Methodological issues in comparing injury incidence across countries

The primary objective was to describe the methodological challenges and devise solutions to compare injury incidence across countries. The research design was a mixed methods study, consisting of a consultation with an expert group and comparison of injury surveillance systems and data from ten European countries. A subset of fractures, selected radiologically verifiable fractures and a method of checking the national representativeness of sample emergency department data were devised and are proposed for further development. These methodological considerations and developments will be further refined and tested and should prove useful tools for those who need to compare injury incidence data across countries.     

Developing physics concepts through hands-on problem solving: a perspective on a technological project design

In a contest featuring hands-on projects, college students were required to design a simple crawling worm using planning, self-monitoring and self-evaluation processes to solve contradictive problems. To enhance the efficiency of problem solving, one needs to practice meta-cognition based on an application of related scientific concepts. The objective of this study, then, was to analyze the physics concepts employed by the students as they completed a hands-on project named “Crawling Worm,” during which they had to overcome problems encountered by the requirements of their design as well as those brought on by competition. Based on the analysis of the participants’ working portfolios and on reviews and interviews by engineering professors, the results of this study show that the crawling worm design competition encouraged the practice of problem solving, and it facilitated the learning of physics concepts such as friction, torque, four bar link, material properties, and so on.     

Fairness in a tradeable-permit treaty for carbon emissions reductions in Europe and the former Soviet Union

This paper evaluates the distributional implications of alternative permit allocations in a tradeable permit regime for carbon emissions reductions (20% below baseline) in 2010 for a region consisting of Europe and the states of the former Soviet Union (FSU). Participation in such a regime is expected to hinge on the fairness of the distributional consequences. We find that initial permit allocations by populationand/or GDP are unlikely to induce participation by most countries of Eastern Europe and FSU because of the net costs involved. We identify a set of initial allocations that would at least compensate these countries. A fair treatment of the countries in Western Europe (WE) is here one which equalizes net costs perGDP. For a wide set of cost functions for carbon emission reductions, the cost gains that WE would reap from a tradeable permit system relative to unilateral reductions by WE as a group are found to be on the order of 85 percent. This would imply, among other things, a significant increase in WE'scapacity to make further emissions reductions.     

Time series analysis of residuals from the St. Louis model

The residuals of the equations of the St. Louis model are analyzed individually and in pairs, using time series techniques in an attempt to discover mis-specifications in the model, in the form of incorrect lags or missing variables. The relationships discovered are,checked both inside and outside the sample. A variety of mis-specifications are apparent, and a much improved specification should be possible. The assumption made in the model that money supply is exogenous does not agree with the data.     

Diffusion of Minimally Invasive Procedures across Hospitals and Traits of Fast Adopting Hospitals

The quality and cost of hospital care depends not only on what technologies have been developed, but on how quickly the most promising and cost-effective technologies diffuse across hospitals. Some technologies are high-cost when they are first introduced into the health care system, but improve in cost-effectiveness as doctors use the technologies and innovate. Some such examples are minimally invasive procedures, which have become more common in recent years. We sought to better understand what hospital characteristics are associated with fast adoption of four minimally invasive procedures (appendectomy, lobectomy, hysterectomy and colectomy). Our findings show that a hospital’s adoption of minimally invasive procedures in one type of procedure (e.g., lobectomy) is not predictive of that hospital’s probability of adopting minimally invasive procedures in another procedure type (e.g., zero appendectomies). The only hospital characteristic consistently correlated with adoption for three of the four procedure types was the extent that the hospital’s geographic neighbors had adopted minimally invasive technology for that particular procedure. These findings regarding peer effects fall in line with conclusions about diffusion from the development literature.     

Cost minimization analysis of capecitabine versus 5-fluorouracil-based treatment for gastric cancer patients in Hong Kong

Background: EOX (epirubicin, oxaliplatin, Xeloda; capecitabine) and FOLFOX4 (5-fluorouracil (5-FU), leucovorin, oxaliplatin) are the common chemotherapy regimens used in the treatment of advanced gastric cancer (aGC) in Hong Kong. This study aimed to compare the costs of these therapies for aGC patients from both the healthcare and societal perspectives. It should be noted that, while FOLFOX4 is routinely administered in an outpatient setting in North America and Europe, inpatient setting is adopted in Hong Kong instead, incurring hospitalization cost as a result.

Methods: Fifty-eight patients were identified from the electronic records in two public tertiary hospitals, with 45 and 13 receiving EOX and FOLFOX4 regimens, respectively. Healthcare cost was direct medical costs including drugs, clinic follow-up, hospitalization, diagnostic laboratories, and radiographs. Societal cost refers to indirect costs such as patient time and travel costs. Cost items were further classified as “expected” or “unexpected”. All cost data was expressed in US dollars.

Results: Patients in the EOX and FOLFOX4 arm received an average of 5.3 and 7.8 cycles of treatment, respectively. The capecitabine-based regimen group had a higher expected medication cost per cycle when compared to the 5-FU-based treatment group (US$290.3 vs US$66.9, p?p?p?p?=?.001), respectively, in the capecitabine-based regimen group. Sensitivity analyses based on full cycle regimen costs and net capecitabine or 5-FU/leucovorin costs still showed EOX to be less costly than FOLFOX4.

Conclusion: The capecitabine-based regimen, EOX, was found to generate significant cost saving from both the healthcare and societal perspectives in regions in which FOLFOX4 is given in an inpatient setting.