Morbidity measures in the presence of recurrent composite endpoints

The analysis of recurrent event data in clinical trials presents a number of difficulties. The statistician is faced with issues of event dependency, composite endpoints, unbalanced follow‐up times and informative dropout. It is not unusual, therefore, for statisticians charged with responsibility for providing reliable and valid analyses to need to derive new methods specific to the clinical indication under investigation. One method is proposed that appears to have possible advantages over those that are often used in the analysis of recurrent event data in clinical trials. Based on an approach that counts periods of time with events instead of single event counts, the proposed method makes an adjustment for patient time on study and incorporates heterogeneity by estimating an individual per‐patient risk of experiencing a morbid event. Monte Carlo simulations demonstrate that, with use of a real clinical study data, the proposed method consistently outperforms other measures of morbidity. Copyright © 2003 John Wiley & Sons, Ltd.     

Correlates of physical activity in a community sample of older adults in Appalachia

Although much has been learned about the global determinants of physical activity in adults, there has been a lack of specific focus on gender, age, and urban/rural differences. In this church-based community sample of Appalachian adults (N = 1,239), the primary correlates of physical activity included age, gender, obesity, and self-efficacy. Overall, 42% of all participants and 31% of adults age 65 years or older met recommended guidelines for physical activity, which suggests that most participants do not engage in adequate levels of physical activity. Of participants who met physical activity guidelines, the most common modes of moderate and vigorous activity were walking briskly or uphill, heavy housework or gardening, light strength training, and biking. These particular activities that focus on building self-efficacy might be viable targets for intervention among older adults in rural communities.     

Finding and Implementing Energy Efficiency Projects in Industrial Facilities

This study addresses the challenges of finding and implementing profitable energy efficiency (EE) projects, a critical foundation for sustainable operations. We focus on manufacturing enterprises, but many of our findings apply also to the back office of service operations. Our starting point is that, in nearly every industrial enterprise, there are many profitable EE projects that could be implemented but are not. An oft‐cited hindrance to implementation is the lack of an internal management framework in which to find, value, and execute these projects. Using a conceptual approach, we rely on proven sustainable operations tools to develop such a framework. We identify three major value drivers of EE projects: savings intensity, “green” image, and project complexity. We then describe a framework for understanding the context of EE projects in industry, with an underlying analytic foundation in optimal portfolio analysis. A case study of a large manufacturing site is used to illustrate emerging best practices—based on Kaizen management principles—for integrating EE project management with operations, engineering, and strategy.     

A Round By Any Other Name: The WTO Agenda After Doha

The WTO agenda decided at Doha in November 2001 has all the hallmarks of a new trade round, although the word ‘round’ has been carefully avoided. To the already mandated negotiations on agriculture and services, Doha added negotiations on industrial products and the environment as well as reviews of the operation of WTO rules in several areas. Negotiations are also to begin on the highly contentious areas of investment and competition policy. Developing countries have been reluctant to contemplate such wider commitments, arguing that much still remains to be done on implementation of the Uruguay Round, and in this they received a degree of satisfaction. In the work ahead, however, much needs to be done to take account of their needs.     

Interstate Migration Has Fallen Less Than You Think: Consequences of Hot Deck Imputation in the Current Population Survey

We show that much of the recent reported decrease in interstate migration is a statistical artifact. Before 2006, the Census Bureau's imputation procedure for dealing with missing data in the Current Population Survey inflated the estimated interstate migration rate. An undocumented change in the procedure corrected the problem starting in 2006, thus reducing the estimated migration rate. The change in imputation procedures explains 90% of the reported decrease in interstate migration between 2005 and 2006, and 42% of the decrease between 2000 (the recent high-water mark) and 2010. After we remove the effect of the change in procedures, we find that the annual interstate migration rate follows a smooth downward trend from 1996 to 2010. Contrary to popular belief, the 2007-2009 recession is not associated with any additional decrease in interstate migration relative to trend.     

Conceptualising the politics of social protection expansion in low income countries: The intersection of transnational ideas and domestic politics

The growing literature on social protection in low income developing countries has tended to focus on definitional debates, policy design and impact evaluations, with relatively little consideration of the ways in which politics shape policy. This article argues that politics needs to be at the centre of efforts to understand social protection and outlines a new conceptual framework for investigating this, with a particular focus on explaining the variation in progress made by low income countries in adopting and implementing social protection. We propose that an adapted ‘political settlements’ framework that incorporates insights from the literatures on welfare state development – notably ‘power constellations’ theory, discursive institutionalism and global policy networks – can help frame political commitment to social protection as flowing from the interaction of domestic political economy and transnational ideas. Importantly, this approach situates social protection within a broader political and policy context, and highlights the influence of underlying power relations at multiple levels.     

The impact of health insurance cost-sharing method on healthcare utilisation in China

In current Chinese health insurance programmes, there are two types of cost-sharing methods: the time-of-service copayment policy and the reimbursement policy. In contrast to the copayment participants, reimbursement participants need to pay for all medical expenses in advance. We study the effect of the reimbursement policy on the utilisation of healthcare services in China. The theoretical analysis indicates that the medical consumption of low income households will be less than the optimal consumption level when enrolled in a reimbursement programme instead of a copayment programme. Empirically, using data from the China Health and Retirement Longitudinal Study (CHARLS), we find that the total inpatient expenditure of the reimbursement participants is 12.7% lower than that of copayment enrolees, and the reimbursement arrangement negatively impacts low-income and rural populations. Therefore, reimbursement participants, those who are financially constrained, are more likely to suffer the up-front payment burden and finally reduce their healthcare needs.