The relevance of personal characteristics in health care rationing: what the Australian public thinks and why

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving “equal priority” to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as “self-harmers”—smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories (“factors”) influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences—e.g., how strongly respondents would “discriminate” against a recreational drug user or preference a person with a healthy diet—is related to the particular class of preferences.     

The generation gap and optimal economic growth

Among the problems confronting those who aspire to the development of a realistic and practicable optimal growth theory is that the human population is not homogeneous with respect to age. Those who are relatively young are apt to prefer a different pattern of capital accumulation from that preferred by those who are relatively old. This paper proposes a tentative solution to this particular problem. Essentially the proposal is that society should remain with what is an optimal private plan of an individual who is at the median age of the population at the beginning of the planning period, for one planning period, after which it revises the plan to switch to the optimal private plan of another individual (one planning period younger than the first) who is at the median age at the commencement of the new planning period. Thus the optimal social plan consists of a succession of one planning period implementations of the first periods of the optimal private plans of individuals who are at the median age at that time period. An example of the application of the method is given. An important sidelight of the paper is a critique of standard constant-rate exponential discounting in social planning of optimal capital accumulation, and the proposal that it be replaced by “mortality discounting.”     

The M/M\1 queue in a heavy-tailed random environment

We consider an M / M /1 queue with the special feature that the speed of the server alternates between two constant values s_L and s_H > s_L . The high-speed periods are exponentially distributed, and the low-speed periods have a regularly varying distribution. We obtain explicit asymptotics for the tail of the workload distribution. The two cases in which the offered traffic load is smaller respectively larger than the low service speed are shown to result in completely different asymptotics.     

基于GIS/GPS/GPRS技术的物流运输监控实验系统开发

GIS/GPS/GPRS技术已逐步应用到不同领域,在高校相关专业开展GIS/GPS/GPRS技术教学已成当务之急。但实验系统相对缺乏。本文设计了基于GIS/GPS/GPRS技术的物流运输监控实验系统。     

The elusive NHS consumer: 1948 to the NHS Plan

Since the creation of the National Health Service in 1948, patients have never been fully-fledged consumers of healthcare; they have never held personal economic power with which to express their needs and preferences to service providers. Nonetheless, the history of the NHS has demonstrated an ever-increasing policy interest in the needs of individual patients and in the responsiveness of services to these needs. Following the collapse of the postwar consensus which gave birth to the welfare state, successive governments have pledged to give priority to consumer needs, but have struggled to realise this priority in practice.Professional and state paternalism in defining patient needs and choices have endured. current policy emphasis on 'patient and public involvement' and 'partnership working' sustains a top-down bureaucratic approach but tempers practice with input from all stakeholders in local health economies. There is much to do to make the culture of the NHS genuinely responsive to consumer needs.     

The effects of input control in a simple scheduling model

Input control is a generic procedure for smoothing production workload by delaying work during intervals of heavy load. While input control techniques have several practical benefits, they also have an inherent disadvantage. By restricting the set of jobs available for scheduling, an input control procedure removes some of the scheduling options that would otherwise be available. This paper examines the impact of such a procedure in a simple simulation model.The simulation model represents a production shop in a simplified way, as a single machine, but the production control system has three distinct parts. The first part assigns due-dates to customer orders, taking into consideration the size of each job and the workload in the shop. The second part is a job releasing rule that implements input control. The third part is a priority dispatching procedure that is aimed at meeting due-dates. By representing this three-part control system the model provides an opportunity to explore the interdependence between input control and other control procedures.Reinforcing previous research, the simulation experiments confirm that modified due-date priorities perform more effectively than other basic priority rules when performance is measured by average tardiness. Moreover, the experiments indicate that performance under the modified due-date regime is never improved by the use of input control. On the other hand, with dispatching rules that rely on shortest-first or critical ratio priorities, the experiments indicate that input control is sometimes advantageous. The effects of input control on scheduling performance thus appear to be somewhat complicated, and further experiments were designed to explore some of the relationships involved. The principal finding, however, provides a warning that input control can be counterproductive.     

The contribution of yoga to the entrepreneurial potential of university students: a SEM approach

The literature suggests that all entrepreneurs share certain psychological and cognitive characteristics. Yoga is currently experiencing a surge in popularity due to both the physical and psychological benefits gained by yogi (practitioners of yoga). Irrespective of its more philosophical dimension, changes attributable to yoga have been identified in individuals’ psychological and behavioural patterns. It is in this context that this study analyses the characteristics associated both with entrepreneurs and yogis, seeking to specifically understand the respective personal attributes or the psychological and cognitive predispositions of both groups. The results of this study demonstrate that students who do engage in yoga show a propensity towards or strengthening of the psychological and cognitive attributes that are commonly associated with an entrepreneurial profile. Thus the study suggests that if entrepreneurial behaviour is a priority, then yoga should be integrated as a compulsory subject into general education from the primary school onwards.     

Optimal investment with taxes: an existence result

We study the deterministic control problem of maximizing utility from consumption of an agent who seeks to optimally allocate his wealth between consumption and investment in a financial asset subject to taxes on benefits with first-in–first-out priority rule on sales. Short sales are prohibited and consumption is restricted to be non-negative. Such a problem has been introduced in a previous paper by the same authors where the first-order conditions have been derived. In this paper, we establish an existence result for this non-classical optimal control problem.     

Treatment effect bounds: An application to Swan–Ganz catheterization

We reanalyze data from the observational study by Connors et al. (1996) on the impact of Swan–Ganz catheterization on mortality outcomes. The study by Connors et al. (1996) assumes that there are no unobserved differences between patients who are catheterized and patients who are not catheterized and finds that catheterization increases patient mortality. We instead allow for such differences between patients by implementing both the instrumental variable bounds of Manski (1990), which only exploits an instrumental variable, and the bounds of Shaikh and Vytlacil (2011), which exploit mild nonparametric, structural assumptions in addition to an instrumental variable. We propose and justify the use of indicators of weekday admission as an instrument for catheterization in this context. We find that in our application, the Manski (1990) bounds do not indicate whether catheterization increases or decreases mortality, where as the Shaikh and Vytlacil (2011) bounds reveal that at least for some diagnoses, Swan–Ganz catheterization reduces mortality at 7 days after catheterization. We show that the bounds of Shaikh and Vytlacil (2011) remain valid under even weaker assumptions than those described in Shaikh and Vytlacil (2011). We also extend the analysis to exploit a further nonparametric, structural assumption–that doctors catheterize individuals with systematically worse latent health–and find that this assumption further narrows these bounds and strengthens our conclusions. In our analysis, we construct confidence regions using the methodology developed in Romano and Shaikh (2008). We show in particular that the confidence regions are uniformly consistent in level over a large class of possible distributions for the observed data that include distributions where the instrument is arbitrarily “weak”.     

基于排队论的航空保障资源配置研究

航空母舰航空保障战位的优化配置在某种程度上影响着舰载机的最大出动强度。通过明确航空站位数量的设置与舰载机及母舰的运行成本之间的关系,可以确定航空保障站位的优化配置数量。本文以俄罗斯航母为模型,运用排队论思想对舰载机等待保障的M/M/1模型进行算例计算及仿真研究,分析出满足舰载机航空勤务保障的合理优化配置数量,研究发现,航空保障站位的配置数量以7组为最佳,此方法可为航空保障资源配置方案的设计提供一定的理论支撑。     

城市滨水景观设计中人的心理需求

城市滨水景观是现代环境设计中的一个重点,而环境与人是在相互影响中共存的.环境会对人产生心理影响,另外人的心理需求也对环境提出了要求.同一景观对不同的受众会产生不同的心理体验,不同年龄阶段、不同层次,身份的人对景观有不同的需求.因此研究不同人群对城市滨水景观的心理需求在项目设计中有一定的实用价值.     

Data-driven forecasting for operational planning of emergency medical services

Emergency medical services (EMS) play a vital role in delivering pre-hospital care. The operational efficiency of such services is critical and adequate demand forecasts can contribute to such a goal. But for that, the available data need to be well characterized before being used. Previous studies have failed to address some important aspects of this need, such as exploring a comprehensive list of contextual data to decide which are relevant to explain the EMS demand behavior. Moreover, modern forecasting techniques have been explored in the EMS context, including neural networks, but the computational complexity inherent to the methods and their use was not discussed. Finally, it is also unclear how different demand patterns can be when predicting the volume of emergency calls considering the priority level and the number of dispatches according to vehicle type. This study proposes a generic data-driven forecasting method to address these shortcomings and to support operational decisions. The results obtained with the proposed method indicate that each priority call and vehicle type shows different patterns, which suggests that such differentiation should contribute to better resource allocation. At the same time, the operational impact of the demand shared by neighboring zones proved to be significant at bases near the border. The models developed resulted in important decision tools that can be used to predict the dynamic demand of EMS on an hourly or shift basis. Additionally, the method adds value for decision-makers that want to plan not only when and how many but also where resources are demanded, avoiding assumptions that impact the operational performance.     

跨数据库中间件在ERP中的应用

网络数据库是动态网站源泉。为保证网络数据库安全,一般采用含有中间件的三层结构访问数据库。文中采用C/M/S结构,实现了一个跨数据库中间件在ERP中的应用。利用J2EE技术开发中间件,详细阐述了在数据库连接、查询等方面的开发设计。     

A satisficing method for fuzzy goal programming problems with different importance and priorities

For treating multiple objectives decision making problems with fuzzy goals and different importance, various kinds of fuzzy goal programming (FGP) models have been developed in the past three decades. Among them, two most widely used methods are: (1) weighted FGP, where the importance of the objectives is represented by weights (2) preemptive priority (also known as “Lexicographic”) FGP, where the priority levels of the goals are set in advance, and the trade-offs among goals placed at different priority levels are implemented strictly. This article presents a satisficing method based on FGP model, which holds that a more important objective has to be achieved as much as possible. The relaxed preemptive priority requirement in the proposed model provides a more efficient, flexible and practicable decision support compared to the weighted and the lexicographic models. In addition, the trade-off between optimization and importance requirement can be realized by the regulation parameter in the presented method. The performance of this method is evaluated by comparing its result with those of the six existing models in the literature.     

Substitution and complementarity between managers and subordinates: Evidence from British football

We use data on British football managers and teams over the 1994-2007 period to study substitution and complementarity between leaders and subordinates. We find for the Premier League (the highest level of competition) that, other things being equal, managers who themselves played at a higher level raise the productivity of less-skilled teams by more than that of highly skilled teams. This is consistent with the hypothesis that one function of a top manager is to communicate to subordinates the skills needed to succeed, since less skilled players have more to learn. However, we also find that managers with more accumulated professional managing experience raise the productivity of talented players by more than that of less-talented players. This is consistent with the hypothesis that a further function of successful managers in high-performance workplaces is to manage the egos of elite workers. Such a function is potentially more important the more accomplished the workers are-as indicated, in our data, by teams with greater payrolls.     

The impact on the pricing process of costly active management and performance chasing clients

One of the necessary features of markets to produce efficient pricing is competition between information-based investors who quickly impound new information into price. However, a significant proportion of funds invested in today’s equity markets are in the hands of managers who pursue a style that utilises little or none of the available information. We simulate such a market where the funds are being managed using the following three investment styles: fundamental, momentum and index. We confirm that the major pricing anomalies that have been highlighted previously in the literature are a natural consequence of competition between managers utilising these three investment styles. More importantly, we show that this situation is unlikely to change as long as markets continue to be dominated by costly active managers with clients who pursue outperformance.     

Life Expectancies for Small Areas: A Bayesian Random Effects Methodology

Monitoring small area contrasts in life expectancy is important for health policy purposes but subject to difficulties under conventional life table analysis. Additionally, the implicit model underlying conventional life table analysis involves a highly parametrized fixed effect approach. An alternative strategy proposed here involves an explicit model based on random effects for both small areas and age groups. The area effects are assumed to be spatially correlated, reflecting unknown mortality risk factors that are themselves typically spatially correlated. Often mortality observations are disaggregated by demographic category as well as by age and area, e.g. by gender or ethnic group, and multivariate area and age random effects will be used to pool over such groups. A case study considers variations in life expectancy in 1 118 small areas (known as wards) in Eastern England over a five-year period 1999–2003. The case study deaths data are classified by gender, age, and area, and a bivariate model for area and age effects is therefore applied. The interrelationship between the random area effects and two major influences on small area life expectancy is demonstrated in the study, these being area socio-economic status (or deprivation) and the location of nursing and residential homes for frail elderly.     

Developing Official Stochastic Population Forecasts at the US Census Bureau

The U.S. Census Bureau is approaching a critical decision regarding a major facet of its methodology for forecasting the United States population. In the past, it has relied on alternative scenarios, low, medium, and high, to reflect varying interpretations of current trends in fertility, mortality, and international migration to forecast population. This approach has limitations that have been noted in the recent literature on population forecasting. Census Bureau researchers are embarking on an attempt to incorporate probabilistic reasoning to forecast prediction intervals around point forecasts to future dates. The current literature offers a choice of approaches to this problem. We are opting to employ formal time series modeling of parameters of fertility, mortality, and international migration, with stochastic renewal processes. The endeavor is complicated by the administrative necessity to produce a large amount of racial and Hispanic origin detail in the population, as well as the ubiquitous cross-categories of age and sex. As official population forecasts must meet user demand, we are faced with the added challenge of presenting and supporting the resulting product in a way that is comprehensible to users, many of whom have little or no comprehension of the technical forecasting literature, and are accustomed to simple, deterministic answers. We may well find a need to modify our strategy, depending on the realities that may emerge from the limitations of data, the administrative requirements of the product, and the diverse needs of our user community.     

Do salaries improve worker performance?

We establish the effects of salaries on worker performance by exploiting a natural experiment in which some workers in a particular occupation (football referees) switch from short-term contracts to salaried contracts. Worker performance improves among those who move onto salaried contracts relative to those who do not. The finding is robust to the introduction of worker fixed effects indicating that it is not driven by better workers being awarded salary contracts. Nor is it sensitive to workers sorting into or out of the profession. Improved performance could arise from the additional effort workers exert due to career concerns, the higher income associated with career contracts (an efficiency wage effect) or improvements in worker quality arising from off-the-job training which accompanies the salaried contracts.     

Prioritizing Sustainability Indicators: Using Materiality Analysis to Guide Sustainability Assessment and Strategy

Despite the growing awareness of complexity in sustainable development, the practical implementation of sustainability assessment through the use of sustainability indicators requires prioritizing the myriad indicators available. This study identifies the highest priority sustainability indicators for the New Zealand wine industry using materiality analysis. Thirteen information sources representative of different stakeholder perspectives considered to drive the need for sustainability assessment are analysed to provide a measure of sustainability issue salience and risk. Based on a meta‐analysis of relevant information, it is found that environmental issues make up the highest priority issues, followed by social issues relating primarily to worker wellbeing. Significantly, economic and governance issues were not found to be high priorities. These findings are discussed in the context of the common bias in agricultural sustainability assessment towards environmental issues, and the broader business implications for sustainability assessment, strategy and policy. Copyright © 2016 John Wiley & Sons, Ltd and ERP Environment