Modern health services and health care behavior: a survey in Kathmandu, Nepal

The most important problem regarding health service utilization in Third World countries is that established indigenous forms of health care are readily available and compete with modern health care. Thus, in addition to understanding the components of the decision to seek medical help, we must understand the conditions that affect the choice of a specific health care system. This study examines the impact of medical pluralism on the use of modern forms of health care in Nepal. The findings show that the presence of medical pluralism is a significant factor which delays use of modern health services. Policy implications are discussed, and the need for more research in this area is stressed.     

Economic Value Added (EVA) for Performance Evaluation of Public Organizations

Public Organization Review - This study tests whether economic value added (EVA) as a performance evaluation metric incentivizes public administrators to increase the performance of public...     

Clustering gene expression time course data using mixtures of multivariate t-distributions

Clustering gene expression time course data is an important problem in bioinformatics because understanding which genes behave similarly can lead to the discovery of important biological information. Statistically, the problem of clustering time course data is a special case of the more general problem of clustering longitudinal data. In this paper, a very general and flexible model-based technique is used to cluster longitudinal data. Mixtures of multivariate t-distributions are utilized, with a linear model for the mean and a modified Cholesky-decomposed covariance structure. Constraints are placed upon the covariance structure, leading to a novel family of mixture models, including parsimonious models. In addition to model-based clustering, these models are also used for model-based classification, i.e., semi-supervised clustering. Parameters, including the component degrees of freedom, are estimated using an expectation-maximization algorithm and two different approaches to model selection are considered. The models are applied to simulated data to illustrate their efficacy; this includes a comparison with their Gaussian analogues—the use of these Gaussian analogues with a linear model for the mean is novel in itself. Our family of multivariate t mixture models is then applied to two real gene expression time course data sets and the results are discussed. We conclude with a summary, suggestions for future work, and a discussion about constraining the degrees of freedom parameter.     

Vulnerability,Risk Perception,and Health Profile of Marginalized People Exposed to Multiple Built‐Environment Stressors in Worcester,Massachusetts: A Pilot Project

Millions of low‐income people of diverse ethnicities inhabit stressful old urban industrial neighborhoods. Yet we know little about the health impacts of built‐environment stressors and risk perceptions in such settings; we lack even basic health profiles. Difficult access is one reason (it took us 30 months to survey 80 households); the lack of multifaceted survey tools is another. We designed and implemented a pilot vulnerability assessment tool in Worcester, Massachusetts. We answer: (1) How can we assess vulnerability to multiple stressors? (2) What is the nature of complex vulnerability—including risk perceptions and health profiles? (3) How can findings be used by our wider community, and what lessons did we learn? (4) What implications arise for science and policy? We sought a holistic picture of neighborhood life. A reasonably representative sample of 80 respondents captured data for 254 people about: demographics, community concerns and resources, time‐activity patterns, health information, risk/stress perceptions, and resources/capacities for coping. Our key findings derive partly from the survey data and partly from our experience in obtaining those data. Data strongly suggest complex vulnerability dominated by psychosocial stress. Unexpected significant gender and ethnic disease disparities emerged: notably, females have twice the disease burden of males, and white females twice the burden of females of color (p < 0.01). Self‐reported depression differentiated by gender and age is illustrative. Community based participatory research (CBPR) approaches require active engagement with marginalized populations, including representatives as funded partners. Complex vulnerability necessitates holistic, participatory approaches to improve scientific understanding and societal responses.     

SNP selection for predicting a quantitative trait

Molecular markers combined with powerful statistical tools have made it possible to detect and analyze multiple loci on the genome that are responsible for the phenotypic variation in quantitative traits. The objectives of the study presented in this paper are to identify a subset of single nucleotide polymorphism (SNP) markers that are associated with a particular trait and to construct a model that can best predict the value of the trait given the genotypic information of the SNPs using a three-step strategy. In the first step, a genome-wide association test is performed to screen SNPs that are associated with the quantitative trait of interest. SNPs with p-values of less than 5% are then analyzed in the second step. In the second step, a large number of randomly selected models, each consisting of a fixed number of randomly selected SNPs, are analyzed using the least angle regression method. This step will further remove redundant SNPs due to the complicated association among SNPs. A subset of SNPs that are shown to have a significant effect on the response trait more often than by chance are considered for the third step. In the third step, two alternative methods are considered: the least angle shrinkage and selection operation and sparse partial least squares regression. For both methods, the predictive ability of the fitted model is evaluated by an independent test set. The performance of the proposed method is illustrated by the analysis of a real data set on Canadian Holstein cattle.     

Helping parents with mental illnesses and their children: a call for family-focused mental health care

1. Large numbers of individuals with mental illnesses are parents to minor children. 2. Recommendations to improve services suggest that services provided by the adult mental health system and child service agencies be coordinated. 3. Nursing care intersects both the adult and child systems, and nurses have the expertise to offer a variety of services. 4. There is an urgent need to improve family-focused mental health nursing care to benefit parents with mental illnesses, their children and families, and the overall community and society.