios; Sandri, Alberto; McKenna, Alexandra; Liew, Shan Liung; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

    2016-05-01

    To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  4. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

    Directory of Open Access Journals (Sweden)

    Weiner Jonathan P

    2010-01-01

    Full Text Available Abstract Background Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. Methods A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234, while those in both 2002 and 2003 were included for prospective analyses (n = 164,562. Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. Results The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster. When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Conclusions Given the

  5. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

    Science.gov (United States)

    Chang, Hsien-Yen; Weiner, Jonathan P

    2010-01-18

    Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

  6. The relationship between the C-statistic of a risk-adjustment model and the accuracy of hospital report cards: a Monte Carlo Study.

    Science.gov (United States)

    Austin, Peter C; Reeves, Mathew J

    2013-03-01

    Hospital report cards, in which outcomes following the provision of medical or surgical care are compared across health care providers, are being published with increasing frequency. Essential to the production of these reports is risk-adjustment, which allows investigators to account for differences in the distribution of patient illness severity across different hospitals. Logistic regression models are frequently used for risk adjustment in hospital report cards. Many applied researchers use the c-statistic (equivalent to the area under the receiver operating characteristic curve) of the logistic regression model as a measure of the credibility and accuracy of hospital report cards. To determine the relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards. Monte Carlo simulations were used to examine this issue. We examined the influence of 3 factors on the accuracy of hospital report cards: the c-statistic of the logistic regression model used for risk adjustment, the number of hospitals, and the number of patients treated at each hospital. The parameters used to generate the simulated datasets came from analyses of patients hospitalized with a diagnosis of acute myocardial infarction in Ontario, Canada. The c-statistic of the risk-adjustment model had, at most, a very modest impact on the accuracy of hospital report cards, whereas the number of patients treated at each hospital had a much greater impact. The c-statistic of a risk-adjustment model should not be used to assess the accuracy of a hospital report card.

  7. Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

    Directory of Open Access Journals (Sweden)

    SONG Yingchun

    2015-02-01

    Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

  8. Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

    Science.gov (United States)

    Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

    2006-08-01

    We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

  9. Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables.

    Science.gov (United States)

    Colais, Paola; Fantini, Maria P; Fusco, Danilo; Carretta, Elisa; Stivanello, Elisa; Lenzi, Jacopo; Pieri, Giulia; Perucci, Carlo A

    2012-06-21

    Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). The TGCS classification is useful for inter-hospital comparison of CS section rates, but

  10. Underwriters' view of risk - An adjuster's perspective

    International Nuclear Information System (INIS)

    Smith, M.

    1992-01-01

    This paper reviews how a risk assessment is performed by an insurance adjuster to determine rates and insurability of a client. It provides a historical perspective on insurance and how information systems are used to monitor past claims to determine future risk. Although this paper does not specifically address the oil and gas industry, it is informative in identifying how insurance rates are determined and risk assessments for various oil and gas operations are performed

  11. Premium adjustment: actuarial analysis on epidemiological models ...

    African Journals Online (AJOL)

    In this paper, we analyse insurance premium adjustment in the context of an epidemiological model where the insurer's future financial liability is greater than the premium from patients. In this situation, it becomes extremely difficult for the insurer since a negative reserve would severely increase its risk of insolvency, ...

  12. Risk-adjustment models for heart failure patients' 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record.

    Science.gov (United States)

    Lenzi, Jacopo; Avaldi, Vera Maria; Hernandez-Boussard, Tina; Descovich, Carlo; Castaldini, Ilaria; Urbinati, Stefano; Di Pasquale, Giuseppe; Rucci, Paola; Fantini, Maria Pia

    2016-09-06

    Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure. This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC). A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08). We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.

  13. Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

    Science.gov (United States)

    Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

    1996-01-01

    Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

  14. A typology of interpartner conflict and maternal parenting practices in high-risk families: examining spillover and compensatory models and implications for child adjustment.

    Science.gov (United States)

    Sturge-Apple, Melissa L; Davies, Patrick T; Cicchetti, Dante; Fittoria, Michael G

    2014-11-01

    The present study incorporates a person-based approach to identify spillover and compartmentalization patterns of interpartner conflict and maternal parenting practices in an ethnically diverse sample of 192 2-year-old children and their mothers who had experienced higher levels of socioeconomic risk. In addition, we tested whether sociocontextual variables were differentially predictive of theses profiles and examined how interpartner-parenting profiles were associated with children's physiological and psychological adjustment over time. As expected, latent class analyses extracted three primary profiles of functioning: adequate functioning, spillover, and compartmentalizing families. Furthermore, interpartner-parenting profiles were differentially associated with both sociocontextual predictors and children's adjustment trajectories. The findings highlight the developmental utility of incorporating person-based approaches to models of interpartner conflict and maternal parenting practices.

  15. Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

    Science.gov (United States)

    Brown, Katherine L; Rogers, Libby; Barron, David J; Tsang, Victor; Anderson, David; Tibby, Shane; Witter, Thomas; Stickley, John; Crowe, Sonya; English, Kate; Franklin, Rodney C; Pagel, Christina

    2017-07-01

    When considering early survival rates after pediatric cardiac surgery it is essential to adjust for risk linked to case complexity. An important but previously less well understood component of case mix complexity is comorbidity. The National Congenital Heart Disease Audit data representing all pediatric cardiac surgery procedures undertaken in the United Kingdom and Ireland between 2009 and 2014 was used to develop and test groupings for comorbidity and additional non-procedure-based risk factors within a risk adjustment model for 30-day mortality. A mixture of expert consensus based opinion and empiric statistical analyses were used to define and test the new comorbidity groups. The study dataset consisted of 21,838 pediatric cardiac surgical procedure episodes in 18,834 patients with 539 deaths (raw 30-day mortality rate, 2.5%). In addition to surgical procedure type, primary cardiac diagnosis, univentricular status, age, weight, procedure type (bypass, nonbypass, or hybrid), and era, the new risk factor groups of non-Down congenital anomalies, acquired comorbidities, increased severity of illness indicators (eg, preoperative mechanical ventilation or circulatory support) and additional cardiac risk factors (eg, heart muscle conditions and raised pulmonary arterial pressure) all independently increased the risk of operative mortality. In an era of low mortality rates across a wide range of operations, non-procedure-based risk factors form a vital element of risk adjustment and their presence leads to wide variations in the predicted risk of a given operation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    Science.gov (United States)

    Ellis, Randall P.; Fernandez, Juan Gabriel

    2013-01-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  17. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    Directory of Open Access Journals (Sweden)

    Randall P. Ellis

    2013-10-01

    Full Text Available Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems.

  18. Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

    Science.gov (United States)

    Smith, Timothy W; Baron, Carolynne E; Grove, Jeremy L

    2014-12-01

    A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease. © 2013 Wiley Periodicals, Inc.

  19. Risk adjusted financial costs of photovoltaics

    Energy Technology Data Exchange (ETDEWEB)

    Szabo, Sandor; Jaeger-Waldau, Arnulf [Joint Research Centre, Institute for Energy, Via E. Fermi 2749, I-21020 Ispra (Italy); Szabo, Laszlo [Joint Research Centre, Institute for Prospective Technological Studies C. Inca Garcilaso, 3. E-41092 Sevilla (Spain)

    2010-07-15

    Recent research shows significant differences in the levelised photovoltaics (PV) electricity cost calculations. The present paper points out that no unique or absolute cost figure can be justified, the correct solution is to use a range of cost figures that is determined in a dynamic power portfolio interaction within the financial scheme, support mechanism and industry cost reduction. The paper draws attention to the increasing role of financial investors in the PV segment of the renewable energy market and the importance they attribute to the risks of all options in the power generation portfolio. Based on these trends, a former version of a financing model is adapted to project the energy mix changes in the EU electricity market due to investors behaviour with different risk tolerance/aversion. The dynamic process of translating these risks into the return expectation in the financial appraisal and investment decision making is also introduced. By doing so, the paper sets up a potential electricity market trend with the associated risk perception and classification. The necessary risk mitigation tasks for all stakeholders in the PV market are summarised which aims to avoid the burden of excessive risk premiums in this market segment. (author)

  20. Risk adjusted financial costs of photovoltaics

    International Nuclear Information System (INIS)

    Szabo, Sandor; Jaeger-Waldau, Arnulf; Szabo, Laszlo

    2010-01-01

    Recent research shows significant differences in the levelised photovoltaics (PV) electricity cost calculations. The present paper points out that no unique or absolute cost figure can be justified, the correct solution is to use a range of cost figures that is determined in a dynamic power portfolio interaction within the financial scheme, support mechanism and industry cost reduction. The paper draws attention to the increasing role of financial investors in the PV segment of the renewable energy market and the importance they attribute to the risks of all options in the power generation portfolio. Based on these trends, a former version of a financing model is adapted to project the energy mix changes in the EU electricity market due to investors behaviour with different risk tolerance/aversion. The dynamic process of translating these risks into the return expectation in the financial appraisal and investment decision making is also introduced. By doing so, the paper sets up a potential electricity market trend with the associated risk perception and classification. The necessary risk mitigation tasks for all stakeholders in the PV market are summarised which aims to avoid the burden of excessive risk premiums in this market segment.

  1. Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information

    NARCIS (Netherlands)

    L.M. Lamers (Leida)

    1999-01-01

    textabstractOBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness

  2. Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

    Science.gov (United States)

    Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

    2004-01-01

    This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

  3. Competition Leverage : How the Demand Side Affects Optimal Risk Adjustment

    NARCIS (Netherlands)

    Bijlsma, M.; Boone, J.; Zwart, Gijsbert

    2011-01-01

    We study optimal risk adjustment in imperfectly competitive health insurance markets when high-risk consumers are less likely to switch insurer than low-risk consumers. First, we find that insurers still have an incentive to select even if risk adjustment perfectly corrects for cost differences

  4. Adjustment or updating of models

    Indian Academy of Sciences (India)

    25, Part 3, June 2000, pp. 235±245 ... While the model is defined in terms of these spatial parameters, ... discussed in terms of `model order' with concern focused on whether or not the ..... In other words, it is not easy to justify what the required.

  5. Ants avoid superinfections by performing risk-adjusted sanitary care.

    Science.gov (United States)

    Konrad, Matthias; Pull, Christopher D; Metzler, Sina; Seif, Katharina; Naderlinger, Elisabeth; Grasse, Anna V; Cremer, Sylvia

    2018-03-13

    Being cared for when sick is a benefit of sociality that can reduce disease and improve survival of group members. However, individuals providing care risk contracting infectious diseases themselves. If they contract a low pathogen dose, they may develop low-level infections that do not cause disease but still affect host immunity by either decreasing or increasing the host's vulnerability to subsequent infections. Caring for contagious individuals can thus significantly alter the future disease susceptibility of caregivers. Using ants and their fungal pathogens as a model system, we tested if the altered disease susceptibility of experienced caregivers, in turn, affects their expression of sanitary care behavior. We found that low-level infections contracted during sanitary care had protective or neutral effects on secondary exposure to the same (homologous) pathogen but consistently caused high mortality on superinfection with a different (heterologous) pathogen. In response to this risk, the ants selectively adjusted the expression of their sanitary care. Specifically, the ants performed less grooming and more antimicrobial disinfection when caring for nestmates contaminated with heterologous pathogens compared with homologous ones. By modulating the components of sanitary care in this way the ants acquired less infectious particles of the heterologous pathogens, resulting in reduced superinfection. The performance of risk-adjusted sanitary care reveals the remarkable capacity of ants to react to changes in their disease susceptibility, according to their own infection history and to flexibly adjust collective care to individual risk.

  6. The bystander effect model of Brenner and Sachs fitted to lung cancer data in 11 cohorts of underground miners, and equivalence of fit of a linear relative risk model with adjustment for attained age and age at exposure

    International Nuclear Information System (INIS)

    Little, M P

    2004-01-01

    Bystander effects following exposure to α-particles have been observed in many experimental systems, and imply that linearly extrapolating low dose risks from high dose data might materially underestimate risk. Brenner and Sachs (2002 Int. J. Radiat. Biol. 78 593-604; 2003 Health Phys. 85 103-8) have recently proposed a model of the bystander effect which they use to explain the inverse dose rate effect observed for lung cancer in underground miners exposed to radon daughters. In this paper we fit the model of the bystander effect proposed by Brenner and Sachs to 11 cohorts of underground miners, taking account of the covariance structure of the data and the period of latency between the development of the first pre-malignant cell and clinically overt cancer. We also fitted a simple linear relative risk model, with adjustment for age at exposure and attained age. The methods that we use for fitting both models are different from those used by Brenner and Sachs, in particular taking account of the covariance structure, which they did not, and omitting certain unjustifiable adjustments to the miner data. The fit of the original model of Brenner and Sachs (with 0 y period of latency) is generally poor, although it is much improved by assuming a 5 or 6 y period of latency from the first appearance of a pre-malignant cell to cancer. The fit of this latter model is equivalent to that of a linear relative risk model with adjustment for age at exposure and attained age. In particular, both models are capable of describing the observed inverse dose rate effect in this data set

  7. INSTITUTIONAL OWNERSHIP LEVEL AND RISK-ADJUSTED RETURN

    OpenAIRE

    Isaiah, Chioma; Li, Meng (Emma)

    2017-01-01

    This paper examines the relationship between the level of institutional ownership andrisk-adjusted return on stocks. We find a significant positive relationship between the level ofinstitutional ownership on a stock and its risk-adjusted return. This result holds both in the longrun and in shorter time periods. Our findings suggest that all things being equal, it is possible toobtain risk-adjusted return by going short on the stocks with low institutional ownership andgoing long on those with...

  8. Adjustment model of thermoluminescence experimental data

    International Nuclear Information System (INIS)

    Moreno y Moreno, A.; Moreno B, A.

    2002-01-01

    This model adjusts the experimental results for thermoluminescence according to the equation: I (T) = I (a i * exp (-1/b i * (T-C i )) where: a i , b i , c i are the i-Th peak adjusted to a gaussian curve. The adjustments of the curve can be operated manual or analytically using the macro function and the solver.xla complement installed previously in the computational system. In this work it is shown: 1. The information of experimental data from a LiF curve obtained from the Physics Institute of UNAM which the data adjustment model is operated in the macro type. 2. A LiF curve of four peaks obtained from Harshaw information simulated in Microsoft Excel, discussed in previous works, as a reference not in macro. (Author)

  9. [Factors affecting in-hospital mortality in patients with sepsis: Development of a risk-adjusted model based on administrative data from German hospitals].

    Science.gov (United States)

    König, Volker; Kolzter, Olaf; Albuszies, Gerd; Thölen, Frank

    2018-05-01

    Inpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis. The analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases). Following the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R 2 value=0.27), which is an excellent result. The CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals

  10. Risk-adjusted capitation: recent experiences in The Netherlands.

    Science.gov (United States)

    van de Ven, W P; van Vliet, R C; van Barneveld, E M; Lamers, L M

    1994-01-01

    The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.

  11. ACA Risk Adjustment - Overview, Context, and Challenges

    Data.gov (United States)

    U.S. Department of Health & Human Services — Volume 4, Issue 3 of the Medicare and Medicaid Research Review includes three articles describing the Department of Health and Human Services (HHS) developed risk...

  12. Extendable linearised adjustment model for deformation analysis

    NARCIS (Netherlands)

    Hiddo Velsink

    2015-01-01

    Author supplied: "This paper gives a linearised adjustment model for the affine, similarity and congruence transformations in 3D that is easily extendable with other parameters to describe deformations. The model considers all coordinates stochastic. Full positive semi-definite covariance matrices

  13. Extendable linearised adjustment model for deformation analysis

    NARCIS (Netherlands)

    Velsink, H.

    2015-01-01

    This paper gives a linearised adjustment model for the affine, similarity and congruence transformations in 3D that is easily extendable with other parameters to describe deformations. The model considers all coordinates stochastic. Full positive semi-definite covariance matrices and correlation

  14. The Persistence of Risk-Adjusted Mutual Fund Performance.

    OpenAIRE

    Elton, Edwin J; Gruber, Martin J; Blake, Christopher R

    1996-01-01

    The authors examine predictability for stock mutual funds using risk-adjusted returns. They find that past performance is predictive of future risk-adjusted performance. Applying modern portfolio theory techniques to past data improves selection and allows the authors to construct a portfolio of funds that significantly outperforms a rule based on past rank alone. In addition, they can form a combination of actively managed portfolios with the same risk as a portfolio of index funds but with ...

  15. Inappropriate use of payment weights to risk adjust readmission rates.

    Science.gov (United States)

    Fuller, Richard L; Goldfield, Norbert I; Averill, Richard F; Hughes, John S

    2012-01-01

    In this article, the authors demonstrate that the use of relative weights, as incorporated within the National Quality Forum-endorsed PacifiCare readmission measure, is inappropriate for risk adjusting rates of hospital readmission.

  16. Risk-adjusted payment and performance assessment for primary care.

    Science.gov (United States)

    Ash, Arlene S; Ellis, Randall P

    2012-08-01

    Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients. Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R(2)'s at patient and practice levels, and within policy-relevant subgroups. The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R(2)'s of 47% versus 5% for predicting "prescriptions for antibiotics of concern." Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.

  17. Belgium: risk adjustment and financial responsibility in a centralised system.

    Science.gov (United States)

    Schokkaert, Erik; Van de Voorde, Carine

    2003-07-01

    Since 1995 Belgian sickness funds are partially financed through a risk adjustment system and are held partially financially responsible for the difference between their actual and their risk-adjusted expenditures. However, they did not get the necessary instruments for exerting a real influence on expenditures and the health insurance market has not been opened for new entrants. At the same time the sickness funds have powerful tools for risk selection, because they also dominate the market for supplementary health insurance. The present risk-adjustment system is based on the results of a regression analysis with aggregate data. The main proclaimed purpose of this system is to guarantee a fair treatment to all the sickness funds. Until now the danger of risk selection has not been taken seriously. Consumer mobility has remained rather low. However, since the degree of financial responsibility is programmed to increase in the near future, the potential profits from cream skimming will increase.

  18. OPEC model : adjustment or new model

    International Nuclear Information System (INIS)

    Ayoub, A.

    1994-01-01

    Since the early eighties, the international oil industry went through major changes : new financial markets, reintegration, opening of the upstream, liberalization of investments, privatization. This article provides answers to two major questions : what are the reasons for these changes ? ; do these changes announce the replacement of OPEC model by a new model in which state intervention is weaker and national companies more autonomous. This would imply a profound change of political and institutional systems of oil producing countries. (Author)

  19. A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

    Science.gov (United States)

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

    Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

  20. A Machine Learning Framework for Plan Payment Risk Adjustment.

    Science.gov (United States)

    Rose, Sherri

    2016-12-01

    To introduce cross-validation and a nonparametric machine learning framework for plan payment risk adjustment and then assess whether they have the potential to improve risk adjustment. 2011-2012 Truven MarketScan database. We compare the performance of multiple statistical approaches within a broad machine learning framework for estimation of risk adjustment formulas. Total annual expenditure was predicted using age, sex, geography, inpatient diagnoses, and hierarchical condition category variables. The methods included regression, penalized regression, decision trees, neural networks, and an ensemble super learner, all in concert with screening algorithms that reduce the set of variables considered. The performance of these methods was compared based on cross-validated R 2 . Our results indicate that a simplified risk adjustment formula selected via this nonparametric framework maintains much of the efficiency of a traditional larger formula. The ensemble approach also outperformed classical regression and all other algorithms studied. The implementation of cross-validated machine learning techniques provides novel insight into risk adjustment estimation, possibly allowing for a simplified formula, thereby reducing incentives for increased coding intensity as well as the ability of insurers to "game" the system with aggressive diagnostic upcoding. © Health Research and Educational Trust.

  1. Can rent adjustment clauses reduce the income risk of farms?

    OpenAIRE

    Hotopp, Henning; Mußhoff, Oliver

    2012-01-01

    Risk management is gaining importance in agriculture. In addition to traditional instruments, new risk management instruments are increasingly being proposed. These proposals include the rent adjustment clauses (RACs), which seem to be an unusual instrument at first sight. In contrast with conventional instruments, RACs intentionally allow fixed-cost ‘rent payments’ to fluctuate. We investigate the whole-farm risk reduction potential of different types of RACs via a historical simulation....

  2. Diagnostic Risk Adjustment for Medicaid: The Disability Payment System

    Science.gov (United States)

    Kronick, Richard; Dreyfus, Tony; Lee, Lora; Zhou, Zhiyuan

    1996-01-01

    This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored. PMID:10172665

  3. Risk-adjusted hospital outcomes for children's surgery.

    Science.gov (United States)

    Saito, Jacqueline M; Chen, Li Ern; Hall, Bruce L; Kraemer, Kari; Barnhart, Douglas C; Byrd, Claudia; Cohen, Mark E; Fei, Chunyuan; Heiss, Kurt F; Huffman, Kristopher; Ko, Clifford Y; Latus, Melissa; Meara, John G; Oldham, Keith T; Raval, Mehul V; Richards, Karen E; Shah, Rahul K; Sutton, Laura C; Vinocur, Charles D; Moss, R Lawrence

    2013-09-01

    BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in

  4. Evaluating intergenerational risks: Probabillity adjusted rank-discounted utilitarianism

    OpenAIRE

    Asheim, Geir B.; Zuber, Stéphane

    2015-01-01

    Climate policies have stochastic consequences that involve a great number of generations. This calls for evaluating social risk (what kind of societies will future people be born into) rather than individual risk (what will happen to people during their own lifetimes). As a response we propose and axiomatize probability adjusted rank-discounted critical-level generalized utilitarianism (PARDCLU), through a key axiom that requires that the social welfare order both be ethical and satisfy first...

  5. Risk-adjusted capitation: Recent experiences in the Netherlands

    NARCIS (Netherlands)

    W.P.M.M. van de Ven (Wynand); R.C.J.A. van Vliet (René); E.M. van Barneveld (Erik); L.M. Lamers (Leida)

    1994-01-01

    textabstractThe market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the

  6. Risk-adjusted capitation: recent experiences in The Netherlands

    NARCIS (Netherlands)

    W.P.M.M. van de Ven (Wynand); E.M. van Barneveld (Erik); L.M. Lamers (Leida); R.C.J.A. van Vliet (René)

    1994-01-01

    textabstractThe market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that

  7. Portfolio balancing and risk adjusted values under constrained budget conditions

    International Nuclear Information System (INIS)

    MacKay, J.A.; Lerche, I.

    1996-01-01

    For a given hydrocarbon exploration opportunity, the influences of value, cost, success probability and corporate risk tolerance provide an optimal working interest that should be taken in the opportunity in order to maximize the risk adjusted value. When several opportunities are available, but when the total budget is insufficient to take optimal working interest in each, an analytic procedure is given for optimizing the risk adjusted value of the total portfolio; the relevant working interests are also derived based on a cost exposure constraint. Several numerical illustrations are provided to exhibit the use of the method under different budget conditions, and with different numbers of available opportunities. When value, cost, success probability, and risk tolerance are uncertain for each and every opportunity, the procedure is generalized to allow determination of probable optimal risk adjusted value for the total portfolio and, at the same time, the range of probable working interest that should be taken in each opportunity is also provided. The result is that the computations of portfolio balancing can be done quickly in either deterministic or probabilistic manners on a small calculator, thereby providing rapid assessments of opportunities and their worth to a corporation. (Author)

  8. Spatial implications of covariate adjustment on patterns of risk

    DEFF Research Database (Denmark)

    Sabel, Clive Eric; Wilson, Jeff Gaines; Kingham, Simon

    2007-01-01

    Epidemiological studies that examine the relationship between environmental exposures and health often address other determinants of health that may influence the relationship being studied by adjusting for these factors as covariates. While disease surveillance methods routinely control...... for covariates such as deprivation, there has been limited investigative work on the spatial movement of risk at the intraurban scale due to the adjustment. It is important that the nature of any spatial relocation be well understood as a relocation to areas of increased risk may also introduce additional...... localised factors that influence the exposure-response relationship. This paper examines the spatial patterns of relative risk and clusters of hospitalisations based on an illustrative small-area example from Christchurch, New Zealand. A four-stage test of the spatial relocation effects of covariate...

  9. A comparison of internal versus external risk-adjustment for monitoring clinical outcomes

    NARCIS (Netherlands)

    Koetsier, Antonie; de Keizer, Nicolette; Peek, Niels

    2011-01-01

    Internal and external prognostic models can be used to calculate severity of illness adjusted mortality risks. However, it is unclear what the consequences are of using an external model instead of an internal model when monitoring an institution's clinical performance. Theoretically, using an

  10. The high-density lipoprotein-adjusted SCORE model worsens SCORE-based risk classification in a contemporary population of 30 824 Europeans

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Afzal, Shoaib; Nordestgaard, Børge G

    2015-01-01

    .8 years of follow-up, 339 individuals died of CVD. In the SCORE target population (age 40-65; n = 30,824), fewer individuals were at baseline categorized as high risk (≥5% 10-year risk of fatal CVD) using SCORE-HDL compared with SCORE (10 vs. 17% in men, 1 vs. 3% in women). SCORE-HDL did not improve...... with SCORE, but deteriorated risk classification based on NRI. Future guidelines should consider lower decision thresholds and prioritize CVD morbidity and people above age 65....

  11. Risk adjustment and the fear of markets: the case of Belgium.

    Science.gov (United States)

    Schokkaert, E; Van de Voorde, C

    2000-02-01

    In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.

  12. Model Risk in Portfolio Optimization

    Directory of Open Access Journals (Sweden)

    David Stefanovits

    2014-08-01

    Full Text Available We consider a one-period portfolio optimization problem under model uncertainty. For this purpose, we introduce a measure of model risk. We derive analytical results for this measure of model risk in the mean-variance problem assuming we have observations drawn from a normal variance mixture model. This model allows for heavy tails, tail dependence and leptokurtosis of marginals. The results show that mean-variance optimization is seriously compromised by model uncertainty, in particular, for non-Gaussian data and small sample sizes. To mitigate these shortcomings, we propose a method to adjust the sample covariance matrix in order to reduce model risk.

  13. Measurement Of Shariah Stock Performance Using Risk Adjusted Performance

    Directory of Open Access Journals (Sweden)

    Zuhairan Y Yunan

    2015-03-01

    Full Text Available The aim of this research is to analyze the shariah stock performance using risk adjusted performance method. There are three parameters to measure the stock performance i.e. Sharpe, Treynor, and Jensen. This performance’s measurements calculate the return and risk factor from shariah stocks. The data that used on this research is using the data of stocks at Jakarta Islamic Index. Sampling method that used on this paper is purposive sampling. This research is using ten companies as a sample. The result shows that from three parameters, the stock that have a best performance are AALI, ANTM, ASII, CPIN, INDF, KLBF, LSIP, and UNTR.DOI: 10.15408/aiq.v7i1.1364

  14. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

    Science.gov (United States)

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-04-01

    When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

  15. Health-based risk adjustment: is inpatient and outpatient diagnostic information sufficient?

    Science.gov (United States)

    Lamers, L M

    Adequate risk adjustment is critical to the success of market-oriented health care reforms in many countries. Currently used risk adjusters based on demographic and diagnostic cost groups (DCGs) do not reflect expected costs accurately. This study examines the simultaneous predictive accuracy of inpatient and outpatient morbidity measures and prior costs. DCGs, pharmacy cost groups (PCGs), and prior year's costs improve the predictive accuracy of the demographic model substantially. DCGs and PCGs seem complementary in their ability to predict future costs. However, this study shows that the combination of DCGs and PCGs still leaves room for cream skimming.

  16. Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment.

    Science.gov (United States)

    Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung

    2010-07-01

    Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.

  17. Assessing At-Risk Youth Using the Reynolds Adolescent Adjustment Screening Inventory with a Latino Population

    Science.gov (United States)

    Balkin, Richard S.; Cavazos, Javier, Jr.; Hernandez, Arthur E.; Garcia, Roberto; Dominguez, Denise L.; Valarezo, Alexandra

    2013-01-01

    Factor analyses were conducted on scores from the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) representing at-risk Latino youth. The 4-factor model of the RAASI did not exhibit a good fit. However, evidence of generalizability for Latino youth was noted. (Contains 3 tables.)

  18. Player Modeling for Intelligent Difficulty Adjustment

    Science.gov (United States)

    Missura, Olana; Gärtner, Thomas

    In this paper we aim at automatically adjusting the difficulty of computer games by clustering players into different types and supervised prediction of the type from short traces of gameplay. An important ingredient of video games is to challenge players by providing them with tasks of appropriate and increasing difficulty. How this difficulty should be chosen and increase over time strongly depends on the ability, experience, perception and learning curve of each individual player. It is a subjective parameter that is very difficult to set. Wrong choices can easily lead to players stopping to play the game as they get bored (if underburdened) or frustrated (if overburdened). An ideal game should be able to adjust its difficulty dynamically governed by the player’s performance. Modern video games utilise a game-testing process to investigate among other factors the perceived difficulty for a multitude of players. In this paper, we investigate how machine learning techniques can be used for automatic difficulty adjustment. Our experiments confirm the potential of machine learning in this application.

  19. A risk adjustment approach to estimating the burden of skin disease in the United States.

    Science.gov (United States)

    Lim, Henry W; Collins, Scott A B; Resneck, Jack S; Bolognia, Jean; Hodge, Julie A; Rohrer, Thomas A; Van Beek, Marta J; Margolis, David J; Sober, Arthur J; Weinstock, Martin A; Nerenz, David R; Begolka, Wendy Smith; Moyano, Jose V

    2018-01-01

    Direct insurance claims tabulation and risk adjustment statistical methods can be used to estimate health care costs associated with various diseases. In this third manuscript derived from the new national Burden of Skin Disease Report from the American Academy of Dermatology, a risk adjustment method that was based on modeling the average annual costs of individuals with or without specific diseases, and specifically tailored for 24 skin disease categories, was used to estimate the economic burden of skin disease. The results were compared with the claims tabulation method used in the first 2 parts of this project. The risk adjustment method estimated the direct health care costs of skin diseases to be $46 billion in 2013, approximately $15 billion less than estimates using claims tabulation. For individual skin diseases, the risk adjustment cost estimates ranged from 11% to 297% of those obtained using claims tabulation for the 10 most costly skin disease categories. Although either method may be used for purposes of estimating the costs of skin disease, the choice of method will affect the end result. These findings serve as an important reference for future discussions about the method chosen in health care payment models to estimate both the cost of skin disease and the potential cost impact of care changes. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  20. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Science.gov (United States)

    2010-01-01

    ...) The bank must have a risk control unit that reports directly to senior management and is independent... management systems at least annually. (c) Market risk factors. The bank's internal model must use risk.... Section 4. Internal Models (a) General. For risk-based capital purposes, a bank subject to this appendix...

  1. Evidence that Risk Adjustment is Unnecessary in Estimates of the User Cost of Money

    Directory of Open Access Journals (Sweden)

    Diego A. Restrepo-Tobón

    2015-12-01

    Full Text Available Investors value the  special attributes of monetary assets (e.g.,  exchangeability, liquidity, and safety  and pay a premium for holding them in the form of a lower return rate. The user cost of holding monetary assets can be measured approximately by the difference between the  returns on illiquid risky assets and  those of safer liquid assets. A more appropriate measure should adjust this difference by the  differential risk of the  assets in question. We investigate the  impact that time  non-separable preferences has on the  estimation of the  risk-adjusted user cost of money. Using U.K. data from 1965Q1 to 2011Q1, we estimate a habit-based asset pricing model  with money  in the utility function and  find that the  risk  adjustment for risky monetary assets is negligible. Thus, researchers can dispense with risk adjusting the  user cost of money  in constructing monetary aggregate indexes.

  2. Risk-adjusted survival after tissue versus mechanical aortic valve replacement: a 23-year assessment.

    Science.gov (United States)

    Gaca, Jeffrey G; Clare, Robert M; Rankin, J Scott; Daneshmand, Mani A; Milano, Carmelo A; Hughes, G Chad; Wolfe, Walter G; Glower, Donald D; Smith, Peter K

    2013-11-01

    Detailed analyses of risk-adjusted outcomes after mitral valve surgery have documented significant survival decrements with tissue valves at any age. Several recent studies of prosthetic aortic valve replacement (AVR) also have suggested a poorer performance of tissue valves, although analyses have been limited to small matched series. The study aim was to test the hypothesis that AVR with tissue valves is associated with a lower risk-adjusted survival, as compared to mechanical valves. Between 1986 and 2009, primary isolated AVR, with or without coronary artery bypass grafting (CABG), was performed with currently available valve types in 2148 patients (1108 tissue valves, 1040 mechanical). Patients were selected for tissue valves to be used primarily in the elderly. Baseline and operative characteristics were documented prospectively with a consistent variable set over the entire 23-year period. Follow up was obtained with mailed questionnaires, supplemented by National Death Index searches. The average time to death or follow up was seven years, and follow up for survival was 96.2% complete. Risk-adjusted survival characteristics for the two groups were evaluated using a Cox proportional hazards model with stepwise selection of candidate variables. Differences in baseline characteristics between groups were (tissue versus mechanical): median age 73 versus 61 years; non-elective surgery 32% versus 28%; CABG 45% versus 35%; median ejection fraction 55% versus 55%; renal failure 6% versus 1%; diabetes 18% versus 7% (pvalves; however, after risk adjustment for the adverse profiles of tissue valve patients, no significant difference was observed in survival after tissue or mechanical AVR. Thus, the hypothesis did not hold, and risk-adjusted survival was equivalent, of course qualified by the fact that selection bias was evident. With selection criteria that employed tissue AVR more frequently in elderly patients, tissue and mechanical valves achieved similar survival

  3. Risk selection and risk adjustment: improving insurance in the individual and small group markets.

    Science.gov (United States)

    Baicker, Katherine; Dow, William H

    2009-01-01

    Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.

  4. Methodological aspects of journaling a dynamic adjusting entry model

    Directory of Open Access Journals (Sweden)

    Vlasta Kašparovská

    2011-01-01

    Full Text Available This paper expands the discussion of the importance and function of adjusting entries for loan receivables. Discussion of the cyclical development of adjusting entries, their negative impact on the business cycle and potential solutions has intensified during the financial crisis. These discussions are still ongoing and continue to be relevant to members of the professional public, banking regulators and representatives of international accounting institutions. The objective of this paper is to evaluate a method of journaling dynamic adjusting entries under current accounting law. It also expresses the authors’ opinions on the potential for consistently implementing basic accounting principles in journaling adjusting entries for loan receivables under a dynamic model.

  5. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

    Science.gov (United States)

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-01-01

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  6. Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

    Science.gov (United States)

    Antioch, K; Walsh, M

    2000-01-01

    This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

  7. The Impact of Capital Structure on Economic Capital and Risk Adjusted Performance

    OpenAIRE

    Porteous, Bruce; Tapadar, Pradip

    2008-01-01

    The impact that capital structure and capital asset allocation have on financial services firm economic capital and risk adjusted performance is considered. A stochastic modelling approach is used in conjunction with banking and insurance examples. It is demonstrated that gearing up Tier 1 capital with Tier 2 capital can be in the interests of bank Tier 1 capital providers, but may not always be so for insurance Tier 1 capital providers. It is also shown that, by allocating a bank or insuranc...

  8. State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

    Science.gov (United States)

    Paul, David A; Mackley, Amy; Locke, Robert G; Stefano, John L; Kroelinger, Charlan

    2009-05-01

    To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are

  9. 12 CFR 615.5210 - Risk-adjusted assets.

    Science.gov (United States)

    2010-01-01

    ... appropriate credit conversion factor in § 615.5212, is assigned to one of the risk categories specified in... risk-based capital requirement for the credit-enhanced assets, the risk-based capital required under..., determine the appropriate risk weight for any asset or credit equivalent amount that does not fit wholly...

  10. Risk-adjusted scoring systems in colorectal surgery.

    Science.gov (United States)

    Leung, Edmund; McArdle, Kirsten; Wong, Ling S

    2011-01-01

    Consequent to recent advances in surgical techniques and management, survival rate has increased substantially over the last 25 years, particularly in colorectal cancer patients. However, post-operative morbidity and mortality from colorectal cancer vary widely across the country. Therefore, standardised outcome measures are emphasised not only for professional accountability, but also for comparison between treatment units and regions. In a heterogeneous population, the use of crude mortality as an outcome measure for patients undergoing surgery is simply misleading. Meaningful comparisons, however, require accurate risk stratification of patients being analysed before conclusions can be reached regarding the outcomes recorded. Sub-specialised colorectal surgical units usually dedicated to more complex and high-risk operations. The need for accurate risk prediction is necessary in these units as both mortality and morbidity often are tools to justify the practice of high-risk surgery. The Acute Physiology And Chronic Health Evaluation (APACHE) is a system for classifying patients in the intensive care unit. However, APACHE score was considered too complex for general surgical use. The American Society of Anaesthesiologists (ASA) grade has been considered useful as an adjunct to informed consent and for monitoring surgical performance through time. ASA grade is simple but too subjective. The Physiological & Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and its variant Portsmouth POSSUM (P-POSSUM) were devised to predict outcomes in surgical patients in general, taking into account of the variables in the case-mix. POSSUM has two parts, which include assessment of physiological parameters and operative scores. There are 12 physiological parameters and 6 operative measures. The physiological parameters are taken at the time of surgery. Each physiological parameter or operative variable is sub-divided into three or four levels with

  11. Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients.

    Science.gov (United States)

    Delahanty, Ryan J; Kaufman, David; Jones, Spencer S

    2018-06-01

    Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes. One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare. A cohort of 237,173 ICU patients discharged between January 2014 and December 2016. The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set. Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms. Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death

  12. New ventures require accurate risk analyses and adjustments.

    Science.gov (United States)

    Eastaugh, S R

    2000-01-01

    For new business ventures to succeed, healthcare executives need to conduct robust risk analyses and develop new approaches to balance risk and return. Risk analysis involves examination of objective risks and harder-to-quantify subjective risks. Mathematical principles applied to investment portfolios also can be applied to a portfolio of departments or strategic business units within an organization. The ideal business investment would have a high expected return and a low standard deviation. Nonetheless, both conservative and speculative strategies should be considered in determining an organization's optimal service line and helping the organization manage risk.

  13. Storm Water Management Model Climate Adjustment Tool (SWMM-CAT)

    Science.gov (United States)

    The US EPA’s newest tool, the Stormwater Management Model (SWMM) – Climate Adjustment Tool (CAT) is meant to help municipal stormwater utilities better address potential climate change impacts affecting their operations. SWMM, first released in 1971, models hydrology and hydrauli...

  14. Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

    Science.gov (United States)

    Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

    2018-02-21

    The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p reimbursement (p reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that

  15. R.M. Solow Adjusted Model of Economic Growth

    Directory of Open Access Journals (Sweden)

    Ion Gh. Rosca

    2007-05-01

    Full Text Available Besides the models of M. Keynes, R.F. Harrod, E. Domar, D. Romer, Ramsey-Cass-Koopmans etc., the R.M. Solow model is part of the category which characterizes the economic growth. The paper proposes the study of the R.M. Solow adjusted model of economic growth, while the adjustment consisting in the model adaptation to the Romanian economic characteristics. The article is the first one from a three paper series dedicated to the macroeconomic modelling theme, using the R.M. Solow model, such as: “Measurement of the economic growth and extensions of the R.M. Solow adjusted model” and “Evolution scenarios at the Romanian economy level using the R.M. Solow adjusted model”. The analysis part of the model is based on the study of the equilibrium to the continuous case with some interpretations of the discreet one, by using the state diagram. The optimization problem at the economic level is also used; it is built up of a specified number of representative consumers and firms in order to reveal the interaction between these elements.

  16. Health plans and selection: formal risk adjustment vs. market design and contracts.

    Science.gov (United States)

    Frank, R G; Rosenthal, M B

    2001-01-01

    In this paper, we explore the demand for risk adjustment by health plans that contract with private employers by considering the conditions under which plans might value risk adjustment. Three factors reduce the value of risk adjustment from the plans' point of view. First, only a relatively small segment of privately insured Americans face a choice of competing health plans. Second, health plans share much of their insurance risk with payers, providers, and reinsurers. Third, de facto experience rating that occurs during the premium negotiation process and management of coverage appear to substitute for risk adjustment. While the current environment has not generated much demand for risk adjustment, we reflect on its future potential.

  17. Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

    Science.gov (United States)

    Martsolf, Grant R; Barrett, Marguerite L; Weiss, Audrey J; Kandrack, Ryan; Washington, Raynard; Steiner, Claudia A; Mehrotra, Ateev; SooHoo, Nelson F; Coffey, Rosanna

    2016-08-17

    Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods. Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals. Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting. Prognostic Level III. See instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  18. Parenting Stress, Mental Health, Dyadic Adjustment: A Structural Equation Model

    Directory of Open Access Journals (Sweden)

    Luca Rollè

    2017-05-01

    Full Text Available Objective: In the 1st year of the post-partum period, parenting stress, mental health, and dyadic adjustment are important for the wellbeing of both parents and the child. However, there are few studies that analyze the relationship among these three dimensions. The aim of this study is to investigate the relationships between parenting stress, mental health (depressive and anxiety symptoms, and dyadic adjustment among first-time parents.Method: We studied 268 parents (134 couples of healthy babies. At 12 months post-partum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Post-natal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Structural equation modeling was used to analyze the potential mediating effects of mental health on the relationship between parenting stress and dyadic adjustment.Results: Results showed the full mediation effect of mental health between parenting stress and dyadic adjustment. A multi-group analysis further found that the paths did not differ across mothers and fathers.Discussion: The results suggest that mental health is an important dimension that mediates the relationship between parenting stress and dyadic adjustment in the transition to parenthood.

  19. Do insurers respond to risk adjustment? A long-term, nationwide analysis from Switzerland.

    Science.gov (United States)

    von Wyl, Viktor; Beck, Konstantin

    2016-03-01

    Community rating in social health insurance calls for risk adjustment in order to eliminate incentives for risk selection. Swiss risk adjustment is known to be insufficient, and substantial risk selection incentives remain. This study develops five indicators to monitor residual risk selection. Three indicators target activities of conglomerates of insurers (with the same ownership), which steer enrollees into specific carriers based on applicants' risk profiles. As a proxy for their market power, those indicators estimate the amount of premium-, health care cost-, and risk-adjustment transfer variability that is attributable to conglomerates. Two additional indicators, derived from linear regression, describe the amount of residual cost differences between insurers that are not covered by risk adjustment. All indicators measuring conglomerate-based risk selection activities showed increases between 1996 and 2009, paralleling the establishment of new conglomerates. At their maxima in 2009, the indicator values imply that 56% of the net risk adjustment volume, 34% of premium variability, and 51% cost variability in the market were attributable to conglomerates. From 2010 onwards, all indicators decreased, coinciding with a pre-announced risk adjustment reform implemented in 2012. Likewise, the regression-based indicators suggest that the volume and variance of residual cost differences between insurers that are not equaled out by risk adjustment have decreased markedly since 2009 as a result of the latest reform. Our analysis demonstrates that risk-selection, especially by conglomerates, is a real phenomenon in Switzerland. However, insurers seem to have reduced risk selection activities to optimize their losses and gains from the latest risk adjustment reform.

  20. One idea of portfolio risk control for absolute return strategy risk adjustments by signals from correlation behavior

    Science.gov (United States)

    Nishiyama, N.

    2001-12-01

    Absolute return strategy provided from fund of funds (FOFs) investment schemes is the focus in Japanese Financial Community. FOFs investment mainly consists of hedge fund investment and it has two major characteristics which are low correlation against benchmark index and little impact from various external changes in the environment given maximizing return. According to the historical track record of survival hedge funds in this business world, they maintain a stable high return and low risk. However, one must keep in mind that low risk would not be equal to risk free. The failure of Long-term capital management (LTCM) that took place in the summer of 1998 was a symbolized phenomenon. The summer of 1998 exhibited a certain limitation of traditional value at risk (VaR) and some possibility that traditional VaR could be ineffectual to the nonlinear type of fluctuation in the market. In this paper, I try to bring self-organized criticality (SOC) into portfolio risk control. SOC would be well known as a model of decay in the natural world. I analyzed nonlinear type of fluctuation in the market as SOC and applied SOC to capture complicated market movement using threshold point of SOC and risk adjustments by scenario correlation as implicit signals. Threshold becomes the control parameter of risk exposure to set downside floor and forecast extreme nonlinear type of fluctuation under a certain probability. Simulation results would show synergy effect of portfolio risk control between SOC and absolute return strategy.

  1. The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

    Science.gov (United States)

    Antioch, Kathryn M; Walsh, Michael K

    2004-06-01

    Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

  2. Latino risk-adjusted mortality in the men screened for the Multiple Risk Factor Intervention Trial.

    Science.gov (United States)

    Thomas, Avis J; Eberly, Lynn E; Neaton, James D; Smith, George Davey

    2005-09-15

    Latinos are now the largest minority in the United States, but their distinctive health needs and mortality patterns remain poorly understood. Proportional hazards regressions were used to compare Latino versus White risk- and income-adjusted mortality over 25 years' follow-up from 5,846 Latino and 300,647 White men screened for the Multiple Risk Factor Intervention Trial. Men were aged 35-57 years and residing in 14 states when screened in 1973-1975. Data on coronary heart disease risk factors, self-reported race/ethnicity, and home addresses were obtained at baseline; income was estimated by linking addresses to census data. Mortality follow-up through 1999 was obtained using the National Death Index. The fully adjusted Latino/White hazard ratio for all-cause mortality was 0.82 (95% confidence interval (CI): 0.77, 0.87), based on 1,085 Latino and 73,807 White deaths; this pattern prevailed over time and across states (thus, likely across Latino subgroups). Hazard ratios were significantly greater than one for stroke (hazard ratio = 1.30, 95% CI: 1.01, 1.68), liver cancer (hazard ratio = 2.02, 95% CI: 1.21, 3.37), and infection (hazard ratio = 1.69, 95% CI: 1.24, 2.32). A substudy found only minor racial/ethnic differences in the quality of Social Security numbers, birth dates, soundex-adjusted names, and National Death Index searches. Results were not likely an artifact of return migration or incomplete mortality data.

  3. Aqua/Aura Updated Inclination Adjust Maneuver Performance Prediction Model

    Science.gov (United States)

    Boone, Spencer

    2017-01-01

    This presentation will discuss the updated Inclination Adjust Maneuver (IAM) performance prediction model that was developed for Aqua and Aura following the 2017 IAM series. This updated model uses statistical regression methods to identify potential long-term trends in maneuver parameters, yielding improved predictions when re-planning past maneuvers. The presentation has been reviewed and approved by Eric Moyer, ESMO Deputy Project Manager.

  4. On Modeling Risk Shocks

    OpenAIRE

    Dorofeenko, Victor; Lee, Gabriel; Salyer, Kevin; Strobel, Johannes

    2016-01-01

    Within the context of a financial accelerator model, we model time-varying uncertainty (i.e. risk shocks) through the use of a mixture Normal model with time variation in the weights applied to the underlying distributions characterizing entrepreneur productivity. Specifically, we model capital producers (i.e. the entrepreneurs) as either low-risk (relatively small second moment for productivity) and high-risk (relatively large second moment for productivity) and the fraction of both types is...

  5. Ensemble of trees approaches to risk adjustment for evaluating a hospital's performance.

    Science.gov (United States)

    Liu, Yang; Traskin, Mikhail; Lorch, Scott A; George, Edward I; Small, Dylan

    2015-03-01

    A commonly used method for evaluating a hospital's performance on an outcome is to compare the hospital's observed outcome rate to the hospital's expected outcome rate given its patient (case) mix and service. The process of calculating the hospital's expected outcome rate given its patient mix and service is called risk adjustment (Iezzoni 1997). Risk adjustment is critical for accurately evaluating and comparing hospitals' performances since we would not want to unfairly penalize a hospital just because it treats sicker patients. The key to risk adjustment is accurately estimating the probability of an Outcome given patient characteristics. For cases with binary outcomes, the method that is commonly used in risk adjustment is logistic regression. In this paper, we consider ensemble of trees methods as alternatives for risk adjustment, including random forests and Bayesian additive regression trees (BART). Both random forests and BART are modern machine learning methods that have been shown recently to have excellent performance for prediction of outcomes in many settings. We apply these methods to carry out risk adjustment for the performance of neonatal intensive care units (NICU). We show that these ensemble of trees methods outperform logistic regression in predicting mortality among babies treated in NICU, and provide a superior method of risk adjustment compared to logistic regression.

  6. The risk-adjusted performance of companies with female directors: A South African case

    Directory of Open Access Journals (Sweden)

    Mkhethwa Mkhize

    2013-04-01

    Full Text Available The objective of this research was to examine the effects of female directors on the risk-adjusted performance of firms listed on the JSE Securities Exchange of South Africa (the JSE. The theoretical underpinning for the relationship between representation of female directors and the risk-adjusted performance of companies was based on institutional theory. The hypothesis that there is no difference between the risk-adjusted performance of companies with female directors and that of companies without female directors was rejected. Implications of the results are discussed and suggestions for future research presented.

  7. Quantile uncertainty and value-at-risk model risk.

    Science.gov (United States)

    Alexander, Carol; Sarabia, José María

    2012-08-01

    This article develops a methodology for quantifying model risk in quantile risk estimates. The application of quantile estimates to risk assessment has become common practice in many disciplines, including hydrology, climate change, statistical process control, insurance and actuarial science, and the uncertainty surrounding these estimates has long been recognized. Our work is particularly important in finance, where quantile estimates (called Value-at-Risk) have been the cornerstone of banking risk management since the mid 1980s. A recent amendment to the Basel II Accord recommends additional market risk capital to cover all sources of "model risk" in the estimation of these quantiles. We provide a novel and elegant framework whereby quantile estimates are adjusted for model risk, relative to a benchmark which represents the state of knowledge of the authority that is responsible for model risk. A simulation experiment in which the degree of model risk is controlled illustrates how to quantify Value-at-Risk model risk and compute the required regulatory capital add-on for banks. An empirical example based on real data shows how the methodology can be put into practice, using only two time series (daily Value-at-Risk and daily profit and loss) from a large bank. We conclude with a discussion of potential applications to nonfinancial risks. © 2012 Society for Risk Analysis.

  8. Modeling wind adjustment factor and midflame wind speed for Rothermel's surface fire spread model

    Science.gov (United States)

    Patricia L. Andrews

    2012-01-01

    Rothermel's surface fire spread model was developed to use a value for the wind speed that affects surface fire, called midflame wind speed. Models have been developed to adjust 20-ft wind speed to midflame wind speed for sheltered and unsheltered surface fuel. In this report, Wind Adjustment Factor (WAF) model equations are given, and the BehavePlus fire modeling...

  9. Use of surveillance data for prevention of healthcare-associated infection: risk adjustment and reporting dilemmas.

    LENUS (Irish Health Repository)

    O'Neill, Eoghan

    2009-08-01

    Healthcare-associated or nosocomial infection (HCAI) is of increasing importance to healthcare providers and the public. Surveillance is crucial but must be adjusted for risk, especially when used for interhospital comparisons or for public reporting.

  10. A simple signaling rule for variable life-adjusted display derived from an equivalent risk-adjusted CUSUM chart.

    Science.gov (United States)

    Wittenberg, Philipp; Gan, Fah Fatt; Knoth, Sven

    2018-04-17

    The variable life-adjusted display (VLAD) is the first risk-adjusted graphical procedure proposed in the literature for monitoring the performance of a surgeon. It displays the cumulative sum of expected minus observed deaths. It has since become highly popular because the statistic plotted is easy to understand. But it is also easy to misinterpret a surgeon's performance by utilizing the VLAD, potentially leading to grave consequences. The problem of misinterpretation is essentially caused by the variance of the VLAD's statistic that increases with sample size. In order for the VLAD to be truly useful, a simple signaling rule is desperately needed. Various forms of signaling rules have been developed, but they are usually quite complicated. Without signaling rules, making inferences using the VLAD alone is difficult if not misleading. In this paper, we establish an equivalence between a VLAD with V-mask and a risk-adjusted cumulative sum (RA-CUSUM) chart based on the difference between the estimated probability of death and surgical outcome. Average run length analysis based on simulation shows that this particular RA-CUSUM chart has similar performance as compared to the established RA-CUSUM chart based on the log-likelihood ratio statistic obtained by testing the odds ratio of death. We provide a simple design procedure for determining the V-mask parameters based on a resampling approach. Resampling from a real data set ensures that these parameters can be estimated appropriately. Finally, we illustrate the monitoring of a real surgeon's performance using VLAD with V-mask. Copyright © 2018 John Wiley & Sons, Ltd.

  11. Reliability of risk-adjusted outcomes for profiling hospital surgical quality.

    Science.gov (United States)

    Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

    2014-05-01

    Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures, it is unclear whether these outcomes reliably reflect hospital performance. To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program, 2009. Participants included all patients (N = 55,466) who underwent colon resection, pancreatic resection, laparoscopic gastric bypass, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass. Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0-1 scale: 0, completely unreliable; and 1, perfectly reliable) for all 3 outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70, good reliability; and >0.50, fair reliability) for each outcome. For overall morbidity, the most common outcome studied, the mean reliability depended on sample size (ie, how high the hospital caseload was) and the event rate (ie, how frequently the outcome occurred). For example, mean reliability for overall morbidity was low for abdominal aortic aneurysm repair (reliability, 0.29; sample size, 25 cases per year; and event rate, 18.3%). In contrast, mean reliability for overall morbidity was higher for colon resection (reliability, 0.61; sample size, 114 cases per year; and event rate, 26.8%). Colon resection (37.7% of hospitals), pancreatic resection (7.1% of hospitals), and laparoscopic gastric bypass (11.5% of hospitals) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their mean

  12. Performance of Comorbidity, Risk Adjustment, and Functional Status Measures in Expenditure Prediction for Patients With Diabetes

    OpenAIRE

    Maciejewski, Matthew L.; Liu, Chuan-Fen; Fihn, Stephan D.

    2009-01-01

    OBJECTIVE?To compare the ability of generic comorbidity and risk adjustment measures, a diabetes-specific measure, and a self-reported functional status measure to explain variation in health care expenditures for individuals with diabetes. RESEARCH DESIGN AND METHODS?This study included a retrospective cohort of 3,092 diabetic veterans participating in a multisite trial. Two comorbidity measures, four risk adjusters, a functional status measure, a diabetes complication count, and baseline ex...

  13. Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) MMSA Age-adjusted Prevalence Data (2011 to Present)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2011 to present. BRFSS SMART MMSA age-adjusted prevalence combined land line and cell phone data. The Selected Metropolitan Area Risk Trends (SMART) project uses the...

  14. [Risk adjusted assessment of quality of perinatal centers - results of perinatal/neonatal quality surveillance in Saxonia].

    Science.gov (United States)

    Koch, R; Gmyrek, D; Vogtmann, Ch

    2005-12-01

    The weak point of the country-wide perinatal/neonatal quality surveillance as a tool for evaluation of achievements of a distinct clinic, is the ignorance of interhospital differences in the case-mix of patients. Therefore, that approach can not result in a reliable bench marking. To adjust the results of quality assessment of different hospitals according to their risk profile of patients by multivariate analysis. The perinatal/neonatal data base of 12.783 newborns of the saxonian quality surveillance from 1998 to 2000 was analyzed. 4 relevant quality indicators of newborn outcome -- a) severe intraventricular hemorrhage in preterm infants 2500 g and d) hypoxic-ischemic encephalopathy -- were targeted to find out specific risk predictors by considering 26 risk factors. A logistic regression model was used to develop the risk predictors. Risk predictors for the 4 quality indicators could be described by 3 - 9 out of 26 analyzed risk factors. The AUC (ROC)-values for these quality indicators were 82, 89, 89 and 89 %, what signifies their reliability. Using the new specific predictors for calculation the risk adjusted incidence rates of quality indicator yielded in some remarkable changes. The apparent differences in the outcome criteria of analyzed hospitals were found to be much less pronounced. The application of the proposed method for risk adjustment of quality indicators makes it possible to perform a more objective comparison of neonatal outcome criteria between different hospitals or regions.

  15. Sperm competition risk drives rapid ejaculate adjustments mediated by seminal fluid.

    Science.gov (United States)

    Bartlett, Michael J; Steeves, Tammy E; Gemmell, Neil J; Rosengrave, Patrice C

    2017-10-31

    In many species, males can make rapid adjustments to ejaculate performance in response to sperm competition risk; however, the mechanisms behind these changes are not understood. Here, we manipulate male social status in an externally fertilising fish, chinook salmon ( Oncorhynchus tshawytscha ), and find that in less than 48 hr, males can upregulate sperm velocity when faced with an increased risk of sperm competition. Using a series of in vitro sperm manipulation and competition experiments, we show that rapid changes in sperm velocity are mediated by seminal fluid and the effect of seminal fluid on sperm velocity directly impacts paternity share and therefore reproductive success. These combined findings, completely consistent with sperm competition theory, provide unequivocal evidence that sperm competition risk drives plastic adjustment of ejaculate quality, that seminal fluid harbours the mechanism for the rapid adjustment of sperm velocity and that fitness benefits accrue to males from such adjustment.

  16. Monitoring risk-adjusted medical outcomes allowing for changes over time.

    Science.gov (United States)

    Steiner, Stefan H; Mackay, R Jock

    2014-10-01

    We consider the problem of monitoring and comparing medical outcomes, such as surgical performance, over time. Performance is subject to change due to a variety of reasons including patient heterogeneity, learning, deteriorating skills due to aging, etc. For instance, we expect inexperienced surgeons to improve their skills with practice. We propose a graphical method to monitor surgical performance that incorporates risk adjustment to account for patient heterogeneity. The procedure gives more weight to recent outcomes and down-weights the influence of outcomes further in the past. The chart is clinically interpretable as it plots an estimate of the failure rate for a "standard" patient. The chart also includes a measure of uncertainty in this estimate. We can implement the method using historical data or start from scratch. As the monitoring proceeds, we can base the estimated failure rate on a known risk model or use the observed outcomes to update the risk model as time passes. We illustrate the proposed method with an example from cardiac surgery. © The Author 2013. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. A method to adjust radiation dose-response relationships for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane Lindegaard; Vogelius, Ivan R

    2012-01-01

    Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...

  18. Melanoma Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing melanoma cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  19. Capital Structure: Target Adjustment Model and a Mediation Moderation Model with Capital Structure as Mediator

    OpenAIRE

    Abedmajid, Mohammed

    2015-01-01

    This study consists of two models. Model one is conducted to check if there is a target adjustment toward optimal capital structure, in the context of Turkish firm listed on the stock market, over the period 2003-2014. Model 2 captures the interaction between firm size, profitability, market value and capital structure using the moderation mediation model. The results of model 1 have shown that there is a partial adjustment of the capital structure to reach target levels. The results of...

  20. Adjusting a cancer mortality-prediction model for disease status-related eligibility criteria

    Directory of Open Access Journals (Sweden)

    Kimmel Marek

    2011-05-01

    Full Text Available Abstract Background Volunteering participants in disease studies tend to be healthier than the general population partially due to specific enrollment criteria. Using modeling to accurately predict outcomes of cohort studies enrolling volunteers requires adjusting for the bias introduced in this way. Here we propose a new method to account for the effect of a specific form of healthy volunteer bias resulting from imposing disease status-related eligibility criteria, on disease-specific mortality, by explicitly modeling the length of the time interval between the moment when the subject becomes ineligible for the study, and the outcome. Methods Using survival time data from 1190 newly diagnosed lung cancer patients at MD Anderson Cancer Center, we model the time from clinical lung cancer diagnosis to death using an exponential distribution to approximate the length of this interval for a study where lung cancer death serves as the outcome. Incorporating this interval into our previously developed lung cancer risk model, we adjust for the effect of disease status-related eligibility criteria in predicting the number of lung cancer deaths in the control arm of CARET. The effect of the adjustment using the MD Anderson-derived approximation is compared to that based on SEER data. Results Using the adjustment developed in conjunction with our existing lung cancer model, we are able to accurately predict the number of lung cancer deaths observed in the control arm of CARET. Conclusions The resulting adjustment was accurate in predicting the lower rates of disease observed in the early years while still maintaining reasonable prediction ability in the later years of the trial. This method could be used to adjust for, or predict the duration and relative effect of any possible biases related to disease-specific eligibility criteria in modeling studies of volunteer-based cohorts.

  1. Credit Risk Modeling

    DEFF Research Database (Denmark)

    Lando, David

    Credit risk is today one of the most intensely studied topics in quantitative finance. This book provides an introduction and overview for readers who seek an up-to-date reference to the central problems of the field and to the tools currently used to analyze them. The book is aimed at researchers...... and students in finance, at quantitative analysts in banks and other financial institutions, and at regulators interested in the modeling aspects of credit risk. David Lando considers the two broad approaches to credit risk analysis: that based on classical option pricing models on the one hand...

  2. Risk adjusted surgical audit in gynaecological oncology: P-POSSUM does not predict outcome.

    Science.gov (United States)

    Das, N; Talaat, A S; Naik, R; Lopes, A D; Godfrey, K A; Hatem, M H; Edmondson, R J

    2006-12-01

    To assess the Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and its validity for use in gynaecological oncology surgery. All patients undergoing gynaecological oncology surgery at the Northern Gynaecological Oncology Centre (NGOC) Gateshead, UK over a period of 12months (2002-2003) were assessed prospectively. Mortality and morbidity predictions using the Portsmouth modification of the POSSUM algorithm (P-POSSUM) were compared to the actual outcomes. Performance of the model was also evaluated using the Hosmer and Lemeshow Chi square statistic (testing the goodness of fit). During this period 468 patients were assessed. The P-POSSUM appeared to over predict mortality rates for our patients. It predicted a 7% mortality rate for our patients compared to an observed rate of 2% (35 predicted deaths in comparison to 10 observed deaths), a difference that was statistically significant (H&L chi(2)=542.9, d.f. 8, prisk of mortality for gynaecological oncology patients undergoing surgery. The P-POSSUM algorithm will require further adjustments prior to adoption for gynaecological cancer surgery as a risk adjusted surgical audit tool.

  3. Model for Adjustment of Aggregate Forecasts using Fuzzy Logic

    Directory of Open Access Journals (Sweden)

    Taracena–Sanz L. F.

    2010-07-01

    Full Text Available This research suggests a contribution in the implementation of forecasting models. The proposed model is developed with the aim to fit the projection of demand to surroundings of firms, and this is based on three considerations that cause that in many cases the forecasts of the demand are different from reality, such as: 1 one of the problems most difficult to model in the forecasts is the uncertainty related to the information available; 2 the methods traditionally used by firms for the projection of demand mainly are based on past behavior of the market (historical demand; and 3 these methods do not consider in their analysis the factors that are influencing so that the observed behaviour occurs. Therefore, the proposed model is based on the implementation of Fuzzy Logic, integrating the main variables that affect the behavior of market demand, and which are not considered in the classical statistical methods. The model was applied to a bottling of carbonated beverages, and with the adjustment of the projection of demand a more reliable forecast was obtained.

  4. Inclusion of Highest Glasgow Coma Scale Motor Component Score in Mortality Risk Adjustment for Benchmarking of Trauma Center Performance.

    Science.gov (United States)

    Gomez, David; Byrne, James P; Alali, Aziz S; Xiong, Wei; Hoeft, Chris; Neal, Melanie; Subacius, Harris; Nathens, Avery B

    2017-12-01

    The Glasgow Coma Scale (GCS) is the most widely used measure of traumatic brain injury (TBI) severity. Currently, the arrival GCS motor component (mGCS) score is used in risk-adjustment models for external benchmarking of mortality. However, there is evidence that the highest mGCS score in the first 24 hours after injury might be a better predictor of death. Our objective was to evaluate the impact of including the highest mGCS score on the performance of risk-adjustment models and subsequent external benchmarking results. Data were derived from the Trauma Quality Improvement Program analytic dataset (January 2014 through March 2015) and were limited to the severe TBI cohort (16 years or older, isolated head injury, GCS ≤8). Risk-adjustment models were created that varied in the mGCS covariates only (initial score, highest score, or both initial and highest mGCS scores). Model performance and fit, as well as external benchmarking results, were compared. There were 6,553 patients with severe TBI across 231 trauma centers included. Initial and highest mGCS scores were different in 47% of patients (n = 3,097). Model performance and fit improved when both initial and highest mGCS scores were included, as evidenced by improved C-statistic, Akaike Information Criterion, and adjusted R-squared values. Three-quarters of centers changed their adjusted odds ratio decile, 2.6% of centers changed outlier status, and 45% of centers exhibited a ≥0.5-SD change in the odds ratio of death after including highest mGCS score in the model. This study supports the concept that additional clinical information has the potential to not only improve the performance of current risk-adjustment models, but can also have a meaningful impact on external benchmarking strategies. Highest mGCS score is a good potential candidate for inclusion in additional models. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  5. A Unified Model of Geostrophic Adjustment and Frontogenesis

    Science.gov (United States)

    Taylor, John; Shakespeare, Callum

    2013-11-01

    Fronts, or regions with strong horizontal density gradients, are ubiquitous and dynamically important features of the ocean and atmosphere. In the ocean, fronts are associated with enhanced air-sea fluxes, turbulence, and biological productivity, while atmospheric fronts are associated with some of the most extreme weather events. Here, we describe a new mathematical framework for describing the formation of fronts, or frontogenesis. This framework unifies two classical problems in geophysical fluid dynamics, geostrophic adjustment and strain-driven frontogenesis, and provides a number of important extensions beyond previous efforts. The model solutions closely match numerical simulations during the early stages of frontogenesis, and provide a means to describe the development of turbulence at mature fronts.

  6. PERMINTAAN BERAS DI PROVINSI JAMBI (Penerapan Partial Adjustment Model

    Directory of Open Access Journals (Sweden)

    Wasi Riyanto

    2013-07-01

    Full Text Available The purpose of this study is to determine the effect of price of rice, flour prices, population, income of population and demand of rice for a year earlier on rice demand, demand rice elasticity and rice demand prediction in Jambi Province. This study uses secondary data, including time series data for 22 years from 1988 until 2009. The study used some variables, consist of rice demand (Qdt, the price of rice (Hb, the price of wheat flour (Hg, population (Jp, the income of the population (PDRB and demand for rice the previous year (Qdt-1. The make of this study are multiple regression and dynamic analysis a Partial Adjustment Model, where the demand for rice is the dependent variable and the price of rice, flour prices, population, income population and demand of rice last year was the independent variable. Partial Adjustment Model analysis results showed that the effect of changes in prices of rice and flour are not significant to changes in demand for rice. The population and demand of rice the previous year has positive and significant impact on demand for rice, while revenues have negative and significant population of rice demand. Variable price of rice, earning population and the price of flour is inelastic the demand of rice, because rice is not a normal good but as a necessity so that there is no substitution of goods (replacement of rice with other commodities in Jambi Province. Based on the analysis, it is recommended to the government to be able to control the rate of population increase given the variable number of people as one of the factors that affect demand for rice.It is expected that the government also began to socialize in a lifestyle of non-rice food consumption to control the increasing amount of demand for rice. Last suggestion, the government developed a diversification of staple foods other than rice.

  7. Quality measurement in the shunt treatment of hydrocephalus: analysis and risk adjustment of the Revision Quotient.

    Science.gov (United States)

    Piatt, Joseph H; Freibott, Christina E

    2014-07-01

    OBJECT.: The Revision Quotient (RQ) has been defined as the ratio of the number of CSF shunt revisions to the number of new shunt insertions for a particular neurosurgical practice in a unit of time. The RQ has been proposed as a quality measure in the treatment of childhood hydrocephalus. The authors examined the construct validity of the RQ and explored the feasibility of risk stratification under this metric. The Kids' Inpatient Database for 1997, 2000, 2003, 2006, and 2009 was queried for admissions with diagnostic codes for hydrocephalus and procedural codes for CSF shunt insertion or revision. Revision quotients were calculated for hospitals that performed 12 or more shunt insertions annually. The univariate associations of hospital RQs with a variety of institutional descriptors were analyzed, and a generalized linear model of the RQ was constructed. There were 12,244 admissions (34%) during which new shunts were inserted, and there were 23,349 admissions (66%) for shunt revision. Three hundred thirty-four annual RQs were calculated for 152 different hospitals. Analysis of variance in hospital RQs over the 5 years of study data supports the construct validity of the metric. The following factors were incorporated into a generalized linear model that accounted for 41% of the variance of the measured RQs: degree of pediatric specialization, proportion of initial case mix in the infant age group, and proportion with neoplastic hydrocephalus. The RQ has construct validity. Risk adjustment is feasible, but the risk factors that were identified relate predominantly to patterns of patient flow through the health care system. Possible advantages of an alternative metric, the Surgical Activity Ratio, are discussed.

  8. Population-Adjusted Street Connectivity, Urbanicity and Risk of Obesity in the U.S

    Science.gov (United States)

    Wang, Fahui; Wen, Ming; Xu, Yanqing

    2013-01-01

    Street connectivity, defined as the number of (3-way or more) intersections per area unit, is an important index of built environments as a proxy for walkability in a neighborhood. This paper examines its geographic variations across the rural-urban continuum (urbanicity), major racial-ethnic groups and various poverty levels. The population-adjusted street connectivity index is proposed as a better measure than the regular index for a large area such as county due to likely concentration of population in limited space within the large area. Based on the data from the Behavioral Risk Factor Surveillance System (BRFSS), this paper uses multilevel modeling to analyze its association with physical activity and obesity while controlling for various individual and county-level variables. Analysis of data subsets indicates that the influences of individual and county-level variables on obesity risk vary across areas of different urbanization levels. The positive influence of street connectivity on obesity control is limited to the more but not the mostly urbanized areas. This demonstrates the value of obesogenic environment research in different geographic settings, helps us reconcile and synthesize some seemingly contradictory results reported in different studies, and also promotes that effective policies need to be highly sensitive to the diversity of demographic groups and geographically adaptable. PMID:23667278

  9. Breast cancer risks and risk prediction models.

    Science.gov (United States)

    Engel, Christoph; Fischer, Christine

    2015-02-01

    BRCA1/2 mutation carriers have a considerably increased risk to develop breast and ovarian cancer. The personalized clinical management of carriers and other at-risk individuals depends on precise knowledge of the cancer risks. In this report, we give an overview of the present literature on empirical cancer risks, and we describe risk prediction models that are currently used for individual risk assessment in clinical practice. Cancer risks show large variability between studies. Breast cancer risks are at 40-87% for BRCA1 mutation carriers and 18-88% for BRCA2 mutation carriers. For ovarian cancer, the risk estimates are in the range of 22-65% for BRCA1 and 10-35% for BRCA2. The contralateral breast cancer risk is high (10-year risk after first cancer 27% for BRCA1 and 19% for BRCA2). Risk prediction models have been proposed to provide more individualized risk prediction, using additional knowledge on family history, mode of inheritance of major genes, and other genetic and non-genetic risk factors. User-friendly software tools have been developed that serve as basis for decision-making in family counseling units. In conclusion, further assessment of cancer risks and model validation is needed, ideally based on prospective cohort studies. To obtain such data, clinical management of carriers and other at-risk individuals should always be accompanied by standardized scientific documentation.

  10. Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

    Science.gov (United States)

    Guenther, Kilian; Vach, Werner; Kachel, Walter; Bruder, Ingo; Hentschel, Roland

    2015-01-01

    Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated. We aimed to validate the PREM, compare its accuracy to that of the original and modified versions of the CRIB and CRIB-II, and examine the congruence of risk categorization. Very-low-birth-weight (VLBW) infants with a gestational age (GA) auditing. It could be useful to combine scores. © 2015 S. Karger AG, Basel.

  11. Does risk-adjusted payment influence primary care providers’ decision on where to set up practices?

    DEFF Research Database (Denmark)

    Anell, Anders; Dackehag, Margareta; Dietrichson, Jens

    2018-01-01

    Background: Providing equal access to healthcare is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access...... to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics. Our aim is to estimate the effects of using...... Index values. Results: Risk-adjusted capitation significantly increases the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does...

  12. Risk modelling study for carotid endarterectomy.

    Science.gov (United States)

    Kuhan, G; Gardiner, E D; Abidia, A F; Chetter, I C; Renwick, P M; Johnson, B F; Wilkinson, A R; McCollum, P T

    2001-12-01

    The aims of this study were to identify factors that influence the risk of stroke or death following carotid endarterectomy (CEA) and to develop a model to aid in comparative audit of vascular surgeons and units. A series of 839 CEAs performed by four vascular surgeons between 1992 and 1999 was analysed. Multiple logistic regression analysis was used to model the effect of 15 possible risk factors on the 30-day risk of stroke or death. Outcome was compared for four surgeons and two units after adjustment for the significant risk factors. The overall 30-day stroke or death rate was 3.9 per cent (29 of 741). Heart disease, diabetes and stroke were significant risk factors. The 30-day predicted stroke or death rates increased with increasing risk scores. The observed 30-day stroke or death rate was 3.9 per cent for both vascular units and varied from 3.0 to 4.2 per cent for the four vascular surgeons. Differences in the outcomes between the surgeons and vascular units did not reach statistical significance after risk adjustment. Diabetes, heart disease and stroke are significant risk factors for stroke or death following CEA. The risk score model identified patients at higher risk and aided in comparative audit.

  13. Measuring Profitability Impacts of Information Technology: Use of Risk Adjusted Measures.

    Science.gov (United States)

    Singh, Anil; Harmon, Glynn

    2003-01-01

    Focuses on understanding how investments in information technology are reflected in the income statements and balance sheets of firms. Shows that the relationship between information technology investments and corporate profitability is much better explained by using risk-adjusted measures of corporate profitability than using the same measures…

  14. School Adjustment of Pupils with ADHD: Cognitive, Emotional and Temperament Risk Factors

    Science.gov (United States)

    Sanchez-Perez, Noelia; Gonzalez-Salinas, Carmen

    2013-01-01

    From different research perspectives, the cognitive and emotional characteristics associated with ADHD in children have been identified as risk factors for the development of diverse adjustment problems in the school context. Research in nonclinical population can additionally help in understanding ADHD deficits, since children with specific…

  15. Prior use of durable medical equipment as a risk adjuster for health-based capitation

    NARCIS (Netherlands)

    R.C. van Kleef (Richard); R.C.J.A. van Vliet (René)

    2010-01-01

    textabstractThis paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a

  16. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Science.gov (United States)

    2010-10-01

    .... Cost-plus-incentive-free (4) 1.0 0 to 2. Cost-plus-fixed-fee (4) 0.5 0 to 1. Time-and-materials... considered cost-plus-fixed-fee contracts for the purposes of assigning profit values. They shall not receive... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment. (a...

  17. Permintaan Beras di Provinsi Jambi (Penerapan Partial Adjustment Model

    Directory of Open Access Journals (Sweden)

    Wasi Riyanto

    2013-07-01

    Full Text Available The purpose of this study is to determine the effect of price of rice, flour prices, population, income of population and demand of rice for a year earlier on rice demand, demand rice elasticity and rice demand prediction in Jambi Province. This study uses secondary data, including time series data for 22 years from 1988 until 2009. The study used some variables, consist of rice demand (Qdt, the price of rice (Hb, the price of wheat flour (Hg, population (Jp, the income of the population (PDRB and demand for rice the previous year (Qdt-1. The make of this study are multiple regression and dynamic analysis  a Partial Adjustment Model, where the demand for rice is the dependent variable and the price of rice, flour prices, population, income population and demand of rice last year was the independent variable. Partial Adjustment Model analysis results showed that the effect of changes in prices of rice  and flour are not significant  to  changes in demand for rice. The population and demand of rice the previous year has positive and significant impact on demand for rice, while revenues have negative and significant population of rice demand. Variable price of rice, earning population and the price of flour is inelastic the demand of rice, because rice is not a normal good but as a necessity so that there is no substitution of goods (replacement of rice with other commodities in Jambi Province. Based on the analysis, it is recommended to the government to be able to control the rate of population increase given the variable number of people as one of the factors that affect demand for rice.It is expected that the  government also began  to  socialize  in a lifestyle  of  non-rice food consumption to control the increasing amount of demand for rice. Last suggestion, the government developed a diversification of staple foods other than rice. Keywords: Demand, Rice, Income Population

  18. Adjusting the Adjusted X[superscript 2]/df Ratio Statistic for Dichotomous Item Response Theory Analyses: Does the Model Fit?

    Science.gov (United States)

    Tay, Louis; Drasgow, Fritz

    2012-01-01

    Two Monte Carlo simulation studies investigated the effectiveness of the mean adjusted X[superscript 2]/df statistic proposed by Drasgow and colleagues and, because of problems with the method, a new approach for assessing the goodness of fit of an item response theory model was developed. It has been previously recommended that mean adjusted…

  19. Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest.

    Science.gov (United States)

    Zgleszewski, Steven E; Graham, Dionne A; Hickey, Paul R; Brustowicz, Robert M; Odegard, Kirsten C; Koka, Rahul; Seefelder, Christian; Navedo, Andres T; Randolph, Adrienne G

    2016-02-01

    Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA. We analyzed a prospectively collected patient cohort data set of anesthetics administered from 2000 to 2011 to children at a large tertiary pediatric hospital. Pre-procedure systemic disease level was characterized by ASA physical status (ASA-PS). Two reviewers independently reviewed cardiac arrests and categorized their anesthesia relatedness. Factors associated with ARCA in the univariate analyses were identified for reevaluation after adjustment for patient age and ASA-PS. Cardiac arrest occurred in 142 of 276,209 anesthetics (incidence 5.1/10,000 anesthetics); 72 (2.6/10,000 anesthetics) were classified as anesthesia-related. In the univariate analyses, risk of ARCA was much higher in cardiac patients and for anesthesiologists with lower annual caseload and/or fewer annual days delivering anesthetics (all P risk adjustment for ASA-PS ≥ III and age ≤ 6 months, however, the association with lower annual days delivering anesthetics remained (P = 0.03), but the other factors were no longer significant. Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for patient risk factors in anesthesia patient safety studies.

  20. Dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses.

    Science.gov (United States)

    Zhang, Xiang; Loda, Justin B; Woodall, William H

    2017-07-20

    For a patient who has survived a surgery, there could be several levels of recovery. Thus, it is reasonable to consider more than two outcomes when monitoring surgical outcome quality. The risk-adjusted cumulative sum (CUSUM) chart based on multiresponses has been developed for monitoring a surgical process with three or more outcomes. However, there is a significant effect of varying risk distributions on the in-control performance of the chart when constant control limits are applied. To overcome this disadvantage, we apply the dynamic probability control limits to the risk-adjusted CUSUM charts for multiresponses. The simulation results demonstrate that the in-control performance of the charts with dynamic probability control limits can be controlled for different patient populations because these limits are determined for each specific sequence of patients. Thus, the use of dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses allows each chart to be designed for the corresponding patient sequence of a surgeon or a hospital and therefore does not require estimating or monitoring the patients' risk distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Models of Credit Risk Measurement

    OpenAIRE

    Hagiu Alina

    2011-01-01

    Credit risk is defined as that risk of financial loss caused by failure by the counterparty. According to statistics, for financial institutions, credit risk is much important than market risk, reduced diversification of the credit risk is the main cause of bank failures. Just recently, the banking industry began to measure credit risk in the context of a portfolio along with the development of risk management started with models value at risk (VAR). Once measured, credit risk can be diversif...

  2. The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line-Associated Bloodstream Infection Risk-Adjustment Methodology.

    Science.gov (United States)

    Jackson, Sarah S; Leekha, Surbhi; Magder, Laurence S; Pineles, Lisa; Anderson, Deverick J; Trick, William E; Woeltje, Keith F; Kaye, Keith S; Stafford, Kristen; Thom, Kerri; Lowe, Timothy J; Harris, Anthony D

    2017-09-01

    BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes. METHODS Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank. RESULTS Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51-0.59) for the ICU-type model and 0.64 (95% CI, 0.60-0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model. CONCLUSIONS Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals. Infect Control Hosp Epidemiol 2017;38:1019-1024.

  3. Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals

    Directory of Open Access Journals (Sweden)

    Rasmussen TB

    2018-04-01

    Full Text Available Thomas Bøjer Rasmussen, Sinna Pilgaard Ulrichsen, Mette Nørgaard Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Background: Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes.Objective: The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses.Materials and methods: We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations.Results: Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54. In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease.Conclusion: The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most

  4. Disaster Hits Home: A Model of Displaced Family Adjustment after Hurricane Katrina

    Science.gov (United States)

    Peek, Lori; Morrissey, Bridget; Marlatt, Holly

    2011-01-01

    The authors explored individual and family adjustment processes among parents (n = 30) and children (n = 55) who were displaced to Colorado after Hurricane Katrina. Drawing on in-depth interviews with 23 families, this article offers an inductive model of displaced family adjustment. Four stages of family adjustment are presented in the model: (a)…

  5. Adjusting for Confounding in Early Postlaunch Settings: Going Beyond Logistic Regression Models.

    Science.gov (United States)

    Schmidt, Amand F; Klungel, Olaf H; Groenwold, Rolf H H

    2016-01-01

    Postlaunch data on medical treatments can be analyzed to explore adverse events or relative effectiveness in real-life settings. These analyses are often complicated by the number of potential confounders and the possibility of model misspecification. We conducted a simulation study to compare the performance of logistic regression, propensity score, disease risk score, and stabilized inverse probability weighting methods to adjust for confounding. Model misspecification was induced in the independent derivation dataset. We evaluated performance using relative bias confidence interval coverage of the true effect, among other metrics. At low events per coefficient (1.0 and 0.5), the logistic regression estimates had a large relative bias (greater than -100%). Bias of the disease risk score estimates was at most 13.48% and 18.83%. For the propensity score model, this was 8.74% and >100%, respectively. At events per coefficient of 1.0 and 0.5, inverse probability weighting frequently failed or reduced to a crude regression, resulting in biases of -8.49% and 24.55%. Coverage of logistic regression estimates became less than the nominal level at events per coefficient ≤5. For the disease risk score, inverse probability weighting, and propensity score, coverage became less than nominal at events per coefficient ≤2.5, ≤1.0, and ≤1.0, respectively. Bias of misspecified disease risk score models was 16.55%. In settings with low events/exposed subjects per coefficient, disease risk score methods can be useful alternatives to logistic regression models, especially when propensity score models cannot be used. Despite better performance of disease risk score methods than logistic regression and propensity score models in small events per coefficient settings, bias, and coverage still deviated from nominal.

  6. Price adjustment for traditional Chinese medicine procedures: Based on a standardized value parity model.

    Science.gov (United States)

    Wang, Haiyin; Jin, Chunlin; Jiang, Qingwu

    2017-11-20

    Traditional Chinese medicine (TCM) is an important part of China's medical system. Due to the prolonged low price of TCM procedures and the lack of an effective mechanism for dynamic price adjustment, the development of TCM has markedly lagged behind Western medicine. The World Health Organization (WHO) has emphasized the need to enhance the development of alternative and traditional medicine when creating national health care systems. The establishment of scientific and appropriate mechanisms to adjust the price of medical procedures in TCM is crucial to promoting the development of TCM. This study has examined incorporating value indicators and data on basic manpower expended, time spent, technical difficulty, and the degree of risk in the latest standards for the price of medical procedures in China, and this study also offers a price adjustment model with the relative price ratio as a key index. This study examined 144 TCM procedures and found that prices of TCM procedures were mainly based on the value of medical care provided; on average, medical care provided accounted for 89% of the price. Current price levels were generally low and the current price accounted for 56% of the standardized value of a procedure, on average. Current price levels accounted for a markedly lower standardized value of acupuncture, moxibustion, special treatment with TCM, and comprehensive TCM procedures. This study selected a total of 79 procedures and adjusted them by priority. The relationship between the price of TCM procedures and the suggested price was significantly optimized (p based on a standardized value parity model is a scientific and suitable method of price adjustment that can serve as a reference for other provinces and municipalities in China and other countries and regions that mainly have fee-for-service (FFS) medical care.

  7. Capital adjustment cost and bias in income based dynamic panel models with fixed effects

    OpenAIRE

    Yoseph Yilma Getachew; Keshab Bhattarai; Parantap Basu

    2012-01-01

    The fixed effects (FE) estimator of "conditional convergence" in income based dynamic panel models could be biased downward when capital adjustment cost is present. Such a capital adjustment cost means a rising marginal cost of investment which could slow down the convergence. The standard FE regression fails to take into account of this capital adjustment cost and thus it could overestimate the rate of convergence. Using a Ramsey model with long-run adjustment cost of capital, we characteriz...

  8. [Family characteristics, organic risk factors, psychopathological picture and premorbid adjustment of hospitalized adolescent patients].

    Science.gov (United States)

    Małkiewicz-Borkowska, M; Namysłowska, I; Siewierska, A; Puzyńska, E; Sredniawa, H; Zechowski, C; Iwanek, A; Ruszkowska, E

    1996-01-01

    The relation of some family characteristics such as cohesion and adaptability with organic risk factors, developmental psychopathology, clinical picture and premorbid adjustment was assessed in the group of 100 hospitalized adolescent patients and families. We found correlation between: some of organic risk factors (pathology of neonatal period, pathology of early childhood), some of indicators of developmental psychopathology (eating disorders, conduct disorders), some of clinical signs (mannerism, grandiosity, hostility, suspciousness, disturbances of content of thinking), premorbid adjustment, and variables related to families, described before. We think that biological variables characterizing child (pathology of neonatal period, pathology of early childhood) have an influence on some family characteristics as independent variable. General system theory and circular thinking support these conclusions. In order to verify them, it is necessary to undertake further investigations, based on other methodology, using this results as preliminary findings.

  9. Screening techniques, sustainability and risk adjusted returns. : - A quantitative study on the Swedish equity funds market

    OpenAIRE

    Ögren, Tobias; Forslund, Petter

    2017-01-01

    Previous studies have primarily compared the performance of sustainable equity funds and non-sustainable equity funds. A meta-analysis over 85 different studies in the field concludes that there is no statistically significant difference in risk-adjusted returns when comparing sustainable funds and non-sustainable funds. This study is thus an extension on previous studies where the authors have chosen to test the two most common sustainability screening techniques to test if there is a differ...

  10. Does Risk-Adjusted Payment Influence Primary Care Providers' Decision on Where to Set Up Practices?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Anell, Anders; Dackehag, Margareta

    Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county...... of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers’ establishment decisions....

  11. Improved implementation of the risk-adjusted Bernoulli CUSUM chart to monitor surgical outcome quality.

    Science.gov (United States)

    Keefe, Matthew J; Loda, Justin B; Elhabashy, Ahmad E; Woodall, William H

    2017-06-01

    The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  12. Household adjustment to flood risk: a survey of coastal residents in Texas and Florida, United States.

    Science.gov (United States)

    Brody, Samuel D; Lee, Yoonjeong; Highfield, Wesley E

    2017-07-01

    Individual households have increasingly borne responsibility for reducing the adverse impacts of flooding on their property. Little observational research has been conducted, however, at the household level to examine the major factors contributing to the selection of a particular household adjustment. This study addresses the issue by evaluating statistically the factors influencing the adoption of various household flood hazard adjustments. The results indicate that respondents with higher-value homes or longer housing tenure are more likely to adopt structural and expensive techniques. In addition, the information source and the Community Rating System (CRS) score for the jurisdiction where the household is located have a significant bearing on household adjustment. In contrast, proximity to risk zones and risk perception yield somewhat mixed results or behave counter to assumptions in the literature. The study findings provide insights that will be of value to governments and decision-makers interested in encouraging homeowners to take protective action given increasing flood risk. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

  13. Suboptimal decision making by children with ADHD in the face of risk: Poor risk adjustment and delay aversion rather than general proneness to taking risks.

    Science.gov (United States)

    Sørensen, Lin; Sonuga-Barke, Edmund; Eichele, Heike; van Wageningen, Heidi; Wollschlaeger, Daniel; Plessen, Kerstin Jessica

    2017-02-01

    Suboptimal decision making in the face of risk (DMR) in children with attention-deficit hyperactivity disorder (ADHD) may be mediated by deficits in a number of different neuropsychological processes. We investigated DMR in children with ADHD using the Cambridge Gambling Task (CGT) to distinguish difficulties in adjusting to changing probabilities of choice outcomes (so-called risk adjustment) from general risk proneness, and to distinguish these 2 processes from delay aversion (the tendency to choose the least delayed option) and impairments in the ability to reflect on choice options. Based on previous research, we predicted that suboptimal performance on this task in children with ADHD would be primarily relate to problems with risk adjustment and delay aversion rather than general risk proneness. Drug naïve children with ADHD (n = 36), 8 to 12 years, and an age-matched group of typically developing children (n = 34) performed the CGT. As predicted, children with ADHD were not more prone to making risky choices (i.e., risk proneness). However, they had difficulty adjusting to changing risk levels and were more delay aversive-with these 2 effects being correlated. Our findings add to the growing body of evidence that children with ADHD do not favor risk taking per se when performing gambling tasks, but rather may lack the cognitive skills or motivational style to appraise changing patterns of risk effectively. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. Risk adjustment for case mix and the effect of surgeon volume on morbidity.

    Science.gov (United States)

    Maas, Matthew B; Jaff, Michael R; Rordorf, Guy A

    2013-06-01

    Retrospective studies of large administrative databases have shown higher mortality for procedures performed by low-volume surgeons, but the adequacy of risk adjustment in those studies is in doubt. To determine whether the relationship between surgeon volume and outcomes is an artifact of case mix using a prospective sample of carotid endarterectomy cases. Observational cohort study from January 1, 2008, through December 31, 2010, with preoperative, immediate postoperative, and 30-day postoperative assessments acquired by independent monitors. Urban, tertiary academic medical center. All 841 patients who underwent carotid endarterectomy performed by a vascular surgeon or cerebrovascular neurosurgeon at the institution. Carotid endarterectomy without another concurrent surgery. Stroke, death, and other surgical complications occurring within 30 days of surgery along with other case data. A low-volume surgeon performed 40 or fewer cases per year. Variables used in a comparison administrative database study, as well as variables identified by our univariate analysis, were used for adjusted analyses to assess for an association between low-volume surgeons and the rate of stroke and death as well as other complications. RESULTS The rate of stroke and death was 6.9% for low-volume surgeons and 2.0% for high-volume surgeons (P = .001). Complications were similarly higher (13.4% vs 7.2%, P = .008). Low-volume surgeons performed more nonelective cases. Low-volume surgeons were significantly associated with stroke and death in the unadjusted analysis as well as after adjustment with variables used in the administrative database study (odds ratio, 3.61; 95% CI, 1.70-7.67, and odds ratio, 3.68; 95% CI, 1.72-7.89, respectively). However, adjusting for the significant disparity of American Society of Anesthesiologists Physical Status classification in case mix eliminated the effect of surgeon volume on the rate of stroke and death (odds ratio, 1.65; 95% CI, 0.59-4.64) and other

  15. Adjustment costs in a two-capital growth model

    Czech Academy of Sciences Publication Activity Database

    Duczynski, Petr

    2002-01-01

    Roč. 26, č. 5 (2002), s. 837-850 ISSN 0165-1889 R&D Projects: GA AV ČR KSK9058117 Institutional research plan: CEZ:AV0Z7085904 Keywords : adjustment costs * capital mobility * convergence * human capital Subject RIV: AH - Economics Impact factor: 0.738, year: 2002

  16. Mate guarding in the Seychelles warbler is energetically costly and adjusted to paternity risk.

    Science.gov (United States)

    Komdeur, J

    2001-10-22

    Males may increase their fitness through extra-pair copulations (copulations outside the pair bond) that result in extra-pair fertilizations, but also risk lost paternity when they leave their own mate unguarded. The fitness costs of cuckoldry for Seychelles warblers (Acrocephalus sechellensis) are considerable because warblers have a single-egg clutch and, given the short breeding season, no time for a successful replacement clutch. Neighbouring males are the primary threat to a male's genetic paternity. Males minimize their loss of paternity by guarding their mates to prevent them from having extra-pair copulations during their fertile period. Here, I provide experimental evidence that mate-guarding behaviour is energetically costly and that the expression of this trade-off is adjusted to paternity risk (local male density). Free-living males that were induced to reduce mate guarding spent significantly more time foraging and gained significantly better body condition than control males. The larger the reduction in mate guarding, the more pronounced was the increase in foraging and body condition (accounting for food availability). An experimental increase in paternity risk resulted in an increase in mate-guarding intensity and a decrease in foraging and body condition, and vice versa. This is examined using both cross-sectional and longitudinal data. This study on the Seychelles warbler offers experimental evidence that mate guarding is energetically costly and adjusted to paternity risk.

  17. Player Modeling Using HOSVD towards Dynamic Difficulty Adjustment in Videogames

    OpenAIRE

    Anagnostou , Kostas; Maragoudakis , Manolis

    2012-01-01

    Part 3: Second International Workshop on Computational Intelligence in Software Engineering (CISE 2012); International audience; In this work, we propose and evaluate a Higher Order Singular Value Decomposition (HOSVD) of a tensor as a means to classify player behavior and adjust game difficulty dynamically. Applying this method to player data collected during a plethora of game sessions resulted in a reduction of the dimensionality of the classification problem and a robust classification of...

  18. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    Science.gov (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. Project HOPE—The People-to-People Health Foundation, Inc.

  19. Risk adjustment of health-care performance measures in a multinational register-based study: A pragmatic approach to a complicated topic

    Directory of Open Access Journals (Sweden)

    Tron Anders Moger

    2014-03-01

    Full Text Available Objectives: Health-care performance comparisons across countries are gaining popularity. In such comparisons, the risk adjustment methodology plays a key role for meaningful comparisons. However, comparisons may be complicated by the fact that not all participating countries are allowed to share their data across borders, meaning that only simple methods are easily used for the risk adjustment. In this study, we develop a pragmatic approach using patient-level register data from Finland, Hungary, Italy, Norway, and Sweden. Methods: Data on acute myocardial infarction patients were gathered from health-care registers in several countries. In addition to unadjusted estimates, we studied the effects of adjusting for age, gender, and a number of comorbidities. The stability of estimates for 90-day mortality and length of stay of the first hospital episode following diagnosis of acute myocardial infarction is studied graphically, using different choices of reference data. Logistic regression models are used for mortality, and negative binomial models are used for length of stay. Results: Results from the sensitivity analysis show that the various models of risk adjustment give similar results for the countries, with some exceptions for Hungary and Italy. Based on the results, in Finland and Hungary, the 90-day mortality after acute myocardial infarction is higher than in Italy, Norway, and Sweden. Conclusion: Health-care registers give encouraging possibilities to performance measurement and enable the comparison of entire patient populations between countries. Risk adjustment methodology is affected by the availability of data, and thus, the building of risk adjustment methodology must be transparent, especially when doing multinational comparative research. In that case, even basic methods of risk adjustment may still be valuable.

  20. Family support and acceptance, gay male identity formation, and psychological adjustment: a path model.

    Science.gov (United States)

    Elizur, Y; Ziv, M

    2001-01-01

    While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

  1. Impact of selected risk factors on quality-adjusted life expectancy in Denmark

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Juel, Knud; Davidsen, Michael

    2007-01-01

    AIMS: The construct quality-adjusted life years (QALYs) combines mortality and overall health status and can be used to quantify the impact of risk factors on population health. The purpose of the study was to estimate the impact of tobacco smoking, high alcohol consumption, physical inactivity...... Health Survey 2000, and Danish EQ-5D values. RESULTS: The quality-adjusted life expectancy of 25-year-olds was 10-11 QALYs shorter for heavy smokers than for those who never smoke. The difference in life expectancy was 9-10 years. Men and women with high alcohol consumption could expect to lose about 5...... and 3 QALYs, respectively. Sedentary persons could expect to have about 7 fewer QALYs than physically active persons. Obesity shortened QALYs by almost 3 for men and 6 for women. CONCLUSIONS: Smoking, high alcohol consumption, physical inactivity, and obesity strongly reduce life expectancy and health...

  2. Structural Adjustment Policy Experiments: The Use of Philippine CGE Models

    OpenAIRE

    Cororaton, Caesar B.

    1994-01-01

    This paper reviews the general structure of the following general computable general equilibrium (CGE): the APEX model, Habito’s second version of the PhilCGE model, Cororaton’s CGE model and Bautista’s first CGE model. These models are chosen as they represent the range of recently constructed CGE models of the Philippine economy. They also represent two schools of thought in CGE modeling: the well defined neoclassical, Walrasian, general equilibrium school where the market-clearing variable...

  3. Regression Trees Identify Relevant Interactions: Can This Improve the Predictive Performance of Risk Adjustment?

    Science.gov (United States)

    Buchner, Florian; Wasem, Jürgen; Schillo, Sonja

    2017-01-01

    Risk equalization formulas have been refined since their introduction about two decades ago. Because of the complexity and the abundance of possible interactions between the variables used, hardly any interactions are considered. A regression tree is used to systematically search for interactions, a methodologically new approach in risk equalization. Analyses are based on a data set of nearly 2.9 million individuals from a major German social health insurer. A two-step approach is applied: In the first step a regression tree is built on the basis of the learning data set. Terminal nodes characterized by more than one morbidity-group-split represent interaction effects of different morbidity groups. In the second step the 'traditional' weighted least squares regression equation is expanded by adding interaction terms for all interactions detected by the tree, and regression coefficients are recalculated. The resulting risk adjustment formula shows an improvement in the adjusted R 2 from 25.43% to 25.81% on the evaluation data set. Predictive ratios are calculated for subgroups affected by the interactions. The R 2 improvement detected is only marginal. According to the sample level performance measures used, not involving a considerable number of morbidity interactions forms no relevant loss in accuracy. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  4. Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk?

    Science.gov (United States)

    Silverstein, Barbara; Fan, Z Joyce; Smith, Caroline K; Bao, Stephen; Howard, Ninica; Spielholz, Peregrin; Bonauto, David; Viikari-Juntura, Eira

    2009-03-01

    The aim was to explore whether "adjustment" for gender masks important exposure differences between men and women in a study of rotator cuff syndrome (RCS) and carpal tunnel syndrome (CTS) and work exposures. This cross-sectional study of 733 subjects in 12 health care and manufacturing workplaces used detailed individual health and work exposure assessment methods. Multiple logistic regression analysis was used to compare gender stratified and adjusted models. Prevalence of RCS and CTS among women was 7.1% and 11.3% respectively, and among men 7.8% and 6.4%. In adjusted (gender, age, body mass index) multivariate analyses of RCS and CTS, gender was not statistically significantly different. For RCS, upper arm flexion >/=45 degrees and forceful pinch increased the odds in the gender-adjusted model (OR 2.66, 95% CI 1.26-5.59) but primarily among women in the stratified analysis (OR 6.68, 95% CI 1.81-24.66 versus OR 1.45, 95% CI 0.53-4.00). For CTS, wrist radial/ulnar deviation >/=4% time and lifting >/=4.5kg >3% time, the adjusted OR was higher for women (OR 4.85, 95% CI 2.12-11.11) and in the gender stratified analyses, the odds were increased for both genders (women OR 5.18, 95% CI 1.70-15.81 and men OR 3.63, 95% CI 1.08-12.18). Gender differences in response to physical work exposures may reflect gender segregation in work and potential differences in pinch and lifting capacity. Reduction in these exposures may reduce prevalence of upper extremity disorders for all workers.

  5. Modeling of an Adjustable Beam Solid State Light

    Data.gov (United States)

    National Aeronautics and Space Administration — This proposal is for the development of a computational model of a prototype variable beam light source using optical modeling software, Zemax OpticStudio ®. The...

  6. Breeds of risk-adjusted fundamentalist strategies in an order-driven market

    Science.gov (United States)

    LiCalzi, Marco; Pellizzari, Paolo

    2006-01-01

    This paper studies an order-driven stock market where agents have heterogeneous estimates of the fundamental value of the risky asset. The agents are budget-constrained and follow a value-based trading strategy which buys or sells depending on whether the price of the asset is below or above its risk-adjusted fundamental value. This environment generates returns that are remarkably leptokurtic and fat-tailed. By extending the study over a grid of different parameters for the fundamentalist trading strategy, we exhibit the existence of monotone relationships between the bid-ask spread demanded by the agents and several statistics of the returns. We conjecture that this effect, coupled with positive dependence of the risk premium on the volatility, generates positive feedbacks that might explain volatility bursts.

  7. Custom v. Standardized Risk Models

    Directory of Open Access Journals (Sweden)

    Zura Kakushadze

    2015-05-01

    Full Text Available We discuss when and why custom multi-factor risk models are warranted and give source code for computing some risk factors. Pension/mutual funds do not require customization but standardization. However, using standardized risk models in quant trading with much shorter holding horizons is suboptimal: (1 longer horizon risk factors (value, growth, etc. increase noise trades and trading costs; (2 arbitrary risk factors can neutralize alpha; (3 “standardized” industries are artificial and insufficiently granular; (4 normalization of style risk factors is lost for the trading universe; (5 diversifying risk models lowers P&L correlations, reduces turnover and market impact, and increases capacity. We discuss various aspects of custom risk model building.

  8. Including investment risk in large-scale power market models

    DEFF Research Database (Denmark)

    Lemming, Jørgen Kjærgaard; Meibom, P.

    2003-01-01

    Long-term energy market models can be used to examine investments in production technologies, however, with market liberalisation it is crucial that such models include investment risks and investor behaviour. This paper analyses how the effect of investment risk on production technology selection...... can be included in large-scale partial equilibrium models of the power market. The analyses are divided into a part about risk measures appropriate for power market investors and a more technical part about the combination of a risk-adjustment model and a partial-equilibrium model. To illustrate...... the analyses quantitatively, a framework based on an iterative interaction between the equilibrium model and a separate risk-adjustment module was constructed. To illustrate the features of the proposed modelling approach we examined how uncertainty in demand and variable costs affects the optimal choice...

  9. Usefulness of administrative databases for risk adjustment of adverse events in surgical patients.

    Science.gov (United States)

    Rodrigo-Rincón, Isabel; Martin-Vizcaíno, Marta P; Tirapu-León, Belén; Zabalza-López, Pedro; Abad-Vicente, Francisco J; Merino-Peralta, Asunción; Oteiza-Martínez, Fabiola

    2016-03-01

    The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  10. Behavioural adjustment in response to increased predation risk: a study in three duck species.

    Directory of Open Access Journals (Sweden)

    Cédric Zimmer

    Full Text Available Predation directly triggers behavioural decisions designed to increase immediate survival. However, these behavioural modifications can have long term costs. There is therefore a trade-off between antipredator behaviours and other activities. This trade-off is generally considered between vigilance and only one other behaviour, thus neglecting potential compensations. In this study, we considered the effect of an increase in predation risk on the diurnal time-budget of three captive duck species during the wintering period. We artificially increased predation risk by disturbing two groups of 14 mallard and teals at different frequencies, and one group of 14 tufted ducks with a radio-controlled stressor. We recorded foraging, vigilance, preening and sleeping durations the week before, during and after disturbance sessions. Disturbed groups were compared to an undisturbed control group. We showed that in all three species, the increase in predation risk resulted in a decrease in foraging and preening and led to an increase in sleeping. It is worth noting that contrary to common observations, vigilance did not increase. However, ducks are known to be vigilant while sleeping. This complex behavioural adjustment therefore seems to be optimal as it may allow ducks to reduce their predation risk. Our results highlight the fact that it is necessary to encompass the whole individual time-budget when studying behavioural modifications under predation risk. Finally, we propose that studies of behavioural time-budget changes under predation risk should be included in the more general framework of the starvation-predation risk trade-off.

  11. Secrets of Success in a Landscape of Fear: Urban Wild Boar Adjust Risk Perception and Tolerate Disturbance

    Directory of Open Access Journals (Sweden)

    Milena Stillfried

    2017-12-01

    Full Text Available In urban areas with a high level of human disturbance, wildlife has to adjust its behavior to deal with the so called “landscape of fear.” This can be studied in risk perception during movement in relation to specific habitat types, whereby individuals trade-off between foraging and disturbance. Due to its high behavioral plasticity and increasing occurrence in urban environments, wild boar (Sus scrofa is an excellent model organism to study adjustment to urbanization. With the help of GPS tracking, space use of 11 wild boar from Berlin's metropolitan region was analyzed: we aimed at understanding how animals adjust space use to deal with the landscape of fear in urban areas compared to rural areas. We compared use vs. availability with help of generalized linear mixed models. First, we studied landscape types selected by rural vs. urban wild boar, second, we analyzed distances of wild boar locations to each of the landscape types. Finally, we mapped the resulting habitat selection probability to predict hotspots of human-wildlife conflicts. A higher tolerance to disturbance in urban wild boar was shown by a one third shorter flight distance and by an increased re-use of areas close to the trap. Urban wild boar had a strong preference for natural landscapes such as swamp areas, green areas and deciduous forests, and areas with high primary productivity, as indicated by high NDVI (normalized difference vegetation index values. The areas selected by urban wild boar were often located closely to roads and houses. The spatial distribution maps show that a large area of Berlin would be suitable for urban wild boar but not their rural conspecifics, with the most likely reason being a different perception of anthropogenic disturbance. Wild boar therefore showed considerable behavioral plasticity suitable to adjust to human-dominated environments in a potentially evolutionarily adaptive manner.

  12. Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2005-01-01

    Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did

  13. Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care

    Science.gov (United States)

    Dalby, Dawn M; Hirdes, John P; Fries, Brant E

    2005-01-01

    Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI). Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the

  14. Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

    Science.gov (United States)

    Walton, Katherine M.; Ingersoll, Brooke R.

    2015-01-01

    This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling…

  15. Risk based modelling

    International Nuclear Information System (INIS)

    Chapman, O.J.V.; Baker, A.E.

    1993-01-01

    Risk based analysis is a tool becoming available to both engineers and managers to aid decision making concerning plant matters such as In-Service Inspection (ISI). In order to develop a risk based method, some form of Structural Reliability Risk Assessment (SRRA) needs to be performed to provide a probability of failure ranking for all sites around the plant. A Probabilistic Risk Assessment (PRA) can then be carried out to combine these possible events with the capability of plant safety systems and procedures, to establish the consequences of failure for the sites. In this way the probability of failures are converted into a risk based ranking which can be used to assist the process of deciding which sites should be included in an ISI programme. This paper reviews the technique and typical results of a risk based ranking assessment carried out for nuclear power plant pipework. (author)

  16. Husbands' perceptions of their wives' breast cancer coping efficacy: testing congruence models of adjustment.

    Science.gov (United States)

    Merluzzi, Thomas V; Martinez Sanchez, MaryAnn

    2018-01-01

    Recent reviews have reinforced the notion that having a supportive spouse can help with the process of coping with and adjusting to cancer. Congruence between spouses' perspectives has been proposed as one mechanism in that process, yet alternative models of congruence have not been examined closely. This study assessed alternative models of congruence in perceptions of coping and their mediating effects on adjustment to breast cancer. Seventy-two women in treatment for breast cancer and their husbands completed measures of marital adjustment, self-efficacy for coping, and adjustment to cancer. Karnofsky Performance Status was obtained from medical records. Wives completed a measure of self-efficacy for coping (wives' ratings of self-efficacy for coping [WSEC]) and husbands completed a measure of self-efficacy for coping (husbands' ratings of wives' self-efficacy for coping [HSEC]) based on their perceptions of their wives' coping efficacy. Interestingly, the correlation between WSEC and HSEC was only 0.207; thus, they are relatively independent perspectives. The following three models were tested to determine the nature of the relationship between WSEC and HSEC: discrepancy model (WSEC - HSEC), additive model (WSEC + HSEC), and multiplicative model (WSEC × HSEC). The discrepancy model was not related to wives' adjustment; however, the additive ( B =0.205, P <0.001) and multiplicative ( B =0.001, P <0.001) models were significantly related to wives' adjustment. Also, the additive model mediated the relationship between performance status and adjustment. Husbands' perception of their wives' coping efficacy contributed marginally to their wives' adjustment, and the combination of WSEC and HSEC mediated the relationship between functional status and wives' adjustment, thus positively impacting wives' adjustment to cancer. Future research is needed to determine the quality of the differences between HSEC and WSEC in order to develop interventions to optimize the

  17. The need for unique risk adjustment for surgical site infections at a high-volume, tertiary care center with inherent high-risk colorectal procedures.

    Science.gov (United States)

    Gorgun, E; Benlice, C; Hammel, J; Hull, T; Stocchi, L

    2017-08-01

    The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers. Demographics, comorbidities, and outcomes were compared. Logistic regression analyses were used to assess the association between SSI and center-related factors. A total of 70,536 patients met the inclusion criteria and underwent CRS, 1090 patients (1.5%) at the CC and 69,446 patients (98.5%) at other centers. Male gender, work-relative value unit, diagnosis of inflammatory bowel disease, pouch formation, open surgery, steroid use, and preoperative radiotherapy rates were significantly higher in the CC cases. Overall morbidity and individual postoperative complication rates were found to be similar in the CC and other centers except for the following: organ-space SSI and sepsis rates (higher in the CC cases); and pneumonia and ventilator dependency rates (higher in the other centers). After covariate adjustment, the estimated degree of difference between the CC and other institutions with respect to organ-space SSI was reduced (OR 1.38, 95% CI 1.08-1.77). The unique risk adjustment strategy may provide center-specific comprehensive analysis, especially for hospitals that perform inherently high-risk procedures. Higher surgical complexity may be the reason for increased SSI rates in the NSQIP at tertiary care centers.

  18. An Adjusted Discount Rate Model for Fuel Cycle Cost Estimation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S. K.; Kang, G. B.; Ko, W. I. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-10-15

    Owing to the diverse nuclear fuel cycle options available, including direct disposal, it is necessary to select the optimum nuclear fuel cycles in consideration of the political and social environments as well as the technical stability and economic efficiency of each country. Economic efficiency is therefore one of the significant evaluation standards. In particular, because nuclear fuel cycle cost may vary in each country, and the estimated cost usually prevails over the real cost, when evaluating the economic efficiency, any existing uncertainty needs to be removed when possible to produce reliable cost information. Many countries still do not have reprocessing facilities, and no globally commercialized HLW (High-level waste) repository is available. A nuclear fuel cycle cost estimation model is therefore inevitably subject to uncertainty. This paper analyzes the uncertainty arising out of a nuclear fuel cycle cost evaluation from the viewpoint of a cost estimation model. Compared to the same discount rate model, the nuclear fuel cycle cost of a different discount rate model is reduced because the generation quantity as denominator in Equation has been discounted. Namely, if the discount rate reduces in the back-end process of the nuclear fuel cycle, the nuclear fuel cycle cost is also reduced. Further, it was found that the cost of the same discount rate model is overestimated compared with the different discount rate model as a whole.

  19. An Adjusted Discount Rate Model for Fuel Cycle Cost Estimation

    International Nuclear Information System (INIS)

    Kim, S. K.; Kang, G. B.; Ko, W. I.

    2013-01-01

    Owing to the diverse nuclear fuel cycle options available, including direct disposal, it is necessary to select the optimum nuclear fuel cycles in consideration of the political and social environments as well as the technical stability and economic efficiency of each country. Economic efficiency is therefore one of the significant evaluation standards. In particular, because nuclear fuel cycle cost may vary in each country, and the estimated cost usually prevails over the real cost, when evaluating the economic efficiency, any existing uncertainty needs to be removed when possible to produce reliable cost information. Many countries still do not have reprocessing facilities, and no globally commercialized HLW (High-level waste) repository is available. A nuclear fuel cycle cost estimation model is therefore inevitably subject to uncertainty. This paper analyzes the uncertainty arising out of a nuclear fuel cycle cost evaluation from the viewpoint of a cost estimation model. Compared to the same discount rate model, the nuclear fuel cycle cost of a different discount rate model is reduced because the generation quantity as denominator in Equation has been discounted. Namely, if the discount rate reduces in the back-end process of the nuclear fuel cycle, the nuclear fuel cycle cost is also reduced. Further, it was found that the cost of the same discount rate model is overestimated compared with the different discount rate model as a whole

  20. Odds per adjusted standard deviation: comparing strengths of associations for risk factors measured on different scales and across diseases and populations.

    Science.gov (United States)

    Hopper, John L

    2015-11-15

    How can the "strengths" of risk factors, in the sense of how well they discriminate cases from controls, be compared when they are measured on different scales such as continuous, binary, and integer? Given that risk estimates take into account other fitted and design-related factors-and that is how risk gradients are interpreted-so should the presentation of risk gradients. Therefore, for each risk factor X0, I propose using appropriate regression techniques to derive from appropriate population data the best fitting relationship between the mean of X0 and all the other covariates fitted in the model or adjusted for by design (X1, X2, … , Xn). The odds per adjusted standard deviation (OPERA) presents the risk association for X0 in terms of the change in risk per s = standard deviation of X0 adjusted for X1, X2, … , Xn, rather than the unadjusted standard deviation of X0 itself. If the increased risk is relative risk (RR)-fold over A adjusted standard deviations, then OPERA = exp[ln(RR)/A] = RR(s). This unifying approach is illustrated by considering breast cancer and published risk estimates. OPERA estimates are by definition independent and can be used to compare the predictive strengths of risk factors across diseases and populations. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Child Adjustment to Parental Combat Deployment: Risk and Resilience Models

    Science.gov (United States)

    2012-03-01

    include words even if bottle). FOODS 1. apple 2. banana 3. bread 4. butter 5. cake 6. candy 7. cereal 8. cheese 9~ coffee 10. cookie 11... obsessions (describe): () 1 2 41. Impulsive or acts without thinking 0 1 2 10. Can’t sit still, restless, or hyperactive () 1 2 42. Would rather be

  2. Spherical Model Integrating Academic Competence with Social Adjustment and Psychopathology.

    Science.gov (United States)

    Schaefer, Earl S.; And Others

    This study replicates and elaborates a three-dimensional, spherical model that integrates research findings concerning social and emotional behavior, psychopathology, and academic competence. Kindergarten teachers completed an extensive set of rating scales on 100 children, including the Classroom Behavior Inventory and the Child Adaptive Behavior…

  3. R.M. Solow Adjusted Model of Economic Growth

    Directory of Open Access Journals (Sweden)

    Ion Gh. Rosca

    2007-05-01

    The analysis part of the model is based on the study of the equilibrium to the continuous case with some interpretations of the discreet one, by using the state diagram. The optimization problem at the economic level is also used; it is built up of a specified number of representative consumers and firms in order to reveal the interaction between these elements.

  4. Flexible Multi-Objective Transmission Expansion Planning with Adjustable Risk Aversion

    Directory of Open Access Journals (Sweden)

    Jing Qiu

    2017-07-01

    Full Text Available This paper presents a multi-objective transmission expansion planning (TEP framework. Rather than using the conventional deterministic reliability criterion, a risk component based on the probabilistic reliability criterion is incorporated into the TEP objectives. This risk component can capture the stochastic nature of power systems, such as load and wind power output variations, component availability, and incentive-based demand response (IBDR costs. Specifically, the formulation of risk value after risk aversion is explicitly given, and it aims to provide network planners with the flexibility to conduct risk analysis. Thus, a final expansion plan can be selected according to individual risk preferences. Moreover, the economic value of IBDR is modeled and integrated into the cost objective. In addition, a relatively new multi-objective evolutionary algorithm called the MOEA/D is introduced and employed to find Pareto optimal solutions, and tradeoffs between overall cost and risk are provided. The proposed approach is numerically verified on the Garver’s six-bus, IEEE 24-bus RTS and Polish 2383-bus systems. Case study results demonstrate that the proposed approach can effectively reduce cost and hedge risk in relation to increasing wind power integration.

  5. Disease-Specific Trends of Comorbidity Coding and Implications for Risk Adjustment in Hospital Administrative Data.

    Science.gov (United States)

    Nimptsch, Ulrike

    2016-06-01

    To investigate changes in comorbidity coding after the introduction of diagnosis related groups (DRGs) based prospective payment and whether trends differ regarding specific comorbidities. Nationwide administrative data (DRG statistics) from German acute care hospitals from 2005 to 2012. Observational study to analyze trends in comorbidity coding in patients hospitalized for common primary diseases and the effects on comorbidity-related risk of in-hospital death. Comorbidity coding was operationalized by Elixhauser diagnosis groups. The analyses focused on adult patients hospitalized for the primary diseases of heart failure, stroke, and pneumonia, as well as hip fracture. When focusing the total frequency of diagnosis groups per record, an increase in depth of coding was observed. Between-hospital variations in depth of coding were present throughout the observation period. Specific comorbidity increases were observed in 15 of the 31 diagnosis groups, and decreases in comorbidity were observed for 11 groups. In patients hospitalized for heart failure, shifts of comorbidity-related risk of in-hospital death occurred in nine diagnosis groups, in which eight groups were directed toward the null. Comorbidity-adjusted outcomes in longitudinal administrative data analyses may be biased by nonconstant risk over time, changes in completeness of coding, and between-hospital variations in coding. Accounting for such issues is important when the respective observation period coincides with changes in the reimbursement system or other conditions that are likely to alter clinical coding practice. © Health Research and Educational Trust.

  6. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

    Science.gov (United States)

    Evans, Scott R; Rubin, Daniel; Follmann, Dean; Pennello, Gene; Huskins, W Charles; Powers, John H; Schoenfeld, David; Chuang-Stein, Christy; Cosgrove, Sara E; Fowler, Vance G; Lautenbach, Ebbing; Chambers, Henry F

    2015-09-01

    Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  7. Profile of congenital heart disease and correlation to risk adjustment for surgery; an echocardiographic study

    International Nuclear Information System (INIS)

    Akhtar, K.; Ahmed, W.

    2008-01-01

    To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric patients (age 1 day to 18 years) presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. Over a period of 6 months, 1149 cases underwent 2-D echocardiography. It was a non-probability purposive sampling. This study showed 25% of all referrals had normal hearts. A male preponderance (38%) was observed from 1 year to 5 years age group. Nineteen percent of the cases were categorized as cyanotic CHD with the remaining as acyanotic variety. Tetralogy of Fallot (TOF) represented 10%, Ventricular Septal Defects (VSD) 24%, followed by Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD), which comprised 6.6% and 6.5% respectively. VSD was the most common association in patients with more complex CHD (10%) followed by PDA in 3% and ASD in 1.2% of the cases. Most of the cases were category 2 in the RACHS-1 scoring system. VSD and TOF formed the major groups of cases profiled. Most of the cases recommended for surgery for congenital heart disease belonged to the risk category 2 (28.1%) followed by the risk category 1 (12.7%) of the RACHS-1 scoring system. (author)

  8. Wildfire Risk Main Model

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The model combines three modeled fire behavior parameters (rate of spread, flame length, crown fire potential) and one modeled ecological health measure (fire regime...

  9. [Do laymen understand information about hospital quality? An empirical verification using risk-adjusted mortality rates as an example].

    Science.gov (United States)

    Sander, Uwe; Kolb, Benjamin; Taheri, Fatemeh; Patzelt, Christiane; Emmert, Martin

    2017-11-01

    The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices. An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice. The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices. We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self

  10. Premorbid adjustment in individuals at ultra-high risk for developing psychosis

    DEFF Research Database (Denmark)

    Dannevang, Anders; Randers, Lasse; Gondan, Matthias

    2017-01-01

    between childhood and early adolescence. The UHR individuals had more premorbid adjustment difficulties on both the social and academic scale, and on the individual PAS scales. Conclusion: From childhood UHR individuals have lower levels of social and academic premorbid adjustment compared to healthy...... and academic scales were computed. Results: Compared to the healthy controls the UHR individuals’ social and academic premorbid adjustment declined across age periods. Social premorbid adjustment declined particularly between late adolescence and adulthood. Academic premorbid adjustment declined particularly...

  11. Family caregiver adjustment and stroke survivor impairment: A path analytic model.

    Science.gov (United States)

    Pendergrass, Anna; Hautzinger, Martin; Elliott, Timothy R; Schilling, Oliver; Becker, Clemens; Pfeiffer, Klaus

    2017-05-01

    Depressive symptoms are a common problem among family caregivers of stroke survivors. The purpose of this study was to examine the association between care recipient's impairment and caregiver depression, and determine the possible mediating effects of caregiver negative problem-orientation, mastery, and leisure time satisfaction. The evaluated model was derived from Pearlin's stress process model of caregiver adjustment. We analyzed baseline data from 122 strained family members who were assisting stroke survivors in Germany for a minimum of 6 months and who consented to participate in a randomized clinical trial. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. The cross-sectional data were analyzed using path analysis. The results show an adequate fit of the model to the data, χ2(1, N = 122) = 0.17, p = .68; comparative fit index = 1.00; root mean square error of approximation: p caregiver depressive symptoms. Results indicate that caregivers at risk for depression reported a negative problem orientation, low caregiving mastery, and low leisure time satisfaction. The situation is particularly affected by the frequency of stroke survivor problematic behavior, and by the degree of their impairments in activities of daily living. The findings provide empirical support for the Pearlin's stress model and emphasize how important it is to target these mediators in health promotion interventions for family caregivers of stroke survivors. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. Modelling allergenic risk

    DEFF Research Database (Denmark)

    Birot, Sophie

    combines second order Monte-Carlo simulations with Bayesian inferences [13]. An alternative method using second order Monte-Carlo simulations was proposed to take into account the uncertainty from the inputs. The uncertainty propagation from the inputs to the risk of allergic reaction was also evaluated...... countries is proposed. Thus, the allergen risk assessment can be performed cross-nationally and for the correct food group. Then the two probabilistic risk assessment methods usually used were reviewed and compared. First order Monte-Carlo simulations are used in one method [14], whereas the other one......Up to 20 million Europeans suffer from food allergies. Due to the lack of knowledge about why food allergies developed or how to protect allergic consumers from the offending food, food allergy management is mainly based on food allergens avoidance. The iFAAM project (Integrated approaches to Food...

  13. Risk and Protective Factors at Age 16: Psychological Adjustment in Children With a Cleft Lip and/or Palate.

    Science.gov (United States)

    Feragen, Kristin Billaud; Stock, Nicola Marie; Kvalem, Ingela Lundin

    2015-09-01

    Explore psychological functioning in adolescents with a cleft at age 16 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and psychosocial adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable adolescents were found across domains or whether risk was limited to specific areas of adjustment. Cross-sectional data based on psychological assessments at age 16 (N = 857). The effect of gender, cleft visibility, and the presence of an additional condition were investigated on all outcome variables. Results were compared with large national samples. Hopkins Symptom Checklist, Harter Self-Perception Scale for Adolescents, Child Experience Questionnaire, and Satisfaction With Appearance scale. The main factor influencing psychological adjustment across domains was gender, with girls in general reporting more psychological problems, as seen in reference groups. The presence of an additional condition also negatively affected some of the measures. No support was found for cleft visibility as a risk factor except for dissatisfaction with appearance. Correlation analyses of risk groups seem to point to an association between social and emotional risk and between social risk and dissatisfaction with appearance. Associations between other domains were found to be weak. The results point to areas of both risk and strength in adolescents born with a cleft lip and/or palate. Future research should investigate how protective factors could counteract potential risk in adolescents with a cleft.

  14. Adjustment of lifetime risks of space radiation-induced cancer by the healthy worker effect and cancer misclassification

    Directory of Open Access Journals (Sweden)

    Leif E. Peterson

    2015-12-01

    Conclusions. The typical life table approach for projecting lifetime risk of radiation-induced cancer mortality and incidence for astronauts and radiation workers can be improved by adjusting for HWE while simulating the uncertainty of input rates, input excess risk coefficients, and bias correction factors during multiple Monte Carlo realizations of the life table.

  15. Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

    Science.gov (United States)

    Peng, Qian; Nunes, Luís M; Greenfield, Ben K; Dang, Fei; Zhong, Huan

    2016-03-01

    Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. A risk-adjusted O-E CUSUM with monitoring bands for monitoring medical outcomes.

    Science.gov (United States)

    Sun, Rena Jie; Kalbfleisch, John D

    2013-03-01

    In order to monitor a medical center's survival outcomes using simple plots, we introduce a risk-adjusted Observed-Expected (O-E) Cumulative SUM (CUSUM) along with monitoring bands as decision criterion.The proposed monitoring bands can be used in place of a more traditional but complicated V-shaped mask or the simultaneous use of two one-sided CUSUMs. The resulting plot is designed to simultaneously monitor for failure time outcomes that are "worse than expected" or "better than expected." The slopes of the O-E CUSUM provide direct estimates of the relative risk (as compared to a standard or expected failure rate) for the data being monitored. Appropriate rejection regions are obtained by controlling the false alarm rate (type I error) over a period of given length. Simulation studies are conducted to illustrate the performance of the proposed method. A case study is carried out for 58 liver transplant centers. The use of CUSUM methods for quality improvement is stressed. Copyright © 2013, The International Biometric Society.

  17. A STUDY ON THE RISK-ADJUSTED PERFORMANCE OF MUTUAL FUNDS INDUSTRY IN INDIA

    Directory of Open Access Journals (Sweden)

    Shivangi Agarwal

    2017-04-01

    Full Text Available Investing through mutual funds has gained interest in recent years as it offers optimal risk adjusted returns to investors. The Indian market is no exception and has witnessed a multifold growth in mutual funds over the years. As of 2016, the Indian market is crowded with over two thousand mutual fund schemes, each promising higher returns compared to their peers. This comes as a challenge for an ordinary investor to select the best portfolio to invest making it critical to analyse the performance of these funds. While understanding and analysing the historical performance of mutual funds do not guarantee future performance, however, this may give an idea of how the fund is likely to perform in different market conditions. In this research we address multiple research issues. These include measuring the performance of selected mutual schemes on the basis of risk and return and compare the performance of these selected schemes with benchmark index to see whether the scheme is outperforming or underperforming the benchmark. We also rank funds on the basis of performance and suggest strategies to invest in a mutual fund and therefore, our findings have significant relevance for investing public.

  18. Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

    Directory of Open Access Journals (Sweden)

    Lampros Kousoulas

    2015-01-01

    Full Text Available Renal transplantation is the treatment of choice for patients suffering end-stage renal disease, but as the long-term renal allograft survival is limited, most transplant recipients will face graft loss and will be considered for a retransplantation. The goal of this study was to evaluate the patient and graft survival of the 61 renal transplant recipients after second or subsequent renal transplantation, transplanted in our institution between 1990 and 2010, and to identify risk factors related to inferior outcomes. Actuarial patient survival was 98.3%, 94.8%, and 88.2% after one, three, and five years, respectively. Actuarial graft survival was 86.8%, 80%, and 78.1% after one, three, and five years, respectively. Risk-adjusted analysis revealed that only age at the time of last transplantation had a significant influence on patient survival, whereas graft survival was influenced by multiple immunological and surgical factors, such as the number of HLA mismatches, the type of immunosuppression, the number of surgical complications, need of reoperation, primary graft nonfunction, and acute rejection episodes. In conclusion, third and subsequent renal transplantation constitute a valid therapeutic option, but inferior outcomes should be expected among elderly patients, hyperimmunized recipients, and recipients with multiple operations at the site of last renal transplantation.

  19. Public Reporting of Primary Care Clinic Quality: Accounting for Sociodemographic Factors in Risk Adjustment and Performance Comparison.

    Science.gov (United States)

    Wholey, Douglas R; Finch, Michael; Kreiger, Rob; Reeves, David

    2018-01-03

    Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison.

  20. Multilevel joint competing risk models

    Science.gov (United States)

    Karunarathna, G. H. S.; Sooriyarachchi, M. R.

    2017-09-01

    Joint modeling approaches are often encountered for different outcomes of competing risk time to event and count in many biomedical and epidemiology studies in the presence of cluster effect. Hospital length of stay (LOS) has been the widely used outcome measure in hospital utilization due to the benchmark measurement for measuring multiple terminations such as discharge, transferred, dead and patients who have not completed the event of interest at the follow up period (censored) during hospitalizations. Competing risk models provide a method of addressing such multiple destinations since classical time to event models yield biased results when there are multiple events. In this study, the concept of joint modeling has been applied to the dengue epidemiology in Sri Lanka, 2006-2008 to assess the relationship between different outcomes of LOS and platelet count of dengue patients with the district cluster effect. Two key approaches have been applied to build up the joint scenario. In the first approach, modeling each competing risk separately using the binary logistic model, treating all other events as censored under the multilevel discrete time to event model, while the platelet counts are assumed to follow a lognormal regression model. The second approach is based on the endogeneity effect in the multilevel competing risks and count model. Model parameters were estimated using maximum likelihood based on the Laplace approximation. Moreover, the study reveals that joint modeling approach yield more precise results compared to fitting two separate univariate models, in terms of AIC (Akaike Information Criterion).

  1. An evaluation of bias in propensity score-adjusted non-linear regression models.

    Science.gov (United States)

    Wan, Fei; Mitra, Nandita

    2018-03-01

    Propensity score methods are commonly used to adjust for observed confounding when estimating the conditional treatment effect in observational studies. One popular method, covariate adjustment of the propensity score in a regression model, has been empirically shown to be biased in non-linear models. However, no compelling underlying theoretical reason has been presented. We propose a new framework to investigate bias and consistency of propensity score-adjusted treatment effects in non-linear models that uses a simple geometric approach to forge a link between the consistency of the propensity score estimator and the collapsibility of non-linear models. Under this framework, we demonstrate that adjustment of the propensity score in an outcome model results in the decomposition of observed covariates into the propensity score and a remainder term. Omission of this remainder term from a non-collapsible regression model leads to biased estimates of the conditional odds ratio and conditional hazard ratio, but not for the conditional rate ratio. We further show, via simulation studies, that the bias in these propensity score-adjusted estimators increases with larger treatment effect size, larger covariate effects, and increasing dissimilarity between the coefficients of the covariates in the treatment model versus the outcome model.

  2. Prostate Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing prostate cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  3. Colorectal Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing colorectal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  4. Esophageal Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing esophageal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  5. Bladder Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing bladder cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  6. Lung Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing lung cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  7. Breast Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing breast cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  8. Pancreatic Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing pancreatic cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  9. Ovarian Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing ovarian cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  10. Liver Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing liver cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  11. Testicular Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of testicular cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  12. Cervical Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  13. Adjusting the Stems Regional Forest Growth Model to Improve Local Predictions

    Science.gov (United States)

    W. Brad Smith

    1983-01-01

    A simple procedure using double sampling is described for adjusting growth in the STEMS regional forest growth model to compensate for subregional variations. Predictive accuracy of the STEMS model (a distance-independent, individual tree growth model for Lake States forests) was improved by using this procedure

  14. Risk modelling in portfolio optimization

    Science.gov (United States)

    Lam, W. H.; Jaaman, Saiful Hafizah Hj.; Isa, Zaidi

    2013-09-01

    Risk management is very important in portfolio optimization. The mean-variance model has been used in portfolio optimization to minimize the investment risk. The objective of the mean-variance model is to minimize the portfolio risk and achieve the target rate of return. Variance is used as risk measure in the mean-variance model. The purpose of this study is to compare the portfolio composition as well as performance between the optimal portfolio of mean-variance model and equally weighted portfolio. Equally weighted portfolio means the proportions that are invested in each asset are equal. The results show that the portfolio composition of the mean-variance optimal portfolio and equally weighted portfolio are different. Besides that, the mean-variance optimal portfolio gives better performance because it gives higher performance ratio than the equally weighted portfolio.

  15. Models for Pesticide Risk Assessment

    Science.gov (United States)

    EPA considers the toxicity of the pesticide as well as the amount of pesticide to which a person or the environments may be exposed in risk assessment. Scientists use mathematical models to predict pesticide concentrations in exposure assessment.

  16. Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

    Science.gov (United States)

    Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

    2006-02-01

    A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

  17. Modeling and Control of the Redundant Parallel Adjustment Mechanism on a Deployable Antenna Panel

    Directory of Open Access Journals (Sweden)

    Lili Tian

    2016-10-01

    Full Text Available With the aim of developing multiple input and multiple output (MIMO coupling systems with a redundant parallel adjustment mechanism on the deployable antenna panel, a structural control integrated design methodology is proposed in this paper. Firstly, the modal information from the finite element model of the structure of the antenna panel is extracted, and then the mathematical model is established with the Hamilton principle; Secondly, the discrete Linear Quadratic Regulator (LQR controller is added to the model in order to control the actuators and adjust the shape of the panel. Finally, the engineering practicality of the modeling and control method based on finite element analysis simulation is verified.

  18. Steps in the construction and verification of an explanatory model of psychosocial adjustment

    Directory of Open Access Journals (Sweden)

    Arantzazu Rodríguez-Fernández

    2016-06-01

    Full Text Available The aim of the present study was to empirically test an explanatory model of psychosocial adjustment during adolescence, with psychosocial adjustment during this stage being understood as a combination of school adjustment (or school engagement and subjective well-being. According to the hypothetic model, psychosocial adjustment depends on self-concept and resilience, which in turn act as mediators of the influence of perceived social support (from family, peers and teachers on this adjustment. Participants were 1250 secondary school students (638 girls and 612 boys aged between 12 and 15 years (Mean = 13.72; SD = 1.09. The results provided evidence of: (a the influence of all three types of perceived support on subject resilience and self-concept, with perceived family support being particularly important in this respect; (b the influence of the support received from teachers on school adjustment and support received from the family on psychological wellbeing; and (c the absence of any direct influence of peer support on psychosocial adjustment, although indirect influence was observed through the psychological variables studied. These results are discussed from an educational perspective and in terms of future research.

  19. Steps in the construction and verification of an explanatory model of psychosocial adjustment

    Directory of Open Access Journals (Sweden)

    Arantzazu Rodríguez-Fernández

    2016-06-01

    Full Text Available The aim of the present study was to empirically test an explanatory model of psychosocial adjustment during adolescence, with psychosocial adjustment during this stage being understood as a combination of school adjustment (or school engagement and subjective well-being. According to the hypothetic model, psychosocial adjustment depends on self-concept and resilience, which in turn act as mediators of the influence of perceived social support (from family, peers and teachers on this adjustment. Participants were 1250 secondary school students (638 girls and 612 boys aged between 12 and 15 years (Mean = 13.72; SD = 1.09. The results provided evidence of: (a the influence of all three types of perceived support on subject resilience and self-concept, with perceived family support being particularly important in this respect; (b the influence of the support received from teachers on school adjustment and support received from the family on psychological wellbeing; and (c the absence of any direct influence of peer support on psychosocial adjustment, although indirect influence was observed through the psychological variables studied. These results are discussed from an educational perspective and in terms of future research

  20. Implication of Mauk Nursing Rehabilitation Model on Adjustment of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Zeinab Ebrahimpour mouziraji

    2014-12-01

    Full Text Available Objectives: Stroke is a neurological syndrome with sudden onset or gradual destruction of brain vessels, which may take 24 hours or more. Complications of stroke effect in the variation aspects of the individual. According to De Spulveda and Chang’s Studies, disability reduced the effective adjustment. This study aimed to overview the adjustment of stroke patients based on the main concepts of rehabilitation nursing Mauk model. Methods: In a quasi-experimental one group pre-posttest design study, data was collected in the neurology clinic of Imam Khomeini hospital and stroke patient rehabilitation centers in Tehran (Tabassom. Data collection included demographic and adjustment questionnaires of stroke patients. The intervention included seven sessions as Mauk model, each session with one hour training, for seven patients. Data analysis performed with SPSS software with paired t-test and was compared with previous results. Results: There were significant differences between the mean scores of patients with stroke adjustment questionnaire in the pre-test-post-test. But in the adjustment sub-scales, except for relationship with wife and Personal adjustment, in other areas, there is no statistically significant difference between the pre and posttest. Discussion: The results indicated that training has been affected on some aspects of adjustment of stroke patients in order to, as improving functions, complications and its limitations. Nurses can help then with implementing of plans such as patients education in this regard.

  1. Modeling renewable energy company risk

    International Nuclear Information System (INIS)

    Sadorsky, Perry

    2012-01-01

    The renewable energy sector is one of the fastest growing components of the energy industry and along with this increased demand for renewable energy there has been an increase in investing and financing activities. The tradeoff between risk and return in the renewable energy sector is, however, precarious. Renewable energy companies are often among the riskiest types of companies to invest in and for this reason it is necessary to have a good understanding of the risk factors. This paper uses a variable beta model to investigate the determinants of renewable energy company risk. The empirical results show that company sales growth has a negative impact on company risk while oil price increases have a positive impact on company risk. When oil price returns are positive and moderate, increases in sales growth can offset the impact of oil price returns and this leads to lower systematic risk.

  2. Modeling Quality-Adjusted Life Expectancy Loss Resulting from Tobacco Use in the United States

    Science.gov (United States)

    Kaplan, Robert M.; Anderson, John P.; Kaplan, Cameron M.

    2007-01-01

    Purpose: To describe the development of a model for estimating the effects of tobacco use upon Quality Adjusted Life Years (QALYs) and to estimate the impact of tobacco use on health outcomes for the United States (US) population using the model. Method: We obtained estimates of tobacco consumption from 6 years of the National Health Interview…

  3. Evaluation of the Stress Adjustment and Adaptation Model among Families Reporting Economic Pressure

    Science.gov (United States)

    Vandsburger, Etty; Biggerstaff, Marilyn A.

    2004-01-01

    This research evaluates the Stress Adjustment and Adaptation Model (double ABCX model) examining the effects resiliency resources on family functioning when families experience economic pressure. Families (N = 128) with incomes at or below the poverty line from a rural area of a southern state completed measures of perceived economic pressure,…

  4. Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

    OpenAIRE

    Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

    2000-01-01

    To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the produc...

  5. Emotional closeness to parents and grandparents: A moderated mediation model predicting adolescent adjustment.

    Science.gov (United States)

    Attar-Schwartz, Shalhevet

    2015-09-01

    Warm and emotionally close relationships with parents and grandparents have been found in previous studies to be linked with better adolescent adjustment. The present study, informed by Family Systems Theory and Intergenerational Solidarity Theory, uses a moderated mediation model analyzing the contribution of the dynamics of these intergenerational relationships to adolescent adjustment. Specifically, it examines the mediating role of emotional closeness to the closest grandparent in the relationship between emotional closeness to a parent (the offspring of the closest grandparent) and adolescent adjustment difficulties. The model also examines the moderating role of emotional closeness to parents in the relationship between emotional closeness to grandparents and adjustment difficulties. The study was based on a sample of 1,405 Jewish Israeli secondary school students (ages 12-18) who completed a structured questionnaire. It was found that emotional closeness to the closest grandparent was more strongly associated with reduced adjustment difficulties among adolescents with higher levels of emotional closeness to their parents. In addition, adolescent adjustment and emotional closeness to parents was partially mediated by emotional closeness to grandparents. Examining the family conditions under which adolescents' relationships with grandparents is stronger and more beneficial for them can help elucidate variations in grandparent-grandchild ties and expand our understanding of the mechanisms that shape child outcomes. (c) 2015 APA, all rights reserved).

  6. Case‐mix adjustment in non‐randomised observational evaluations: the constant risk fallacy

    OpenAIRE

    Nicholl, Jon

    2007-01-01

    Observational studies comparing groups or populations to evaluate services or interventions usually require case‐mix adjustment to account for imbalances between the groups being compared. Simulation studies have, however, shown that case‐mix adjustment can make any bias worse.

  7. Measuring Risk-adjusted Customer Lifetime Value and its Impact on Relationship Marketing Strategies and Shareholder Value

    OpenAIRE

    Ryals, Lynette; Knox, Simon

    2005-01-01

    The calculations which underlie efforts to balance marketing spending on customer acquisition and customer retention are usually based on either single- period customer profitability or forecasts of customer lifetime value (CLTV). This paper argues instead for risk-adjusted CLTV, which is termed the economic value (EV) of a customer, as the means for marketing to assess both customer profitability and shareholder value gains.

  8. The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.

    Science.gov (United States)

    Meddings, Jennifer; Reichert, Heidi; Smith, Shawna N; Iwashyna, Theodore J; Langa, Kenneth M; Hofer, Timothy P; McMahon, Laurence F

    2017-01-01

    Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. Outcomes measured were readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and 'other' race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status

  9. Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups.

    Science.gov (United States)

    Jian, Weiyan; Huang, Yinmin; Hu, Mu; Zhang, Xiumei

    2009-04-30

    The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context. Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals. Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals. It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to

  10. Information risk and security modeling

    Science.gov (United States)

    Zivic, Predrag

    2005-03-01

    This research paper presentation will feature current frameworks to addressing risk and security modeling and metrics. The paper will analyze technical level risk and security metrics of Common Criteria/ISO15408, Centre for Internet Security guidelines, NSA configuration guidelines and metrics used at this level. Information IT operational standards view on security metrics such as GMITS/ISO13335, ITIL/ITMS and architectural guidelines such as ISO7498-2 will be explained. Business process level standards such as ISO17799, COSO and CobiT will be presented with their control approach to security metrics. Top level, the maturity standards such as SSE-CMM/ISO21827, NSA Infosec Assessment and CobiT will be explored and reviewed. For each defined level of security metrics the research presentation will explore the appropriate usage of these standards. The paper will discuss standards approaches to conducting the risk and security metrics. The research findings will demonstrate the need for common baseline for both risk and security metrics. This paper will show the relation between the attribute based common baseline and corporate assets and controls for risk and security metrics. IT will be shown that such approach spans over all mentioned standards. The proposed approach 3D visual presentation and development of the Information Security Model will be analyzed and postulated. Presentation will clearly demonstrate the benefits of proposed attributes based approach and defined risk and security space for modeling and measuring.

  11. Cabin Environment Physics Risk Model

    Science.gov (United States)

    Mattenberger, Christopher J.; Mathias, Donovan Leigh

    2014-01-01

    This paper presents a Cabin Environment Physics Risk (CEPR) model that predicts the time for an initial failure of Environmental Control and Life Support System (ECLSS) functionality to propagate into a hazardous environment and trigger a loss-of-crew (LOC) event. This physics-of failure model allows a probabilistic risk assessment of a crewed spacecraft to account for the cabin environment, which can serve as a buffer to protect the crew during an abort from orbit and ultimately enable a safe return. The results of the CEPR model replace the assumption that failure of the crew critical ECLSS functionality causes LOC instantly, and provide a more accurate representation of the spacecraft's risk posture. The instant-LOC assumption is shown to be excessively conservative and, moreover, can impact the relative risk drivers identified for the spacecraft. This, in turn, could lead the design team to allocate mass for equipment to reduce overly conservative risk estimates in a suboptimal configuration, which inherently increases the overall risk to the crew. For example, available mass could be poorly used to add redundant ECLSS components that have a negligible benefit but appear to make the vehicle safer due to poor assumptions about the propagation time of ECLSS failures.

  12. Droop Control with an Adjustable Complex Virtual Impedance Loop based on Cloud Model Theory

    DEFF Research Database (Denmark)

    Li, Yan; Shuai, Zhikang; Xu, Qinming

    2016-01-01

    Droop control framework with an adjustable virtual impedance loop is proposed in this paper, which is based on the cloud model theory. The proposed virtual impedance loop includes two terms: a negative virtual resistor and an adjustable virtual inductance. The negative virtual resistor term...... sometimes. The cloud model theory is applied to get online the changing line impedance value, which relies on the relevance of the reactive power responding the changing line impedance. The verification of the proposed control strategy is done according to the simulation in a low voltage microgrid in Matlab....

  13. Contact angle adjustment in equation-of-state-based pseudopotential model.

    Science.gov (United States)

    Hu, Anjie; Li, Longjian; Uddin, Rizwan; Liu, Dong

    2016-05-01

    The single component pseudopotential lattice Boltzmann model has been widely applied in multiphase simulation due to its simplicity and stability. In many studies, it has been claimed that this model can be stable for density ratios larger than 1000. However, the application of the model is still limited to small density ratios when the contact angle is considered. The reason is that the original contact angle adjustment method influences the stability of the model. Moreover, simulation results in the present work show that, by applying the original contact angle adjustment method, the density distribution near the wall is artificially changed, and the contact angle is dependent on the surface tension. Hence, it is very inconvenient to apply this method with a fixed contact angle, and the accuracy of the model cannot be guaranteed. To solve these problems, a contact angle adjustment method based on the geometry analysis is proposed and numerically compared with the original method. Simulation results show that, with our contact angle adjustment method, the stability of the model is highly improved when the density ratio is relatively large, and it is independent of the surface tension.

  14. Adjustment for smoking reduces radiation risk: fifth analysis of mortality of nuclear industry workers in Japan, 1999-2010

    Energy Technology Data Exchange (ETDEWEB)

    Kudo, S.; Ishida, J.; Yoshimoto, K.; Mizuno, S.; Ohshima, S.; Kasagi, F., E-mail: s_kudo@rea.or.jp [Instituto of Radiation Epidemiology, Radiation Effects Association, 1-9-16 Kajicho, Chiyoda-ku, 101-0044 Tokyo (Japan)

    2015-10-15

    Full text: Many cohort studies among nuclear industry workers have been carried out to determine the possible health effects of low-level radiation. In those studies, confounding factors, for example, age was adjusted to exclude the effect of difference of mortality by age to estimate radiation risk. But there are few studies adjusting for smoking that is known as a strong factor which affects mortality. Radiation Effects Association (Rea) initiated a cohort study of nuclear industry workers mortality in 1990. To examine non-radiation factors confounding on the mortality risk among the radiation workers, Rea have performed life-style questionnaire surveys among the part of workers at 1997 and 2003 and found the correlation between radiation dose and smoking rate. Mortality follow-up were made on 75,442 male respondents for an average of 8.3 years during the observation period 1999-2010. Estimates of Excess Relative Risk percent (Err %) per 10 mSv were obtained by using the Poisson regression. The Err for all causes was statistically significant (1.05 (90 % CI 0.31 : 1.80)), but no longer significant after adjusting for smoking (0.45 (-0.24 : 1.13)). The Err for all cancers excluding leukemia was not significant (0.92 (-0.30 : 2.16)), but after adjusting for smoking, it decreased (0.36 (-0.79 : 1.50)). Thus smoking has a large effect to obscure a radiation risk, so adjustment for smoking is important to estimate radiation risk. (Author)

  15. Adjustment for smoking reduces radiation risk: fifth analysis of mortality of nuclear industry workers in Japan, 1999-2010

    International Nuclear Information System (INIS)

    Kudo, S.; Ishida, J.; Yoshimoto, K.; Mizuno, S.; Ohshima, S.; Kasagi, F.

    2015-10-01

    Full text: Many cohort studies among nuclear industry workers have been carried out to determine the possible health effects of low-level radiation. In those studies, confounding factors, for example, age was adjusted to exclude the effect of difference of mortality by age to estimate radiation risk. But there are few studies adjusting for smoking that is known as a strong factor which affects mortality. Radiation Effects Association (Rea) initiated a cohort study of nuclear industry workers mortality in 1990. To examine non-radiation factors confounding on the mortality risk among the radiation workers, Rea have performed life-style questionnaire surveys among the part of workers at 1997 and 2003 and found the correlation between radiation dose and smoking rate. Mortality follow-up were made on 75,442 male respondents for an average of 8.3 years during the observation period 1999-2010. Estimates of Excess Relative Risk percent (Err %) per 10 mSv were obtained by using the Poisson regression. The Err for all causes was statistically significant (1.05 (90 % CI 0.31 : 1.80)), but no longer significant after adjusting for smoking (0.45 (-0.24 : 1.13)). The Err for all cancers excluding leukemia was not significant (0.92 (-0.30 : 2.16)), but after adjusting for smoking, it decreased (0.36 (-0.79 : 1.50)). Thus smoking has a large effect to obscure a radiation risk, so adjustment for smoking is important to estimate radiation risk. (Author)

  16. Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care.

    Science.gov (United States)

    Damman, Olga C; Stubbe, Janine H; Hendriks, Michelle; Arah, Onyebuchi A; Spreeuwenberg, Peter; Delnoij, Diana M J; Groenewegen, Peter P

    2009-04-01

    Ratings on the quality of healthcare from the consumer's perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for analyzing healthcare performance data, it has rarely been used to assess case-mix adjustment of such data. The purpose of this article is to investigate whether multilevel regression analysis is a useful tool to detect case-mix adjusters in consumer assessment of healthcare. We used data on 11,539 consumers from 27 Dutch health plans, which were collected using the Dutch Consumer Quality Index health plan instrument. We conducted multilevel regression analyses of consumers' responses nested within health plans to assess the effects of consumer characteristics on consumer experience. We compared our findings to the results of another methodology: the impact factor approach, which combines the predictive effect of each case-mix variable with its heterogeneity across health plans. Both multilevel regression and impact factor analyses showed that age and education were the most important case-mix adjusters for consumer experience and ratings of health plans. With the exception of age, case-mix adjustment had little impact on the ranking of health plans. On both theoretical and practical grounds, multilevel modeling is useful for adequate case-mix adjustment and analysis of performance ratings.

  17. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Stamou, Sotiris C; Dullum, Mercedes K C; Hill, Peter C; Haile, Elizabeth; Boyce, Steven W; Bafi, Ammar S; Petro, Kathleen R; Corso, Paul J

    2004-11-01

    Cerebral embolization of atherosclerotic plaque debris caused by aortic manipulation during conventional coronary artery bypass grafting (CABG) is a major mechanism of postoperative cerebrovascular accidents (CVA). Off-pump CABG (OPCABG) reduces stroke rates by minimizing aortic manipulation. Consequently, the effect of different levels of aortic manipulation on neurologic outcomes after CABG surgery was examined. From January 1998 to June 2002, 7,272 patients underwent isolated CABG surgery through three levels of aortic manipulation: full plus tangential (side-biting) aortic clamp application (on-pump surgery; n = 4,269), only tangential aortic clamp application (OPCABG surgery; n = 2,527) or an "aortic no-touch" technique (OPCABG surgery; n = 476). A risk-adjusted logistic regression analysis was performed to establish the likelihood of postoperative stroke with each technique. Preoperative risk factors for stroke from the literature, and those found significant in a univariable model were used. A significant association for postoperative stroke correspondingly increasing with the extent of aortic manipulation was demonstrated by the univariable analysis (CVA incidence respectively increasing from 0.8% to 1.6% to a maximum of 2.2%, p < 0.01). In the logistic regression model, patients who had a full and a tangential aortic clamp applied were 1.8 times more likely to have a stroke versus those without any aortic manipulation (95% confidence interval: 1.15 to 2.74, p < 0.01) and 1.7 times more likely to develop a postoperative stroke than those with only a tangential aortic clamp applied (95% confidence interval: 1.11 to 2.48, p < 0.01). Aortic manipulation during CABG is a contributing mechanism for postoperative stroke. The incidence of postoperative stroke increases with increased levels of aortic manipulation.

  18. Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism.

    Science.gov (United States)

    Kaeberich, Anja; Seeber, Valerie; Jiménez, David; Kostrubiec, Maciej; Dellas, Claudia; Hasenfuß, Gerd; Giannitsis, Evangelos; Pruszczyk, Piotr; Konstantinides, Stavros; Lankeit, Mareike

    2015-05-01

    High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk. Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL(-1) retained its high prognostic value (OR (95% CI) 16.64 (2.24-123.74); p=0.006) compared with the cut-off value of 33 pg·mL(-1) calculated by receiver operating characteristic analysis (7.14 (2.64-19.26); pvalue of 45 pg·mL(-1) but not the established cut-off value of 14 pg·mL(-1) predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL(-1) for patients aged risk (12.4% adverse outcome). Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy. Copyright ©ERS 2015.

  19. On adjustment for auxiliary covariates in additive hazard models for the analysis of randomized experiments

    DEFF Research Database (Denmark)

    Vansteelandt, S.; Martinussen, Torben; Tchetgen, E. J Tchetgen

    2014-01-01

    We consider additive hazard models (Aalen, 1989) for the effect of a randomized treatment on a survival outcome, adjusting for auxiliary baseline covariates. We demonstrate that the Aalen least-squares estimator of the treatment effect parameter is asymptotically unbiased, even when the hazard...... that, in view of its robustness against model misspecification, Aalen least-squares estimation is attractive for evaluating treatment effects on a survival outcome in randomized experiments, and the primary reasons to consider baseline covariate adjustment in such settings could be interest in subgroup......'s dependence on time or on the auxiliary covariates is misspecified, and even away from the null hypothesis of no treatment effect. We furthermore show that adjustment for auxiliary baseline covariates does not change the asymptotic variance of the estimator of the effect of a randomized treatment. We conclude...

  20. Behavioral Risk Factor Surveillance System (BRFSS) Age-Adjusted Prevalence Data (2011 to present)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2011 to present. BRFSS combined land line and cell phone age-adjusted prevalence data. The BRFSS is a continuous, state-based surveillance system that collects...

  1. Variational assimilation of streamflow into operational distributed hydrologic models: effect of spatiotemporal adjustment scale

    Science.gov (United States)

    Lee, H.; Seo, D.-J.; Liu, Y.; Koren, V.; McKee, P.; Corby, R.

    2012-01-01

    State updating of distributed rainfall-runoff models via streamflow assimilation is subject to overfitting because large dimensionality of the state space of the model may render the assimilation problem seriously under-determined. To examine the issue in the context of operational hydrology, we carry out a set of real-world experiments in which streamflow data is assimilated into gridded Sacramento Soil Moisture Accounting (SAC-SMA) and kinematic-wave routing models of the US National Weather Service (NWS) Research Distributed Hydrologic Model (RDHM) with the variational data assimilation technique. Study basins include four basins in Oklahoma and five basins in Texas. To assess the sensitivity of data assimilation performance to dimensionality reduction in the control vector, we used nine different spatiotemporal adjustment scales, where state variables are adjusted in a lumped, semi-distributed, or distributed fashion and biases in precipitation and potential evaporation (PE) are adjusted hourly, 6-hourly, or kept time-invariant. For each adjustment scale, three different streamflow assimilation scenarios are explored, where streamflow observations at basin interior points, at the basin outlet, or at both interior points and the outlet are assimilated. The streamflow assimilation experiments with nine different basins show that the optimum spatiotemporal adjustment scale varies from one basin to another and may be different for streamflow analysis and prediction in all of the three streamflow assimilation scenarios. The most preferred adjustment scale for seven out of nine basins is found to be the distributed, hourly scale, despite the fact that several independent validation results at this adjustment scale indicated the occurrence of overfitting. Basins with highly correlated interior and outlet flows tend to be less sensitive to the adjustment scale and could benefit more from streamflow assimilation. In comparison to outlet flow assimilation, interior flow

  2. Fuzzy audit risk modeling algorithm

    Directory of Open Access Journals (Sweden)

    Zohreh Hajihaa

    2011-07-01

    Full Text Available Fuzzy logic has created suitable mathematics for making decisions in uncertain environments including professional judgments. One of the situations is to assess auditee risks. During recent years, risk based audit (RBA has been regarded as one of the main tools to fight against fraud. The main issue in RBA is to determine the overall audit risk an auditor accepts, which impact the efficiency of an audit. The primary objective of this research is to redesign the audit risk model (ARM proposed by auditing standards. The proposed model of this paper uses fuzzy inference systems (FIS based on the judgments of audit experts. The implementation of proposed fuzzy technique uses triangular fuzzy numbers to express the inputs and Mamdani method along with center of gravity are incorporated for defuzzification. The proposed model uses three FISs for audit, inherent and control risks, and there are five levels of linguistic variables for outputs. FISs include 25, 25 and 81 rules of if-then respectively and officials of Iranian audit experts confirm all the rules.

  3. Testing a social ecological model for relations between political violence and child adjustment in Northern Ireland.

    Science.gov (United States)

    Cummings, E Mark; Merrilees, Christine E; Schermerhorn, Alice C; Goeke-Morey, Marcie C; Shirlow, Peter; Cairns, Ed

    2010-05-01

    Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family, and child psychological processes in child adjustment, supporting study of interrelations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M = 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures of community discord, family relations, and children's regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members' reports of current sectarian antisocial behavior and nonsectarian antisocial behavior. Interparental conflict and parental monitoring and children's emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children's adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world.

  4. A Threshold Model of Social Support, Adjustment, and Distress after Breast Cancer Treatment

    Science.gov (United States)

    Mallinckrodt, Brent; Armer, Jane M.; Heppner, P. Paul

    2012-01-01

    This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support…

  5. Development of a model for case-mix adjustment of pressure ulcer prevalence rates.

    NARCIS (Netherlands)

    Bours, G.J.J.W.; Halfens, J.; Berger, M.P.; Abu-Saad, H.H.; Grol, R.P.T.M.

    2003-01-01

    BACKGROUND: Acute care hospitals participating in the Dutch national pressure ulcer prevalence survey use the results of this survey to compare their outcomes and assess their quality of care regarding pressure ulcer prevention. The development of a model for case-mix adjustment is essential for the

  6. 10 km running performance predicted by a multiple linear regression model with allometrically adjusted variables.

    Science.gov (United States)

    Abad, Cesar C C; Barros, Ronaldo V; Bertuzzi, Romulo; Gagliardi, João F L; Lima-Silva, Adriano E; Lambert, Mike I; Pires, Flavio O

    2016-06-01

    The aim of this study was to verify the power of VO 2max , peak treadmill running velocity (PTV), and running economy (RE), unadjusted or allometrically adjusted, in predicting 10 km running performance. Eighteen male endurance runners performed: 1) an incremental test to exhaustion to determine VO 2max and PTV; 2) a constant submaximal run at 12 km·h -1 on an outdoor track for RE determination; and 3) a 10 km running race. Unadjusted (VO 2max , PTV and RE) and adjusted variables (VO 2max 0.72 , PTV 0.72 and RE 0.60 ) were investigated through independent multiple regression models to predict 10 km running race time. There were no significant correlations between 10 km running time and either the adjusted or unadjusted VO 2max . Significant correlations (p 0.84 and power > 0.88. The allometrically adjusted predictive model was composed of PTV 0.72 and RE 0.60 and explained 83% of the variance in 10 km running time with a standard error of the estimate (SEE) of 1.5 min. The unadjusted model composed of a single PVT accounted for 72% of the variance in 10 km running time (SEE of 1.9 min). Both regression models provided powerful estimates of 10 km running time; however, the unadjusted PTV may provide an uncomplicated estimation.

  7. Towards an Integrated Conceptual Model of International Student Adjustment and Adaptation

    Science.gov (United States)

    Schartner, Alina; Young, Tony Johnstone

    2016-01-01

    Despite a burgeoning body of empirical research on "the international student experience", the area remains under-theorized. The literature to date lacks a guiding conceptual model that captures the adjustment and adaptation trajectories of this unique, growing, and important sojourner group. In this paper, we therefore put forward a…

  8. A Four-Part Model of Autonomy during Emerging Adulthood: Associations with Adjustment

    Science.gov (United States)

    Lamborn, Susie D.; Groh, Kelly

    2009-01-01

    We found support for a four-part model of autonomy that links connectedness, separation, detachment, and agency to adjustment during emerging adulthood. Based on self-report surveys of 285 American college students, expected associations among the autonomy variables were found. In addition, agency, as measured by self-reliance, predicted lower…

  9. Testing an Attachment Model of Latina/o College Students' Psychological Adjustment

    Science.gov (United States)

    Garriott, Patton O.; Love, Keisha M.; Tyler, Kenneth M.; Thomas, Deneia M.; Roan-Belle, Clarissa R.; Brown, Carrie L.

    2010-01-01

    The present study examined the influence of attachment relationships on the psychological adjustment of Latina/o university students (N = 80) attending predominantly White institutions of higher education. A path analysis conducted to test a hypothesized model of parent and peer attachment, self-esteem, and psychological distress indicated that…

  10. Applying Four Different Risk Models in Local Ore Selection

    International Nuclear Information System (INIS)

    Richmond, Andrew

    2002-01-01

    Given the uncertainty in grade at a mine location, a financially risk-averse decision-maker may prefer to incorporate this uncertainty into the ore selection process. A FORTRAN program risksel is presented to calculate local risk-adjusted optimal ore selections using a negative exponential utility function and three dominance models: mean-variance, mean-downside risk, and stochastic dominance. All four methods are demonstrated in a grade control environment. In the case study, optimal selections range with the magnitude of financial risk that a decision-maker is prepared to accept. Except for the stochastic dominance method, the risk models reassign material from higher cost to lower cost processing options as the aversion to financial risk increases. The stochastic dominance model usually was unable to determine the optimal local selection

  11. Model of MSD Risk Assessment at Workplace

    OpenAIRE

    K. Sekulová; M. Šimon

    2015-01-01

    This article focuses on upper-extremity musculoskeletal disorders risk assessment model at workplace. In this model are used risk factors that are responsible for musculoskeletal system damage. Based on statistic calculations the model is able to define what risk of MSD threatens workers who are under risk factors. The model is also able to say how MSD risk would decrease if these risk factors are eliminated.

  12. Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors.

    Science.gov (United States)

    Brody, Gene H; Yu, Tianyi; Chen, Yi-fu; Kogan, Steven M; Evans, Gary W; Beach, Steven R H; Windle, Michael; Simons, Ronald L; Gerrard, Meg; Gibbons, Frederick X; Philibert, Robert A

    2013-05-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

  13. Adjustment modes in the trajectory of progressive multiple sclerosis: a qualitative study and conceptual model.

    Science.gov (United States)

    Bogosian, Angeliki; Morgan, Myfanwy; Bishop, Felicity L; Day, Fern; Moss-Morris, Rona

    2017-03-01

    We examined cognitive and behavioural challenges and adaptations for people with progressive multiple sclerosis (MS) and developed a preliminary conceptual model of changes in adjustment over time. Using theoretical sampling, 34 semi-structured interviews were conducted with people with MS. Participants were between 41 and 77 years of age. Thirteen were diagnosed with primary progressive MS and 21 with secondary progressive MS. Data were analysed using a grounded theory approach. Participants described initially bracketing the illness off and carrying on their usual activities but this became problematic as the condition progressed and they employed different adjustment modes to cope with increased disabilities. Some scaled back their activities to live a more comfortable life, others identified new activities or adapted old ones, whereas at times, people disengaged from the adjustment process altogether and resigned to their condition. Relationships with partners, emotional reactions, environment and perception of the environment influenced adjustment, while people were often flexible and shifted among modes. Adjusting to a progressive condition is a fluid process. Future interventions can be tailored to address modifiable factors at different stages of the condition and may involve addressing emotional reactions concealing/revealing the condition and perceptions of the environment.

  14. Can parents adjust to the idea that their child is at risk for a sudden death?: Psychological impact of risk for Long QT Syndrome

    NARCIS (Netherlands)

    Hendriks, Karin S. W. H.; Grosfeld, F. J. M.; van Tintelen, J. P.; van Langen, I. M.; Wilde, A. A. M.; van den Bout, J.; ten Kroode, H. F. J.

    2005-01-01

    Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death,

  15. Can parents adjust to the idea that their child is at risk for a sudden death? : Psychological impact of risk for Long QT Syndrome

    NARCIS (Netherlands)

    Hendriks, Karin S. W. H.; Grosfeld, FJM; van Tintelen, JP; van Langen, IM; Wilde, AAM; van den Bout, J; ten Kroode, HFJ

    2005-01-01

    Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death,

  16. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    Science.gov (United States)

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  17. Model dependencies of risk aversion and working interest estimates

    International Nuclear Information System (INIS)

    Lerche, I.

    1996-01-01

    Working interest, W, and risk adjusted value, RAV, are evaluated using both Cozzolino's formula for exponential dependence of risk aversion and also for a hyperbolic tangent dependence. In addition, the general method is given of constructing an RAV formula for any functional choice of risk aversion dependence. Two examples are given to illustrate how the model dependencies influence choices of working interest and risk adjusted value depending on whether the expected value of the project is positive or negative. In general the Cozzolino formula provides a more conservative position for risk than does the hyperbolic tangent formula, reflecting the difference in corporate attitudes to risk aversion. The commonly used Cozzolino formula is shown to have simple exact arithmetic expressions for maximum working interest and maximum RAV; the hyperbolic tangent formula has approximate analytic expressions. Both formulae also yield approximate analytical expressions for the working interest yielding a risk neutral RAV of zero. These arithmetic results are useful for making quick estimates of working interest ranges and risk adjusted values. (Author)

  18. Evolution Scenarios at the Romanian Economy Level, Using the R.M. Solow Adjusted Model

    Directory of Open Access Journals (Sweden)

    Stelian Stancu

    2008-06-01

    Full Text Available Besides the models of M. Keynes, R.F. Harrod, E. Domar, D. Romer, Ramsey-Cass-Koopmans model etc., the R.M. Solow model is part of the category which characterizes the economic growth. The paper proposes the presentation of the R.M. Solow adjusted model with specific simulation characteristics and economic growth scenario. Considering these aspects, there are presented the values obtained at the economy level, behind the simulations, about the ratio Capital on the output volume, Output volume on employee, equal with the current labour efficiency, as well as the Labour efficiency value.

  19. The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients.

    Science.gov (United States)

    Barton, Christopher A; Bassett, Katherine L; Buckman, Julie; Effing, Tanja W; Frith, Peter A; van der Palen, Job; Sloots, Joanne M

    2017-02-01

    We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT algorithms. Two multivariate logistic regression models for infrequent (≤1/year) versus frequent (>1/year) future respiratory-related hospitalizations were defined: one with the adjusted CAT score that correlated best with future hospitalizations and one with the original CAT score. Patient characteristics related to future hospitalizations ( p ≤ 0.2) were also entered. Eighty-two COPD patients were included. The CAT algorithm derived from the nurse focus group was a borderline significant predictor of hospitalization risk (odds ratio (OR): 1.07; 95% confidence interval (CI): 1.00-1.14; p = 0.050) in a model that also included hospitalization frequency in the previous year (OR: 3.98; 95% CI: 1.30-12.16; p = 0.016) and anticholinergic risk score (OR: 3.08; 95% CI: 0.87-10.89; p = 0.081). Presence of ischemic heart disease and/or heart failure appeared 'protective' (OR: 0.17; 95% CI: 0.05-0.62; p = 0.007). The original CAT score was not significantly associated with hospitalization risk. In conclusion, as a predictor of respiratory-related hospitalizations, an adjusted CAT score was marginally significant (although the original CAT score was not). 'Previous respiratory-related hospitalizations' was the strongest factor in this equation.

  20. Pathways of Parenting Style on Adolescents' College Adjustment, Academic Achievement, and Alcohol Risk

    Science.gov (United States)

    Kenney, Shannon R.; Lac, Andrew; Hummer, Justin F.; Grimaldi, Elizabeth M.; LaBrie, Joseph W.

    2015-01-01

    This study examined the pathways of parenting style (permissive, authoritarian, and authoritative) to alcohol consumption and consequences through the mediators of college adjustment and academic achievement (grade point average [GPA]). Participants were 289 students from a private, mid-size, West Coast university (mean age 19.01 years, 58.8%…

  1. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

    OpenAIRE

    Martín-Fernández, Jesus; Polentinos-Castro, Elena; del Cura-González, Ma Isabel; Ariza-Cardiel, Gloria; Abraira, Victor; Gil-LaCruz, Ana Isabel; García-Pérez, Sonia

    2014-01-01

    Background This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Methods Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic an...

  2. Spatiotemporal Modeling of Community Risk

    Science.gov (United States)

    2016-03-01

    Ertugay, and Sebnem Duzgun, “Exploratory and Inferential Methods for Spatio-Temporal Analysis of Residential Fire Clustering in Urban Areas,” Fire ...response in communities.”26 In “Exploratory and Inferential Methods for Spatio-temporal Analysis of Residential Fire Clustering in Urban Areas,” Ceyhan...of fire resources spread across the community. Spatiotemporal modeling shows that actualized risk is dynamic and relatively patterned. Though

  3. The Use of the Kurtosis-Adjusted Cumulative Noise Exposure Metric in Evaluating the Hearing Loss Risk for Complex Noise.

    Science.gov (United States)

    Xie, Hong-Wei; Qiu, Wei; Heyer, Nicholas J; Zhang, Mei-Bian; Zhang, Peng; Zhao, Yi-Ming; Hamernik, Roger P

    2016-01-01

    To test a kurtosis-adjusted cumulative noise exposure (CNE) metric for use in evaluating the risk of hearing loss among workers exposed to industrial noises. Specifically, to evaluate whether the kurtosis-adjusted CNE (1) provides a better association with observed industrial noise-induced hearing loss, and (2) provides a single metric applicable to both complex (non-Gaussian [non-G]) and continuous or steady state (Gaussian [G]) noise exposures for predicting noise-induced hearing loss (dose-response curves). Audiometric and noise exposure data were acquired on a population of screened workers (N = 341) from two steel manufacturing plants located in Zhejiang province and a textile manufacturing plant located in Henan province, China. All the subjects from the two steel manufacturing plants (N = 178) were exposed to complex noise, whereas the subjects from textile manufacturing plant (N = 163) were exposed to a G continuous noise. Each subject was given an otologic examination to determine their pure-tone HTL and had their personal 8-hr equivalent A-weighted noise exposure (LAeq) and full-shift noise kurtosis statistic (which is sensitive to the peaks and temporal characteristics of noise exposures) measured. For each subject, an unadjusted and kurtosis-adjusted CNE index for the years worked was created. Multiple linear regression analysis controlling for age was used to determine the relationship between CNE (unadjusted and kurtosis adjusted) and the mean HTL at 3, 4, and 6 kHz (HTL346) among the complex noise-exposed group. In addition, each subject's HTLs from 0.5 to 8.0 kHz were age and sex adjusted using Annex A (ISO-1999) to determine whether they had adjusted high-frequency noise-induced hearing loss (AHFNIHL), defined as an adjusted HTL shift of 30 dB or greater at 3.0, 4.0, or 6.0 kHz in either ear. Dose-response curves for AHFNIHL were developed separately for workers exposed to G and non-G noise using both unadjusted and adjusted CNE as the exposure

  4. Analysis of uncertainty in modeling perceived risks

    International Nuclear Information System (INIS)

    Melnyk, R.; Sandquist, G.M.

    2005-01-01

    Expanding on a mathematical model developed for quantifying and assessing perceived risks, the distribution functions, variances, and uncertainties associated with estimating the model parameters are quantified. The analytical model permits the identification and assignment of any number of quantifiable risk perception factors that can be incorporated within standard risk methodology. Those risk perception factors associated with major technical issues are modeled using lognormal probability density functions to span the potentially large uncertainty variations associated with these risk perceptions. The model quantifies the logic of public risk perception and provides an effective means for measuring and responding to perceived risks. (authors)

  5. Model risk analysis for risk management and option pricing

    NARCIS (Netherlands)

    Kerkhof, F.L.J.

    2003-01-01

    Due to the growing complexity of products in financial markets, market participants rely more and more on quantitative models for trading and risk management decisions. This introduces a fairly new type of risk, namely, model risk. In the first part of this thesis we investigate the quantitative

  6. Risk Adjusted Production Efficiency of Maize Farmers in Ethiopia: Implication for Improved Maize Varieties Adoption

    Directory of Open Access Journals (Sweden)

    Sisay Diriba Lemessa

    2017-09-01

    Full Text Available This study analyzes the technical efficiency and production risk of 862 maize farmers in major maize producing regions of Ethiopia. It employs the stochastic frontier approach (SFA to estimate the level of technical efficiencies of stallholder farmers. The stochastic frontier approach (SFA uses flexible risk properties to account for production risk. Thus, maize production variability is assessed from two perspectives, the production risk and the technical efficiency. The study also attempts to determine the socio-economic and farm characteristics that influence technical efficiency of maize production in the study area. The findings of the study showed the existence of both production risk and technical inefficiency in maize production process. Input variables (amounts per hectare such as fertilizer and labor positively influence maize output. The findings also show that farms in the study area exhibit decreasing returns to scale. Fertilizer and ox plough days reduce output risk while labor and improved seed increase output risk. The mean technical efficiency for maize farms is 48 percent. This study concludes that production risk and technical inefficiency prevents the maize farmers from realizing their frontier output. The best factors that improve the efficiency of the maize farmers in the study area include: frequency of extension contact, access to credit and use of intercropping. It was also realized that altitude and terracing in maize farms had influence on farmer efficiency.

  7. Parametric Adjustments to the Rankine Vortex Wind Model for Gulf of Mexico Hurricanes

    Science.gov (United States)

    2012-11-01

    2012 4. TITLE AND SUBTITLE Parametric Adjustments to the Rankine Vortex Wind Model for Gulf of Mexico Hurricanes 5a. CONTRACT NUMBER 5b. GRANT ...may be used to construct spatially varying wind fields for the GOM region (e.g., Thompson and Cardone [12]), but this requires using a complicated...Storm Damage Reduc- tion, and Dredging Operations and Environmental Research (DOER). The USACE Headquarters granted permission to publish this paper

  8. Radar adjusted data versus modelled precipitation: a case study over Cyprus

    Directory of Open Access Journals (Sweden)

    M. Casaioli

    2006-01-01

    Full Text Available In the framework of the European VOLTAIRE project (Fifth Framework Programme, simulations of relatively heavy precipitation events, which occurred over the island of Cyprus, by means of numerical atmospheric models were performed. One of the aims of the project was indeed the comparison of modelled rainfall fields with multi-sensor observations. Thus, for the 5 March 2003 event, the 24-h accumulated precipitation BOlogna Limited Area Model (BOLAM forecast was compared with the available observations reconstructed from ground-based radar data and estimated by rain gauge data. Since radar data may be affected by errors depending on the distance from the radar, these data could be range-adjusted by using other sensors. In this case, the Precipitation Radar aboard the Tropical Rainfall Measuring Mission (TRMM satellite was used to adjust the ground-based radar data with a two-parameter scheme. Thus, in this work, two observational fields were employed: the rain gauge gridded analysis and the observational analysis obtained by merging the range-adjusted radar and rain gauge fields. In order to verify the modelled precipitation, both non-parametric skill scores and the contiguous rain area (CRA analysis were applied. Skill score results show some differences when using the two observational fields. CRA results are instead quite in agreement, showing that in general a 0.27° eastward shift optimizes the forecast with respect to the two observational analyses. This result is also supported by a subjective inspection of the shifted forecast field, whose gross features agree with the analysis pattern more than the non-shifted forecast one. However, some open questions, especially regarding the effect of other range adjustment techniques, remain open and need to be addressed in future works.

  9. COX-2 rs689466, rs5275, and rs20417 polymorphisms and risk of head and neck squamous cell carcinoma: a meta-analysis of adjusted and unadjusted data

    International Nuclear Information System (INIS)

    Leng, Wei-Dong; Wen, Xiu-Jie; Kwong, Joey S. W.; Huang, Wei; Chen, Jian-Gang; Zeng, Xian-Tao

    2016-01-01

    Numerous case–control studies have been performed to investigate the association between three cyclooxygenase-2 (COX-2) polymorphisms (rs20417 (−765G > C), rs689466 (−1195G > A), and rs5275 (8473 T > C)) and the risk of head and neck squamous cell carcinoma (HNSCC). However, the results were inconsistent. Therefore, we conducted this meta-analysis to investigate the association. We searched in PubMed, Embase, and Web of Science up to January 20, 2015 (last updated on May 12, 2016). Two independent reviewers extracted the data. Odds ratios (ORs) with their 95 % confidence intervals (CIs) were used to assess the association. All statistical analyses were performed using the Review Manager (RevMan) 5.2 software. Finally 8 case–control studies were included in this meta-analysis. For unadjusted data, an association with increased risk was observed in three genetic models in COX-2 rs689466 polymorphism; however, COX-2 rs5275 and rs20417 polymorphisms were not related to HNSCC risk in this study. The pooled results from adjusted data all revealed non-significant association between these three polymorphisms and risk of HNSCC. We also found a similar result in the subgroup analyses, based on both unadjusted data and adjusted data. Current results suggest that COX-2 rs689466, rs5275, and rs20417 polymorphisms are not associated with HNSCC. Further large and well-designed studies are necessary to validate this association

  10. Economic analysis of coal price-electricity price adjustment in China based on the CGE model

    International Nuclear Information System (INIS)

    He, Y.X.; Zhang, S.L.; Yang, L.Y.; Wang, Y.J.; Wang, J.

    2010-01-01

    In recent years, coal price has risen rapidly, which has also brought a sharp increase in the expenditures of thermal power plants in China. Meantime, the power production price and power retail price have not been adjusted accordingly and a large number of thermal power plants have incurred losses. The power industry is a key industry in the national economy. As such, a thorough analysis and evaluation of the economic influence of the electricity price should be conducted before electricity price adjustment is carried out. This paper analyses the influence of coal price adjustment on the electric power industry, and the influence of electricity price adjustment on the macroeconomy in China based on computable general equilibrium models. The conclusions are as follows: (1) a coal price increase causes a rise in the cost of the electric power industry, but the influence gradually descends with increase in coal price; and (2) an electricity price increase has an adverse influence on the total output, Gross Domestic Product (GDP), and the Consumer Price Index (CPI). Electricity price increases have a contractionary effect on economic development and, consequently, electricity price policy making must consequently consider all factors to minimize their adverse influence.

  11. A metallic solution model with adjustable parameter for describing ternary thermodynamic properties from its binary constituents

    International Nuclear Information System (INIS)

    Fang Zheng; Qiu Guanzhou

    2007-01-01

    A metallic solution model with adjustable parameter k has been developed to predict thermodynamic properties of ternary systems from those of its constituent three binaries. In the present model, the excess Gibbs free energy for a ternary mixture is expressed as a weighted probability sum of those of binaries and the k value is determined based on an assumption that the ternary interaction generally strengthens the mixing effects for metallic solutions with weak interaction, making the Gibbs free energy of mixing of the ternary system more negative than that before considering the interaction. This point is never considered in the models currently reported, where the only difference in a geometrical definition of molar values of components is considered that do not involve thermodynamic principles but are completely empirical. The current model describes the results of experiments very well, and by adjusting the k value also agrees with those from models used widely in the literature. Three ternary systems, Mg-Cu-Ni, Zn-In-Cd, and Cd-Bi-Pb are recalculated to demonstrate the method of determining k and the precision of the model. The results of the calculations, especially those in Mg-Cu-Ni system, are better than those predicted by the current models in the literature

  12. Conceptual Model for Simulating the Adjustments of Bankfull Characteristics in the Lower Yellow River, China

    Directory of Open Access Journals (Sweden)

    Yuanjian Wang

    2014-01-01

    Full Text Available We present a conceptual model for simulating the temporal adjustments in the banks of the Lower Yellow River (LYR. Basic conservation equations for mass, friction, and sediment transport capacity and the Exner equation were adopted to simulate the hydrodynamics underlying fluvial processes. The relationship between changing rates in bankfull width and depth, derived from quasiuniversal hydraulic geometries, was used as a closure for the hydrodynamic equations. On inputting the daily flow discharge and sediment load, the conceptual model successfully simulated the 30-year adjustments in the bankfull geometries of typical reaches of the LYR. The square of the correlating coefficient reached 0.74 for Huayuankou Station in the multiple-thread reach and exceeded 0.90 for Lijin Station in the meandering reach. This proposed model allows multiple dependent variables and the input of daily hydrological data for long-term simulations. This links the hydrodynamic and geomorphic processes in a fluvial river and has potential applicability to fluvial rivers undergoing significant adjustments.

  13. Biologically Inspired Visual Model With Preliminary Cognition and Active Attention Adjustment.

    Science.gov (United States)

    Qiao, Hong; Xi, Xuanyang; Li, Yinlin; Wu, Wei; Li, Fengfu

    2015-11-01

    Recently, many computational models have been proposed to simulate visual cognition process. For example, the hierarchical Max-Pooling (HMAX) model was proposed according to the hierarchical and bottom-up structure of V1 to V4 in the ventral pathway of primate visual cortex, which could achieve position- and scale-tolerant recognition. In our previous work, we have introduced memory and association into the HMAX model to simulate visual cognition process. In this paper, we improve our theoretical framework by mimicking a more elaborate structure and function of the primate visual cortex. We will mainly focus on the new formation of memory and association in visual processing under different circumstances as well as preliminary cognition and active adjustment in the inferior temporal cortex, which are absent in the HMAX model. The main contributions of this paper are: 1) in the memory and association part, we apply deep convolutional neural networks to extract various episodic features of the objects since people use different features for object recognition. Moreover, to achieve a fast and robust recognition in the retrieval and association process, different types of features are stored in separated clusters and the feature binding of the same object is stimulated in a loop discharge manner and 2) in the preliminary cognition and active adjustment part, we introduce preliminary cognition to classify different types of objects since distinct neural circuits in a human brain are used for identification of various types of objects. Furthermore, active cognition adjustment of occlusion and orientation is implemented to the model to mimic the top-down effect in human cognition process. Finally, our model is evaluated on two face databases CAS-PEAL-R1 and AR. The results demonstrate that our model exhibits its efficiency on visual recognition process with much lower memory storage requirement and a better performance compared with the traditional purely computational

  14. Estimation of group means when adjusting for covariates in generalized linear models.

    Science.gov (United States)

    Qu, Yongming; Luo, Junxiang

    2015-01-01

    Generalized linear models are commonly used to analyze categorical data such as binary, count, and ordinal outcomes. Adjusting for important prognostic factors or baseline covariates in generalized linear models may improve the estimation efficiency. The model-based mean for a treatment group produced by most software packages estimates the response at the mean covariate, not the mean response for this treatment group for the studied population. Although this is not an issue for linear models, the model-based group mean estimates in generalized linear models could be seriously biased for the true group means. We propose a new method to estimate the group mean consistently with the corresponding variance estimation. Simulation showed the proposed method produces an unbiased estimator for the group means and provided the correct coverage probability. The proposed method was applied to analyze hypoglycemia data from clinical trials in diabetes. Copyright © 2014 John Wiley & Sons, Ltd.

  15. Using Green's Functions to initialize and adjust a global, eddying ocean biogeochemistry general circulation model

    Science.gov (United States)

    Brix, H.; Menemenlis, D.; Hill, C.; Dutkiewicz, S.; Jahn, O.; Wang, D.; Bowman, K.; Zhang, H.

    2015-11-01

    The NASA Carbon Monitoring System (CMS) Flux Project aims to attribute changes in the atmospheric accumulation of carbon dioxide to spatially resolved fluxes by utilizing the full suite of NASA data, models, and assimilation capabilities. For the oceanic part of this project, we introduce ECCO2-Darwin, a new ocean biogeochemistry general circulation model based on combining the following pre-existing components: (i) a full-depth, eddying, global-ocean configuration of the Massachusetts Institute of Technology general circulation model (MITgcm), (ii) an adjoint-method-based estimate of ocean circulation from the Estimating the Circulation and Climate of the Ocean, Phase II (ECCO2) project, (iii) the MIT ecosystem model "Darwin", and (iv) a marine carbon chemistry model. Air-sea gas exchange coefficients and initial conditions of dissolved inorganic carbon, alkalinity, and oxygen are adjusted using a Green's Functions approach in order to optimize modeled air-sea CO2 fluxes. Data constraints include observations of carbon dioxide partial pressure (pCO2) for 2009-2010, global air-sea CO2 flux estimates, and the seasonal cycle of the Takahashi et al. (2009) Atlas. The model sensitivity experiments (or Green's Functions) include simulations that start from different initial conditions as well as experiments that perturb air-sea gas exchange parameters and the ratio of particulate inorganic to organic carbon. The Green's Functions approach yields a linear combination of these sensitivity experiments that minimizes model-data differences. The resulting initial conditions and gas exchange coefficients are then used to integrate the ECCO2-Darwin model forward. Despite the small number (six) of control parameters, the adjusted simulation is significantly closer to the data constraints (37% cost function reduction, i.e., reduction in the model-data difference, relative to the baseline simulation) and to independent observations (e.g., alkalinity). The adjusted air-sea gas

  16. Detection of superior genotype of fatty acid synthase in Korean native cattle by an environment-adjusted statistical model

    Directory of Open Access Journals (Sweden)

    Jea-Young Lee

    2017-06-01

    Full Text Available Objective This study examines the genetic factors influencing the phenotypes (four economic traits:oleic acid [C18:1], monounsaturated fatty acids, carcass weight, and marbling score of Hanwoo. Methods To enhance the accuracy of the genetic analysis, the study proposes a new statistical model that excludes environmental factors. A statistically adjusted, analysis of covariance model of environmental and genetic factors was developed, and estimated environmental effects (covariate effects of age and effects of calving farms were excluded from the model. Results The accuracy was compared before and after adjustment. The accuracy of the best single nucleotide polymorphism (SNP in C18:1 increased from 60.16% to 74.26%, and that of the two-factor interaction increased from 58.69% to 87.19%. Also, superior SNPs and SNP interactions were identified using the multifactor dimensionality reduction method in Table 1 to 4. Finally, high- and low-risk genotypes were compared based on their mean scores for each trait. Conclusion The proposed method significantly improved the analysis accuracy and identified superior gene-gene interactions and genotypes for each of the four economic traits of Hanwoo.

  17. Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies.

    Science.gov (United States)

    Rakovitch, E; Gray, R; Baehner, F L; Sutradhar, R; Crager, M; Gu, S; Nofech-Mozes, S; Badve, S S; Hanna, W; Hughes, L L; Wood, W C; Davidson, N E; Paszat, L; Shak, S; Sparano, J A; Solin, L J

    2018-06-01

    Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus  > 1-2.5 cm (1.45, 1.47), age ≥ 50 versus  15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.

  18. Lung cancer among coal miners, ore miners and quarrymen : smoking-adjusted risk estimates from the synergy pooled analysis of case-control studies

    NARCIS (Netherlands)

    Taeger, Dirk; Pesch, Beate; Kendzia, Benjamin; Behrens, Thomas; Jöckel, Karl-Heinz; Dahmann, Dirk; Siemiatycki, Jack; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Olsson, Ann; Brüske, Irene; Wichmann, Heinz-Erich; Stücker, Isabelle; Guida, Florence; Tardón, Adonina; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Pohlabeln, Hermann; Ahrens, Wolfgang; Landi, Maria Teresa; Caporaso, Neil; Pesatori, Angela Cecilia; Mukeriya, Anush; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Gustavsson, Per; Field, John; Marcus, Michael W; Fabianova, Eleonora; 't Mannetje, Andrea; Pearce, Neil; Rudnai, Peter; Bencko, Vladimir; Janout, Vladimir; Dumitru, Rodica Stanescu; Foretova, Lenka; Forastiere, Francesco; John McLaughlin, John McLaughlin; Paul Demers, Paul Demers; Bas Bueno-de-Mesquita, Bas Bueno-de-Mesquita; Joachim Schüz, Joachim Schüz; Kurt Straif, Kurt Straif; Brüning, Thomas

    2015-01-01

    OBJECTIVES: Working in mines and quarries has been associated with an elevated lung cancer risk but with inconsistent results for coal miners. This study aimed to estimate the smoking-adjusted lung cancer risk among coal miners and compare the risk pattern with lung cancer risks among ore miners and

  19. Electromagnetic structure of pion in the framework of adjusted VMD model with elastic cut

    International Nuclear Information System (INIS)

    Dubnicka, S.; Furdik, I.; Meshcheryakov, V.A.

    1987-01-01

    The vector dominance model (VMD) parametrization of pion form factor is transformed into the pion c.m. momentum variable. Then the corresponding VMD poles are shifted by means of the nonzero widths of vector mesons from the real axis into the complex region of the second sheet of Riemann surface generated by the square-root two-pion-threshold branchpoint. A realistic description of all existing data is achieved in the framework of this adjusted VMD model and the presence of ρ'(1250) and ρ''(1600) mesons in e + e - →π + π - is confirmed by determination of their parameters directly from the fit of data

  20. Credit Risk Evaluation : Modeling - Analysis - Management

    OpenAIRE

    Wehrspohn, Uwe

    2002-01-01

    An analysis and further development of the building blocks of modern credit risk management: -Definitions of default -Estimation of default probabilities -Exposures -Recovery Rates -Pricing -Concepts of portfolio dependence -Time horizons for risk calculations -Quantification of portfolio risk -Estimation of risk measures -Portfolio analysis and portfolio improvement -Evaluation and comparison of credit risk models -Analytic portfolio loss distributions The thesis contributes to the evaluatio...

  1. Why and when is ethnic harassment a risk for immigrant adolescents' school adjustment? understanding the processes and conditions.

    Science.gov (United States)

    Bayram Özdemir, Sevgi; Stattin, Håkan

    2014-08-01

    Ethnically harassed immigrant youth are at risk for experiencing a wide range of school adjustment problems. However, it is still unclear why and under what conditions experiencing ethnic harassment leads to school adjustment difficulties. To address this limitation in the literature, we examined two important questions. First, we investigated whether self-esteem and/or depressive symptoms would mediate the associations between ethnic harassment and poor school adjustment among immigrant youth. Second, we examined whether immigrant youths' perception of school context would play a buffering role in the pathways between ethnic harassment and school adjustment difficulties. The sample (n = 330; M age = 14.07, SD = .90; 49% girls at T1) was drawn from a longitudinal study in Sweden. The results revealed that experiencing ethnic harassment led to a decrease in immigrant youths' self-esteem over time, and that youths' expectations of academic failure increased. Further, youths' relationships with their teachers and their perceptions of school democracy moderated the mediation processes. Specifically, when youth had poor relationships with their teachers or perceived their school context as less democratic, being exposed to ethnic harassment led to a decrease in their self-esteem. In turn, they reported low school satisfaction and perceived themselves as being unsuccessful in school. Such indirect effects were not observed when youth had high positive relationships with their teachers or perceived their school as offering a democratic environment. These findings highlight the importance of understanding underlying processes and conditions in the examination of the effects of ethnic devaluation experiences in order to reach a more comprehensive understanding of immigrant youths' school adjustment.

  2. Characterizing and Addressing the Need for Statistical Adjustment of Global Climate Model Data

    Science.gov (United States)

    White, K. D.; Baker, B.; Mueller, C.; Villarini, G.; Foley, P.; Friedman, D.

    2017-12-01

    As part of its mission to research and measure the effects of the changing climate, the U. S. Army Corps of Engineers (USACE) regularly uses the World Climate Research Programme's Coupled Model Intercomparison Project Phase 5 (CMIP5) multi-model dataset. However, these data are generated at a global level and are not fine-tuned for specific watersheds. This often causes CMIP5 output to vary from locally observed patterns in the climate. Several downscaling methods have been developed to increase the resolution of the CMIP5 data and decrease systemic differences to support decision-makers as they evaluate results at the watershed scale. Evaluating preliminary comparisons of observed and projected flow frequency curves over the US revealed a simple framework for water resources decision makers to plan and design water resources management measures under changing conditions using standard tools. Using this framework as a basis, USACE has begun to explore to use of statistical adjustment to alter global climate model data to better match the locally observed patterns while preserving the general structure and behavior of the model data. When paired with careful measurement and hypothesis testing, statistical adjustment can be particularly effective at navigating the compromise between the locally observed patterns and the global climate model structures for decision makers.

  3. Behavioral adjustments of African herbivores to predation risk by lions: spatiotemporal variations influence habitat use.

    Science.gov (United States)

    Valeix, M; Loveridge, A J; Chamaillé-Jammes, S; Davidson, Z; Murindagomo, F; Fritz, H; Macdonald, D W

    2009-01-01

    Predators may influence their prey populations not only through direct lethal effects, but also through indirect behavioral changes. Here, we combined spatiotemporal fine-scale data from GPS radio collars on lions with habitat use information on 11 African herbivores in Hwange National Park (Zimbabwe) to test whether the risk of predation by lions influenced the distribution of herbivores in the landscape. Effects of long-term risk of predation (likelihood of lion presence calculated over four months) and short-term risk of predation (actual presence of lions in the vicinity in the preceding 24 hours) were contrasted. The long-term risk of predation by lions appeared to influence the distributions of all browsers across the landscape, but not of grazers. This result strongly suggests that browsers and grazers, which face different ecological constraints, are influenced at different spatial and temporal scales in the variation of the risk of predation by lions. The results also show that all herbivores tend to use more open habitats preferentially when lions are in their vicinity, probably an effective anti-predator behavior against such an ambush predator. Behaviorally induced effects of lions may therefore contribute significantly to structuring African herbivore communities, and hence possibly their effects on savanna ecosystems.

  4. Remote Sensing-based Methodologies for Snow Model Adjustments in Operational Streamflow Prediction

    Science.gov (United States)

    Bender, S.; Miller, W. P.; Bernard, B.; Stokes, M.; Oaida, C. M.; Painter, T. H.

    2015-12-01

    Water management agencies rely on hydrologic forecasts issued by operational agencies such as NOAA's Colorado Basin River Forecast Center (CBRFC). The CBRFC has partnered with the Jet Propulsion Laboratory (JPL) under funding from NASA to incorporate research-oriented, remotely-sensed snow data into CBRFC operations and to improve the accuracy of CBRFC forecasts. The partnership has yielded valuable analysis of snow surface albedo as represented in JPL's MODIS Dust Radiative Forcing in Snow (MODDRFS) data, across the CBRFC's area of responsibility. When dust layers within a snowpack emerge, reducing the snow surface albedo, the snowmelt rate may accelerate. The CBRFC operational snow model (SNOW17) is a temperature-index model that lacks explicit representation of snowpack surface albedo. CBRFC forecasters monitor MODDRFS data for emerging dust layers and may manually adjust SNOW17 melt rates. A technique was needed for efficient and objective incorporation of the MODDRFS data into SNOW17. Initial development focused in Colorado, where dust-on-snow events frequently occur. CBRFC forecasters used retrospective JPL-CBRFC analysis and developed a quantitative relationship between MODDRFS data and mean areal temperature (MAT) data. The relationship was used to generate adjusted, MODDRFS-informed input for SNOW17. Impacts of the MODDRFS-SNOW17 MAT adjustment method on snowmelt-driven streamflow prediction varied spatially and with characteristics of the dust deposition events. The largest improvements occurred in southwestern Colorado, in years with intense dust deposition events. Application of the method in other regions of Colorado and in "low dust" years resulted in minimal impact. The MODDRFS-SNOW17 MAT technique will be implemented in CBRFC operations in late 2015, prior to spring 2016 runoff. Collaborative investigation of remote sensing-based adjustment methods for the CBRFC operational hydrologic forecasting environment will continue over the next several years.

  5. Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

    Science.gov (United States)

    Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

    2000-04-01

    To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the production of bromate. We applied clinical, epidemiologic, and toxicologic data on morbidity and mortality to calculate the net health benefit in DALYs. We estimated the median risk of infection with C. parvum as 10(-3)/person-year. Ozonation reduces the median risk in the baseline approximately 7-fold, but bromate is produced in a concentration above current guideline levels. However, the health benefits of preventing gastroenteritis in the general population and premature death in patients with acquired immunodeficiency syndrome outweigh health losses by premature death from renal cell cancer by a factor of > 10. The net benefit is approximately 1 DALY/million person-years. The application of DALYs in principle allows us to more explicitly compare the public health risks and benefits of different management options. In practice, the application of DALYs may be hampered by the substantial degree of uncertainty, as is typical for risk assessment.

  6. Male crickets adjust ejaculate quality with both risk and intensity of sperm competition.

    Science.gov (United States)

    Simmons, Leigh W; Denholm, Amy; Jackson, Chantelle; Levy, Esther; Madon, Ewa

    2007-10-22

    Sperm competition theory predicts that males should increase their expenditure on the ejaculate with increasing risk of sperm competition, but decrease their expenditure with increasing intensity. There is accumulating evidence for sperm competition theory, based on examinations of testes size and/or the numbers of sperm ejaculated. However, recent studies suggest that ejaculate quality can also be subject to selection by sperm competition. We used experimental manipulations of the risk and intensity of sperm competition in the cricket, Teleogryllus oceanicus. We found that males produced ejaculates with a greater percentage of live sperm when they had encountered a rival male prior to mating. However, when mating with a female that presented a high intensity of sperm competition, males did not respond to risk, but produced ejaculates with a reduced percentage of live sperm. Our data suggest that males exhibit a fine-tuned hierarchy of responses to these cues of sperm competition.

  7. Identifying Military and Combat Specific Risk Factors for Child Adjustment: Comparing High and Low Risk Military Families and Civilian Families

    Science.gov (United States)

    2016-06-01

    separation and the potentially destabilizing impact of deployment on the remaining caregiver and daily routines. The project entails the assessment of...milestones, and; 2) examine the role of spousal-perceived Service Member risk on caregiver behaviors associated with parental deployment in the prediction...n/a INTRODUCTION There is an emerging consensus that parental combat deployment may increase risk for child development; but details on what the

  8. Dynamically adjustable foot-ground contact model to estimate ground reaction force during walking and running.

    Science.gov (United States)

    Jung, Yihwan; Jung, Moonki; Ryu, Jiseon; Yoon, Sukhoon; Park, Sang-Kyoon; Koo, Seungbum

    2016-03-01

    Human dynamic models have been used to estimate joint kinetics during various activities. Kinetics estimation is in demand in sports and clinical applications where data on external forces, such as the ground reaction force (GRF), are not available. The purpose of this study was to estimate the GRF during gait by utilizing distance- and velocity-dependent force models between the foot and ground in an inverse-dynamics-based optimization. Ten males were tested as they walked at four different speeds on a force plate-embedded treadmill system. The full-GRF model whose foot-ground reaction elements were dynamically adjusted according to vertical displacement and anterior-posterior speed between the foot and ground was implemented in a full-body skeletal model. The model estimated the vertical and shear forces of the GRF from body kinematics. The shear-GRF model with dynamically adjustable shear reaction elements according to the input vertical force was also implemented in the foot of a full-body skeletal model. Shear forces of the GRF were estimated from body kinematics, vertical GRF, and center of pressure. The estimated full GRF had the lowest root mean square (RMS) errors at the slow walking speed (1.0m/s) with 4.2, 1.3, and 5.7% BW for anterior-posterior, medial-lateral, and vertical forces, respectively. The estimated shear forces were not significantly different between the full-GRF and shear-GRF models, but the RMS errors of the estimated knee joint kinetics were significantly lower for the shear-GRF model. Providing COP and vertical GRF with sensors, such as an insole-type pressure mat, can help estimate shear forces of the GRF and increase accuracy for estimation of joint kinetics. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Utilizing Visual Effects Software for Efficient and Flexible Isostatic Adjustment Modelling

    Science.gov (United States)

    Meldgaard, A.; Nielsen, L.; Iaffaldano, G.

    2017-12-01

    The isostatic adjustment signal generated by transient ice sheet loading is an important indicator of past ice sheet extent and the rheological constitution of the interior of the Earth. Finite element modelling has proved to be a very useful tool in these studies. We present a simple numerical model for 3D visco elastic Earth deformation and a new approach to the design of such models utilizing visual effects software designed for the film and game industry. The software package Houdini offers an assortment of optimized tools and libraries which greatly facilitate the creation of efficient numerical algorithms. In particular, we make use of Houdini's procedural work flow, the SIMD programming language VEX, Houdini's sparse matrix creation and inversion libraries, an inbuilt tetrahedralizer for grid creation, and the user interface, which facilitates effortless manipulation of 3D geometry. We mitigate many of the time consuming steps associated with the authoring of efficient algorithms from scratch while still keeping the flexibility that may be lost with the use of commercial dedicated finite element programs. We test the efficiency of the algorithm by comparing simulation times with off-the-shelf solutions from the Abaqus software package. The algorithm is tailored for the study of local isostatic adjustment patterns, in close vicinity to present ice sheet margins. In particular, we wish to examine possible causes for the considerable spatial differences in the uplift magnitude which are apparent from field observations in these areas. Such features, with spatial scales of tens of kilometres, are not resolvable with current global isostatic adjustment models, and may require the inclusion of local topographic features. We use the presented algorithm to study a near field area where field observations are abundant, namely, Disko Bay in West Greenland with the intention of constraining Earth parameters and ice thickness. In addition, we assess how local

  10. Mate guarding in the Seychelles warbler is energetically costly and adjusted to paternity risk

    NARCIS (Netherlands)

    Komdeur, Jan

    2001-01-01

    Males may increase their fitness through extra-pair copulations (copulations outside the pair bond) that result in extra-pair fertilizations, but also risk lost paternity when they leave their own mate unguarded. The fitness costs of cuckoldry for Seychelles warblers (Acrocephalus sechellensis) are

  11. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    Science.gov (United States)

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

  12. Risk, Conflict, Mothers' Parenting, and Children's Adjustment in Low-Income, Mexican Immigrant, and Mexican American Families.

    Science.gov (United States)

    Dumka, Larry E.; Roosa, Mark W.; Jackson, Kristina M.

    1997-01-01

    Reports on a test of a risk-stress process model. Examines the influence of mothers' supportive parenting and inconsistent discipline practices on risk factors and family conflict as these affect children's conduct disorder and depression. Tests on 121 families indicate that mothers' supportive patenting partially mediated family conflict effects…

  13. Environmental modeling and health risk analysis (ACTS/RISK)

    National Research Council Canada - National Science Library

    Aral, M. M

    2010-01-01

    ... presents a review of the topics of exposure and health risk analysis. The Analytical Contaminant Transport Analysis System (ACTS) and Health RISK Analysis (RISK) software tools are an integral part of the book and provide computational platforms for all the models discussed herein. The most recent versions of these two softwa...

  14. Statistical models for competing risk analysis

    International Nuclear Information System (INIS)

    Sather, H.N.

    1976-08-01

    Research results on three new models for potential applications in competing risks problems. One section covers the basic statistical relationships underlying the subsequent competing risks model development. Another discusses the problem of comparing cause-specific risk structure by competing risks theory in two homogeneous populations, P1 and P2. Weibull models which allow more generality than the Berkson and Elveback models are studied for the effect of time on the hazard function. The use of concomitant information for modeling single-risk survival is extended to the multiple failure mode domain of competing risks. The model used to illustrate the use of this methodology is a life table model which has constant hazards within pre-designated intervals of the time scale. Two parametric models for bivariate dependent competing risks, which provide interesting alternatives, are proposed and examined

  15. Risk matrix model for rotating equipment

    Directory of Open Access Journals (Sweden)

    Wassan Rano Khan

    2014-07-01

    Full Text Available Different industries have various residual risk levels for their rotating equipment. Accordingly the occurrence rate of the failures and associated failure consequences categories are different. Thus, a generalized risk matrix model is developed in this study which can fit various available risk matrix standards. This generalized risk matrix will be helpful to develop new risk matrix, to fit the required risk assessment scenario for rotating equipment. Power generation system was taken as case study. It was observed that eight subsystems were under risk. Only vibration monitor system was under high risk category, while remaining seven subsystems were under serious and medium risk categories.

  16. Models of quality-adjusted life years when health varies over time

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Østerdal, Lars Peter Raahave

    2006-01-01

    Qualityadjusted life year (QALY) models are widely used for economic evaluation in the health care sector. In the first part of the paper, we establish an overview of QALY models where health varies over time and provide a theoretical analysis of model identification and parameter estimation from...... time tradeoff (TTO) and standard gamble (SG) scores. We investigate deterministic and probabilistic models and consider five different families of discounting functions in all. The second part of the paper discusses four issues recurrently debated in the literature. This discussion includes questioning...... of these two can be used to disentangle risk aversion from discounting. We find that caution must be taken when drawing conclusions from models with chronic health states to situations where health varies over time. One notable difference is that in the former case, risk aversion may be indistinguishable from...

  17. Risk adjustment policy options for casemix funding: international lessons in financing reform.

    Science.gov (United States)

    Antioch, Kathryn M; Ellis, Randall P; Gillett, Steve; Borovnicar, Daniel; Marshall, Ric P

    2007-09-01

    This paper explores modified hospital casemix payment formulae that would refine the diagnosis-related group (DRG) system in Victoria, Australia, which already makes adjustments for teaching, severity and demographics. We estimate alternative casemix funding methods using multiple regressions for individual hospital episodes from 2001 to 2003 on 70 high-deficit DRGs, focussing on teaching hospitals where the largest deficits have occurred. Our casemix variables are diagnosis- and procedure-based severity markers, counts of diagnoses and procedures, disease types, complexity, day outliers, emergency admission and "transfers in." The results are presented for four policy options that vary according to whether all of the dollars or only some are reallocated, whether all or some hospitals are used and whether the alternatives augment or replace existing payments. While our approach identifies variables that help explain patient cost variations, hospital-level simulations suggest that the approaches explored would only reduce teaching hospital underpayment by about 10%. The implications of various policy options are discussed.

  18. Scalability of a Methodology for Generating Technical Trading Rules with GAPs Based on Risk-Return Adjustment and Incremental Training

    Science.gov (United States)

    de La Cal, E. A.; Fernández, E. M.; Quiroga, R.; Villar, J. R.; Sedano, J.

    In previous works a methodology was defined, based on the design of a genetic algorithm GAP and an incremental training technique adapted to the learning of series of stock market values. The GAP technique consists in a fusion of GP and GA. The GAP algorithm implements the automatic search for crisp trading rules taking as objectives of the training both the optimization of the return obtained and the minimization of the assumed risk. Applying the proposed methodology, rules have been obtained for a period of eight years of the S&P500 index. The achieved adjustment of the relation return-risk has generated rules with returns very superior in the testing period to those obtained applying habitual methodologies and even clearly superior to Buy&Hold. This work probes that the proposed methodology is valid for different assets in a different market than previous work.

  19. Analisis Portofolio Optimum Saham Syariah Menggunakan Liquidity Adjusted Capital Asset Pricing Model (LCAPM

    Directory of Open Access Journals (Sweden)

    Nila Cahyati

    2015-04-01

    Full Text Available Investasi mempunyai karakteristik antara return dan resiko. Pembentukan portofolio optimal digunakan untuk memaksimalkan keuntungan dan meminimumkan resiko. Liquidity Adjusted Capital Asset Pricing Model (LCAPM merupakan metode pengembangan baru dari CAPM yang dipengaruhi likuiditas. Indikator likuiditas apabila digabungkan dengan metode CAPM dapat membantu memaksimalkan return dan meminimumkan resiko. Tujuan penelitian adalah membandingkan expected retun dan resiko saham serta mengetahui proporsi pada portofolio optimal. Sampel yang digunakan merupakan saham JII (Jakarta Islamic Index  periode Januari 2013 – November 2014. Hasil penelitian menunjukkan bahwa expected return portofolio LCAPM sebesar 0,0956 dengan resiko 0,0043 yang membentuk proporsi saham AALI (55,19% dan saham PGAS (44,81%.

  20. An Efficient Bundle Adjustment Model Based on Parallax Parametrization for Environmental Monitoring

    Science.gov (United States)

    Chen, R.; Sun, Y. Y.; Lei, Y.

    2017-12-01

    With the rapid development of Unmanned Aircraft Systems (UAS), more and more research fields have been successfully equipped with this mature technology, among which is environmental monitoring. One difficult task is how to acquire accurate position of ground object in order to reconstruct the scene more accurate. To handle this problem, we combine bundle adjustment method from Photogrammetry with parallax parametrization from Computer Vision to create a new method call APCP (aerial polar-coordinate photogrammetry). One impressive advantage of this method compared with traditional method is that the 3-dimensional point in space is represented using three angles (elevation angle, azimuth angle and parallax angle) rather than the XYZ value. As the basis for APCP, bundle adjustment could be used to optimize the UAS sensors' pose accurately, reconstruct the 3D models of environment, thus serving as the criterion of accurate position for monitoring. To verity the effectiveness of the proposed method, we test on several UAV dataset obtained by non-metric digital cameras with large attitude angles, and we find that our methods could achieve 1 or 2 times better efficiency with no loss of accuracy than traditional ones. For the classical nonlinear optimization of bundle adjustment model based on the rectangular coordinate, it suffers the problem of being seriously dependent on the initial values, making it unable to converge fast or converge to a stable state. On the contrary, APCP method could deal with quite complex condition of UAS when conducting monitoring as it represent the points in space with angles, including the condition that the sequential images focusing on one object have zero parallax angle. In brief, this paper presents the parameterization of 3D feature points based on APCP, and derives a full bundle adjustment model and the corresponding nonlinear optimization problems based on this method. In addition, we analyze the influence of convergence and

  1. Empiric model for mean generation time adjustment factor for classic point kinetics equations

    Energy Technology Data Exchange (ETDEWEB)

    Goes, David A.B.V. de; Martinez, Aquilino S.; Goncalves, Alessandro da C., E-mail: david.goes@poli.ufrj.br, E-mail: aquilino@lmp.ufrj.br, E-mail: alessandro@con.ufrj.br [Coordenacao de Pos-Graduacao e Pesquisa de Engenharia (COPPE/UFRJ), Rio de Janeiro, RJ (Brazil). Departamento de Engenharia Nuclear

    2017-11-01

    Point reactor kinetics equations are the easiest way to observe the neutron production time behavior in a nuclear reactor. These equations are derived from the neutron transport equation using an approximation called Fick's law leading to a set of first order differential equations. The main objective of this study is to review classic point kinetics equation in order to approximate its results to the case when it is considered the time variation of the neutron currents. The computational modeling used for the calculations is based on the finite difference method. The results obtained with this model are compared with the reference model and then it is determined an empirical adjustment factor that modifies the point reactor kinetics equation to the real scenario. (author)

  2. Empiric model for mean generation time adjustment factor for classic point kinetics equations

    International Nuclear Information System (INIS)

    Goes, David A.B.V. de; Martinez, Aquilino S.; Goncalves, Alessandro da C.

    2017-01-01

    Point reactor kinetics equations are the easiest way to observe the neutron production time behavior in a nuclear reactor. These equations are derived from the neutron transport equation using an approximation called Fick's law leading to a set of first order differential equations. The main objective of this study is to review classic point kinetics equation in order to approximate its results to the case when it is considered the time variation of the neutron currents. The computational modeling used for the calculations is based on the finite difference method. The results obtained with this model are compared with the reference model and then it is determined an empirical adjustment factor that modifies the point reactor kinetics equation to the real scenario. (author)

  3. Automatic parameter estimation of multicompartmental neuron models via minimization of trace error with control adjustment.

    Science.gov (United States)

    Brookings, Ted; Goeritz, Marie L; Marder, Eve

    2014-11-01

    We describe a new technique to fit conductance-based neuron models to intracellular voltage traces from isolated biological neurons. The biological neurons are recorded in current-clamp with pink (1/f) noise injected to perturb the activity of the neuron. The new algorithm finds a set of parameters that allows a multicompartmental model neuron to match the recorded voltage trace. Attempting to match a recorded voltage trace directly has a well-known problem: mismatch in the timing of action potentials between biological and model neuron is inevitable and results in poor phenomenological match between the model and data. Our approach avoids this by applying a weak control adjustment to the model to promote alignment during the fitting procedure. This approach is closely related to the control theoretic concept of a Luenberger observer. We tested this approach on synthetic data and on data recorded from an anterior gastric receptor neuron from the stomatogastric ganglion of the crab Cancer borealis. To test the flexibility of this approach, the synthetic data were constructed with conductance models that were different from the ones used in the fitting model. For both synthetic and biological data, the resultant models had good spike-timing accuracy. Copyright © 2014 the American Physiological Society.

  4. Evaluating variation in use of definitive therapy and risk-adjusted prostate cancer mortality in England and the USA.

    Science.gov (United States)

    Sachdeva, Ashwin; van der Meulen, Jan H; Emberton, Mark; Cathcart, Paul J

    2015-02-24

    Prostate cancer mortality (PCM) in the USA is among the lowest in the world, whereas PCM in England is among the highest in Europe. This paper aims to assess the association of variation in use of definitive therapy on risk-adjusted PCM in England as compared with the USA. Observational study. Cancer registry data from England and the USA. Men diagnosed with non-metastatic prostate cancer (PCa) in England and the USA between 2004 and 2008. Competing-risks survival analyses to estimate subhazard ratios (SHR) of PCM adjusted for age, ethnicity, year of diagnosis, Gleason score (GS) and clinical tumour (cT) stage. 222,163 men were eligible for inclusion. Compared with American patients, English patients were more likely to present at an older age (70-79 years: England 44.2%, USA 29.3%, pUSA 8.6%, pUSA 11.2%, pUSA 77%, pUSA. This difference may be explained by less frequent use of definitive therapy in England. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Asymmetric adjustment

    NARCIS (Netherlands)

    2010-01-01

    A method of adjusting a signal processing parameter for a first hearing aid and a second hearing aid forming parts of a binaural hearing aid system to be worn by a user is provided. The binaural hearing aid system comprises a user specific model representing a desired asymmetry between a first ear

  6. Models for assessing and managing credit risk

    Directory of Open Access Journals (Sweden)

    Neogradi Slađana

    2014-01-01

    Full Text Available This essay deals with the definition of a model for assessing and managing credit risk. Risk is an inseparable component of any average and normal credit transaction. Looking at the different aspects of the identification and classification of risk in the banking industry as well as representation of the key components of modern risk management. In the first part of the essay will analyze how the impact of credit risk on bank and empirical models for determining the financial difficulties in which the company can be found. Bank on the basis of these models can reduce number of approved risk assets. In the second part, we consider models for improving credit risk with emphasis on Basel I, II and III, and the third part, we conclude that the most appropriate model and gives the best effect for measuring credit risk in domestic banks.

  7. Risk Based Milk Pricing Model at Dairy Farmers Level

    Directory of Open Access Journals (Sweden)

    W. Septiani

    2017-12-01

    Full Text Available The milk price from a cooperative institution to farmer does not fully cover the production cost. Though, dairy farmers encounter various risks and uncertainties in conducting their business. The highest risk in milk supply lies in the activities at the farm. This study was designed to formulate a model for calculating milk price at farmer’s level based on risk. Risks that occur on farms include the risk of cow breeding, sanitation, health care, cattle feed management, milking and milk sales. This research used the location of the farm in West Java region. There were five main stages in the preparation of this model, (1 identification and analysis of influential factors, (2 development of a conceptual model, (3 structural analysis and the amount of production costs, (4 model calculation of production cost with risk factors, and (5 risk based milk pricing model. This research built a relationship between risks on smallholder dairy farms with the production costs to be incurred by the farmers. It was also obtained the formulation of risk adjustment factor calculation for the variable costs of production in dairy cattle farm. The difference in production costs with risk and the total production cost without risk was about 8% to 10%. It could be concluded that the basic price of milk proposed based on the research was around IDR 4,250-IDR 4,350/L for 3 to 4 cows ownership. Increasing farmer income was expected to be obtained by entering the value of this risk in the calculation of production costs. 

  8. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    Science.gov (United States)

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders.

  9. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    Directory of Open Access Journals (Sweden)

    Davina Fevery

    Full Text Available Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq is used in environmental policy in Flanders (Belgium. The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN. The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders.

  10. Performance of risk-adjusted control charts to monitor in-hospital mortality of intensive care unit patients: A simulation study

    NARCIS (Netherlands)

    Koetsier, Antonie; de Keizer, Nicolette F.; de Jonge, Evert; Cook, David A.; Peek, Niels

    2012-01-01

    Objectives: Increases in case-mix adjusted mortality may be indications of decreasing quality of care. Risk-adjusted control charts can be used for in-hospital mortality monitoring in intensive care units by issuing a warning signal when there are more deaths than expected. The aim of this study was

  11. RISK LOAN PORTFOLIO OPTIMIZATION MODEL BASED ON CVAR RISK MEASURE

    Directory of Open Access Journals (Sweden)

    Ming-Chang LEE

    2015-07-01

    Full Text Available In order to achieve commercial banks liquidity, safety and profitability objective requirements, loan portfolio risk analysis based optimization decisions are rational allocation of assets.  The risk analysis and asset allocation are the key technology of banking and risk management.  The aim of this paper, build a loan portfolio optimization model based on risk analysis.  Loan portfolio rate of return by using Value-at-Risk (VaR and Conditional Value-at-Risk (CVaR constraint optimization decision model reflects the bank's risk tolerance, and the potential loss of direct control of the bank.  In this paper, it analyze a general risk management model applied to portfolio problems with VaR and CVaR risk measures by using Using the Lagrangian Algorithm.  This paper solves the highly difficult problem by matrix operation method.  Therefore, the combination of this paper is easy understanding the portfolio problems with VaR and CVaR risk model is a hyperbola in mean-standard deviation space.  It is easy calculation in proposed method.

  12. Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany.

    Science.gov (United States)

    Pilny, Adam; Wübker, Ansgar; Ziebarth, Nicolas R

    2017-12-01

    To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Calculating disability-adjusted life years (DALY) as a measure of excess cancer risk following radiation exposure

    International Nuclear Information System (INIS)

    Shimada, K; Kai, M

    2015-01-01

    This paper has proposed that disability-adjusted life year (DALY) can be used as a measure of radiation health risk. DALY is calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). This multidimensional concept can be expressed as a risk index without a probability measure to avoid the misuse of the current radiation detriment at low doses. In this study, we calculated YLL and YLD using Japanese population data by gender. DALY for all cancers in Japan per 1 Gy per person was 0.84 year in men and 1.34 year in women. The DALY for all cancers in the Japanese baseline was 4.8 in men and 3.5 in women. When we calculated the ICRP detriment from the same data, DALYs for the cancer sites were similar to the radiation detriment in the cancer sites, excluding leukemia, breast and thyroid cancer. These results suggested that the ICRP detriment overestimate the weighting fraction of leukemia risk and underestimate the weighting fraction of breast and thyroid cancer. A big advantage over the ICRP detriment is that DALY can calculate the risk components for non-fatal diseases without the data of lethality. This study showed that DALY is a practical tool that can compare many types of diseases encountered in public health. (paper)

  14. Antenatal steroids and risk of bronchopulmonary dysplasia: a lack of effect or a case of over-adjustment?

    Science.gov (United States)

    Gagliardi, Luigi; Bellù, Roberto; Rusconi, Franca; Merazzi, Daniele; Mosca, Fabio

    2007-07-01

    Although antenatal steroids reduce risk factors for bronchopulmonary dysplasia (BPD) in preterm infants, their effect on BPD is conflicting. We hypothesised that the lack of protective effect found in some studies could derive from over-adjustment during analysis, caused by controlling for factors intermediate in the causal pathway between treatment and outcome. We prospectively studied a cohort of infants 23-32 weeks gestation steroids. In univariable analysis, steroids were not significantly protective against BPD; some intermediate factors (mechanical ventilation, greater severity of illness as measured by Clinical Risk Index for Babies score, patent ductus arteriosus) were significantly positively associated with (i.e. were risk factors for) BPD (OR = 11.0, 1.55, 4.42, respectively, all P steroids (OR = 0.58, 0.92, and 0.58, respectively, all P steroid-treated infants had a lower risk of BPD (OR 0.59 [95% CI 0.36, 0.97], P = 0.036); male sex (OR = 2.08), late-onset sepsis (OR = 4.26), and birthweight (OR = 0.63 for 100 g increase) were also associated with BPD, all P effect of steroids disappeared; ventilation (OR = 3.03), increased illness severity (OR = 1.11), and patent ductus arteriosus (OR = 1.90) were significant risk factors. This study suggests that including variables that are potential mediators in the causal chain can obscure the ability to detect a protective effect of treatment. We observed such a phenomenon in our analyses of the relationship between antenatal steroids and BPD, suggesting that steroid effect is partly mediated through a reduction in the classical risk factors.

  15. A new multivariate zero-adjusted Poisson model with applications to biomedicine.

    Science.gov (United States)

    Liu, Yin; Tian, Guo-Liang; Tang, Man-Lai; Yuen, Kam Chuen

    2018-05-25

    Recently, although advances were made on modeling multivariate count data, existing models really has several limitations: (i) The multivariate Poisson log-normal model (Aitchison and Ho, ) cannot be used to fit multivariate count data with excess zero-vectors; (ii) The multivariate zero-inflated Poisson (ZIP) distribution (Li et al., 1999) cannot be used to model zero-truncated/deflated count data and it is difficult to apply to high-dimensional cases; (iii) The Type I multivariate zero-adjusted Poisson (ZAP) distribution (Tian et al., 2017) could only model multivariate count data with a special correlation structure for random components that are all positive or negative. In this paper, we first introduce a new multivariate ZAP distribution, based on a multivariate Poisson distribution, which allows the correlations between components with a more flexible dependency structure, that is some of the correlation coefficients could be positive while others could be negative. We then develop its important distributional properties, and provide efficient statistical inference methods for multivariate ZAP model with or without covariates. Two real data examples in biomedicine are used to illustrate the proposed methods. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  16. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Mohammed Mohammed A

    2007-06-01

    Full Text Available Abstract Background Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care. Methods We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria. Results From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51% but the remainder showed no correlation (16/51 31% or a paradoxical correlation (9/51 18%. Conclusion The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.

  17. Adjusting kinematics and kinetics in a feedback-controlled toe walking model

    Directory of Open Access Journals (Sweden)

    Olenšek Andrej

    2012-08-01

    Full Text Available Abstract Background In clinical gait assessment, the correct interpretation of gait kinematics and kinetics has a decisive impact on the success of the therapeutic programme. Due to the vast amount of information from which primary anomalies should be identified and separated from secondary compensatory changes, as well as the biomechanical complexity and redundancy of the human locomotion system, this task is considerably challenging and requires the attention of an experienced interdisciplinary team of experts. The ongoing research in the field of biomechanics suggests that mathematical modeling may facilitate this task. This paper explores the possibility of generating a family of toe walking gait patterns by systematically changing selected parameters of a feedback-controlled model. Methods From the selected clinical case of toe walking we identified typical toe walking characteristics and encoded them as a set of gait-oriented control objectives to be achieved in a feedback-controlled walking model. They were defined as fourth order polynomials and imposed via feedback control at the within-step control level. At the between-step control level, stance leg lengthening velocity at the end of the single support phase was adaptively adjusted after each step so as to facilitate gait velocity control. Each time the gait velocity settled at the desired value, selected intra-step gait characteristics were modified by adjusting the polynomials so as to mimic the effect of a typical therapeutical intervention - inhibitory casting. Results By systematically adjusting the set of control parameters we were able to generate a family of gait kinematic and kinetic patterns that exhibit similar principal toe walking characteristics, as they were recorded by means of an instrumented gait analysis system in the selected clinical case of toe walking. We further acknowledge that they to some extent follow similar improvement tendencies as those which one can

  18. MODELING CREDIT RISK THROUGH CREDIT SCORING

    OpenAIRE

    Adrian Cantemir CALIN; Oana Cristina POPOVICI

    2014-01-01

    Credit risk governs all financial transactions and it is defined as the risk of suffering a loss due to certain shifts in the credit quality of a counterpart. Credit risk literature gravitates around two main modeling approaches: the structural approach and the reduced form approach. In addition to these perspectives, credit risk assessment has been conducted through a series of techniques such as credit scoring models, which form the traditional approach. This paper examines the evolution of...

  19. Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality.

    Science.gov (United States)

    Li, Pengxiang; Kim, Michelle M; Doshi, Jalpa A

    2010-08-20

    The Centers for Medicare and Medicaid Services (CMS) has implemented the CMS-Hierarchical Condition Category (CMS-HCC) model to risk adjust Medicare capitation payments. This study intends to assess the performance of the CMS-HCC risk adjustment method and to compare it to the Charlson and Elixhauser comorbidity measures in predicting in-hospital and six-month mortality in Medicare beneficiaries. The study used the 2005-2006 Chronic Condition Data Warehouse (CCW) 5% Medicare files. The primary study sample included all community-dwelling fee-for-service Medicare beneficiaries with a hospital admission between January 1st, 2006 and June 30th, 2006. Additionally, four disease-specific samples consisting of subgroups of patients with principal diagnoses of congestive heart failure (CHF), stroke, diabetes mellitus (DM), and acute myocardial infarction (AMI) were also selected. Four analytic files were generated for each sample by extracting inpatient and/or outpatient claims for each patient. Logistic regressions were used to compare the methods. Model performance was assessed using the c-statistic, the Akaike's information criterion (AIC), the Bayesian information criterion (BIC) and their 95% confidence intervals estimated using bootstrapping. The CMS-HCC had statistically significant higher c-statistic and lower AIC and BIC values than the Charlson and Elixhauser methods in predicting in-hospital and six-month mortality across all samples in analytic files that included claims from the index hospitalization. Exclusion of claims for the index hospitalization generally led to drops in model performance across all methods with the highest drops for the CMS-HCC method. However, the CMS-HCC still performed as well or better than the other two methods. The CMS-HCC method demonstrated better performance relative to the Charlson and Elixhauser methods in predicting in-hospital and six-month mortality. The CMS-HCC model is preferred over the Charlson and Elixhauser methods

  20. Measurement of the Economic Growth and Add-on of the R.M. Solow Adjusted Model

    Directory of Open Access Journals (Sweden)

    Ion Gh. Rosca

    2007-08-01

    Full Text Available Besides the models of M. Keynes, R.F. Harrod, E. Domar, D. Romer, Ramsey-Cass-Koopmans model etc., the R.M. Solow model is part of the category which characterizes the economic growth.The paper aim is the economic growth measurement and add-on of the R.M. Solow adjusted model.

  1. Diseño de un Modelo de Estimación de Retornos Ajustados por Riesgo para Actividades de Valoración en Mercados Emergentes (Design of a risk-adjusted rate of return model for the evaluation of projects and companies in Costa Rica

    Directory of Open Access Journals (Sweden)

    Manrique Hernández Ramírez

    2012-12-01

    Full Text Available El artículo explica un modelo ajustado para un mercado emergente que, a partir de la versión original del Capital Asset Pricing Model (CAPM, permite la estimación de rendimientos esperados sobre los recursos propios (KE para apoyar el cálculo del costo promedio ponderado de capital dentro de los procesos habituales de valoración de activos riesgosos, como es el caso del análisis de proyectos o empresas, situados en esos mercados. Para ello se toma como ejemplo de aplicación el caso costarricense. Sobre la base de la investigación realizada se logra crear un modelo dinámico y ajustado diseñado en hojas de cálculo, que permite la estimación de retornos exigidos por los socios a la realidad del mercado analizado, para gran cantidad de industrias y sujeto de sensibilización por parte de los usuarios finales de la herramienta teórico práctica.   ABSTRACT This article presents an adjusted model for an emerging market, based on the original Capital Asset Pricing Model, that estimates the expected yield of own resources of supporting the calculation of capital weighted average cost, in the usual risky assets valuation processes, as is the case of the analysis of projects or companies on such a market, and applying it to a Costa Rican case. Based on the investigation, a dynamic custom model based in worksheets is created for several industries, that allow the estimate of the required returns by investing partners for the market under study, and is capable of sensitivity modification by its final users.

  2. A comparison of models for risk assessment

    International Nuclear Information System (INIS)

    Kellerer, A.M.; Jing Chen

    1993-01-01

    Various mathematical models have been used to represent the dependence of excess cancer risk on dose, age and time since exposure. For solid cancers, i.e. all cancers except leukaemia, the so-called relative risk model is usually employed. However, there can be quite different relative risk models. The most usual model for the quantification of excess tumour rate among the atomic bomb survivors has been a dependence of the relative risk on age at exposure, but it has been shown recently that an age attained model can be equally applied, to represent the observations among the atomic bomb survivors. The differences between the models and their implications are explained. It is also shown that the age attained model is similar to the approaches that have been used in the analysis of lung cancer incidence among radon exposed miners. A more unified approach to modelling of radiation risks can thus be achieved. (3 figs.)

  3. Competing Risks and Multistate Models with R

    CERN Document Server

    Beyersmann, Jan; Schumacher, Martin

    2012-01-01

    This book covers competing risks and multistate models, sometimes summarized as event history analysis. These models generalize the analysis of time to a single event (survival analysis) to analysing the timing of distinct terminal events (competing risks) and possible intermediate events (multistate models). Both R and multistate methods are promoted with a focus on nonparametric methods.

  4. Modeling Research Project Risks with Fuzzy Maps

    Science.gov (United States)

    Bodea, Constanta Nicoleta; Dascalu, Mariana Iuliana

    2009-01-01

    The authors propose a risks evaluation model for research projects. The model is based on fuzzy inference. The knowledge base for fuzzy process is built with a causal and cognitive map of risks. The map was especially developed for research projects, taken into account their typical lifecycle. The model was applied to an e-testing research…

  5. Phenotypic plasticity in anti-intraguild predator strategies: mite larvae adjust their behaviours according to vulnerability and predation risk.

    Science.gov (United States)

    Walzer, Andreas; Schausberger, Peter

    2013-05-01

    Interspecific threat-sensitivity allows prey to maximize the net benefit of antipredator strategies by adjusting the type and intensity of their response to the level of predation risk. This is well documented for classical prey-predator interactions but less so for intraguild predation (IGP). We examined threat-sensitivity in antipredator behaviour of larvae in a predatory mite guild sharing spider mites as prey. The guild consisted of the highly vulnerable intraguild (IG) prey and weak IG predator Phytoseiulus persimilis, the moderately vulnerable IG prey and moderate IG predator Neoseiulus californicus and the little vulnerable IG prey and strong IG predator Amblyseius andersoni. We videotaped the behaviour of the IG prey larvae of the three species in presence of either a low- or a high-risk IG predator female or predator absence and analysed time, distance, path shape and interaction parameters of predators and prey. The least vulnerable IG prey A. andersoni was insensitive to differing IGP risks but the moderately vulnerable IG prey N. californicus and the highly vulnerable IG prey P. persimilis responded in a threat-sensitive manner. Predator presence triggered threat-sensitive behavioural changes in one out of ten measured traits in N. californicus larvae but in four traits in P. persimilis larvae. Low-risk IG predator presence induced a typical escape response in P. persimilis larvae, whereas they reduced their activity in the high-risk IG predator presence. We argue that interspecific threat-sensitivity may promote co-existence of IG predators and IG prey and should be common in predator guilds with long co-evolutionary history.

  6. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences.

    Science.gov (United States)

    Martín-Fernández, Jesus; Polentinos-Castro, Elena; del Cura-González, Ma Isabel; Ariza-Cardiel, Gloria; Abraira, Victor; Gil-LaCruz, Ana Isabel; García-Pérez, Sonia

    2014-07-03

    This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject's self-evaluation, and through lottery games. Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when "out of pocket" payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning.

  7. Competing Risk Approach (CRA) for Estimation of Disability Adjusted Life Years (DALY's) for Female Breast Cancer in India.

    Science.gov (United States)

    Kunnavil, Radhika; Thirthahalli, Chethana; Nooyi, Shalini Chandrashekar; Shivaraj, N S; Murthy, Nandagudi Srinivasa

    2015-10-01

    Competing Risk Approach (CRA) has been used to compute burden of disease in terms of Disability Adjusted Life Years (DALYs) based on a life table for an initially disease-free cohort over time. To compute Years of Life Lost (YLL) due to premature mortality, Years of life lost due to Disability (YLD), DALYs and loss in expectation of life (LEL) using competing risk approach for female breast cancer patients for the year 2008 in India. The published data on breast cancer by age & sex, incidence & mortality for the year 2006-2008 relating to six population based cancer registries (PBCR) under Indian Council of Medical Research (ICMR), general mortality rates of 2007 in India, published in national health profile 2010; based on Sample Registration System (SRS) were utilized for computations. Three life tables were constructed by applying attrition of factors: (i) risk of death from all causes ('a'; where a is the general death rate); (ii) risk of incidence and that of death from causes other than breast cancer ('b-a+c'; where 'b' is the incidence of breast cancer and 'c' is the mortality of breast cancer); and (iii) risk of death from all other causes after excluding cancer mortality ('a-c'). Taking the differences in Total Person Years Lived (TPYL), YLD and YLL were derived along with LEL. CRA revealed that the DALYs were 40209 per 100,000 females in the life time of 0-70+ years with a LEL of 0.11 years per person. Percentage of YLL to DALYs was 28.20% in the cohort. The method of calculation of DALYs based on the CRA is simple and this will help to identify the burden of diseases using minimal information in terms of YLL, YLD, DALYs and LEL.

  8. Adjustment of automatic control systems of production facilities at coal processing plants using multivariant physico- mathematical models

    Science.gov (United States)

    Evtushenko, V. F.; Myshlyaev, L. P.; Makarov, G. V.; Ivushkin, K. A.; Burkova, E. V.

    2016-10-01

    The structure of multi-variant physical and mathematical models of control system is offered as well as its application for adjustment of automatic control system (ACS) of production facilities on the example of coal processing plant.

  9. An Analysis of Missile Systems Cost Growth and Implementation of Acquisition Reform Initiatives Using a Hybrid Adjusted Cost Growth Model

    National Research Council Canada - National Science Library

    Abate, Christopher

    2004-01-01

    ...) data with a hybrid adjusted cost growth (ACG) model. In addition, an analysis of acquisition reform initiatives during the treatment period was conducted to determine if reform efforts impacted missile system cost growth. A pre-reform...

  10. Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register.

    Science.gov (United States)

    Hickey, Graeme L; Grant, Stuart W; Freemantle, Nick; Cunningham, David; Munsch, Christopher M; Livesey, Steven A; Roxburgh, James; Buchan, Iain; Bridgewater, Ben

    2014-09-01

    To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience). Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification. UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012. All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon. All-cause in-hospital mortality. A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant (p=0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005-1.021 for each year of 'experience'). Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required. © The Royal Society of Medicine.

  11. Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market.

    Science.gov (United States)

    Van Barneveld, E M; Lamers, L M; van Vliet, R C; van de Ven, W P

    1998-07-01

    Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in many countries. RACPs based on demographic variables only are insufficient, because they leave ample room for cream skimming. However, the implementation of improved RACPs does not appear to be straightforward. A solution might be to supplement imperfect RACPs with a form of mandatory pooling that reduces the incentives for cream skimming. In a previous paper it was concluded that high-risk pooling (HRP), is a promising supplement to RACPs. The purpose of this paper is to compare HRP with two other main variants of mandatory pooling. These variants are called excess-of-loss (EOL) and proportional pooling (PP). Each variant includes ex post compensations to insurers for some members which depend to various degrees on actually incurred costs. Therefore, these pooling variants reduce the incentives for cream skimming which are inherent in imperfect RACPs, but they also reduce the incentives for efficiency and cost containment. As a rough measure of the latter incentives we use the percentage of total costs for which an insurer is at risk. This paper analyzes which of the three main pooling variants yields the greatest reduction of incentives for cream skimming given such a percentage. The results show that HRP is the most effective of the three pooling variants.

  12. Bankruptcy risk model and empirical tests

    Science.gov (United States)

    Podobnik, Boris; Horvatic, Davor; Petersen, Alexander M.; Urošević, Branko; Stanley, H. Eugene

    2010-01-01

    We analyze the size dependence and temporal stability of firm bankruptcy risk in the US economy by applying Zipf scaling techniques. We focus on a single risk factor—the debt-to-asset ratio R—in order to study the stability of the Zipf distribution of R over time. We find that the Zipf exponent increases during market crashes, implying that firms go bankrupt with larger values of R. Based on the Zipf analysis, we employ Bayes’s theorem and relate the conditional probability that a bankrupt firm has a ratio R with the conditional probability of bankruptcy for a firm with a given R value. For 2,737 bankrupt firms, we demonstrate size dependence in assets change during the bankruptcy proceedings. Prepetition firm assets and petition firm assets follow Zipf distributions but with different exponents, meaning that firms with smaller assets adjust their assets more than firms with larger assets during the bankruptcy process. We compare bankrupt firms with nonbankrupt firms by analyzing the assets and liabilities of two large subsets of the US economy: 2,545 Nasdaq members and 1,680 New York Stock Exchange (NYSE) members. We find that both assets and liabilities follow a Pareto distribution. The finding is not a trivial consequence of the Zipf scaling relationship of firm size quantified by employees—although the market capitalization of Nasdaq stocks follows a Pareto distribution, the same distribution does not describe NYSE stocks. We propose a coupled Simon model that simultaneously evolves both assets and debt with the possibility of bankruptcy, and we also consider the possibility of firm mergers. PMID:20937903

  13. Risk Modelling for Passages in Approach Channel

    Directory of Open Access Journals (Sweden)

    Leszek Smolarek

    2013-01-01

    Full Text Available Methods of multivariate statistics, stochastic processes, and simulation methods are used to identify and assess the risk measures. This paper presents the use of generalized linear models and Markov models to study risks to ships along the approach channel. These models combined with simulation testing are used to determine the time required for continuous monitoring of endangered objects or period at which the level of risk should be verified.

  14. Modeling for operational event risk assessment

    International Nuclear Information System (INIS)

    Sattison, M.B.

    1997-01-01

    The U.S. Nuclear Regulatory Commission has been using risk models to evaluate the risk significance of operational events in U.S. commercial nuclear power plants for more seventeen years. During that time, the models have evolved in response to the advances in risk assessment technology and insights gained with experience. Evaluation techniques fall into two categories, initiating event assessments and condition assessments. The models used for these analyses have become uniquely specialized for just this purpose

  15. Risk and protection factors in the peer context: how do other children contribute to the psychosocial adjustment of the adolescent?

    Directory of Open Access Journals (Sweden)

    Marie-Hélène Véronneau

    2014-03-01

    Full Text Available As children become adolescents, peers assume greater importance in their lives. Peer experiences can either help them thrive or negatively affect their psychosocial adjustment. In this review article definitions for the types of peer experiences are provided followed by an overview of common psychosocial issues encountered by adolescents. Past research that has pointed to risk and protection factors that emerge from peer experiences during adolescence and the role of peer influences in the context of current issues relevant to adolescent education are discussed. Research suggests that friendships with deviant peers, involvement in bullying and the experience of rejection from the overall peer group are related to adjustment problems, whereas friendships with prosocial and academically oriented peers and social acceptance in the peer group are related to healthy development. Friendship quality, popularity among peers, and involvement in friendship cliques cannot be clearly categorized as either positive or negative influences, because they interact with other factors in shaping the development of adolescents. The promotion of social skills and positive youth leadership as an integral part of the student's learning process in school is recommended.

  16. MATHEMATICAL RISK ANALYSIS: VIA NICHOLAS RISK MODEL AND BAYESIAN ANALYSIS

    Directory of Open Access Journals (Sweden)

    Anass BAYAGA

    2010-07-01

    Full Text Available The objective of this second part of a two-phased study was to explorethe predictive power of quantitative risk analysis (QRA method andprocess within Higher Education Institution (HEI. The method and process investigated the use impact analysis via Nicholas risk model and Bayesian analysis, with a sample of hundred (100 risk analysts in a historically black South African University in the greater Eastern Cape Province.The first findings supported and confirmed previous literature (KingIII report, 2009: Nicholas and Steyn, 2008: Stoney, 2007: COSA, 2004 that there was a direct relationship between risk factor, its likelihood and impact, certiris paribus. The second finding in relation to either controlling the likelihood or the impact of occurrence of risk (Nicholas risk model was that to have a brighter risk reward, it was important to control the likelihood ofoccurrence of risks as compared with its impact so to have a direct effect on entire University. On the Bayesian analysis, thus third finding, the impact of risk should be predicted along three aspects. These aspects included the human impact (decisions made, the property impact (students and infrastructural based and the business impact. Lastly, the study revealed that although in most business cases, where as business cycles considerably vary dependingon the industry and or the institution, this study revealed that, most impacts in HEI (University was within the period of one academic.The recommendation was that application of quantitative risk analysisshould be related to current legislative framework that affects HEI.

  17. ELECTRICAL CONDUCTIVITY OF SOYBEAN SEED CULTIVARS AND ADJUSTED MODELS OF LEAKAGE CURVES ALONG THE TIME

    Directory of Open Access Journals (Sweden)

    ADRIANA RITA SALINAS

    2010-01-01

    Full Text Available The objective of this work was to study the behavior of ten soybean [Glycine max (L. Merr.] cultivars using the electrical conductivity (EC test by the comparison of curves of the accumulative electrolyte leakage along the time and to establish the statistical model that allow the best adjust of the curves. Ten soybean cultivars were used and they were mechanically harvested in 2004 in the EEA Oliveros, Santa Fe, Argentina. Measurements of EC were made for 100 individual seeds of each cultivar during 20 hours of immersion at intervals of 1 hour using an equipment that permit an individual seed analysis (Seed Automatic Analyzer SAD 9000S. There were proposed two statistical models to study the EC along the time of the 10 cultivars studied using SAS Statistics Program, to select the model that better allow us to understand the EC behavior along the time. Model 1 allowed to make comparisons of EC along the time between cultivars and to study the influence of the production environment on the physiological quality of soybean seeds. The time to reach the stabilization of the EC must not be lower than 19 hours for the different cultivars.

  18. Korean risk assessment model for breast cancer risk prediction.

    Science.gov (United States)

    Park, Boyoung; Ma, Seung Hyun; Shin, Aesun; Chang, Myung-Chul; Choi, Ji-Yeob; Kim, Sungwan; Han, Wonshik; Noh, Dong-Young; Ahn, Sei-Hyun; Kang, Daehee; Yoo, Keun-Young; Park, Sue K

    2013-01-01

    We evaluated the performance of the Gail model for a Korean population and developed a Korean breast cancer risk assessment tool (KoBCRAT) based upon equations developed for the Gail model for predicting breast cancer risk. Using 3,789 sets of cases and controls, risk factors for breast cancer among Koreans were identified. Individual probabilities were projected using Gail's equations and Korean hazard data. We compared the 5-year and lifetime risk produced using the modified Gail model which applied Korean incidence and mortality data and the parameter estimators from the original Gail model with those produced using the KoBCRAT. We validated the KoBCRAT based on the expected/observed breast cancer incidence and area under the curve (AUC) using two Korean cohorts: the Korean Multicenter Cancer Cohort (KMCC) and National Cancer Center (NCC) cohort. The major risk factors under the age of 50 were family history, age at menarche, age at first full-term pregnancy, menopausal status, breastfeeding duration, oral contraceptive usage, and exercise, while those at and over the age of 50 were family history, age at menarche, age at menopause, pregnancy experience, body mass index, oral contraceptive usage, and exercise. The modified Gail model produced lower 5-year risk for the cases than for the controls (p = 0.017), while the KoBCRAT produced higher 5-year and lifetime risk for the cases than for the controls (pKorean women, especially urban women.

  19. Optimal Scheme Selection of Agricultural Production Structure Adjustment - Based on DEA Model; Punjab (Pakistan)

    Institute of Scientific and Technical Information of China (English)

    Zeeshan Ahmad; Meng Jun; Muhammad Abdullah; Mazhar Nadeem Ishaq; Majid Lateef; Imran Khan

    2015-01-01

    This paper used the modern evaluation method of DEA (Data Envelopment Analysis) to assess the comparative efficiency and then on the basis of this among multiple schemes chose the optimal scheme of agricultural production structure adjustment. Based on the results of DEA model, we dissected scale advantages of each discretionary scheme or plan. We examined scale advantages of each discretionary scheme, tested profoundly a definitive purpose behind not-DEA efficient, which elucidated the system and methodology to enhance these discretionary plans. At the end, another method had been proposed to rank and select the optimal scheme. The research was important to guide the practice if the modification of agricultural production industrial structure was carried on.

  20. SU-E-T-247: Multi-Leaf Collimator Model Adjustments Improve Small Field Dosimetry in VMAT Plans

    Energy Technology Data Exchange (ETDEWEB)

    Young, L; Yang, F [University of Washington, Seattle, WA (United States)

    2014-06-01

    Purpose: The Elekta beam modulator linac employs a 4-mm micro multileaf collimator (MLC) backed by a fixed jaw. Out-of-field dose discrepancies between treatment planning system (TPS) calculations and output water phantom measurements are caused by the 1-mm leaf gap required for all moving MLCs in a VMAT arc. In this study, MLC parameters are optimized to improve TPS out-of-field dose approximations. Methods: Static 2.4 cm square fields were created with a 1-mm leaf gap for MLCs that would normally park behind the jaw. Doses in the open field and leaf gap were measured with an A16 micro ion chamber and EDR2 film for comparison with corresponding point doses in the Pinnacle TPS. The MLC offset table and tip radius were adjusted until TPS point doses agreed with photon measurements. Improvements to the beam models were tested using static arcs consisting of square fields ranging from 1.6 to 14.0 cm, with 45° collimator rotation, and 1-mm leaf gap to replicate VMAT conditions. Gamma values for the 3-mm distance, 3% dose difference criteria were evaluated using standard QA procedures with a cylindrical detector array. Results: The best agreement in point doses within the leaf gap and open field was achieved by offsetting the default rounded leaf end table by 0.1 cm and adjusting the leaf tip radius to 13 cm. Improvements in TPS models for 6 and 10 MV photon beams were more significant for smaller field sizes 3.6 cm or less where the initial gamma factors progressively increased as field size decreased, i.e. for a 1.6cm field size, the Gamma increased from 56.1% to 98.8%. Conclusion: The MLC optimization techniques developed will achieve greater dosimetric accuracy in small field VMAT treatment plans for fixed jaw linear accelerators. Accurate predictions of dose to organs at risk may reduce adverse effects of radiotherapy.

  1. Short term load forecasting technique based on the seasonal exponential adjustment method and the regression model

    International Nuclear Information System (INIS)

    Wu, Jie; Wang, Jianzhou; Lu, Haiyan; Dong, Yao; Lu, Xiaoxiao

    2013-01-01

    Highlights: ► The seasonal and trend items of the data series are forecasted separately. ► Seasonal item in the data series is verified by the Kendall τ correlation testing. ► Different regression models are applied to the trend item forecasting. ► We examine the superiority of the combined models by the quartile value comparison. ► Paired-sample T test is utilized to confirm the superiority of the combined models. - Abstract: For an energy-limited economy system, it is crucial to forecast load demand accurately. This paper devotes to 1-week-ahead daily load forecasting approach in which load demand series are predicted by employing the information of days before being similar to that of the forecast day. As well as in many nonlinear systems, seasonal item and trend item are coexisting in load demand datasets. In this paper, the existing of the seasonal item in the load demand data series is firstly verified according to the Kendall τ correlation testing method. Then in the belief of the separate forecasting to the seasonal item and the trend item would improve the forecasting accuracy, hybrid models by combining seasonal exponential adjustment method (SEAM) with the regression methods are proposed in this paper, where SEAM and the regression models are employed to seasonal and trend items forecasting respectively. Comparisons of the quartile values as well as the mean absolute percentage error values demonstrate this forecasting technique can significantly improve the accuracy though models applied to the trend item forecasting are eleven different ones. This superior performance of this separate forecasting technique is further confirmed by the paired-sample T tests

  2. ISM Approach to Model Offshore Outsourcing Risks

    Directory of Open Access Journals (Sweden)

    Sunand Kumar

    2014-07-01

    Full Text Available In an effort to achieve a competitive advantage via cost reductions and improved market responsiveness, organizations are increasingly employing offshore outsourcing as a major component of their supply chain strategies. But as evident from literature number of risks such as Political risk, Risk due to cultural differences, Compliance and regulatory risk, Opportunistic risk and Organization structural risk, which adversely affect the performance of offshore outsourcing in a supply chain network. This also leads to dissatisfaction among different stake holders. The main objective of this paper is to identify and understand the mutual interaction among various risks which affect the performance of offshore outsourcing.  To this effect, authors have identified various risks through extant review of literature.  From this information, an integrated model using interpretive structural modelling (ISM for risks affecting offshore outsourcing is developed and the structural relationships between these risks are modeled.  Further, MICMAC analysis is done to analyze the driving power and dependency of risks which shall be helpful to managers to identify and classify important criterions and to reveal the direct and indirect effects of each criterion on offshore outsourcing. Results show that political risk and risk due to cultural differences are act as strong drivers.

  3. ADJUSTMENT OF MORPHOMETRIC PARAMETERS OF WATER BASINS BASED ON DIGITAL TERRAIN MODELS

    Directory of Open Access Journals (Sweden)

    Krasil'nikov Vitaliy Mikhaylovich

    2012-10-01

    Full Text Available The authors argue that effective use of water resources requires accurate morphometric characteristics of water basins. Accurate parameters are needed to analyze their condition, and to assure their appropriate control and operation. Today multiple water basins need their morphometric characteristics to be adjusted and properly stored. The procedure employed so far is based on plane geometric horizontals depicted onto topographic maps. It is described in the procedural guidelines issued in respect of the «Application of water resource regulations governing the operation of waterworks facilities of power plants». The technology described there is obsolete due to the availability of specialized software. The computer technique is based on a digital terrain model. The authors provide an overview of the technique implemented at Rybinsk and Gorkiy water basins in this article. Thus, the digital terrain model generated on the basis of the field data is used at Gorkiy water basin, while the model based on maps and charts is applied at Rybinsk water basin. The authors believe that the software technique can be applied to any other water basin on the basis of the analysis and comparison of morphometric characteristics of the two water basins.

  4. Ice loading model for Glacial Isostatic Adjustment in the Barents Sea constrained by GRACE gravity observations

    Science.gov (United States)

    Root, Bart; Tarasov, Lev; van der Wal, Wouter

    2014-05-01

    The global ice budget is still under discussion because the observed 120-130 m eustatic sea level equivalent since the Last Glacial Maximum (LGM) can not be explained by the current knowledge of land-ice melt after the LGM. One possible location for the missing ice is the Barents Sea Region, which was completely covered with ice during the LGM. This is deduced from relative sea level observations on Svalbard, Novaya Zemlya and the North coast of Scandinavia. However, there are no observations in the middle of the Barents Sea that capture the post-glacial uplift. With increased precision and longer time series of monthly gravity observations of the GRACE satellite mission it is possible to constrain Glacial Isostatic Adjustment in the center of the Barents Sea. This study investigates the extra constraint provided by GRACE data for modeling the past ice geometry in the Barents Sea. We use CSR release 5 data from February 2003 to July 2013. The GRACE data is corrected for the past 10 years of secular decline of glacier ice on Svalbard, Novaya Zemlya and Frans Joseph Land. With numerical GIA models for a radially symmetric Earth, we model the expected gravity changes and compare these with the GRACE observations after smoothing with a 250 km Gaussian filter. The comparisons show that for the viscosity profile VM5a, ICE-5G has too strong a gravity signal compared to GRACE. The regional calibrated ice sheet model (GLAC) of Tarasov appears to fit the amplitude of the GRACE signal. However, the GRACE data are very sensitive to the ice-melt correction, especially for Novaya Zemlya. Furthermore, the ice mass should be more concentrated to the middle of the Barents Sea. Alternative viscosity models confirm these conclusions.

  5. Location memory for dots in polygons versus cities in regions: evaluating the category adjustment model.

    Science.gov (United States)

    Friedman, Alinda; Montello, Daniel R; Burte, Heather

    2012-09-01

    We conducted 3 experiments to examine the category adjustment model (Huttenlocher, Hedges, & Duncan, 1991) in circumstances in which the category boundaries were irregular schematized polygons made from outlines of maps. For the first time, accuracy was tested when only perceptual and/or existing long-term memory information about identical locations was cued. Participants from Alberta, Canada and California received 1 of 3 conditions: dots-only, in which a dot appeared within the polygon, and after a 4-s dynamic mask the empty polygon appeared and the participant indicated where the dot had been; dots-and-names, in which participants were told that the first polygon represented Alberta/California and that each dot was in the correct location for the city whose name appeared outside the polygon; and names-only, in which there was no first polygon, and participants clicked on the city locations from extant memory alone. Location recall in the dots-only and dots-and-names conditions did not differ from each other and had small but significant directional errors that pointed away from the centroids of the polygons. In contrast, the names-only condition had large and significant directional errors that pointed toward the centroids. Experiments 2 and 3 eliminated the distribution of stimuli and overall screen position as causal factors. The data suggest that in the "classic" category adjustment paradigm, it is difficult to determine a priori when Bayesian cue combination is applicable, making Bayesian analysis less useful as a theoretical approach to location estimation. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  6. Concordance for prognostic models with competing risks

    DEFF Research Database (Denmark)

    Wolbers, Marcel; Blanche, Paul; Koller, Michael T

    2014-01-01

    The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate i...

  7. Why operational risk modelling creates inverse incentives

    NARCIS (Netherlands)

    Doff, R.

    2015-01-01

    Operational risk modelling has become commonplace in large international banks and is gaining popularity in the insurance industry as well. This is partly due to financial regulation (Basel II, Solvency II). This article argues that operational risk modelling is fundamentally flawed, despite efforts

  8. Positive Adjustment Among American Repatriated Prisoners of the Vietnam War: Modeling the Long-Term Effects of Captivity.

    Science.gov (United States)

    King, Daniel W; King, Lynda A; Park, Crystal L; Lee, Lewina O; Kaiser, Anica Pless; Spiro, Avron; Moore, Jeffrey L; Kaloupek, Danny G; Keane, Terence M

    2015-11-01

    A longitudinal lifespan model of factors contributing to later-life positive adjustment was tested on 567 American repatriated prisoners from the Vietnam War. This model encompassed demographics at time of capture and attributes assessed after return to the U.S. (reports of torture and mental distress) and approximately 3 decades later (later-life stressors, perceived social support, positive appraisal of military experiences, and positive adjustment). Age and education at time of capture and physical torture were associated with repatriation mental distress, which directly predicted poorer adjustment 30 years later. Physical torture also had a salutary effect, enhancing later-life positive appraisals of military experiences. Later-life events were directly and indirectly (through concerns about retirement) associated with positive adjustment. Results suggest that the personal resources of older age and more education and early-life adverse experiences can have cascading effects over the lifespan to impact well-being in both positive and negative ways.

  9. Response Adjusted for Days of Antibiotic Risk (RADAR): evaluation of a novel method to compare strategies to optimize antibiotic use.

    Science.gov (United States)

    Schweitzer, V A; van Smeden, M; Postma, D F; Oosterheert, J J; Bonten, M J M; van Werkhoven, C H

    2017-12-01

    The Response Adjusted for Days of Antibiotic Risk (RADAR) statistic was proposed to improve the efficiency of trials comparing antibiotic stewardship strategies to optimize antibiotic use. We studied the behaviour of RADAR in a non-inferiority trial in which a β-lactam monotherapy strategy (n = 656) was non-inferior to fluoroquinolone monotherapy (n = 888) for patients with moderately severe community-acquired pneumonia. Patients were ranked according to clinical outcome, using five or eight categories, and antibiotic use. RADAR was calculated as the probability that the β-lactam group had a more favourable ranking than the fluoroquinolone group. To investigate the sensitivity of RADAR to detrimental clinical outcome we simulated increasing rates of 90-day mortality in the β-lactam group and performed the RADAR and non-inferiority analysis. The RADAR of the β-lactam group compared with the fluoroquinolone group was 60.3% (95% CI 57.9%-62.7%) using five and 58.4% (95% CI 56.0%-60.9%) using eight clinical outcome categories, all in favour of β-lactam. Sample sizes for RADAR were 38% (250/653) and 89% (580/653) of the non-inferiority sample size calculation, using five or eight clinical outcome categories, respectively. With simulated mortality rates, loss of non-inferiority of the β-lactam group occurred at a relative risk of 1.125 in the conventional analysis, whereas using RADAR the β-lactam group lost superiority at a relative risk of mortality of 1.25 and 1.5, with eight and five clinical outcome categories, respectively. RADAR favoured β-lactam over fluoroquinolone therapy for community-acquired pneumonia. Although RADAR required fewer patients than conventional non-inferiority analysis, the statistic was less sensitive to detrimental outcomes. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  10. Calculating excess lifetime risk in relative risk models

    International Nuclear Information System (INIS)

    Vaeth, M.; Pierce, D.A.

    1990-01-01

    When assessing the impact of radiation exposure it is common practice to present the final conclusions in terms of excess lifetime cancer risk in a population exposed to a given dose. The present investigation is mainly a methodological study focusing on some of the major issues and uncertainties involved in calculating such excess lifetime risks and related risk projection methods. The age-constant relative risk model used in the recent analyses of the cancer mortality that was observed in the follow-up of the cohort of A-bomb survivors in Hiroshima and Nagasaki is used to describe the effect of the exposure on the cancer mortality. In this type of model the excess relative risk is constant in age-at-risk, but depends on the age-at-exposure. Calculation of excess lifetime risks usually requires rather complicated life-table computations. In this paper we propose a simple approximation to the excess lifetime risk; the validity of the approximation for low levels of exposure is justified empirically as well as theoretically. This approximation provides important guidance in understanding the influence of the various factors involved in risk projections. Among the further topics considered are the influence of a latent period, the additional problems involved in calculations of site-specific excess lifetime cancer risks, the consequences of a leveling off or a plateau in the excess relative risk, and the uncertainties involved in transferring results from one population to another. The main part of this study relates to the situation with a single, instantaneous exposure, but a brief discussion is also given of the problem with a continuous exposure at a low-dose rate

  11. [Construction and validation of a multidimensional model of students' adjustment to college context].

    Science.gov (United States)

    Soares, Ana Paula; Guisande, M Adelina; Diniz, António M; Almeida, Leandro S

    2006-05-01

    This article presents a model of interaction of personal and contextual variables in the prediction of academic performance and psychosocial development of Portuguese college students. The sample consists of 560 first-year college students of the University of Minho. The path analysis results suggest that initial expectations of the students' involvement in academic life constituted an effective predictor of their involvement during their first year; as well as the social climate of the classroom influenced their involvement, well-being and levels of satisfaction obtained. However, these relationships were not strong enough to influence the criterion variables integrated in the model (academic performance and psychosocial development). Academic performance was predicted by the high school grades and college entrance examination scores, and the level of psychosocial development was determined by the level of development showed at the time they entered college. Though more research is needed, these results point to the importance of students' pre-college characteristics when we are considering the quality of their college adjustment process.

  12. Adjusting multistate capture-recapture models for misclassification bias: manatee breeding proportions

    Science.gov (United States)

    Kendall, W.L.; Hines, J.E.; Nichols, J.D.

    2003-01-01

    Matrix population models are important tools for research and management of populations. Estimating the parameters of these models is an important step in applying them to real populations. Multistate capture-recapture methods have provided a useful means for estimating survival and parameters of transition between locations or life history states but have mostly relied on the assumption that the state occupied by each detected animal is known with certainty. Nevertheless, in some cases animals can be misclassified. Using multiple capture sessions within each period of interest, we developed a method that adjusts estimates of transition probabilities for bias due to misclassification. We applied this method to 10 years of sighting data for a population of Florida manatees (Trichechus manatus latirostris) in order to estimate the annual probability of transition from nonbreeding to breeding status. Some sighted females were unequivocally classified as breeders because they were clearly accompanied by a first-year calf. The remainder were classified, sometimes erroneously, as nonbreeders because an attendant first-year calf was not observed or was classified as more than one year old. We estimated a conditional breeding probability of 0.31 + 0.04 (estimate + 1 SE) when we ignored misclassification bias, and 0.61 + 0.09 when we accounted for misclassification.

  13. Standardized binomial models for risk or prevalence ratios and differences.

    Science.gov (United States)

    Richardson, David B; Kinlaw, Alan C; MacLehose, Richard F; Cole, Stephen R

    2015-10-01

    Epidemiologists often analyse binary outcomes in cohort and cross-sectional studies using multivariable logistic regression models, yielding estimates of adjusted odds ratios. It is widely known that the odds ratio closely approximates the risk or prevalence ratio when the outcome is rare, and it does not do so when the outcome is common. Consequently, investigators may decide to directly estimate the risk or prevalence ratio using a log binomial regression model. We describe the use of a marginal structural binomial regression model to estimate standardized risk or prevalence ratios and differences. We illustrate the proposed approach using data from a cohort study of coronary heart disease status in Evans County, Georgia, USA. The approach reduces problems with model convergence typical of log binomial regression by shifting all explanatory variables except the exposures of primary interest from the linear predictor of the outcome regression model to a model for the standardization weights. The approach also facilitates evaluation of departures from additivity in the joint effects of two exposures. Epidemiologists should consider reporting standardized risk or prevalence ratios and differences in cohort and cross-sectional studies. These are readily-obtained using the SAS, Stata and R statistical software packages. The proposed approach estimates the exposure effect in the total population. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  14. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment.

    Science.gov (United States)

    Mogasale, Vittal; Maskery, Brian; Ochiai, R Leon; Lee, Jung Seok; Mogasale, Vijayalaxmi V; Ramani, Enusa; Kim, Young Eun; Park, Jin Kyung; Wierzba, Thomas F

    2014-10-01

    No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine. Copyright © 2014 Mogasale et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

  15. City-Level Adult Stroke Prevalence in Relation to Remote Sensing Derived PM2.5 Adjusting for Unhealthy Behaviors and Medical Risk Factors

    Science.gov (United States)

    Hu, Z.

    2018-04-01

    This research explores the use of PM2.5 gird derived from remote sensing for assessing the effect of long-term exposure to PM2.5 (ambient air pollution of particulate matter with an aerodynamic diameter of 2.5 μm or less) on stroke, adjusting for unhealthy behaviors and medical risk factors. Health data was obtained from the newly published CDC "500 Cities Project" which provides city- and census tract-level small area estimates for chronic disease risk factors, and clinical preventive service use for the largest 500 cities in the United States. PM2.5 data was acquired from the "The Global Annual PM2.5 Grids from MODIS, MISR and SeaWiFS Aerosol Optical Depth (AOD), V1 (1998-2012)" datasets. Average PM2.5 were calculated for each city using a GIS zonal statistics function. Map data visualization and pattern comparison, univariate linear regression, and a multivariate linear regression model fitted using a generalized linear model via penalized maximum likelihood found that long-term exposure to ambient PM2.5 may increase the risk of stroke. Increasing physical activity, reducing smoking and body weight, enough sleeping, controlling diseases such as blood pressure, coronary heart disease, diabetes, and cholesterol, may mitigate the effect. PM2.5 grids derived from moderate resolution satellite remote sensing imagery may offer a unique opportunity to fill the data gap due to limited ground monitoring at broader scales. The evidence of raised stroke prevalence risk in high PM2.5 areas would support targeting of policy interventions on such areas to reduce pollution levels and protect human health.

  16. CITY-LEVEL ADULT STROKE PREVALENCE IN RELATION TO REMOTE SENSING DERIVED PM2.5 ADJUSTING FOR UNHEALTHY BEHAVIORS AND MEDICAL RISK FACTORS

    Directory of Open Access Journals (Sweden)

    Z. Hu

    2018-04-01

    Full Text Available This research explores the use of PM2.5 gird derived from remote sensing for assessing the effect of long-term exposure to PM2.5 (ambient air pollution of particulate matter with an aerodynamic diameter of 2.5 μm or less on stroke, adjusting for unhealthy behaviors and medical risk factors. Health data was obtained from the newly published CDC “500 Cities Project” which provides city- and census tract-level small area estimates for chronic disease risk factors, and clinical preventive service use for the largest 500 cities in the United States. PM2.5 data was acquired from the “The Global Annual PM2.5 Grids from MODIS, MISR and SeaWiFS Aerosol Optical Depth (AOD, V1 (1998–2012” datasets. Average PM2.5 were calculated for each city using a GIS zonal statistics function. Map data visualization and pattern comparison, univariate linear regression, and a multivariate linear regression model fitted using a generalized linear model via penalized maximum likelihood found that long-term exposure to ambient PM2.5 may increase the risk of stroke. Increasing physical activity, reducing smoking and body weight, enough sleeping, controlling diseases such as blood pressure, coronary heart disease, diabetes, and cholesterol, may mitigate the effect. PM2.5 grids derived from moderate resolution satellite remote sensing imagery may offer a unique opportunity to fill the data gap due to limited ground monitoring at broader scales. The evidence of raised stroke prevalence risk in high PM2.5 areas would support targeting of policy interventions on such areas to reduce pollution levels and protect human health.

  17. Models of traumatic experiences and children's psychological adjustment: the roles of perceived parenting and the children's own resources and activity.

    Science.gov (United States)

    Punamäki, R L; Qouta, S; el Sarraj, E

    1997-08-01

    The relations between traumatic events, perceived parenting styles, children's resources, political activity, and psychological adjustment were examined among 108 Palestinian boys and girls of 11-12 years of age. The results showed that exposure to traumatic events increased psychological adjustment problems directly and via 2 mediating paths. First, the more traumatic events children had experienced, the more negative parenting they experienced. And, the poorer they perceived parenting, the more they suffered from high neuroticism and low self-esteem. Second, the more traumatic events children had experienced, the more political activity they showed, and the more active they were, the more they suffered from psychological adjustment problems. Good perceived parenting protected children's psychological adjustment by making them less vulnerable in two ways. First, traumatic events decreased their intellectual, creative, and cognitive resources, and a lack of resources predicted many psychological adjustment problems in a model excluding perceived parenting. Second, political activity increased psychological adjustment problems in the same model, but not in the model including good parenting.

  18. A methodology for modeling regional terrorism risk.

    Science.gov (United States)

    Chatterjee, Samrat; Abkowitz, Mark D

    2011-07-01

    Over the past decade, terrorism risk has become a prominent consideration in protecting the well-being of individuals and organizations. More recently, there has been interest in not only quantifying terrorism risk, but also placing it in the context of an all-hazards environment in which consideration is given to accidents and natural hazards, as well as intentional acts. This article discusses the development of a regional terrorism risk assessment model designed for this purpose. The approach taken is to model terrorism risk as a dependent variable, expressed in expected annual monetary terms, as a function of attributes of population concentration and critical infrastructure. This allows for an assessment of regional terrorism risk in and of itself, as well as in relation to man-made accident and natural hazard risks, so that mitigation resources can be allocated in an effective manner. The adopted methodology incorporates elements of two terrorism risk modeling approaches (event-based models and risk indicators), producing results that can be utilized at various jurisdictional levels. The validity, strengths, and limitations of the model are discussed in the context of a case study application within the United States. © 2011 Society for Risk Analysis.

  19. [Susceptibility to strategy of the drug component of the IPHCC+RxGroups classification system in a risk-adjusted morbidity compensation scheme--a conceptional and data-supported analysis].

    Science.gov (United States)

    Behrend, C; Felder, S; Busse, R

    2007-01-01

    A report commissioned by the German Ministry of Health recommends to the existing scheme for calculating risk-adjusted transfers to sickness funds supplement with the IPHCC+RxGroups method. The method is based on inpatient diagnoses and prescribed drugs as health status measures deduced from prior use. The present study investigates the sickness fund's expected net return from gaming based on the drug component of the risk adjuster. The study explores three possible strategies using the RxGroups method. For the stimulations, insurees are assigned to additional indications or to higher valued RxGroups within the same indication. Then, costs and financial benefits attributable to the altered drug use are estimated and compared with the status quo. The study uses 2000 and 2001 sample data of more than 370,000 insurees of Germany's company-based sickness funds system (BKK). While upgrading increases overall costs, it can be beneficial for the individual sickness funds. Their net return crucially depends on the number of sickness funds gaming the system: the more participating in the game, the smaller is the average net return. Moreover, not participating often is even worse, which in turn points to a prisoner's dilemma. When extending the risk adjustment scheme in social health insurance, the German legislator should take into account the perverse incentives of risk adjusters such as the described prescription drug model.

  20. A Network Model of Credit Risk Contagion

    Directory of Open Access Journals (Sweden)

    Ting-Qiang Chen

    2012-01-01

    Full Text Available A network model of credit risk contagion is presented, in which the effect of behaviors of credit risk holders and the financial market regulators and the network structure are considered. By introducing the stochastic dominance theory, we discussed, respectively, the effect mechanisms of the degree of individual relationship, individual attitude to credit risk contagion, the individual ability to resist credit risk contagion, the monitoring strength of the financial market regulators, and the network structure on credit risk contagion. Then some derived and proofed propositions were verified through numerical simulations.

  1. Assessing climate change effects on long-term forest development: adjusting growth, phenology, and seed production in a gap model

    NARCIS (Netherlands)

    Meer, van der P.J.; Jorritsma, I.T.M.; Kramer, K.

    2002-01-01

    The sensitivity of forest development to climate change is assessed using a gap model. Process descriptions in the gap model of growth, phenology, and seed production were adjusted for climate change effects using a detailed process-based growth modeland a regression analysis. Simulation runs over

  2. Expert judgement models in quantitative risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Rosqvist, T. [VTT Automation, Helsinki (Finland); Tuominen, R. [VTT Automation, Tampere (Finland)

    1999-12-01

    Expert judgement is a valuable source of information in risk management. Especially, risk-based decision making relies significantly on quantitative risk assessment, which requires numerical data describing the initiator event frequencies and conditional probabilities in the risk model. This data is seldom found in databases and has to be elicited from qualified experts. In this report, we discuss some modelling approaches to expert judgement in risk modelling. A classical and a Bayesian expert model is presented and applied to real case expert judgement data. The cornerstone in the models is the log-normal distribution, which is argued to be a satisfactory choice for modelling degree-of-belief type probability distributions with respect to the unknown parameters in a risk model. Expert judgements are qualified according to bias, dispersion, and dependency, which are treated differently in the classical and Bayesian approaches. The differences are pointed out and related to the application task. Differences in the results obtained from the different approaches, as applied to real case expert judgement data, are discussed. Also, the role of a degree-of-belief type probability in risk decision making is discussed.

  3. Expert judgement models in quantitative risk assessment

    International Nuclear Information System (INIS)

    Rosqvist, T.; Tuominen, R.

    1999-01-01

    Expert judgement is a valuable source of information in risk management. Especially, risk-based decision making relies significantly on quantitative risk assessment, which requires numerical data describing the initiator event frequencies and conditional probabilities in the risk model. This data is seldom found in databases and has to be elicited from qualified experts. In this report, we discuss some modelling approaches to expert judgement in risk modelling. A classical and a Bayesian expert model is presented and applied to real case expert judgement data. The cornerstone in the models is the log-normal distribution, which is argued to be a satisfactory choice for modelling degree-of-belief type probability distributions with respect to the unknown parameters in a risk model. Expert judgements are qualified according to bias, dispersion, and dependency, which are treated differently in the classical and Bayesian approaches. The differences are pointed out and related to the application task. Differences in the results obtained from the different approaches, as applied to real case expert judgement data, are discussed. Also, the role of a degree-of-belief type probability in risk decision making is discussed

  4. Comparison of Two Foreign Body Retrieval Devices with Adjustable Loops in a Swine Model

    International Nuclear Information System (INIS)

    Konya, Andras

    2006-01-01

    The purpose of the study was to compare two similar foreign body retrieval devices, the Texan TM (TX) and the Texan LONGhorn TM (TX-LG), in a swine model. Both devices feature a ≤30-mm adjustable loop. Capture times and total procedure times for retrieving foreign bodies from the infrarenal aorta, inferior vena cava, and stomach were compared. All attempts with both devices (TX, n = 15; TX-LG, n = 14) were successful. Foreign bodies in the vasculature were captured quickly using both devices (mean ± SD, 88 ± 106 sec for TX vs 67 ± 42 sec for TX-LG) with no significant difference between them. The TX-LG, however, allowed significantly better capture times than the TX in the stomach (p = 0.022), Overall, capture times for the TX-LG were significantly better than for the TX (p = 0.029). There was no significant difference between the total procedure times in any anatomic region. TX-LG performed significantly better than the TX in the stomach and therefore overall. The better torque control and maneuverability of TX-LG resulted in better performance in large anatomic spaces

  5. Modeling and Dynamic Simulation of the Adjust and Control System Mechanism for Reactor CAREM-25

    International Nuclear Information System (INIS)

    Larreteguy, A.E; Mazufri, C.M

    2000-01-01

    The adjust and control system mechanism, MSAC, is an advanced, and in some senses unique, hydromechanical device.The efforts in modeling this mechanism are aimed to: Get a deep understanding of the physical phenomena involved,Identify the set of parameters relevant to the dynamics of the system,Allow the numerical simulation of the system,Predict the behavior of the mechanism in conditions other than that obtainable within the range of operation of the experimental setup (CEM), and Help in defining the design of the CAPEM (loop for testing the mechanism under high pressure/high temperature conditions).Thanks to the close interaction between the mechanics, the experimenters, and the modelists that compose the MSAC task force, it has been possible to suggest improvements, not only in the design of the mechanism, but also in the design and the operation of the pulse generator (GDP) and the rest of the CEM.This effort has led to a design mature enough so as to be tested in a high-pressure loop

  6. Homoclinic connections and subcritical Neimark bifurcation in a duopoly model with adaptively adjusted productions

    International Nuclear Information System (INIS)

    Agliari, Anna

    2006-01-01

    In this paper we study some global bifurcations arising in the Puu's oligopoly model when we assume that the producers do not adjust to the best reply but use an adaptive process to obtain at each step the new production. Such bifurcations cause the appearance of a pair of closed invariant curves, one attracting and one repelling, this latter being involved in the subcritical Neimark bifurcation of the Cournot equilibrium point. The aim of the paper is to highlight the relationship between the global bifurcations causing the appearance/disappearance of two invariant closed curves and the homoclinic connections of some saddle cycle, already conjectured in [Agliari A, Gardini L, Puu T. Some global bifurcations related to the appearance of closed invariant curves. Comput Math Simul 2005;68:201-19]. We refine the results obtained in such a paper, showing that the appearance/disappearance of closed invariant curves is not necessarily related to the existence of an attracting cycle. The characterization of the periodicity tongues (i.e. a region of the parameter space in which an attracting cycle exists) associated with a subcritical Neimark bifurcation is also discussed

  7. Adjustments of the TaD electron density reconstruction model with GNSS-TEC parameters for operational application purposes

    Directory of Open Access Journals (Sweden)

    Belehaki Anna

    2012-12-01

    Full Text Available Validation results on the latest version of TaD model (TaDv2 show realistic reconstruction of the electron density profiles (EDPs with an average error of 3 TECU, similar to the error obtained from GNSS-TEC calculated paremeters. The work presented here has the aim to further improve the accuracy of the TaD topside reconstruction, adjusting the TEC parameter calculated from TaD model with the TEC parameter calculated by GNSS transmitting RINEX files provided by receivers co-located with the Digisondes. The performance of the new version is tested during a storm period demonstrating further improvements in respect to the previous version. Statistical comparison of modeled and observed TEC confirms the validity of the proposed adjustment. A significant benefit of the proposed upgrade is that it facilitates the real-time implementation of TaD. The model needs a reliable measure of the scale height at the peak height, which is supposed to be provided by Digisondes. Oftenly, the automatic scaling software fails to correctly calculate the scale height at the peak, Hm, due to interferences in the receiving signal. Consequently the model estimated topside scale height is wrongly calculated leading to unrealistic results for the modeled EDP. The proposed TEC adjustment forces the model to correctly reproduce the topside scale height, despite the inaccurate values of Hm. This adjustment is very important for the application of TaD in an operational environment.

  8. Health economic modeling of the potential cost saving effects of Neurally Adjusted Ventilator Assist.

    Science.gov (United States)

    Hjelmgren, Jonas; Bruce Wirta, Sara; Huetson, Pernilla; Myrén, Karl-Johan; Göthberg, Sylvia

    2016-02-01

    Asynchrony between patient and ventilator breaths is associated with increased duration of mechanical ventilation (MV). Neurally Adjusted Ventilatory Assist (NAVA) controls MV through an esophageal reading of diaphragm electrical activity via a nasogastric tube mounted with electrode rings. NAVA has been shown to decrease asynchrony in comparison to pressure support ventilation (PSV). The objective of this study was to conduct a health economic evaluation of NAVA compared with PSV. We developed a model based on an indirect link between improved synchrony with NAVA versus PSV and fewer days spent on MV in synchronous patients. Unit costs for MV were obtained from the Swedish intensive care unit register, and used in the model along with NAVA-specific costs. The importance of each parameter (proportion of asynchronous patients, costs, and average MV duration) for the overall results was evaluated through sensitivity analyses. Base case results showed that 21% of patients ventilated with NAVA were asynchronous versus 52% of patients receiving PSV. This equals an absolute difference of 31% and an average of 1.7 days less on MV and a total cost saving of US$7886 (including NAVA catheter costs). A breakeven analysis suggested that NAVA was cost effective compared with PSV given an absolute difference in the proportion of asynchronous patients greater than 2.5% (49.5% versus 52% asynchronous patients with NAVA and PSV, respectively). The base case results were stable to changes in parameters, such as difference in asynchrony, duration of ventilation and daily intensive care unit costs. This study showed economically favorable results for NAVA versus PSV. Our results show that only a minor decrease in the proportion of asynchronous patients with NAVA is needed for investments to pay off and generate savings. Future studies need to confirm this result by directly relating improved synchrony to the number of days on MV. © The Author(s), 2015.

  9. [Adjustment of the Andersen's model to the Mexican context: access to prenatal care].

    Science.gov (United States)

    Tamez-González, Silvia; Valle-Arcos, Rosa Irene; Eibenschutz-Hartman, Catalina; Méndez-Ramírez, Ignacio

    2006-01-01

    The aim of this work was to propose an adjustment to the Model of Andersen who answers better to the social inequality of the population in the Mexico City and allows to evaluate the effect of socioeconomic factors in the access to the prenatal care of a sample stratified according to degree of marginalization. The data come from a study of 663 women, randomly selected from a framework sample of 21,421 homes in Mexico City. This work collects information about factors that affect utilization of health services, as well as predisposing factors (age and socioeconomic level), as enabling factors (education, social support, entitlement, pay out of pocket and opinion of health services), and need factors. The sample was ranked according to exclusion variables into three stratums. The data were analyzed through the technique of path analysis. The results indicate that socioeconomic level takes part like predisposed variable for utilization of prenatal care services into three stratums. Otherwise, education and social support were the most important enabling variables for utilization of prenatal care services in the same three groups. In regard to low stratum, the most important enabling variables were education and entitlement. For high stratum the principal enabling variables were pay out of pocket and social support. The medium stratum shows atypical behavior which it was difficult to explain and understand. There was not mediating role with need variable in three models. This indicated absence of equality in all stratums. However, the most correlations in high stratum perhaps indicate less inequitable conditions regarding other stratums.

  10. Competing Risks Copula Models for Unemployment Duration

    DEFF Research Database (Denmark)

    Lo, Simon M. S.; Stephan, Gesine; Wilke, Ralf

    2017-01-01

    The copula graphic estimator (CGE) for competing risks models has received little attention in empirical research, despite having been developed into a comprehensive research method. In this paper, we bridge the gap between theoretical developments and applied research by considering a general...... class of competing risks copula models, which nests popular models such as the Cox proportional hazards model, the semiparametric multivariate mixed proportional hazards model (MMPHM), and the CGE as special cases. Analyzing the effects of a German Hartz reform on unemployment duration, we illustrate...

  11. Risk Monitoring through Traceability Information Model

    OpenAIRE

    Juan P. Zamora; Wilson Adarme; Laura Palacios

    2012-01-01

    This paper shows a traceability framework for supply risk monitoring, beginning with the identification, analysis, and evaluation of the supply chain risk and focusing on the supply operations of the Health Care Institutions with oncology services in Bogota, Colombia. It includes a brief presentation of the state of the art of the Supply Chain Risk Management and traceability systems in logistics operations, and it concludes with the methodology to integrate the SCRM model with the traceabili...

  12. Criterion of Semi-Markov Dependent Risk Model

    Institute of Scientific and Technical Information of China (English)

    Xiao Yun MO; Xiang Qun YANG

    2014-01-01

    A rigorous definition of semi-Markov dependent risk model is given. This model is a generalization of the Markov dependent risk model. A criterion and necessary conditions of semi-Markov dependent risk model are obtained. The results clarify relations between elements among semi-Markov dependent risk model more clear and are applicable for Markov dependent risk model.

  13. Risk management model of winter navigation operations

    International Nuclear Information System (INIS)

    Valdez Banda, Osiris A.; Goerlandt, Floris; Kuzmin, Vladimir; Kujala, Pentti; Montewka, Jakub

    2016-01-01

    The wintertime maritime traffic operations in the Gulf of Finland are managed through the Finnish–Swedish Winter Navigation System. This establishes the requirements and limitations for the vessels navigating when ice covers this area. During winter navigation in the Gulf of Finland, the largest risk stems from accidental ship collisions which may also trigger oil spills. In this article, a model for managing the risk of winter navigation operations is presented. The model analyses the probability of oil spills derived from collisions involving oil tanker vessels and other vessel types. The model structure is based on the steps provided in the Formal Safety Assessment (FSA) by the International Maritime Organization (IMO) and adapted into a Bayesian Network model. The results indicate that ship independent navigation and convoys are the operations with higher probability of oil spills. Minor spills are most probable, while major oil spills found very unlikely but possible. - Highlights: •A model to assess and manage the risk of winter navigation operations is proposed. •The risks of oil spills in winter navigation in the Gulf of Finland are analysed. •The model assesses and prioritizes actions to control the risk of the operations. •The model suggests navigational training as the most efficient risk control option.

  14. Opportunities for Improving Army Modeling and Simulation Development: Making Fundamental Adjustments and Borrowing Commercial Business Practices

    National Research Council Canada - National Science Library

    Lee, John

    2000-01-01

    ...; requirements which span the conflict spectrum. The Army's current staff training simulation development process could better support all possible scenarios by making some fundamental adjustments and borrowing commercial business practices...

  15. Using Multilevel Modeling to Assess Case-Mix Adjusters in Consumer Experience Surveys in Health Care

    NARCIS (Netherlands)

    Damman, Olga C.; Stubbe, Janine H.; Hendriks, Michelle; Arah, Onyebuchi A.; Spreeuwenberg, Peter; Delnoij, Diana M. J.; Groenewegen, Peter P.

    2009-01-01

    Background: Ratings on the quality of healthcare from the consumer's perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for

  16. Effect of the spray volume adjustment model on the efficiency of fungicides and residues in processing tomato

    Energy Technology Data Exchange (ETDEWEB)

    Ratajkiewicz, H.; Kierzek, R.; Raczkowski, M.; Hołodyńska-Kulas, A.; Łacka, A.; Wójtowicz, A.; Wachowiak, M.

    2016-11-01

    This study compared the effects of a proportionate spray volume (PSV) adjustment model and a fixed model (300 L/ha) on the infestation of processing tomato with potato late blight (Phytophthora infestans (Mont.) de Bary) (PLB) and azoxystrobin and chlorothalonil residues in fruits in three consecutive seasons. The fungicides were applied in alternating system with or without two spreader adjuvants. The proportionate spray volume adjustment model was based on the number of leaves on plants and spray volume index. The modified Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method was optimized and validated for extraction of azoxystrobin and chlorothalonil residue. Gas chromatography with a nitrogen and phosphorus detector and an electron capture detector were used for the analysis of fungicides. The results showed that higher fungicidal residues were connected with lower infestation of tomato with PLB. PSV adjustment model resulted in lower infestation of tomato than the fixed model (300 L/ha) when fungicides were applied at half the dose without adjuvants. Higher expected spray interception into the tomato canopy with the PSV system was recognized as the reasons of better control of PLB. The spreader adjuvants did not have positive effect on the biological efficacy of spray volume application systems. The results suggest that PSV adjustment model can be used to determine the spray volume for fungicide application for processing tomato crop. (Author)

  17. Effect of the spray volume adjustment model on the efficiency of fungicides and residues in processing tomato

    Directory of Open Access Journals (Sweden)

    Henryk Ratajkiewicz

    2016-08-01

    Full Text Available This study compared the effects of a proportionate spray volume (PSV adjustment model and a fixed model (300 L/ha on the infestation of processing tomato with potato late blight (Phytophthora infestans (Mont. de Bary (PLB and azoxystrobin and chlorothalonil residues in fruits in three consecutive seasons. The fungicides were applied in alternating system with or without two spreader adjuvants. The proportionate spray volume adjustment model was based on the number of leaves on plants and spray volume index. The modified Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS method was optimized and validated for extraction of azoxystrobin and chlorothalonil residue. Gas chromatography with a nitrogen and phosphorus detector and an electron capture detector were used for the analysis of fungicides. The results showed that higher fungicidal residues were connected with lower infestation of tomato with PLB. PSV adjustment model resulted in lower infestation of tomato than the fixed model (300 L/ha when fungicides were applied at half the dose without adjuvants. Higher expected spray interception into the tomato canopy with the PSV system was recognized as the reasons of better control of PLB. The spreader adjuvants did not have positive effect on the biological efficacy of spray volume application systems. The results suggest that PSV adjustment model can be used to determine the spray volume for fungicide application for processing tomato crop.

  18. A model-based risk management framework

    Energy Technology Data Exchange (ETDEWEB)

    Gran, Bjoern Axel; Fredriksen, Rune

    2002-08-15

    The ongoing research activity addresses these issues through two co-operative activities. The first is the IST funded research project CORAS, where Institutt for energiteknikk takes part as responsible for the work package for Risk Analysis. The main objective of the CORAS project is to develop a framework to support risk assessment of security critical systems. The second, called the Halden Open Dependability Demonstrator (HODD), is established in cooperation between Oestfold University College, local companies and HRP. The objective of HODD is to provide an open-source test bed for testing, teaching and learning about risk analysis methods, risk analysis tools, and fault tolerance techniques. The Inverted Pendulum Control System (IPCON), which main task is to keep a pendulum balanced and controlled, is the first system that has been established. In order to make risk assessment one need to know what a system does, or is intended to do. Furthermore, the risk assessment requires correct descriptions of the system, its context and all relevant features. A basic assumption is that a precise model of this knowledge, based on formal or semi-formal descriptions, such as UML, will facilitate a systematic risk assessment. It is also necessary to have a framework to integrate the different risk assessment methods. The experiences so far support this hypothesis. This report presents CORAS and the CORAS model-based risk management framework, including a preliminary guideline for model-based risk assessment. The CORAS framework for model-based risk analysis offers a structured and systematic approach to identify and assess security issues of ICT systems. From the initial assessment of IPCON, we also believe that the framework is applicable in a safety context. Further work on IPCON, as well as the experiences from the CORAS trials, will provide insight and feedback for further improvements. (Author)

  19. The air emissions risk assessment model (AERAM)

    International Nuclear Information System (INIS)

    Gratt, L.B.

    1991-01-01

    AERAM is an environmental analysis and power generation station investment decision support tool. AERAM calculates the public health risk (in terms of the lifetime cancers) in the nearby population from pollutants released into the air. AERAM consists of four main subroutines: Emissions, Air, Exposure and Risk. The Emission subroutine uses power plant parameters to calculate the expected release of the pollutants. A coal-fired and oil-fired power plant are currently available. A gas-fired plant model is under preparation. The release of the pollutants into the air is followed by their dispersal in the environment. The dispersion in the Air Subroutine uses the Environmental Protection Agency's model, Industrial Source Complex-Long Term. Additional dispersion models (Industrial Source Complex - Short Term and Cooling Tower Drift) are being implemented for future AERAM versions. The Expose Subroutine uses the ambient concentrations to compute population exposures for the pollutants of concern. The exposures are used with corresponding dose-response model in the Risk Subroutine to estimate both the total population risk and individual risk. The risk for the dispersion receptor-population centroid for the maximum concentration is also calculated for regulatory-population purposes. In addition, automated interfaces with AirTox (an air risk decision model) have been implemented to extend AERAM's steady-state single solution to the decision-under-uncertainty domain. AERAM was used for public health risks, the investment decision for additional pollution control systems based on health risk reductions, and the economics of fuel vs. health risk tradeoffs. AERAM provides that state-of-the-art capability for evaluating the public health impact airborne toxic substances in response to regulations and public concern

  20. [A model list of high risk drugs].

    Science.gov (United States)

    Cotrina Luque, J; Guerrero Aznar, M D; Alvarez del Vayo Benito, C; Jimenez Mesa, E; Guzman Laura, K P; Fernández Fernández, L

    2013-12-01

    «High-risk drugs» are those that have a very high «risk» of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs » for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration). Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  1. DaMoScope and its internet graphics for the visual control of adjusting mathematical models describing experimental data

    International Nuclear Information System (INIS)

    Belousov, V. I.; Ezhela, V. V.; Kuyanov, Yu. V.; Tkachenko, N. P.

    2015-01-01

    The experience of using the dynamic atlas of the experimental data and mathematical models of their description in the problems of adjusting parametric models of observable values depending on kinematic variables is presented. The functional possibilities of an image of a large number of experimental data and the models describing them are shown by examples of data and models of observable values determined by the amplitudes of elastic scattering of hadrons. The Internet implementation of an interactive tool DaMoScope and its interface with the experimental data and codes of adjusted parametric models with the parameters of the best description of data are schematically shown. The DaMoScope codes are freely available

  2. DaMoScope and its internet graphics for the visual control of adjusting mathematical models describing experimental data

    Science.gov (United States)

    Belousov, V. I.; Ezhela, V. V.; Kuyanov, Yu. V.; Tkachenko, N. P.

    2015-12-01

    The experience of using the dynamic atlas of the experimental data and mathematical models of their description in the problems of adjusting parametric models of observable values depending on kinematic variables is presented. The functional possibilities of an image of a large number of experimental data and the models describing them are shown by examples of data and models of observable values determined by the amplitudes of elastic scattering of hadrons. The Internet implementation of an interactive tool DaMoScope and its interface with the experimental data and codes of adjusted parametric models with the parameters of the best description of data are schematically shown. The DaMoScope codes are freely available.

  3. DaMoScope and its internet graphics for the visual control of adjusting mathematical models describing experimental data

    Energy Technology Data Exchange (ETDEWEB)

    Belousov, V. I.; Ezhela, V. V.; Kuyanov, Yu. V., E-mail: Yu.Kuyanov@gmail.com; Tkachenko, N. P. [Institute for High Energy Physics, National Research Center Kurchatov Institute, COMPAS Group (Russian Federation)

    2015-12-15

    The experience of using the dynamic atlas of the experimental data and mathematical models of their description in the problems of adjusting parametric models of observable values depending on kinematic variables is presented. The functional possibilities of an image of a large number of experimental data and the models describing them are shown by examples of data and models of observable values determined by the amplitudes of elastic scattering of hadrons. The Internet implementation of an interactive tool DaMoScope and its interface with the experimental data and codes of adjusted parametric models with the parameters of the best description of data are schematically shown. The DaMoScope codes are freely available.

  4. Data Assimilation and Adjusted Spherical Harmonic Model of VTEC Map over Thailand

    Science.gov (United States)

    Klinngam, Somjai; Maruyama, Takashi; Tsugawa, Takuya; Ishii, Mamoru; Supnithi, Pornchai; Chiablaem, Athiwat

    2016-07-01

    The global navigation satellite system (GNSS) and high frequency (HF) communication are vulnerable to the ionospheric irregularities, especially when the signal travels through the low-latitude region and around the magnetic equator known as equatorial ionization anomaly (EIA) region. In order to study the ionospheric effects to the communications performance in this region, the regional map of the observed total electron content (TEC) can show the characteristic and irregularities of the ionosphere. In this work, we develop the two-dimensional (2D) map of vertical TEC (VTEC) over Thailand using the adjusted spherical harmonic model (ASHM) and the data assimilation technique. We calculate the VTEC from the receiver independent exchange (RINEX) files recorded by the dual-frequency global positioning system (GPS) receivers on July 8th, 2012 (quiet day) at 12 stations around Thailand: 0° to 25°E and 95°N to 110°N. These stations are managed by Department of Public Works and Town & Country Planning (DPT), Thailand, and the South East Asia Low-latitude ionospheric Network (SEALION) project operated by National Institute of Information and Communications Technology (NICT), Japan, and King Mongkut's Institute of Technology Ladkrabang (KMITL). We compute the median observed VTEC (OBS-VTEC) in the grids with the spatial resolution of 2.5°x5° in latitude and longitude and time resolution of 2 hours. We assimilate the OBS-VTEC with the estimated VTEC from the International Reference Ionosphere model (IRI-VTEC) as well as the ionosphere map exchange (IONEX) files provided by the International GNSS Service (IGS-VTEC). The results show that the estimation of the 15-degree ASHM can be improved when both of IRI-VTEC and IGS-VTEC are weighted by the latitude-dependent factors before assimilating with the OBS-VTEC. However, the IRI-VTEC assimilation can improve the ASHM estimation more than the IGS-VTEC assimilation. Acknowledgment: This work is partially funded by the

  5. Adjustment of regional regression models of urban-runoff quality using data for Chattanooga, Knoxville, and Nashville, Tennessee

    Science.gov (United States)

    Hoos, Anne B.; Patel, Anant R.

    1996-01-01

    Model-adjustment procedures were applied to the combined data bases of storm-runoff quality for Chattanooga, Knoxville, and Nashville, Tennessee, to improve predictive accuracy for storm-runoff quality for urban watersheds in these three cities and throughout Middle and East Tennessee. Data for 45 storms at 15 different sites (five sites in each city) constitute the data base. Comparison of observed values of storm-runoff load and event-mean concentration to the predicted values from the regional regression models for 10 constituents shows prediction errors, as large as 806,000 percent. Model-adjustment procedures, which combine the regional model predictions with local data, are applied to improve predictive accuracy. Standard error of estimate after model adjustment ranges from 67 to 322 percent. Calibration results may be biased due to sampling error in the Tennessee data base. The relatively large values of standard error of estimate for some of the constituent models, although representing significant reduction (at least 50 percent) in prediction error compared to estimation with unadjusted regional models, may be unacceptable for some applications. The user may wish to collect additional local data for these constituents and repeat the analysis, or calibrate an independent local regression model.

  6. Adolescent Sibling Relationship Quality and Adjustment: Sibling Trustworthiness and Modeling, as Factors Directly and Indirectly Influencing These Associations

    Science.gov (United States)

    Gamble, Wendy C.; Yu, Jeong Jin; Kuehn, Emily D.

    2011-01-01

    The main goal of this study was to examine the direct and moderating effects of trustworthiness and modeling on adolescent siblings' adjustment. Data were collected from 438 families including a mother, a younger sibling in fifth, sixth, or seventh grade (M = 11.6 years), and an older sibling (M = 14.3 years). Respondents completed Web-based…

  7. Ecological models and pesticide risk assessment: current modeling practice.

    Science.gov (United States)

    Schmolke, Amelie; Thorbek, Pernille; Chapman, Peter; Grimm, Volker

    2010-04-01

    Ecological risk assessments of pesticides usually focus on risk at the level of individuals, and are carried out by comparing exposure and toxicological endpoints. However, in most cases the protection goal is populations rather than individuals. On the population level, effects of pesticides depend not only on exposure and toxicity, but also on factors such as life history characteristics, population structure, timing of application, presence of refuges in time and space, and landscape structure. Ecological models can integrate such factors and have the potential to become important tools for the prediction of population-level effects of exposure to pesticides, thus allowing extrapolations, for example, from laboratory to field. Indeed, a broad range of ecological models have been applied to chemical risk assessment in the scientific literature, but so far such models have only rarely been used to support regulatory risk assessments of pesticides. To better understand the reasons for this situation, the current modeling practice in this field was assessed in the present study. The scientific literature was searched for relevant models and assessed according to nine characteristics: model type, model complexity, toxicity measure, exposure pattern, other factors, taxonomic group, risk assessment endpoint, parameterization, and model evaluation. The present study found that, although most models were of a high scientific standard, many of them would need modification before they are suitable for regulatory risk assessments. The main shortcomings of currently available models in the context of regulatory pesticide risk assessments were identified. When ecological models are applied to regulatory risk assessments, we recommend reviewing these models according to the nine characteristics evaluated here. (c) 2010 SETAC.

  8. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study

    Science.gov (United States)

    Robinson, Emily J; Power, Geraldine S; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M

    2016-01-01

    Background Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. Objective To describe IHCA demographics during three day/time periods—weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)—and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. Methods We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Results Risk-adjusted outcomes (OR (95% CI)) were worse (p20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. Conclusions IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during

  9. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study.

    Science.gov (United States)

    Robinson, Emily J; Smith, Gary B; Power, Geraldine S; Harrison, David A; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M

    2016-11-01

    Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. To describe IHCA demographics during three day/time periods-weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)-and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Risk-adjusted outcomes (OR (95% CI)) were worse (p20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at

  10. Lung cancer risk models from experimental animals

    International Nuclear Information System (INIS)

    Gilbert, E.S.

    1988-03-01

    The objective of this paper is to present analyses of data based on methods that adequately account for time-related factors and competiting risks, and that yield results that are expressed in a form comparable to results obtained from recent analyses of epidemiological studies of humans exposed to radon and radon daughters. These epidemiological analyses have modeled the hazard, or age-specific death rates, as a function of factors such as dose and dose rate, time from exposure, and time from cessation of exposure. The starting point for many of the analyses of human data has been the constant relative risk modeling which the age-specific death rates are assumed to be a function of cumulative dose, and the risks due to exposure are assumed to be proportional to the age-specific baseline death rates. However, departures from this initial model, such as dependence of risks on age at risk and/or time from exposure, have been investigated. These analyses have frequently been based on a non-parametric model that requires minimal assumptions regarding the baseline risks and their dependence on age

  11. Quantitative occupational risk model: Single hazard

    International Nuclear Information System (INIS)

    Papazoglou, I.A.; Aneziris, O.N.; Bellamy, L.J.; Ale, B.J.M.; Oh, J.

    2017-01-01

    A model for the quantification of occupational risk of a worker exposed to a single hazard is presented. The model connects the working conditions and worker behaviour to the probability of an accident resulting into one of three types of consequence: recoverable injury, permanent injury and death. Working conditions and safety barriers in place to reduce the likelihood of an accident are included. Logical connections are modelled through an influence diagram. Quantification of the model is based on two sources of information: a) number of accidents observed over a period of time and b) assessment of exposure data of activities and working conditions over the same period of time and the same working population. Effectiveness of risk reducing measures affecting the working conditions, worker behaviour and/or safety barriers can be quantified through the effect of these measures on occupational risk. - Highlights: • Quantification of occupational risk from a single hazard. • Influence diagram connects working conditions, worker behaviour and safety barriers. • Necessary data include the number of accidents and the total exposure of worker • Effectiveness of risk reducing measures is quantified through the impact on the risk • An example illustrates the methodology.

  12. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

  13. A Key Challenge in Global HRM: Adding New Insights to Existing Expatriate Spouse Adjustment Models

    Science.gov (United States)

    Gupta, Ritu; Banerjee, Pratyush; Gaur, Jighyasu

    2012-01-01

    This study is an attempt to strengthen the existing knowledge about factors affecting the adjustment process of the trailing expatriate spouse and the subsequent impact of any maladjustment or expatriate failure. We conducted a qualitative enquiry using grounded theory methodology with 26 Indian spouses who had to deal with their partner's…

  14. Using multilevel modelling to assess case-mix adjusters in consumers experience surveys in health care

    NARCIS (Netherlands)

    Damman, O.C.; Stubbe, J.H.; Hendriks, M.; Arah, O.A.; Spreeuwenberg, P.; Delnoij, D.M.J.; Groenewegen, P.P.

    2009-01-01

    Background: Ratings on the quality of healthcare from the consumer’s perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for

  15. Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care.

    NARCIS (Netherlands)

    Damman, O.C.; Stubbe, J.H.; Hendriks, M.; Arah, O.A.; Spreeuwenberg, P.; Delnoij, D.M.J.; Groenewegen, P.P.

    2009-01-01

    Background: Ratings on the quality of healthcare from the consumer’s perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for

  16. Conceptual models for cumulative risk assessment.

    Science.gov (United States)

    Linder, Stephen H; Sexton, Ken

    2011-12-01

    In the absence of scientific consensus on an appropriate theoretical framework, cumulative risk assessment and related research have relied on speculative conceptual models. We argue for the importance of theoretical backing for such models and discuss 3 relevant theoretical frameworks, each supporting a distinctive "family" of models. Social determinant models postulate that unequal health outcomes are caused by structural inequalities; health disparity models envision social and contextual factors acting through individual behaviors and biological mechanisms; and multiple stressor models incorporate environmental agents, emphasizing the intermediary role of these and other stressors. The conclusion is that more careful reliance on established frameworks will lead directly to improvements in characterizing cumulative risk burdens and accounting for disproportionate adverse health effects.

  17. Fuzzy logic model to quantify risk perception

    International Nuclear Information System (INIS)

    Bukh, Julia; Dickstein, Phineas

    2008-01-01

    The aim of this study is a quantification of public risk perception towards the nuclear field so as to be considered in decision making whenever the public involvement is sought. The proposed model includes both qualitative factors such as familiarity and voluntariness and numerical factors influencing risk perception, such as probability of occurrence and severity of consequence. Since part of these factors can be characterized only by qualitative expressions and the determination of them are linked with vagueness, imprecision and uncertainty, the most suitable method for the risk level assessment is Fuzzy Logic, which models qualitative aspects of knowledge and reasoning processes without employing precise quantitative analyses. This work, then, offers a Fuzzy-Logic based mean of representing the risk perception by a single numerical feature, which can be weighted and accounted for in decision making procedures. (author)

  18. Lifestyle-based risk model for fall risk assessment

    OpenAIRE

    Sannino, Giovanna; De Falco, Ivanoe; De Pietro, Guiseppe

    2016-01-01

    Purpose: The aim of this study was to identify the explicit relationship between life-style and the risk of falling under the form of a mathematical model. Starting from some personal and behavioral information of a subject as, e.g., weight, height, age, data about physical activity habits, and concern about falling, the model would estimate the score of her/his Mini-Balance Evaluation Systems (Mini-BES) test. This score ranges within 0 and 28, and the lower its value the more likely the subj...

  19. Exploring the predictive power of interaction terms in a sophisticated risk equalization model using regression trees.

    Science.gov (United States)

    van Veen, S H C M; van Kleef, R C; van de Ven, W P M M; van Vliet, R C J A

    2018-02-01

    This study explores the predictive power of interaction terms between the risk adjusters in the Dutch risk equalization (RE) model of 2014. Due to the sophistication of this RE-model and the complexity of the associations in the dataset (N = ~16.7 million), there are theoretically more than a million interaction terms. We used regression tree modelling, which has been applied rarely within the field of RE, to identify interaction terms that statistically significantly explain variation in observed expenses that is not already explained by the risk adjusters in this RE-model. The interaction terms identified were used as additional risk adjusters in the RE-model. We found evidence that interaction terms can improve the prediction of expenses overall and for specific groups in the population. However, the prediction of expenses for some other selective groups may deteriorate. Thus, interactions can reduce financial incentives for risk selection for some groups but may increase them for others. Furthermore, because regression trees are not robust, additional criteria are needed to decide which interaction terms should be used in practice. These criteria could be the right incentive structure for risk selection and efficiency or the opinion of medical experts. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion.

    Science.gov (United States)

    Major, B; Richards, C; Cooper, M L; Cozzarelli, C; Zubek, J

    1998-03-01

    We hypothesized that the effects of personality (self-esteem, control, and optimism) on postabortion adaptation (distress, well-being, and decision satisfaction) would be fully mediated by preabortion cognitive appraisals (stress appraisals and self-efficacy appraisals) and postabortion coping. We further proposed that the effects of preabortion appraisals on adaptation would be fully mediated by postabortion coping. Results of a longitudinal study of 527 women who had first-trimester abortions supported our hypotheses. Women with more resilient personalities appraised their abortion as less stressful and had higher self-efficacy for coping with the abortion. More positive appraisals predicted greater acceptance/reframing coping and lesser avoidance/denial, venting, support seeking, and religious coping. Acceptance-reframing predicted better adjustment on all measures, whereas avoidance-denial and venting related to poorer adjustment on all measures. Greater support seeking was associated with reduced distress, and greater religious coping was associated with less decision satisfaction.

  1. Risk Measurement and Risk Modelling Using Applications of Vine Copulas

    Directory of Open Access Journals (Sweden)

    David E. Allen

    2017-09-01

    Full Text Available This paper features an application of Regular Vine copulas which are a novel and recently developed statistical and mathematical tool which can be applied in the assessment of composite financial risk. Copula-based dependence modelling is a popular tool in financial applications, but is usually applied to pairs of securities. By contrast, Vine copulas provide greater flexibility and permit the modelling of complex dependency patterns using the rich variety of bivariate copulas which may be arranged and analysed in a tree structure to explore multiple dependencies. The paper features the use of Regular Vine copulas in an analysis of the co-dependencies of 10 major European Stock Markets, as represented by individual market indices and the composite STOXX 50 index. The sample runs from 2005 to the end of 2013 to permit an exploration of how correlations change indifferent economic circumstances using three different sample periods: pre-GFC (January 2005–July 2007, GFC (July 2007– September 2009, and post-GFC periods (September 2009–December 2013. The empirical results suggest that the dependencies change in a complex manner, and are subject to change in different economic circumstances. One of the attractions of this approach to risk modelling is the flexibility in the choice of distributions used to model co-dependencies. The practical application of Regular Vine metrics is demonstrated via an example of the calculation of the VaR of a portfolio made up of the indices.

  2. Inclusion of Functional Status Measures in the Risk Adjustment of 30-Day Mortality After Transcatheter Aortic Valve Replacement: A Report From the Society of Thoracic Surgeons/American College of Cardiology TVT Registry.

    Science.gov (United States)

    Arnold, Suzanne V; O'Brien, Sean M; Vemulapalli, Sreekanth; Cohen, David J; Stebbins, Amanda; Brennan, J Matthew; Shahian, David M; Grover, Fred L; Holmes, David R; Thourani, Vinod H; Peterson, Eric D; Edwards, Fred H

    2018-03-26

    The aim of this study was to develop and validate a risk adjustment model for 30-day mortality after transcatheter aortic valve replacement (TAVR) that accounted for both standard clinical factors and pre-procedural health status and frailty. Assessment of risk for TAVR is important both for patient selection and provider comparisons. Prior efforts for risk adjustment have focused on in-hospital mortality, which is easily obtainable but can be biased because of early discharge of ill patients. Using data from patients who underwent TAVR as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry (June 2013 to May 2016), a hierarchical logistic regression model to estimate risk for 30-day mortality after TAVR based only on pre-procedural factors and access site was developed and internally validated. The model included factors from the original TVT Registry in-hospital mortality model but added the Kansas City Cardiomyopathy Questionnaire (health status) and gait speed (5-m walk test). Among 21,661 TAVR patients at 188 sites, 1,025 (4.7%) died within 30 days. Independent predictors of 30-day death included older age, low body weight, worse renal function, peripheral artery disease, home oxygen, prior myocardial infarction, left main coronary artery disease, tricuspid regurgitation, nonfemoral access, worse baseline health status, and inability to walk. The predicted 30-day mortality risk ranged from 1.1% (lowest decile of risk) to 13.8% (highest decile of risk). The model was able to stratify risk on the basis of patient factors with good discrimination (C = 0.71 [derivation], C = 0.70 [split-sample validation]) and excellent calibration, both overall and in key patient subgroups. A clinical risk model was developed for 30-day death after TAVR that included clinical data as well as health status and frailty. This model will facilitate tracking outcomes over time as TAVR expands to lower risk patients and

  3. Performance Models and Risk Management in Communications Systems

    CERN Document Server

    Harrison, Peter; Rüstem, Berç

    2011-01-01

    This volume covers recent developments in the design, operation, and management of telecommunication and computer network systems in performance engineering and addresses issues of uncertainty, robustness, and risk. Uncertainty regarding loading and system parameters leads to challenging optimization and robustness issues. Stochastic modeling combined with optimization theory ensures the optimum end-to-end performance of telecommunication or computer network systems. In view of the diverse design options possible, supporting models have many adjustable parameters and choosing the best set for a particular performance objective is delicate and time-consuming. An optimization based approach determines the optimal possible allocation for these parameters. Researchers and graduate students working at the interface of telecommunications and operations research will benefit from this book. Due to the practical approach, this book will also serve as a reference tool for scientists and engineers in telecommunication ...

  4. Mistral project: identification and parameter adjustment. Theoretical part; Projet Mistral: identification et recalage des modeles. Etude theorique

    Energy Technology Data Exchange (ETDEWEB)

    Faille, D.; Codrons, B.; Gevers, M.

    1996-03-01

    This document belongs to the methodological part of the project MISTRAL, which builds a library of power plant models. The model equations are generally obtained from the first principles. The parameters are actually not always easily calculable (at least accurately) from the dimension data. We are therefore investigating the possibility of automatically adjusting the value of those parameters from experimental data. To do that, we must master the optimization algorithms and the techniques that are analyzing the model structure, like the identifiability theory. (authors). 7 refs., 1 fig., 1 append.

  5. A Probabilistic Typhoon Risk Model for Vietnam

    Science.gov (United States)

    Haseemkunju, A.; Smith, D. F.; Brolley, J. M.

    2017-12-01

    Annually, the coastal Provinces of low-lying Mekong River delta region in the southwest to the Red River Delta region in Northern Vietnam is exposed to severe wind and flood risk from landfalling typhoons. On average, about two to three tropical cyclones with a maximum sustained wind speed of >=34 knots make landfall along the Vietnam coast. Recently, Typhoon Wutip (2013) crossed Central Vietnam as a category 2 typhoon causing significant damage to properties. As tropical cyclone risk is expected to increase with increase in exposure and population growth along the coastal Provinces of Vietnam, insurance/reinsurance, and capital markets need a comprehensive probabilistic model to assess typhoon risk in Vietnam. In 2017, CoreLogic has expanded the geographical coverage of its basin-wide Western North Pacific probabilistic typhoon risk model to estimate the economic and insured losses from landfalling and by-passing tropical cyclones in Vietnam. The updated model is based on 71 years (1945-2015) of typhoon best-track data and 10,000 years of a basin-wide simulated stochastic tracks covering eight countries including Vietnam. The model is capable of estimating damage from wind, storm surge and rainfall flooding using vulnerability models, which relate typhoon hazard to building damageability. The hazard and loss models are validated against past historical typhoons affecting Vietnam. Notable typhoons causing significant damage in Vietnam are Lola (1993), Frankie (1996), Xangsane (2006), and Ketsana (2009). The central and northern coastal provinces of Vietnam are more vulnerable to wind and flood hazard, while typhoon risk in the southern provinces are relatively low.

  6. Risk terrain modeling predicts child maltreatment.

    Science.gov (United States)

    Daley, Dyann; Bachmann, Michael; Bachmann, Brittany A; Pedigo, Christian; Bui, Minh-Thuy; Coffman, Jamye

    2016-12-01

    As indicated by research on the long-term effects of adverse childhood experiences (ACEs), maltreatment has far-reaching consequences for affected children. Effective prevention measures have been elusive, partly due to difficulty in identifying vulnerable children before they are harmed. This study employs Risk Terrain Modeling (RTM), an analysis of the cumulative effect of environmental factors thought to be conducive for child maltreatment, to create a highly accurate prediction model for future substantiated child maltreatment cases in the City of Fort Worth, Texas. The model is superior to commonly used hotspot predictions and more beneficial in aiding prevention efforts in a number of ways: 1) it identifies the highest risk areas for future instances of child maltreatment with improved precision and accuracy; 2) it aids the prioritization of risk-mitigating efforts by informing about the relative importance of the most significant contributing risk factors; 3) since predictions are modeled as a function of easily obtainable data, practitioners do not have to undergo the difficult process of obtaining official child maltreatment data to apply it; 4) the inclusion of a multitude of environmental risk factors creates a more robust model with higher predictive validity; and, 5) the model does not rely on a retrospective examination of past instances of child maltreatment, but adapts predictions to changing environmental conditions. The present study introduces and examines the predictive power of this new tool to aid prevention efforts seeking to improve the safety, health, and wellbeing of vulnerable children. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Risk considerations related to lung modeling

    International Nuclear Information System (INIS)

    Masse, R.; Cross, F.T.

    1989-01-01

    Improved lung models provide a more accurate assessment of dose from inhalation exposures and, therefore, more accurate dose-response relationships for risk evaluation and exposure limitation. Epidemiological data for externally irradiated persons indicate that the numbers of excess respiratory tract carcinomas differ in the upper airways, bronchi, and distal lung. Neither their histogenesis and anatomical location nor their progenitor cells are known with sufficient accuracy for accurate assessment of the microdosimetry. The nuclei of sensitive cells generally can be assumed to be distributed at random in the epithelium, beneath the mucus and tips of the beating cilia and cells. In stratified epithelia, basal cells may be considered the only cells at risk. Upper-airway tumors have been observed in both therapeutically irradiated patients and in Hiroshima-Nagasaki survivors. The current International Commission on Radiological Protection Lung-Model Task Group proposes that the upper airways and lung have a similar relative risk coefficient for cancer induction. The partition of the risk weighting factor, therefore, will be proportional to the spontaneous death rate from tumors, and 80% of the weighting factor for the respiratory tract should be attributed to the lung. For Weibel lung-model branching generations 0 to 16 and 17 to 23, the Task Group proposes an 80/20 partition of the risk, i.e., 64% and 16%, respectively, of the total risk. Regarding risk in animals, recent data in rats indicate a significantly lower effectiveness for lung-cancer induction at low doses from insoluble long-lived alpha-emitters than from Rn daughters. These findings are due, in part, to the fact that different regions of the lung are irradiated. Tumors in the lymph nodes are rare in people and animals exposed to radiation.44 references

  8. Modeling foreign exchange risk premium in Armenia

    Czech Academy of Sciences Publication Activity Database

    Poghosyan, T.; Kočenda, E.; Zemčík, Petr

    2008-01-01

    Roč. 44, č. 1 (2008), s. 41-61 ISSN 1540-496X R&D Projects: GA MŠk LC542 Institutional research plan: CEZ:AV0Z70850503 Keywords : foreign exchange risk premium * Armenia * affine term structure models Subject RIV: AH - Economics Impact factor: 0.611, year: 2008

  9. Modeling foreign exchange risk premium in Armenia

    Czech Academy of Sciences Publication Activity Database

    Poghosyan, Tigran; Kočenda, Evžen; Zemčík, P.

    2008-01-01

    Roč. 44, č. 1 (2008), s. 41-61 ISSN 1540-496X R&D Projects: GA MŠk LC542 Institutional research plan: CEZ:MSM0021620846 Keywords : foreign exchange risk premium * Armenia * affine term structure models Subject RIV: AH - Economics Impact factor: 0.611, year: 2008

  10. A Probabilistic Asteroid Impact Risk Model

    Science.gov (United States)

    Mathias, Donovan L.; Wheeler, Lorien F.; Dotson, Jessie L.

    2016-01-01

    Asteroid threat assessment requires the quantification of both the impact likelihood and resulting consequence across the range of possible events. This paper presents a probabilistic asteroid impact risk (PAIR) assessment model developed for this purpose. The model incorporates published impact frequency rates with state-of-the-art consequence assessment tools, applied within a Monte Carlo framework that generates sets of impact scenarios from uncertain parameter distributions. Explicit treatment of atmospheric entry is included to produce energy deposition rates that account for the effects of thermal ablation and object fragmentation. These energy deposition rates are used to model the resulting ground damage, and affected populations are computed for the sampled impact locations. The results for each scenario are aggregated into a distribution of potential outcomes that reflect the range of uncertain impact parameters, population densities, and strike probabilities. As an illustration of the utility of the PAIR model, the results are used to address the question of what minimum size asteroid constitutes a threat to the population. To answer this question, complete distributions of results are combined with a hypothetical risk tolerance posture to provide the minimum size, given sets of initial assumptions. Model outputs demonstrate how such questions can be answered and provide a means for interpreting the effect that input assumptions and uncertainty can have on final risk-based decisions. Model results can be used to prioritize investments to gain knowledge in critical areas or, conversely, to identify areas where additional data has little effect on the metrics of interest.

  11. Issues in Value-at-Risk Modeling and Evaluation

    NARCIS (Netherlands)

    J. Daníelsson (Jón); C.G. de Vries (Casper); B.N. Jorgensen (Bjørn); P.F. Christoffersen (Peter); F.X. Diebold (Francis); T. Schuermann (Til); J.A. Lopez (Jose); B. Hirtle (Beverly)

    1998-01-01

    textabstractDiscusses the issues in value-at-risk modeling and evaluation. Value of value at risk; Horizon problems and extreme events in financial risk management; Methods of evaluating value-at-risk estimates.

  12. A new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model.

    Science.gov (United States)

    Harrison, David A; Parry, Gareth J; Carpenter, James R; Short, Alasdair; Rowan, Kathy

    2007-04-01

    To develop a new model to improve risk prediction for admissions to adult critical care units in the UK. Prospective cohort study. The setting was 163 adult, general critical care units in England, Wales, and Northern Ireland, December 1995 to August 2003. Patients were 216,626 critical care admissions. None. The performance of different approaches to modeling physiologic measurements was evaluated, and the best methods were selected to produce a new physiology score. This physiology score was combined with other information relating to the critical care admission-age, diagnostic category, source of admission, and cardiopulmonary resuscitation before admission-to develop a risk prediction model. Modeling interactions between diagnostic category and physiology score enabled the inclusion of groups of admissions that are frequently excluded from risk prediction models. The new model showed good discrimination (mean c index 0.870) and fit (mean Shapiro's R 0.665, mean Brier's score 0.132) in 200 repeated validation samples and performed well when compared with recalibrated versions of existing published risk prediction models in the cohort of patients eligible for all models. The hypothesis of perfect fit was rejected for all models, including the Intensive Care National Audit & Research Centre (ICNARC) model, as is to be expected in such a large cohort. The ICNARC model demonstrated better discrimination and overall fit than existing risk prediction models, even following recalibration of these models. We recommend it be used to replace previously published models for risk adjustment in the UK.

  13. Resolution of a Rank-Deficient Adjustment Model Via an Isomorphic Geometrical Setup with Tensor Structure.

    Science.gov (United States)

    1987-03-01

    holds an economical advantage. We now formulate 1. from (65) in conjunction with (57): IH]T T I TI (4 L [I R)T(I + RR ) (L*4) where the positive...sizes of the matrices to be inverted, an economical edge of the analytical formulation hecomes apparent as well. Chapter 3 contains one such matrix of...the relat ions Sthat can tie iibta i ned via the tensor vers ion of adjustment quant it ies. Alt Iihut t . ho’ ) mpu it iona I merits of the CholeskI

  14. Modeling and Predicting the EUR/USD Exchange Rate: The Role of Nonlinear Adjustments to Purchasing Power Parity

    OpenAIRE

    Jesús Crespo Cuaresma; Anna Orthofer

    2010-01-01

    Reliable medium-term forecasts are essential for forward-looking monetary policy decisionmaking. Traditionally, predictions of the exchange rate tend to be linked to the equilibrium concept implied by the purchasing power parity (PPP) theory. In particular, the traditional benchmark for exchange rate models is based on a linear adjustment of the exchange rate to the level implied by PPP. In the presence of aggregation effects, transaction costs or uncertainty, however, economic theory predict...

  15. The adjustment of global and partial dry biomass models for Pinus pinaster in the North-East of Portugal

    OpenAIRE

    Lopes, Domingos; Almeida, L.R.; Castro, João Paulo; Aranha, José

    2005-01-01

    Ecosystems net primary production quantification can be done by means of allometric equations. Carbon sequestration studies also involve the quantification of growth dry biomass, knowing the carbon percentage of dry biomass. Fieldwork complexity to collect these kind of data are often limitative for obtaining these mathematical models. Allometric equations were adjusted to estimate dry biomass of individual Pinus pinaster trees, using data from 30 trees. Statisticals form the final equatio...

  16. Modeling inputs to computer models used in risk assessment

    International Nuclear Information System (INIS)

    Iman, R.L.

    1987-01-01

    Computer models for various risk assessment applications are closely scrutinized both from the standpoint of questioning the correctness of the underlying mathematical model with respect to the process it is attempting to model and from the standpoint of verifying that the computer model correctly implements the underlying mathematical model. A process that receives less scrutiny, but is nonetheless of equal importance, concerns the individual and joint modeling of the inputs. This modeling effort clearly has a great impact on the credibility of results. Model characteristics are reviewed in this paper that have a direct bearing on the model input process and reasons are given for using probabilities-based modeling with the inputs. The authors also present ways to model distributions for individual inputs and multivariate input structures when dependence and other constraints may be present

  17. Psychosocial Adjustment over a Two-Year Period in Children Referred for Learning Problems: Risk, Resilience, and Adaptation.

    Science.gov (United States)

    Sorensen, Lisa G.; Forbes, Peter W.; Bernstein, Jane H.; Weiler, Michael D.; Mitchell, William M.; Waber, Deborah P.

    2003-01-01

    A 2-year study evaluated the relationship among psychosocial adjustment, changes in academic skills, and contextual factors in 100 children (ages 7-11) with learning problems. Contextual variables were significantly associated with psychosocial adaptation, including the effectiveness of the clinical assessment, extent of academic support, and the…

  18. Parental Dysphoria and Children's Adjustment: Marital Conflict Styles, Children's Emotional Security, and Parenting as Mediators of Risk

    Science.gov (United States)

    Du Rocher Schudlich, Tina D.; Cummings, E. Mark

    2007-01-01

    Dimensions of martial conflict, children's emotional security regarding interparental conflict, and parenting style were examined as mediators between parental dysphoria and child adjustment. A community sample of 262 children, ages 8-16, participated with their parents. Behavioral observations were made of parents' interactions during marital…

  19. Model based risk assessment - the CORAS framework

    Energy Technology Data Exchange (ETDEWEB)

    Gran, Bjoern Axel; Fredriksen, Rune; Thunem, Atoosa P-J.

    2004-04-15

    Traditional risk analysis and assessment is based on failure-oriented models of the system. In contrast to this, model-based risk assessment (MBRA) utilizes success-oriented models describing all intended system aspects, including functional, operational and organizational aspects of the target. The target models are then used as input sources for complementary risk analysis and assessment techniques, as well as a basis for the documentation of the assessment results. The EU-funded CORAS project developed a tool-supported methodology for the application of MBRA in security-critical systems. The methodology has been tested with successful outcome through a series of seven trial within the telemedicine and ecommerce areas. The CORAS project in general and the CORAS application of MBRA in particular have contributed positively to the visibility of model-based risk assessment and thus to the disclosure of several potentials for further exploitation of various aspects within this important research field. In that connection, the CORAS methodology's possibilities for further improvement towards utilization in more complex architectures and also in other application domains such as the nuclear field can be addressed. The latter calls for adapting the framework to address nuclear standards such as IEC 60880 and IEC 61513. For this development we recommend applying a trial driven approach within the nuclear field. The tool supported approach for combining risk analysis and system development also fits well with the HRP proposal for developing an Integrated Design Environment (IDE) providing efficient methods and tools to support control room systems design. (Author)

  20. Mechanistic modeling for mammography screening risks

    International Nuclear Information System (INIS)

    Bijwaard, Harmen

    2008-01-01

    Full text: Western populations show a very high incidence of breast cancer and in many countries mammography screening programs have been set up for the early detection of these cancers. Through these programs large numbers of women (in the Netherlands, 700.000 per year) are exposed to low but not insignificant X-ray doses. ICRP based risk estimates indicate that the number of breast cancer casualties due to mammography screening can be as high as 50 in the Netherlands per year. The number of lives saved is estimated to be much higher, but for an accurate calculation of the benefits of screening a better estimate of these risks is indispensable. Here it is attempted to better quantify the radiological risks of mammography screening through the application of a biologically based model for breast tumor induction by X-rays. The model is applied to data obtained from the National Institutes of Health in the U.S. These concern epidemiological data of female TB patients who received high X-ray breast doses in the period 1930-1950 through frequent fluoroscopy of their lungs. The mechanistic model that is used to describe the increased breast cancer incidence is based on an earlier study by Moolgavkar et al. (1980), in which the natural background incidence of breast cancer was modeled. The model allows for a more sophisticated extrapolation of risks to the low dose X-ray exposures that are common in mammography screening and to the higher ages that are usually involved. Furthermore, it allows for risk transfer to other (non-western) populations. The results have implications for decisions on the frequency of screening, the number of mammograms taken at each screening, minimum and maximum ages for screening and the transfer to digital equipment. (author)

  1. Siblings' Perceptions of Differential Treatment, Fairness, and Jealousy and Adolescent Adjustment: A Moderated Indirect Effects Model.

    Science.gov (United States)

    Loeser, Meghan K; Whiteman, Shawn D; McHale, Susan M

    2016-08-01

    Youth's perception of parents' differential treatment (PDT) are associated with maladjustment during adolescence. Although the direct relations between PDT and youth's maladjustment have been well established, the mechanisms underlying these associations remain unclear. We addressed this gap by examining whether sibling jealousy accounted for the links between PDT and youth's depressive symptoms, self-worth, and risky behaviors. Additionally, we examined whether youth's perceptions of fairness regarding their treatment as well as the gender constellation of the dyad moderated these indirect relations (i.e., moderated-indirect effects). Participants were first- and second-born adolescent siblings ( M = 15.96, SD = .72 years for older siblings, M = 13.48, SD = 1.02 years for younger siblings) and their parents from 197 working and middle class European American families. Data were collected via home interviews. A series of Conditional Process Analyses revealed significant indirect effects of PDT through sibling jealousy to all three adjustment outcomes. Furthermore, perceptions of fairness moderated the relations between PDT and jealousy, such that the indirect effects were only significant at low (-1 SD ) and average levels of fairness. At high levels of fairness (+1 SD ) there was no association between PDT, jealousy, and youth adjustment. Taken together, results indicate that youth and parents would benefit from engaging in clear communication regarding the reasoning for the occurrence of differential treatment, likely maximizing youth and parent perceptions of that treatment as being fair, and in turn mitigating sibling jealousy and maladjustment.

  2. Siblings’ Perceptions of Differential Treatment, Fairness, and Jealousy and Adolescent Adjustment: A Moderated Indirect Effects Model

    Science.gov (United States)

    Loeser, Meghan K.; Whiteman, Shawn D.; McHale, Susan M.

    2016-01-01

    Youth's perception of parents’ differential treatment (PDT) are associated with maladjustment during adolescence. Although the direct relations between PDT and youth's maladjustment have been well established, the mechanisms underlying these associations remain unclear. We addressed this gap by examining whether sibling jealousy accounted for the links between PDT and youth's depressive symptoms, self-worth, and risky behaviors. Additionally, we examined whether youth's perceptions of fairness regarding their treatment as well as the gender constellation of the dyad moderated these indirect relations (i.e., moderated-indirect effects). Participants were first- and second-born adolescent siblings (M = 15.96, SD = .72 years for older siblings, M = 13.48, SD = 1.02 years for younger siblings) and their parents from 197 working and middle class European American families. Data were collected via home interviews. A series of Conditional Process Analyses revealed significant indirect effects of PDT through sibling jealousy to all three adjustment outcomes. Furthermore, perceptions of fairness moderated the relations between PDT and jealousy, such that the indirect effects were only significant at low (−1 SD) and average levels of fairness. At high levels of fairness (+1 SD) there was no association between PDT, jealousy, and youth adjustment. Taken together, results indicate that youth and parents would benefit from engaging in clear communication regarding the reasoning for the occurrence of differential treatment, likely maximizing youth and parent perceptions of that treatment as being fair, and in turn mitigating sibling jealousy and maladjustment. PMID:27867295

  3. Risk analysis: divergent models and convergent interpretations

    Science.gov (United States)

    Carnes, B. A.; Gavrilova, N.

    2001-01-01

    Material presented at a NASA-sponsored workshop on risk models for exposure conditions relevant to prolonged space flight are described in this paper. Analyses used mortality data from experiments conducted at Argonne National Laboratory on the long-term effects of external whole-body irradiation on B6CF1 mice by 60Co gamma rays and fission neutrons delivered as a single exposure or protracted over either 24 or 60 once-weekly exposures. The maximum dose considered was restricted to 1 Gy for neutrons and 10 Gy for gamma rays. Proportional hazard models were used to investigate the shape of the dose response at these lower doses for deaths caused by solid-tissue tumors and tumors of either connective or epithelial tissue origin. For protracted exposures, a significant mortality effect was detected at a neutron dose of 14 cGy and a gamma-ray dose of 3 Gy. For single exposures, radiation-induced mortality for neutrons also occurred within the range of 10-20 cGy, but dropped to 86 cGy for gamma rays. Plots of risk relative to control estimated for each observed dose gave a visual impression of nonlinearity for both neutrons and gamma rays. At least for solid-tissue tumors, male and female mortality was nearly identical for gamma-ray exposures, but mortality risks for females were higher than for males for neutron exposures. As expected, protracting the gamma-ray dose reduced mortality risks. Although curvature consistent with that observed visually could be detected by a model parameterized to detect curvature, a relative risk term containing only a simple term for total dose was usually sufficient to describe the dose response. Although detectable mortality for the three pathology end points considered typically occurred at the same level of dose, the highest risks were almost always associated with deaths caused by tumors of epithelial tissue origin.

  4. Risk management model in road transport systems

    Science.gov (United States)

    Sakhapov, R. L.; Nikolaeva, R. V.; Gatiyatullin, M. H.; Makhmutov, M. M.

    2016-08-01

    The article presents the results of a study of road safety indicators that influence the development and operation of the transport system. Road safety is considered as a continuous process of risk management. Authors constructed a model that relates the social risks of a major road safety indicator - the level of motorization. The model gives a fairly accurate assessment of the level of social risk for any given level of motorization. Authors calculated the dependence of the level of socio-economic costs of accidents and injured people in them. The applicability of the concept of socio-economic damage is caused by the presence of a linear relationship between the natural and economic indicators damage from accidents. The optimization of social risk is reduced to finding the extremum of the objective function that characterizes the economic effect of the implementation of measures to improve safety. The calculations make it possible to maximize the net present value, depending on the costs of improving road safety, taking into account socio-economic damage caused by accidents. The proposed econometric models make it possible to quantify the efficiency of the transportation system, allow to simulate the change in road safety indicators.

  5. Modelling the potential impact of a sugar-sweetened beverage tax on stroke mortality, costs and health-adjusted life years in South Africa

    Directory of Open Access Journals (Sweden)

    Mercy Manyema

    2016-05-01

    Full Text Available Abstract Background Stroke poses a growing human and economic burden in South Africa. Excess sugar consumption, especially from sugar-sweetened beverages (SSBs, has been associated with increased obesity and stroke risk. Research shows that price increases for SSBs can influence consumption and modelling evidence suggests that taxing SSBs has the potential to reduce obesity and related diseases. This study estimates the potential impact of an SSB tax on stroke-related mortality, costs and health-adjusted life years in South Africa. Methods A proportional multi-state life table-based model was constructed in Microsoft Excel (2010. We used consumption data from the 2012 South African National Health and Nutrition Examination Survey, previously published own and cross price elasticities of SSBs and energy balance equations to estimate changes in daily energy intake and BMI arising from increased SSB prices. Stroke relative risk, and prevalent years lived with disability estimates from the Global Burden of Disease Study and modelled disease epidemiology estimates from a previous study, were used to estimate the effect of the BMI changes on the burden of stroke. Results Our model predicts that an SSB tax may avert approximately 72 000 deaths, 550 000 stroke-related health-adjusted life years and over ZAR5 billion, (USD400 million in health care costs over 20 years (USD296-576 million. Over 20 years, the number of incident stroke cases may be reduced by approximately 85 000 and prevalent cases by about 13 000. Conclusions Fiscal policy has the potential, as part of a multi-faceted approach, to mitigate the growing burden of stroke in South Africa and contribute to the achievement of the target set by the Department of Health to reduce relative premature mortality (less than 60 years from non-communicable diseases by the year 2020.

  6. Differentiation of Self and Dyadic Adjustment in Couple Relationships: A Dyadic Analysis Using the Actor-Partner Interdependence Model.

    Science.gov (United States)

    Lampis, Jessica; Cataudella, Stefania; Agus, Mirian; Busonera, Alessandra; Skowron, Elizabeth A

    2018-06-10

    Bowen's multigenerational theory provides an account of how the internalization of experiences within the family of origin promotes development of the ability to maintain a distinct self whilst also making intimate connections with others. Differentiated people can maintain their I-position in intimate relationships. They can remain calm in conflictual relationships, resolve relational problems effectively, and reach compromises. Fusion with others, emotional cut-off, and emotional reactivity instead are common reactions to relational stress in undifferentiated people. Emotional reactivity is the tendency to react to stressors with irrational and intense emotional arousal. Fusion with others is an excessive emotional involvement in significant relationships, whilst emotional cut-off is the tendency to manage relationship anxiety through physical and emotional distance. This study is based on Bowen's theory, starting from the assumption that dyadic adjustment can be affected both by a member's differentiation of self (actor effect) and by his or her partner's differentiation of self (partner effect). We used the Actor-Partner Interdependence Model to study the relationship between differentiation of self and dyadic adjustment in a convenience sample of 137 heterosexual Italian couples (nonindependent, dyadic data). The couples completed the Differentiation of Self Inventory and the Dyadic Adjustment Scale. Men's dyadic adjustment depended only on their personal I-position, whereas women's dyadic adjustment was affected by their personal I-position and emotional cut-off as well as by their partner's I-position and emotional cut-off. The empirical and clinical implications of the results are discussed. © 2018 Family Process Institute.

  7. Construction of Site Risk Model using Individual Unit Risk Model in a NPP Site

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Ho Gon; Han, Sang Hoon [KAERI, Daejeon (Korea, Republic of)

    2016-05-15

    Since Fukushima accident, strong needs to estimate site risk has been increased to identify the possibility of re-occurrence of such a tremendous disaster and prevent such a disaster. Especially, in a site which has large fleet of nuclear power plants, reliable site risk assessment is very emergent to confirm the safety. In Korea, there are several nuclear power plant site which have more than 6 NPPs. In general, risk model of a NPP in terms of PSA is very complicated and furthermore, it is expected that the site risk model is more complex than that. In this paper, the method for constructing site risk model is proposed by using individual unit risk model. Procedure for the development of site damage (risk) model was proposed in the present paper. Since the site damage model is complicated in the sense of the scale of the system and dependency of the components of the system, conventional method may not be applicable in many side of the problem.

  8. Value at Risk models for Energy Risk Management

    OpenAIRE

    Novák, Martin

    2010-01-01

    The main focus of this thesis lies on description of Risk Management in context of Energy Trading. The paper will predominantly discuss Value at Risk and its modifications as a main overall indicator of Energy Risk.

  9. Real time adjustment of slow changing flow components in distributed urban runoff models

    DEFF Research Database (Denmark)

    Borup, Morten; Grum, M.; Mikkelsen, Peter Steen

    2011-01-01

    In many urban runoff systems infiltrating water contributes with a substantial part of the total inflow and therefore most urban runoff modelling packages include hydrological models for simulating the infiltrating inflow. This paper presents a method for deterministic updating of the hydrological...... improvements for regular simulations as well as up to 10 hour forecasts. The updating method reduces the impact of non-representative precipitation estimates as well as model structural errors and leads to better overall modelling results....

  10. A non-Gaussian generalisation of the Airline model for robust Seasonal Adjustment

    NARCIS (Netherlands)

    Aston, J.; Koopman, S.J.

    2006-01-01

    In their seminal book Time Series Analysis: Forecasting and Control, Box and Jenkins (1976) introduce the Airline model, which is still routinely used for the modelling of economic seasonal time series. The Airline model is for a differenced time series (in levels and seasons) and constitutes a

  11. THE INSTANTANEOUS SPEED OF ADJUSTMENT ASSUMPTION AND STABILITY OF ECONOMIC-MODELS

    NARCIS (Netherlands)

    SCHOONBEEK, L

    In order to simplify stability analysis of an economic model one can assume that one of the model variables moves infinitely fast towards equilibrium, given the values of the other slower variables. We present conditions such that stability of the simplified model implies, or is implied by,

  12. Return predictability and intertemporal asset allocation: Evidence from a bias-adjusted VAR model

    DEFF Research Database (Denmark)

    Engsted, Tom; Pedersen, Thomas Quistgaard

    with quarterly data from 1952 to 2006. The results show that correcting the VAR parameters for small-sample bias has both quantitatively and qualitatively important e¤ects on the strategic intertemporal part of optimal portfolio choice, especially for bonds: for intermediate values of risk...

  13. Crop insurance: Risks and models of insurance

    Directory of Open Access Journals (Sweden)

    Čolović Vladimir

    2014-01-01

    Full Text Available The issue of crop protection is very important because of a variety of risks that could cause difficult consequences. One type of risk protection is insurance. The author in the paper states various models of insurance in some EU countries and the systems of subsidizing of insurance premiums by state. The author also gives a picture of crop insurance in the U.S., noting that in this country pays great attention to this matter. As for crop insurance in Serbia, it is not at a high level. The main problem with crop insurance is not only the risks but also the way of protection through insurance. The basic question that arises not only in the EU is the question is who will insure and protect crops. There are three possibilities: insurance companies under state control, insurance companies that are public-private partnerships or private insurance companies on a purely commercial basis.

  14. Assessing the risk of Legionnaires' disease: the inhalation exposure model and the estimated risk in residential bathrooms.

    Science.gov (United States)

    Azuma, Kenichi; Uchiyama, Iwao; Okumura, Jiro

    2013-02-01

    Legionella are widely found in the built environment. Patients with Legionnaires' disease have been increasing in Japan; however, health risks from Legionella bacteria in the environment are not appropriately assessed. We performed a quantitative health risk assessment modeled on residential bathrooms in the Adachi outbreak area and estimated risk levels. The estimated risks in the Adachi outbreak approximately corresponded to the risk levels exponentially extrapolated into lower levels on the basis of infection and mortality rates calculated from actual outbreaks, suggesting that the model of Legionnaires' disease in residential bathrooms was adequate to predict disease risk for the evaluated outbreaks. Based on this model, the infection and mortality risk levels per year in 10 CFU/100 ml (100 CFU/L) of the Japanese water quality guideline value were approximately 10(-2) and 10(-5), respectively. However, acceptable risk levels of infection and mortality from Legionnaires' disease should be adjusted to approximately 10(-4) and 10(-7), respectively, per year. Therefore, a reference value of 0.1 CFU/100 ml (1 CFU/L) as a water quality guideline for Legionella bacteria is recommended. This value is occasionally less than the actual detection limit. Legionella levels in water system should be maintained as low as reasonably achievable (<1 CFU/L). Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Modelling Counterparty Credit Risk in Czech Interest Rate Swaps

    Directory of Open Access Journals (Sweden)

    Lenka Křivánková

    2017-01-01

    Full Text Available According to the Basel Committee’s estimate, three quarters of counterparty credit risk losses during the financial crisis in 2008 originate from credit valuation adjustment’s losses and not from actual defaults. Therefore, from 2015, the Third Basel Accord (EU, 2013a and (EU, 2013b instructed banks to calculate the capital requirement for the risk of credit valuation adjustment (CVA. Banks are trying to model CVA to hold the prescribed standards and also reach the lowest possible impact on their profit. In this paper, we try to model CVA using methods that are in compliance with the prescribed standards and also achieve the smallest possible impact on the bank’s earnings. To do so, a data set of interest rate swaps from 2015 is used. The interest rate term structure is simulated using the Hull-White one-factor model and Monte Carlo methods. Then, the probability of default for each counterparty is constructed. A safe level of CVA is reached in spite of the calculated the CVA achieving a lower level than CVA previously used by the bank. This allows a reduction of capital requirements for banks.

  16. Estimation of emission adjustments from the application of four-dimensional data assimilation to photochemical air quality modeling

    International Nuclear Information System (INIS)

    Mendoza-Dominguez, A.; Russell, A.G.

    2001-01-01

    Four-dimensional data assimilation applied to photochemical air quality modeling is used to suggest adjustments to the emissions inventory of the Atlanta, Georgia metropolitan area. In this approach, a three-dimensional air quality model, coupled with direct sensitivity analysis, develops spatially and temporally varying concentration and sensitivity fields that account for chemical and physical processing, and receptor analysis is used to adjust source strengths. Proposed changes to domain-wide NO x , volatile organic compounds (VOCs) and CO emissions from anthropogenic sources and for VOC emissions from biogenic sources were estimated, as well as modifications to sources based on their spatial location (urban vs. rural areas). In general, domain-wide anthropogenic VOC emissions were increased approximately two times their base case level to best match observations, domain-wide anthropogenic NO x and biogenic VOC emissions (BEIS2 estimates) remained close to their base case value and domain-wide CO emissions were decreased. Adjustments for anthropogenic NO x emissions increased their level of uncertainty when adjustments were computed for mobile and area sources (or urban and rural sources) separately, due in part to the poor spatial resolution of the observation field of nitrogen-containing species. Estimated changes to CO emissions also suffer from poor spatial resolution of the measurements. Results suggest that rural anthropogenic VOC emissions appear to be severely underpredicted. The FDDA approach was also used to investigate the speciation profiles of VOC emissions, and results warrant revision of these profiles. In general, the results obtained here are consistent with what are viewed as the current deficiencies in emissions inventories as derived by other top-down techniques, such as tunnel studies and analysis of ambient measurements. (Author)

  17. Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk

    NARCIS (Netherlands)

    Dragt, Sara; Nieman, Dorien H.; Veltman, Doede; Becker, Hiske E.; van de Fliert, Reinaud; de Haan, Lieuwe; Linszen, Don H.

    2011-01-01

    BACKGROUND: The onset of schizophrenia is associated with genetic, symptomatic, social and environmental risk factors. The aim of the present study was to determine which environmental factors may contribute to a prediction of a first psychotic episode in subjects at Ultra High Risk (UHR) for

  18. Adjustment of nitrogen fertilization to the needs of plants and limitations posed by the risk of nitrate accumulation and pollution of the soil and subsoil

    Energy Technology Data Exchange (ETDEWEB)

    Muller, J C

    1980-01-01

    In chalky Champagne, nitrogen balance is study to adjust availability to plant response. For this, it is necessary to know some parameters whose measurement is obtained progressively; plants exportation, nitrogen transformations in terms of transport processes in soil system, kinetic of mineralization of soil organic nitrogen, plants residus and agricultural waste waters. Lysimeters with rotation of Champagne (wheat, sugarbeet, potatoes...) are used to measure losses of nitrogen and follow transport of nitrates by mean of soil solution captors. Comparisons with field results, lysimeters results and laboratory experimentations are used to adjust an experimental model. Two examples show: 1) Nitrogen fertilizer requirement for wheat. 2) Possibility of maximum application for agricultural waste waters.

  19. Improvement of the projection models for radiogenic cancer risk

    International Nuclear Information System (INIS)

    Tong Jian

    2005-01-01

    Calculations of radiogenic cancer risk are based on the risk projection models for specific cancer sites. Improvement has been made for the parameters used in the previous models including introductions of mortality and morbidity risk coefficients, and age-/ gender-specific risk coefficients. These coefficients have been applied to calculate the radiogenic cancer risks for specific organs and radionuclides under different exposure scenarios. (authors)

  20. Opportunities for Improving Army Modeling and Simulation Development: Making Fundamental Adjustments and Borrowing Commercial Business Practices

    National Research Council Canada - National Science Library

    Lee, John

    2000-01-01

    .... This paper briefly explores project management principles, leadership theory, and commercial business practices, suggesting improvements to the Army's modeling and simulation development process...

  1. Dynamic Modeling of Adjustable-Speed Pumped Storage Hydropower Plant: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, E.; Singh, M.; Gevorgian, V.; Mohanpurkar, M.; Havsapian, R.; Koritarov, V.

    2015-04-06

    Hydropower is the largest producer of renewable energy in the U.S. More than 60% of the total renewable generation comes from hydropower. There is also approximately 22 GW of pumped storage hydropower (PSH). Conventional PSH uses a synchronous generator, and thus the rotational speed is constant at synchronous speed. This work details a hydrodynamic model and generator/power converter dynamic model. The optimization of the hydrodynamic model is executed by the hydro-turbine controller, and the electrical output real/reactive power is controlled by the power converter. All essential controllers to perform grid-interface functions and provide ancillary services are included in the model.

  2. Human Plague Risk: Spatial-Temporal Models

    Science.gov (United States)

    Pinzon, Jorge E.

    2010-01-01

    This chpater reviews the use of spatial-temporal models in identifying potential risks of plague outbreaks into the human population. Using earth observations by satellites remote sensing there has been a systematic analysis and mapping of the close coupling between the vectors of the disease and climate variability. The overall result is that incidence of plague is correlated to positive El Nino/Southem Oscillation (ENSO).

  3. Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units

    Directory of Open Access Journals (Sweden)

    A. Różańska

    2015-06-01

    Conclusions: The general condition of VLBW infants statistically increase both their risk of mortality and LOS; this is in contrast to the presence of infection, which significantly prolonged LOS only.

  4. Linear identification and model adjustment of a PEM fuel cell stack

    Energy Technology Data Exchange (ETDEWEB)

    Kunusch, C; Puleston, P F; More, J J [LEICI, Departamento de Electrotecnia, Universidad Nacional de La Plata, calle 1 esq. 47 s/n, 1900 La Plata (Argentina); Consejo de Investigaciones Cientificas y Tecnicas (CONICET) (Argentina); Husar, A [Institut de Robotica i Informatica Industrial (CSIC-UPC), c/ Llorens i Artigas 4-6, 08028 Barcelona (Spain); Mayosky, M A [LEICI, Departamento de Electrotecnia, Universidad Nacional de La Plata, calle 1 esq. 47 s/n, 1900 La Plata (Argentina); Comision de Investigaciones Cientificas (CIC), Provincia de Buenos Aires (Argentina)

    2008-07-15

    In the context of fuel cell stack control a mayor challenge is modeling the interdependence of various complex subsystem dynamics. In many cases, the states interaction is usually modeled through several look-up tables, decision blocks and piecewise continuous functions. Many internal variables are inaccessible for measurement and cannot be used in control algorithms. To make significant contributions in this area, it is necessary to develop reliable models for control and design purposes. In this paper, a linear model based on experimental identification of a 7-cell stack was developed. The procedure followed to obtain a linear model of the system consisted in performing spectroscopy tests of four different single-input single-output subsystems. The considered inputs for the tests were the stack current and the cathode oxygen flow rate, while the measured outputs were the stack voltage and the cathode total pressure. The resulting model can be used either for model-based control design or for on-line analysis and errors detection. (author)

  5. A joint logistic regression and covariate-adjusted continuous-time Markov chain model.

    Science.gov (United States)

    Rubin, Maria Laura; Chan, Wenyaw; Yamal, Jose-Miguel; Robertson, Claudia Sue

    2017-12-10

    The use of longitudinal measurements to predict a categorical outcome is an increasingly common goal in research studies. Joint models are commonly used to describe two or more models simultaneously by considering the correlated nature of their outcomes and the random error present in the longitudinal measurements. However, there is limited research on joint models with longitudinal predictors and categorical cross-sectional outcomes. Perhaps the most challenging task is how to model the longitudinal predictor process such that it represents the true biological mechanism that dictates the association with the categorical response. We propose a joint logistic regression and Markov chain model to describe a binary cross-sectional response, where the unobserved transition rates of a two-state continuous-time Markov chain are included as covariates. We use the method of maximum likelihood to estimate the parameters of our model. In a simulation study, coverage probabilities of about 95%, standard deviations close to standard errors, and low biases for the parameter values show that our estimation method is adequate. We apply the proposed joint model to a dataset of patients with traumatic brain injury to describe and predict a 6-month outcome based on physiological data collected post-injury and admission characteristics. Our analysis indicates that the information provided by physiological changes over time may help improve prediction of long-term functional status of these severely ill subjects. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Burden of Disease Measured by Disability-Adjusted Life Years and a Disease Forecasting Time Series Model of Scrub Typhus in Laiwu, China

    Science.gov (United States)

    Yang, Li-Ping; Liang, Si-Yuan; Wang, Xian-Jun; Li, Xiu-Jun; Wu, Yan-Ling; Ma, Wei

    2015-01-01

    Background Laiwu District is recognized as a hyper-endemic region for scrub typhus in Shandong Province, but the seriousness of this problem has been neglected in public health circles. Methodology/Principal Findings A disability-adjusted life years (DALYs) approach was adopted to measure the burden of scrub typhus in Laiwu, China during the period 2006 to 2012. A multiple seasonal autoregressive integrated moving average model (SARIMA) was used to identify the most suitable forecasting model for scrub typhus in Laiwu. Results showed that the disease burden of scrub typhus is increasing yearly in Laiwu, and which is higher in females than males. For both females and males, DALY rates were highest for the 60–69 age group. Of all the SARIMA models tested, the SARIMA(2,1,0)(0,1,0)12 model was the best fit for scrub typhus cases in Laiwu. Human infections occurred mainly in autumn with peaks in October. Conclusions/Significance Females, especially those of 60 to 69 years of age, were at highest risk of developing scrub typhus in Laiwu, China. The SARIMA (2,1,0)(0,1,0)12 model was the best fit forecasting model for scrub typhus in Laiwu, China. These data are useful for developing public health education and intervention programs to reduce disease. PMID:25569248

  7. The combined geodetic network adjusted on the reference ellipsoid – a comparison of three functional models for GNSS observations

    Directory of Open Access Journals (Sweden)

    Kadaj Roman

    2016-12-01

    Full Text Available The adjustment problem of the so-called combined (hybrid, integrated network created with GNSS vectors and terrestrial observations has been the subject of many theoretical and applied works. The network adjustment in various mathematical spaces was considered: in the Cartesian geocentric system on a reference ellipsoid and on a mapping plane. For practical reasons, it often takes a geodetic coordinate system associated with the reference ellipsoid. In this case, the Cartesian GNSS vectors are converted, for example, into geodesic parameters (azimuth and length on the ellipsoid, but the simple form of converted pseudo-observations are the direct differences of the geodetic coordinates. Unfortunately, such an approach may be essentially distorted by a systematic error resulting from the position error of the GNSS vector, before its projection on the ellipsoid surface. In this paper, an analysis of the impact of this error on the determined measures of geometric ellipsoid elements, including the differences of geodetic coordinates or geodesic parameters is presented. Assuming that the adjustment of a combined network on the ellipsoid shows that the optimal functional approach in relation to the satellite observation, is to create the observational equations directly for the original GNSS Cartesian vector components, writing them directly as a function of the geodetic coordinates (in numerical applications, we use the linearized forms of observational equations with explicitly specified coefficients. While retaining the original character of the Cartesian vector, one avoids any systematic errors that may occur in the conversion of the original GNSS vectors to ellipsoid elements, for example the vector of the geodesic parameters. The problem is theoretically developed and numerically tested. An example of the adjustment of a subnet loaded from the database of reference stations of the ASG-EUPOS system was considered for the preferred functional

  8. Elasto-plastic hardening models adjustment to ferritic, austenitic and austenoferritic Rebar

    International Nuclear Information System (INIS)

    Hortigóna, B.; Gallardo, J.M.; Nieto-García, E.J.; López, J.A.

    2017-01-01

    The elastoplastic behaviour of steel used for structural member fabrication has received attention to facilitate a mechanical-resistant design. New Zealand and South African standards have adopted various theoretical approaches to describe such behaviour in stainless steels. With respect to the building industry, describing the tensile behaviour of steel rebar used to produce reinforced concrete structures is of interest. Differences compared with the homogenous material described in the above mentioned standards and related literatures are discussed in this paper. Specifically, the presence of ribs and the TEMPCORE® technology used to produce carbon steel rebar may alter the elastoplastic model. Carbon steel rebar is shown to fit a Hollomon model giving hardening exponent values on the order of 0.17. Austenitic stainless steel rebar behaviour is better described using a modified Rasmussen model with a free fitted exponent of 6. Duplex stainless steel shows a poor fit to any previous model. [es

  9. Modeling and simulation of M/M/c queuing pharmacy system with adjustable parameters

    Science.gov (United States)

    Rashida, A. R.; Fadzli, Mohammad; Ibrahim, Safwati; Goh, Siti Rohana

    2016-02-01

    This paper studies a discrete event simulation (DES) as a computer based modelling that imitates a real system of pharmacy unit. M/M/c queuing theo is used to model and analyse the characteristic of queuing system at the pharmacy unit of Hospital Tuanku Fauziah, Kangar in Perlis, Malaysia. The input of this model is based on statistical data collected for 20 working days in June 2014. Currently, patient waiting time of pharmacy unit is more than 15 minutes. The actual operation of the pharmacy unit is a mixed queuing server with M/M/2 queuing model where the pharmacist is referred as the server parameters. DES approach and ProModel simulation software is used to simulate the queuing model and to propose the improvement for queuing system at this pharmacy system. Waiting time for each server is analysed and found out that Counter 3 and 4 has the highest waiting time which is 16.98 and 16.73 minutes. Three scenarios; M/M/3, M/M/4 and M/M/5 are simulated and waiting time for actual queuing model and experimental queuing model are compared. The simulation results show that by adding the server (pharmacist), it will reduce patient waiting time to a reasonable improvement. Almost 50% average patient waiting time is reduced when one pharmacist is added to the counter. However, it is not necessary to fully utilize all counters because eventhough M/M/4 and M/M/5 produced more reduction in patient waiting time, but it is ineffective since Counter 5 is rarely used.

  10. Model-based Adjustment of Droplet Characteristic for 3D Electronic Printing

    Directory of Open Access Journals (Sweden)

    Lin Na

    2017-01-01

    Full Text Available The major challenge in 3D electronic printing is the print resolution and accuracy. In this paper, a typical mode - lumped element modeling method (LEM - is adopted to simulate the droplet jetting characteristic. This modeling method can quickly get the droplet velocity and volume with a high accuracy. Experimental results show that LEM has a simpler structure with the sufficient simulation and prediction accuracy.

  11. Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level

    DEFF Research Database (Denmark)

    Thorell, Kristine; Ranstad, Karin; Midlöv, Patrik

    2014-01-01

    BACKGROUND: Risk factors for hip fracture are well studied because of the negative impact on patients and the community, with mortality in the first year being almost 30% in the elderly. Age, gender and fall risk-increasing drugs, identified by the National Board of Health and Welfare in Sweden......, are well known risk factors for hip fracture, but how multimorbidity level affects the risk of hip fracture during use of fall risk-increasing drugs is to our knowledge not as well studied. This study explored the relationship between use of fall risk-increasing drugs in combination with multimorbidity...... level and risk of hip fracture in an elderly population. METHODS: Data were from Östergötland County, Sweden, and comprised the total population in the county aged 75 years and older during 2006. The odds ratio (OR) for hip fracture during use of fall risk-increasing drugs was calculated by multivariate...

  12. Reciprocal Influences Between Maternal Parenting and Child Adjustment in a High-risk Population: A Five-Year Cross-Lagged Analysis of Bidirectional Effects

    Science.gov (United States)

    Barbot, Baptiste; Crossman, Elizabeth; Hunter, Scott R.; Grigorenko, Elena L.; Luthar, Suniya S.

    2014-01-01

    This study examines longitudinally the bidirectional influences between maternal parenting (behaviors and parenting stress) and mothers' perceptions of their children's adjustment, in a multivariate approach. Data was gathered from 361 low-income mothers (many with psychiatric diagnoses) reporting on their parenting behavior, parenting stress and their child's adjustment, in a two-wave longitudinal study over 5 years. Measurement models were developed to derive four broad parenting constructs (Involvement, Control, Rejection, and Stress) and three child adjustment constructs (Internalizing problems, Externalizing problems, and Social competence). After measurement invariance of these constructs was confirmed across relevant groups and over time, both measurement models were integrated in a single crossed-lagged regression analysis of latent constructs. Multiple reciprocal influence were observed between parenting and perceived child adjustment over time: Externalizing and internalizing problems in children were predicted by baseline maternal parenting behaviors, while child social competence was found to reduce parental stress and increase parental involvement and appropriate monitoring. These findings on the motherhood experience are discussed in light of recent research efforts to understand mother-child bi-directional influences, and their potential for practical applications. PMID:25089759

  13. Model of Axiological Dimension Risk Management

    Directory of Open Access Journals (Sweden)

    Kulińska Ewa

    2016-01-01

    Full Text Available It was on the basis of the obtained results that identify the key prerequisites for the integration of the management of logistics processes, management of the value creation process, and risk management that the methodological basis for the construction of the axiological dimension of the risk management (ADRM model of logistics processes was determined. By taking into account the contribution of individual concepts to the new research area, its essence was defined as an integrated, structured instrumentation aimed at the identification and implementation of logistics processes supporting creation of the value added as well as the identification and elimination of risk factors disturbing the process of the value creation for internal and external customers. The base for the ADRM concept of logistics processes is the use of the potential being inherent in synergistic effects which are obtained by using prerequisites for the integration of the management of logistics processes, of value creation and risk management as the key determinants of the value creation.

  14. Adjusting particle-size distributions to account for aggregation in tephra-deposit model forecasts

    Science.gov (United States)

    Mastin, Larry G.; Van Eaton, Alexa; Durant, A.J.

    2016-01-01

    Volcanic ash transport and dispersion (VATD) models are used to forecast tephra deposition during volcanic eruptions. Model accuracy is limited by the fact that fine-ash aggregates (clumps into clusters), thus altering patterns of deposition. In most models this is accounted for by ad hoc changes to model input, representing fine ash as aggregates with density ρagg, and a log-normal size distribution with median μagg and standard deviation σagg. Optimal values may vary between eruptions. To test the variance, we used the Ash3d tephra model to simulate four deposits: 18 May 1980 Mount St. Helens; 16–17 September 1992 Crater Peak (Mount Spurr); 17 June 1996 Ruapehu; and 23 March 2009 Mount Redoubt. In 192 simulations, we systematically varied μagg and σagg, holding ρagg constant at 600 kg m−3. We evaluated the fit using three indices that compare modeled versus measured (1) mass load at sample locations; (2) mass load versus distance along the dispersal axis; and (3) isomass area. For all deposits, under these inputs, the best-fit value of μagg ranged narrowly between  ∼  2.3 and 2.7φ (0.20–0.15 mm), despite large variations in erupted mass (0.25–50 Tg), plume height (8.5–25 km), mass fraction of fine ( discrete process that is insensitive to eruptive style or magnitude. This result offers the potential for a simple, computationally efficient parameterization scheme for use in operational model forecasts. Further research may indicate whether this narrow range also reflects physical constraints on processes in the evolving cloud.

  15. Electricity market pricing, risk hedging and modeling

    Science.gov (United States)

    Cheng, Xu

    In this dissertation, we investigate the pricing, price risk hedging/arbitrage, and simplified system modeling for a centralized LMP-based electricity market. In an LMP-based market model, the full AC power flow model and the DC power flow model are most widely used to represent the transmission system. We investigate the differences of dispatching results, congestion pattern, and LMPs for the two power flow models. An appropriate LMP decomposition scheme to quantify the marginal costs of the congestion and real power losses is critical for the implementation of financial risk hedging markets. However, the traditional LMP decomposition heavily depends on the slack bus selection. In this dissertation we propose a slack-independent scheme to break LMP down into energy, congestion, and marginal loss components by analyzing the actual marginal cost of each bus at the optimal solution point. The physical and economic meanings of the marginal effect at each bus provide accurate price information for both congestion and losses, and thus the slack-dependency of the traditional scheme is eliminated. With electricity priced at the margin instead of the average value, the market operator typically collects more revenue from power sellers than that paid to power buyers. According to the LMP decomposition results, the revenue surplus is then divided into two parts: congestion charge surplus and marginal loss revenue surplus. We apply the LMP decomposition results to the financial tools, such as financial transmission right (FTR) and loss hedging right (LHR), which have been introduced to hedge against price risks associated to congestion and losses, to construct a full price risk hedging portfolio. The two-settlement market structure and the introduction of financial tools inevitably create market manipulation opportunities. We investigate several possible market manipulation behaviors by virtual bidding and propose a market monitor approach to identify and quantify such

  16. Experimental Robot Model Adjustments Based on Force–Torque Sensor Information

    Directory of Open Access Journals (Sweden)

    Santiago Martinez

    2018-03-01

    Full Text Available The computational complexity of humanoid robot balance control is reduced through the application of simplified kinematics and dynamics models. However, these simplifications lead to the introduction of errors that add to other inherent electro-mechanic inaccuracies and affect the robotic system. Linear control systems deal with these inaccuracies if they operate around a specific working point but are less precise if they do not. This work presents a model improvement based on the Linear Inverted Pendulum Model (LIPM to be applied in a non-linear control system. The aim is to minimize the control error and reduce robot oscillations for multiple working points. The new model, named the Dynamic LIPM (DLIPM, is used to plan the robot behavior with respect to changes in the balance status denoted by the zero moment point (ZMP. Thanks to the use of information from force–torque sensors, an experimental procedure has been applied to characterize the inaccuracies and introduce them into the new model. The experiments consist of balance perturbations similar to those of push-recovery trials, in which step-shaped ZMP variations are produced. The results show that the responses of the robot with respect to balance perturbations are more precise and the mechanical oscillations are reduced without comprising robot dynamics.

  17. A phased transition to a market adjustment of the pseudo model of Russian economy

    Directory of Open Access Journals (Sweden)

    N. Komkov

    2015-01-01

    Full Text Available We consider a phased reform of the economic model of Russia. In less than one century, Russia was in the extreme conditions of the model economy: the developed socialism (1917 and perfect capitalism (1991. Within each of them there was the instability of socio-economic development: economic recovery alternated recession and huge reserves of natural resources and to develop and use of land is not always effective. At each extremity of the selection was based largely on the current political aims and attitudes formed by various social groups. Russia achieved the economic situation and the prevailing socio-economic model of many subjected to fair criticism. To improve it proposes a phased approach to reform, when the main focus is on "how" to move to a new state. The approach is based on consideration of the scenario approach to the reform of the basic components of the economic model that involves the formation of a better scenario analysis and evaluation of the expert community the degree of closeness of planned versions of the model national development objectives of the country.

  18. Regional scale ecological risk assessment: using the relative risk model

    National Research Council Canada - National Science Library

    Landis, Wayne G

    2005-01-01

    ...) in the performance of regional-scale ecological risk assessments. The initial chapters present the methodology and the critical nature of the interaction between risk assessors and decision makers...

  19. Adjustment and Characterization of an Original Model of Chronic Ischemic Heart Failure in Pig

    Directory of Open Access Journals (Sweden)

    Laurent Barandon

    2010-01-01

    Full Text Available We present and characterize an original experimental model to create a chronic ischemic heart failure in pig. Two ameroid constrictors were placed around the LAD and the circumflex artery. Two months after surgery, pigs presented a poor LV function associated with a severe mitral valve insufficiency. Echocardiography analysis showed substantial anomalies in radial and circumferential deformations, both on the anterior and lateral surface of the heart. These anomalies in function were coupled with anomalies of perfusion observed in echocardiography after injection of contrast medium. No demonstration of myocardial infarction was observed with histological analysis. Our findings suggest that we were able to create and to stabilize a chronic ischemic heart failure model in the pig. This model represents a useful tool for the development of new medical or surgical treatment in this field.

  20. Psychosocial adjustment of children with chronic illness: an evaluation of three models.

    Science.gov (United States)

    Gartstein, M A; Short, A D; Vannatta, K; Noll, R B

    1999-06-01

    This study was designed to assess social, emotional, and behavioral functioning of children with chronic illness and to evaluate three models addressing the impact of chronic illness on psychosocial functioning: discrete disease, noncategorical, and mixed. Families of children with cancer, sickle cell disease, hemophilia, and juvenile rheumatoid arthritis participated, along with families of classroom comparison peers without a chronic illness who had the closest date of birth and were of the same race and gender (COMPs). Mothers, fathers, and children provided information regarding current functioning of the child with chronic illness or the COMP child. Child Behavior Checklist and Children's Depression Inventory scores were examined. Results provided support for the noncategorical model. Thus, the mixed model evaluated in this study requires modifications before its effectiveness as a classification system can be demonstrated.

  1. A statistical adjustment approach for climate projections of snow conditions in mountain regions using energy balance land surface models

    Science.gov (United States)

    Verfaillie, Deborah; Déqué, Michel; Morin, Samuel; Lafaysse, Matthieu

    2017-04-01

    Projections of future climate change have been increasingly called for lately, as the reality of climate change has been gradually accepted and societies and governments have started to plan upcoming mitigation and adaptation policies. In mountain regions such as the Alps or the Pyrenees, where winter tourism and hydropower production are large contributors to the regional revenue, particular attention is brought to current and future snow availability. The question of the vulnerability of mountain ecosystems as well as the occurrence of climate-related hazards such as avalanches and debris-flows is also under consideration. In order to generate projections of snow conditions, however, downscaling global climate models (GCMs) by using regional climate models (RCMs) is not sufficient to capture the fine-scale processes and thresholds at play. In particular, the altitudinal resolution matters, since the phase of precipitation is mainly controlled by the temperature which is altitude-dependent. Simulations from GCMs and RCMs moreover suffer from biases compared to local observations, due to their rather coarse spatial and altitudinal resolution, and often provide outputs at too coarse time resolution to drive impact models. RCM simulations must therefore be adjusted using empirical-statistical downscaling and error correction methods, before they can be used to drive specific models such as energy balance land surface models. In this study, time series of hourly temperature, precipitation, wind speed, humidity, and short- and longwave radiation were generated over the Pyrenees and the French Alps for the period 1950-2100, by using a new approach (named ADAMONT for ADjustment of RCM outputs to MOuNTain regions) based on quantile mapping applied to daily data, followed by time disaggregation accounting for weather patterns selection. We first introduce a thorough evaluation of the method using using model runs from the ALADIN RCM driven by a global reanalysis over the

  2. Clearing margin system in the futures markets—Applying the value-at-risk model to Taiwanese data

    Science.gov (United States)

    Chiu, Chien-Liang; Chiang, Shu-Mei; Hung, Jui-Cheng; Chen, Yu-Lung

    2006-07-01

    This article sets out to investigate if the TAIFEX has adequate clearing margin adjustment system via unconditional coverage, conditional coverage test and mean relative scaled bias to assess the performance of three value-at-risk (VaR) models (i.e., the TAIFEX, RiskMetrics and GARCH-t). For the same model, original and absolute returns are compared to explore which can accurately capture the true risk. For the same return, daily and tiered adjustment methods are examined to evaluate which corresponds to risk best. The results indicate that the clearing margin adjustment of the TAIFEX cannot reflect true risks. The adjustment rules, including the use of absolute return and tiered adjustment of the clearing margin, have distorted VaR-based margin requirements. Besides, the results suggest that the TAIFEX should use original return to compute VaR and daily adjustment system to set clearing margin. This approach would improve the funds operation efficiency and the liquidity of the futures markets.

  3. Adjustment of cast metal post/cores modeled with different acrylic resins

    OpenAIRE

    Gusmão, João Milton Rocha; Pereira, Renato Piai; Alves, Guilhermino Oliveira; Pithon, Matheus Melo; Moreira, David Costa

    2016-01-01

    Aim: Evaluate the performance of four commercially available chemically-activated acrylic resins (CAARs) by measuring the level of displacement of the cores following casting. Materials and Methods: Two devices were constructed to model the cores based on a natural tooth. Forty post/cores were modeled, 10 in each of the following CAARs: Duralay (Reliance Dental, Illinois, USA), Pattern Resin (GC, Tokyo, Japan), Dencrilay (Dencril, Sao Paulo, Brazil), and Jet (Clássico, Sao Paulo, Brazil). Two...

  4. The Linear Quadratic Adjustment Cost Model and the Demand for Labour

    DEFF Research Database (Denmark)

    Engsted, Tom; Haldrup, Niels

    1994-01-01

    Der udvikles en ny metode til estimation og test af den lineære kvadratiske tilpasningsomkostningsmodel når de underliggende tidsserier er ikke-stationære, og metoden anvendes til modellering af arbejdskraftefterspørgslen i danske industrisektorer.......Der udvikles en ny metode til estimation og test af den lineære kvadratiske tilpasningsomkostningsmodel når de underliggende tidsserier er ikke-stationære, og metoden anvendes til modellering af arbejdskraftefterspørgslen i danske industrisektorer....

  5. Repatriation Adjustment: Literature Review

    Directory of Open Access Journals (Sweden)

    Gamze Arman

    2009-12-01

    Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

  6. Effect of Treatment Education Based on the Roy Adaptation Model on Adjustment of Hemodialysis Patients.

    Science.gov (United States)

    Kacaroglu Vicdan, Ayse; Gulseven Karabacak, Bilgi

    2016-01-01

    The Roy Adaptation Model examines the individual in 4 fields: physiological mode, self-concept mode, role function mode, and interdependence mode. Hemodialysis treatment is associated with the Roy Adaptation Model as it involves fields that might be needed by the individual with chronic renal disease. This research was conducted as randomized controlled experiment with the aim of determining the effect of the education given in accordance with the Roy Adaptation Model on physiological, psychological, and social adaptation of individuals undergoing hemodialysis treatment. This was a random controlled experimental study. The study was conducted at a dialysis center in Konya-Aksehir in Turkey between July 1 and December 31, 2012. The sample was composed of 82 individuals-41 experimental and 41 control. In the second interview, there was a decrease in the systolic blood pressures and body weights of the experimental group, an increase in the scores of functional performance and self-respect, and a decrease in the scores of psychosocial adaptation. In the control group, on the other hand, there was a decrease in the scores of self-respect and an increase in the scores of psychosocial adaptation. The 2 groups were compared in terms of adaptation variables and a difference was determined on behalf of the experimental group. The training that was provided and evaluated for individuals receiving hemodialysis according to 4 modes of the Roy Adaptation Model increased physical, psychological, and social adaptation.

  7. A Unified Model Exploring Parenting Practices as Mediators of Marital Conflict and Children's Adjustment

    Science.gov (United States)

    Coln, Kristen L.; Jordan, Sara S.; Mercer, Sterett H.

    2013-01-01

    We examined positive and negative parenting practices and psychological control as mediators of the relations between constructive and destructive marital conflict and children's internalizing and externalizing problems in a unified model. Married mothers of 121 children between the ages of 6 and 12 completed questionnaires measuring marital…

  8. NGNP Risk Management Database: A Model for Managing Risk

    International Nuclear Information System (INIS)

    Collins, John

    2009-01-01

    To facilitate the implementation of the Risk Management Plan, the Next Generation Nuclear Plant (NGNP) Project has developed and employed an analytical software tool called the NGNP Risk Management System (RMS). A relational database developed in Microsoft(reg s ign) Access, the RMS provides conventional database utility including data maintenance, archiving, configuration control, and query ability. Additionally, the tool's design provides a number of unique capabilities specifically designed to facilitate the development and execution of activities outlined in the Risk Management Plan. Specifically, the RMS provides the capability to establish the risk baseline, document and analyze the risk reduction plan, track the current risk reduction status, organize risks by reference configuration system, subsystem, and component (SSC) and Area, and increase the level of NGNP decision making.

  9. NGNP Risk Management Database: A Model for Managing Risk

    Energy Technology Data Exchange (ETDEWEB)

    John Collins

    2009-09-01

    To facilitate the implementation of the Risk Management Plan, the Next Generation Nuclear Plant (NGNP) Project has developed and employed an analytical software tool called the NGNP Risk Management System (RMS). A relational database developed in Microsoft® Access, the RMS provides conventional database utility including data maintenance, archiving, configuration control, and query ability. Additionally, the tool’s design provides a number of unique capabilities specifically designed to facilitate the development and execution of activities outlined in the Risk Management Plan. Specifically, the RMS provides the capability to establish the risk baseline, document and analyze the risk reduction plan, track the current risk reduction status, organize risks by reference configuration system, subsystem, and component (SSC) and Area, and increase the level of NGNP decision making.

  10. Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

    Science.gov (United States)

    Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

    2013-01-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

  11. Acculturation and Adjustment in Latino Adolescents: How Cultural Risk Factors and Assets Influence Multiple Domains of Adolescent Mental Health

    Science.gov (United States)

    Smokowski, Paul; Buchanan, Rachel L.; Bacallao, Martica L.

    2009-01-01

    The purpose of this study was to examine the relationships among risk factors, cultural assets, and Latino adolescent mental health outcomes. We extend past research by using a longitudinal design and evaluating direct and moderated acculturation effects across a range of internalizing, externalizing, and academic engagement outcomes. The sample…

  12. Angle-adjustable density field formulation for the modeling of crystalline microstructure

    Science.gov (United States)

    Wang, Zi-Le; Liu, Zhirong; Huang, Zhi-Feng

    2018-05-01

    A continuum density field formulation with particle-scale resolution is constructed to simultaneously incorporate the orientation dependence of interparticle interactions and the rotational invariance of the system, a fundamental but challenging issue in modeling the structure and dynamics of a broad range of material systems across variable scales. This generalized phase field crystal-type approach is based upon the complete expansion of particle direct correlation functions and the concept of isotropic tensors. Through applications to the modeling of various two- and three-dimensional crystalline structures, our study demonstrates the capability of bond-angle control in this continuum field theory and its effects on the emergence of ordered phases, and provides a systematic way of performing tunable angle analyses for crystalline microstructures.

  13. Aggregate Demand–Inflation Adjustment Model Applied to Southeast European Economies

    Directory of Open Access Journals (Sweden)

    Apostolov Mico

    2016-01-01

    Full Text Available Applying IS-MP-IA model and the Taylor rule to selected Southeast European economies (Albania, Bosnia and Herzegovina, Macedonia and Serbia we find that the change of effective exchange rate positively affects output, while the change of the world interest rate negatively affects output or it does not affect the output at all, and additional world output would help to increase output of the selected economies.

  14. Recent development of risk-prediction models for incident hypertension: An updated systematic review.

    Directory of Open Access Journals (Sweden)

    Dongdong Sun

    Full Text Available Hypertension is a leading global health threat and a major cardiovascular disease. Since clinical interventions are effective in delaying the disease progression from prehypertension to hypertension, diagnostic prediction models to identify patient populations at high risk for hypertension are imperative.Both PubMed and Embase databases were searched for eligible reports of either prediction models or risk scores of hypertension. The study data were collected, including risk factors, statistic methods, characteristics of study design and participants, performance measurement, etc.From the searched literature, 26 studies reporting 48 prediction models were selected. Among them, 20 reports studied the established models using traditional risk factors, such as body mass index (BMI, age, smoking, blood pressure (BP level, parental history of hypertension, and biochemical factors, whereas 6 reports used genetic risk score (GRS as the prediction factor. AUC ranged from 0.64 to 0.97, and C-statistic ranged from 60% to 90%.The traditional models are still the predominant risk prediction models for hypertension, but recently, more models have begun to incorporate genetic factors as part of their model predictors. However, these genetic predictors need to be well selected. The current reported models have acceptable to good discrimination and calibration ability, but whether the models can be applied in clinical practice still needs more validation and adjustment.

  15. A Generic Model for Relative Adjustment Between Optical Sensors Using Rigorous Orbit Mechanics

    Directory of Open Access Journals (Sweden)

    B. Islam

    2008-06-01

    Full Text Available The classical calibration or space resection is the fundamental task in photogrammetry. The lack of sufficient knowledge of interior and exterior orientation parameters lead to unreliable results in the photogrammetric process. One of the earliest in approaches using in photogrammetry was the plumb line calibration method. This method is suitable to recover the radial and decentering lens distortion coefficients, while the remaining interior(focal length and principal point coordinates and exterior orientation parameters have to be determined by a complimentary method. As the lens distortion remains very less it not considered as the interior orientation parameters, in the present rigorous sensor model. There are several other available methods based on the photogrammetric collinearity equations, which consider the determination of exterior orientation parameters, with no mention to the simultaneous determination of inner orientation parameters. Normal space resection methods solve the problem using control points, whose coordinates are known both in image and object reference systems. The non-linearity of the model and the problems, in point location in digital images and identifying the maximum GPS measured control points are the main drawbacks of the classical approaches. This paper addresses mathematical model based on the fundamental assumption of collineariy of three points of two Along-Track Stereo imagery sensors and independent object point. Assuming this condition it is possible to extract the exterior orientation (EO parameters for a long strip and single image together, without and with using the control points. Moreover, after extracting the EO parameters the accuracy for satellite data products are compared in with using single and with no control points.

  16. Constructing Quality Adjusted Price Indexes: a Comparison of Hedonic and Discrete Choice Models

    OpenAIRE

    N. Jonker

    2001-01-01

    The Boskin report (1996) concluded that the US consumer price index (CPI) overestimated the inflation by 1.1 percentage points. This was due to several measurement errors in the CPI. One of them is called quality change bias. In this paper two methods are compared which can be used to eliminate quality change bias, namely the hedonic method and a method based on the use of discrete choice models. The underlying micro-economic fundations of the two methods are compared as well as their empiric...

  17. Integrated source-risk model for radon: A definition study

    International Nuclear Information System (INIS)

    Laheij, G.M.H.; Aldenkamp, F.J.; Stoop, P.

    1993-10-01

    The purpose of a source-risk model is to support policy making on radon mitigation by comparing effects of various policy options and to enable optimization of counter measures applied to different parts of the source-risk chain. There are several advantages developing and using a source-risk model: risk calculations are standardized; the effects of measures applied to different parts of the source-risk chain can be better compared because interactions are included; and sensitivity analyses can be used to determine the most important parameters within the total source-risk chain. After an inventory of processes and sources to be included in the source-risk chain, the models presently available in the Netherlands are investigated. The models were screened for completeness, validation and operational status. The investigation made clear that, by choosing for each part of the source-risk chain the most convenient model, a source-risk chain model for radon may be realized. However, the calculation of dose out of the radon concentrations and the status of the validation of most models should be improved. Calculations with the proposed source-risk model will give estimations with a large uncertainty at the moment. For further development of the source-risk model an interaction between the source-risk model and experimental research is recommended. Organisational forms of the source-risk model are discussed. A source-risk model in which only simple models are included is also recommended. The other models are operated and administrated by the model owners. The model owners execute their models for a combination of input parameters. The output of the models is stored in a database which will be used for calculations with the source-risk model. 5 figs., 15 tabs., 7 appendices, 14 refs

  18. External adjustment of unmeasured confounders in a case-control study of benzodiazepine use and cancer risk

    DEFF Research Database (Denmark)

    Thygesen, Lau Caspar; Pottegård, Anton; Ersbøll, Annette Kjaer

    2017-01-01

    AIMS: Previous studies have reported diverging results on the association between benzodiazepine use and cancer risk. METHODS: We investigated this association in a matched case-control study including incident cancer cases during 2002-2009 in the Danish Cancer Registry (n = 94 923) and age......% confidence interval 1.00-1.19) and for smoking-related cancers from 1.20 to 1.10 (95% confidence interval 1.00-1.21). CONCLUSION: We conclude that the increased risk observed in the solely register-based study could partly be attributed to unmeasured confounding....... PSs were used: The error-prone PS using register-based confounders and the calibrated PS based on both register- and survey-based confounders, retrieved from the Health Interview Survey. RESULTS: Register-based data showed that cancer cases had more diagnoses, higher comorbidity score and more co...

  19. Dynamic gauge adjustment of high-resolution X-band radar data for convective rain storms: Model-based evaluation against measured combined sewer overflow

    DEFF Research Database (Denmark)

    Borup, Morten; Grum, Morten; Linde, Jens Jørgen

    2016-01-01

    estimates through a hydraulic urban drainage model. The model is built entirely from physical data, without any calibration, to avoid bias towards any specific type of rainfall estimate. The performance is assessed by comparing measured and modelled water levels at a weir downstream of a highly impermeable......Numerous studies have shown that radar rainfall estimates need to be adjusted against rain gauge measurements in order to be useful for hydrological modelling. In the current study we investigate if adjustment can improve radar rainfall estimates to the point where they can be used for modelling...... overflows from urban drainage systems, and we furthermore investigate the importance of the aggregation period of the adjustment scheme. This is done by continuously adjusting X-band radar data based on the previous 5–30 min of rain data recorded by multiple rain gauges and propagating the rainfall...

  20. Automating risk analysis of software design models.

    Science.gov (United States)

    Frydman, Maxime; Ruiz, Guifré; Heymann, Elisa; César, Eduardo; Miller, Barton P

    2014-01-01

    The growth of the internet and networked systems has exposed software to an increased amount of security threats. One of the responses from software developers to these threats is the introduction of security activities in the software development lifecycle. This paper describes an approach to reduce the need for costly human expertise to perform risk analysis in software, which is common in secure development methodologies, by automating threat modeling. Reducing the dependency on security experts aims at reducing the cost of secure development by allowing non-security-aware developers to apply secure development with little to no additional cost, making secure development more accessible. To automate threat modeling two data structures are introduced, identification trees and mitigation trees, to identify threats in software designs and advise mitigation techniques, while taking into account specification requirements and cost concerns. These are the components of our model for automated threat modeling, AutSEC. We validated AutSEC by implementing it in a tool based on data flow diagrams, from the Microsoft security development methodology, and applying it to VOMS, a grid middleware component, to evaluate our model's performance.

  1. Adjusting for overdispersion in piecewise exponential regression models to estimate excess mortality rate in population-based research.

    Science.gov (United States)

    Luque-Fernandez, Miguel Angel; Belot, Aurélien; Quaresma, Manuela; Maringe, Camille; Coleman, Michel P; Rachet, Bernard

    2016-10-01

    In population-based cancer research, piecewise exponential regression models are used to derive adjusted estimates of excess mortality due to cancer using the Poisson generalized linear modelling framework. However, the assumption that the conditional mean and variance of the rate parameter given the set of covariates x i are equal is strong and may fail to account for overdispersion given the variability of the rate parameter (the variance exceeds the mean). Using an empirical example, we aimed to describe simple methods to test and correct for overdispersion. We used a regression-based score test for overdispersion under the relative survival framework and proposed different approaches to correct for overdispersion including a quasi-likelihood, robust standard errors estimation, negative binomial regression and flexible piecewise modelling. All piecewise exponential regression models showed the presence of significant inherent overdispersion (p-value regression modelling, with either a quasi-likelihood or robust standard errors, was the best approach as it deals with both, overdispersion due to model misspecification and true or inherent overdispersion.

  2. FDG PET/CT diagnostic criteria may need adjustment based on MRI to estimate the presurgical risk of extrapelvic infiltration in patients with uterine endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sudo, Satoko; Sakuragi, Noriaki [Hokkaido University Graduate School of Medicine, Department of Gynecology, Sapporo (Japan); Hattori, Naoya; Manabe, Osamu; Hirata, Kenji; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Kitaku, Sapporo (Japan); Kato, Fumi; Mimura, Rie; Magota, Keiichi; Sugimori, Hiroyuki [Hokkaido University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Sapporo (Japan)

    2015-04-01

    The staging of endometrial cancer requires surgery which carries the risk of morbidity. FDG PET/CT combined with anatomical imaging may reduce the number of unnecessary lymphadenectomies by demonstrating the risk of extrapelvic infiltration. The purpose of this study was to optimize FDG PET/CT diagnostic criteria for risk assessment in endometrial cancer after first-line risk triage with MRI. The study population comprised 37 patients who underwent curative surgery for the treatment of endometrial cancer. First, the risk of extrapelvic infiltration was triaged using MRI. Second, multiple glucose metabolic profiles of the primary lesion were assessed with FDG PET/CT, and these were correlated with the histopathological risk of extrapelvic infiltration including lymphovascular space invasion (LVSI) and high-grade malignancy (grades 2 and 3). The results of histological correlation were used to adjust FDG PET/CT diagnostic criteria. Presurgical assessment using MRI was positive for deep (>50 %) myometrial invasion in 17 patients. The optimal FDG PET/CT diagnostic criteria vary depending on the results of MRI. Specifically, SUVmax (≥16.0) was used to indicate LVSI risk with an overall diagnostic accuracy of 88.2 % in patients with MRI findings showing myometrial invasion. High-grade malignancy did not correlate with any of metabolic profiles in this patient group. In the remaining patients without myometrial invasion, lesion glycolysis (LG) or metabolic volume were better indicators of LVSI than SUVmax with the same diagnostic accuracy of 80.0 %. In addition, LG (≥26.9) predicted high-grade malignancy with an accuracy of 72.2 %. Using the optimized cut-off criteria for LVSI, glucose metabolic profiling of primary lesions correctly predicted lymph node metastasis with an accuracy of 73.0 %, which was comparable with the accuracy of visual assessment for lymph node metastasis using MRI and FDG PET/CT. FDG PET/CT diagnostic criteria may need adjustment based on the

  3. Covariate-adjusted measures of discrimination for survival data

    DEFF Research Database (Denmark)

    White, Ian R; Rapsomaniki, Eleni; Frikke-Schmidt, Ruth

    2015-01-01

    by the study design (e.g. age and sex) influence discrimination and can make it difficult to compare model discrimination between studies. Although covariate adjustment is a standard procedure for quantifying disease-risk factor associations, there are no covariate adjustment methods for discrimination...... statistics in censored survival data. OBJECTIVE: To develop extensions of the C-index and D-index that describe the prognostic ability of a model adjusted for one or more covariate(s). METHOD: We define a covariate-adjusted C-index and D-index for censored survival data, propose several estimators......, and investigate their performance in simulation studies and in data from a large individual participant data meta-analysis, the Emerging Risk Factors Collaboration. RESULTS: The proposed methods perform well in simulations. In the Emerging Risk Factors Collaboration data, the age-adjusted C-index and D-index were...

  4. Compensatory Postural Adjustments in an Oculus Virtual Reality Environment and the Risk of Falling in Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    Miguel F. Gago

    2016-06-01

    Full Text Available Background/Aims: Alzheimer's disease (AD patients have an impaired ability to quickly reweight central sensory dependence in response to unexpected body perturbations. Herein, we aim to study provoked compensatory postural adjustments (CPAs in a conflicting sensory paradigm with unpredictable visual displacements using virtual reality goggles. Methods: We used kinematic time-frequency analyses of two frequency bands: a low-frequency band (LB; 0.3-1.5 Hz; mechanical strategy and a high-frequency band (HB; 1.5-3.5 Hz; cognitive strategy. We enrolled 19 healthy subjects (controls and 21 AD patients, divided according to their previous history of falls. Results: The AD faller group presented higher-power LB CPAs, reflecting their worse inherent postural stability. The AD patients had a time lag in their HB CPA reaction. Conclusion: The slower reaction by CPA in AD may be a reflection of different cognitive resources including body schema self-perception, visual motion, depth perception, or a different state of fear and/or anxiety.

  5. Effect of Laparoscopic Adjustable Gastric Banding on Metabolic Syndrome and Its Risk Factors in Morbidly Obese Adolescents

    Directory of Open Access Journals (Sweden)

    Rushika Conroy

    2011-01-01

    Full Text Available We examined the effect of laparoscopic adjustable gastric banding (LAGB on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14–18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8% after 6 months and 69.6% after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective for short-term improvement in weight, inflammatory markers, and components of MeS in morbidly obese adolescents.

  6. An ice flow modeling perspective on bedrock adjustment patterns of the Greenland ice sheet

    Directory of Open Access Journals (Sweden)

    M. Olaizola

    2012-11-01

    Full Text Available Since the launch in 2002 of the Gravity Recovery and Climate Experiment (GRACE satellites, several estimates of the mass balance of the Greenland ice sheet (GrIS have been produced. To obtain ice mass changes, the GRACE data need to be corrected for the effect of deformation changes of the Earth's crust. Recently, a new method has been proposed where ice mass changes and bedrock changes are simultaneously solved. Results show bedrock subsidence over almost the entirety of Greenland in combination with ice mass loss which is only half of the currently standing estimates. This subsidence can be an elastic response, but it may however also be a delayed response to past changes. In this study we test whether these subsidence patterns are consistent with ice dynamical modeling results. We use a 3-D ice sheet–bedrock model with a surface mass balance forcing based on a mass balance gradient approach to study the pattern and magnitude of bedrock changes in Greenland. Different mass balance forcings are used. Simulations since the Last Glacial Maximum yield a bedrock delay with respect to the mass balance forcing of nearly 3000 yr and an average uplift at present of 0.3 mm yr−1. The spatial pattern of bedrock changes shows a small central subsidence as well as more intense uplift in the south. These results are not compatible with the gravity based reconstructions showing a subsidence with a maximum in central Greenland, thereby questioning whether the claim of halving of the ice mass change is justified.

  7. Modifying the baricity of local anesthetics for spinal anesthesia by temperature adjustment: model calculations.

    Science.gov (United States)

    Heller, Axel R; Zimmermann, Katrin; Seele, Kristin; Rössel, Thomas; Koch, Thea; Litz, Rainer J

    2006-08-01

    Although local anesthetics (LAs) are hyperbaric at room temperature, density drops within minutes after administration into the subarachnoid space. LAs become hypobaric and therefore may cranially ascend during spinal anesthesia in an uncontrolled manner. The authors hypothesized that temperature and density of LA solutions have a nonlinear relation that may be described by a polynomial equation, and that conversion of this equation may provide the temperature at which individual LAs are isobaric. Density of cerebrospinal fluid was measured using a vibrating tube densitometer. Temperature-dependent density data were obtained from all LAs commonly used for spinal anesthesia, at least in triplicate at 5 degrees, 20 degrees, 30 degrees, and 37 degrees C. The hypothesis was tested by fitting the obtained data into polynomial mathematical models allowing calculations of substance-specific isobaric temperatures. Cerebrospinal fluid at 37 degrees C had a density of 1.000646 +/- 0.000086 g/ml. Three groups of local anesthetics with similar temperature (T, degrees C)-dependent density (rho) characteristics were identified: articaine and mepivacaine, rho1(T) = 1.008-5.36 E-06 T2 (heavy LAs, isobaric at body temperature); L-bupivacaine, rho2(T) = 1.007-5.46 E-06 T2 (intermediate LA, less hypobaric than saline); bupivacaine, ropivacaine, prilocaine, and lidocaine, rho3(T) = 1.0063-5.0 E-06 T (light LAs, more hypobaric than saline). Isobaric temperatures (degrees C) were as follows: 5 mg/ml bupivacaine, 35.1; 5 mg/ml L-bupivacaine, 37.0; 5 mg/ml ropivacaine, 35.1; 20 mg/ml articaine, 39.4. Sophisticated measurements and mathematic models now allow calculation of the ideal injection temperature of LAs and, thus, even better control of LA distribution within the cerebrospinal fluid. The given formulae allow the adaptation on subpopulations with varying cerebrospinal fluid density.

  8. The Problem with the Low-Tax Backlash: Rethinking Corporate Tax Policies to Adjust for Uneven Reputational Risks

    Directory of Open Access Journals (Sweden)

    Jack M. Mintz

    2015-05-01

    Full Text Available When a major corporation is found to be paying little or no taxes, public backlash and media furor over the issue may ensue. Some governments may well be just fine with it, while others like U.S. may take steps to ensure companies pay more tax. Sometimes, companies being in a non-taxpaying position properly reflects appropriate tax policy. That explanation, however, does not sell lattés, which is why in 2012, after the British public grew outraged over the discovery that Starbucks was paying no corporate taxes in the U.K., the coffee retailer actually volunteered to just write a cheque to the government. The reputational damage to Starbucks’ brand, the company calculated, was not worth the money it was saving in avoiding taxes, even if it was doing so perfectly legally. The fear of this kind of reputational damage can foil the very taxation policies that governments design specifically as a means to tax corporations fairly, efficiently and competitively. It may be good tax policy to allow corporations various deductions, or the ability to carry forward or carry back losses, but it can be politically vexatious. U.S. President Barack Obama demonstrated that explicitly when he suggested certain American companies using so-called tax inversions to relocate their headquarters to low-tax jurisdictions, were failing in their “economic patriotism.” Yet more multinationals than ever are legally and quite appropriately using tax strategies to minimize their taxes in various jurisdictions to the point where they are paying little to no corporate tax. For some corporations, the risk of public backlash is greater than it is for others: Starbucks and Facebook, being consumer-facing companies with a great deal of brand goodwill, have a lot more at risk than do Pfizer and Oracle. This risk makes the playing field for taxation less level, jeopardizing the fundamental tax principle of horizontal equity — that those of similar means should pay similar

  9. Nuclear power investment risk economic model

    International Nuclear Information System (INIS)

    Houghton, W.J.; Postula, F.D.

    1985-12-01

    This paper describes an economic model which was developed to evaluate the net costs incurred by a utility due to an accident induced outage at a nuclear power plant. During such an outage the portion of the plant operating costs associated with power production are saved; however, the owning utility faces a sizable expense as fossil fuels are burned as a substitute for the incapacitated nuclear power. Additional expenses are incurred by the utility for plant repair and if necessary, decontamination costs. The model makes provision for mitigating these costs by sales of power, property damage insurance payments, tax write-offs and increased rates. Over 60 economic variables contribute to the net cost uncertainty. The values of these variables are treated as uncertainty distributions and are used in a Monte carlo computer program to evaluate the cost uncertainty (investment risk) associated with damage which could occur from various categories of initiating accidents. As an example, results of computations for various levels of damage associated with a loss of coolant accident are shown as a range of consequential plant downtime and unrecovered cost. A typical investment risk profile is shown for these types of accidents. Cost/revenue values for each economic factor are presented for a Three Mile Island - II type accident, e.g., uncontrolled core heatup. 4 refs., 6 figs., 3 tabs

  10. Fast Cloud Adjustment to Increasing CO2 in a Superparameterized Climate Model

    Directory of Open Access Journals (Sweden)

    Marat Khairoutdinov

    2012-05-01

    Full Text Available Two-year simulation experiments with a superparameterized climate model, SP-CAM, are performed to understand the fast tropical (30S-30N cloud response to an instantaneous quadrupling of CO2 concentration with SST held fixed at present-day values.The greenhouse effect of the CO2 perturbation quickly warms the tropical land surfaces by an average of 0.5 K. This shifts rising motion, surface precipitation, and cloud cover at all levels from the ocean to the land, with only small net tropical-mean cloud changes. There is a widespread average reduction of about 80 m in the depth of the trade inversion capping the marine boundary layer (MBL over the cooler subtropical oceans.One apparent contributing factor is CO2-enhanced downwelling longwave radiation, which reduces boundary-layer radiative cooling, a primary driver of turbulent entrainment through the trade inversion. A second contributor is a slight CO2-induced heating of the free troposphere above the MBL, which strengthens the trade inversion and also inhibits entrainment. There is a corresponding downward displacement of MBL clouds with a very slight decrease in mean cloud cover and albedo.Two-dimensional cloud-resolving model (CRM simulations of this MBL response are run to steady state using composite SP-CAM simulated thermodynamic and wind profiles from a representative cool subtropical ocean regime, for the control and 4xCO2 cases. Simulations with a CRM grid resolution equal to that of SP-CAM are compared with much finer resolution simulations. The coarse-resolution simulations maintain a cloud fraction and albedo comparable to SP-CAM, but the fine-resolution simulations have a much smaller cloud fraction. Nevertheless, both CRM configurations simulate a reduction in inversion height comparable to SP-CAM. The changes in low cloud cover and albedo in the CRM simulations are small, but both simulations predict a slight reduction in low cloud albedo as in SP-CAM.

  11. A model for assessing the risk of human trafficking on a local level

    Science.gov (United States)

    Colegrove, Amanda

    Human trafficking is a human rights violation that is difficult to quantify. Models for estimating the number of victims of trafficking presented by previous researchers depend on inconsistent, poor quality data. As an intermediate step to help current efforts by nonprofits to combat human trafficking, this project presents a model that is not dependent on quantitative data specific to human trafficking, but rather profiles the risk of human trafficking at the local level through causative factors. Businesses, indicated by the literature, were weighted based on the presence of characteristics that increase the likelihood of trafficking in persons. The mean risk was calculated by census tract to reveal the multiplicity of risk levels in both rural and urban settings. Results indicate that labor trafficking may be a more diffuse problem in Missouri than sex trafficking. Additionally, spatial patterns of risk remained largely the same regardless of adjustments made to the model.

  12. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  13. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  14. Model-based mitigation of availability risks

    NARCIS (Netherlands)

    Zambon, E.; Bolzoni, D.; Etalle, S.; Salvato, M.

    2007-01-01

    The assessment and mitigation of risks related to the availability of the IT infrastructure is becoming increasingly important in modern organizations. Unfortunately, present standards for risk assessment and mitigation show limitations when evaluating and mitigating availability risks. This is due

  15. Model-Based Mitigation of Availability Risks

    NARCIS (Netherlands)

    Zambon, Emmanuele; Bolzoni, D.; Etalle, Sandro; Salvato, Marco

    2007-01-01

    The assessment and mitigation of risks related to the availability of the IT infrastructure is becoming increasingly important in modern organizations. Unfortunately, present standards for Risk Assessment and Mitigation show limitations when evaluating and mitigating availability risks. This is due

  16. Shaft adjuster

    Science.gov (United States)

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  17. ISM Approach to Model Offshore Outsourcing Risks

    OpenAIRE

    Kumar, Sunand; Sharma, Rajiv Kumar; Chauhan, Prashant

    2014-01-01

    [EN] In an effort to achieve a competitive advantage via cost reductions and improved market responsiveness, organizations are increasingly employing offshore outsourcing as a major component of their supply chain strategies. But as evident from literature number of risks such as Political risk, Risk due to cultural differences, Compliance and regulatory risk, Opportunistic risk and Organization structural risk, which adversely affect the performance of offshore outsourcing in a supply chain ...

  18. Adjustable collimator

    International Nuclear Information System (INIS)

    Carlson, R.W.; Covic, J.; Leininger, G.

    1981-01-01

    In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

  19. A structural model for stress, coping, and psychosocial adjustment: A multi-group analysis by stages of survivorship in Korean women with breast cancer.

    Science.gov (United States)

    Jang, Miyoung; Kim, Jiyoung

    2018-04-01

    Prospective studies have examined factors directly affecting psychosocial adjustment during breast cancer treatment. Survivorship stage may moderate a direct effect of stress on psychosocial adjustment. This study aimed to examine relationships between stress, social support, self-efficacy, coping, and psychosocial adjustment to construct a model of the effect pathways between those factors, and determine if survivorship stage moderates those effects. Six hundred people with breast cancer completed questionnaires. Examined stages of survivorship after treatment were as follows: acute (i.e., 5 years). Stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), self-efficacy (New General Self Efficacy Scale), coping (Ways of Coping Checklist), and psychosocial adjustment (Psychosocial Adjustment to Illness Scale-Self-Report-Korean Version) were measured. Self-efficacy significantly correlated with psychosocial adjustment in the acute survival stage (γ = -0.37, P psychosocial adjustment was greater in the acute (γ = -0.42, P psychosocial adjustment was stronger in the lasting survival stage (β = 0.42, P psychosocial adjustment of female breast cancer patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.

    Science.gov (United States)

    Jenkins, Kathy J; Koch Kupiec, Jennifer; Owens, Pamela L; Romano, Patrick S; Geppert, Jeffrey J; Gauvreau, Kimberlee

    2016-05-20

    The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile). Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.