Integrating ethical enquiry and health technology assessment: limits and opportunities for efficiency and equity

This paper aims at discussing some contributions, limitations and opportunities that efficiency and equity studies could make to form a better understanding of ethical issues involved in health technology assessment (HTA). Prenatal detection of Down syndrome is used as a case study for further discussions regarding efficiency and equity, as well as other ethical principles including beneficence, non-maleficence and autonomy. The development and use of adequate methods and the need for context appraisal are two imperative issues in this field of knowledge. The analysis of ethical implications in HTA should account for both. Economic evaluation methodologies have great potential in the assessment of some key ethical principles such as efficiency and equity but are of limited use concerning other fundamental principles. Social and individual values play a prominent role in this respect.     

Quality strategies in supply chain alliances of disposable items

This paper studies a single-product distribution channel where a supplier manufactures items of a given type, some of which are defective, that are sold by a retailer who only detects a subset of the defective items, passing the rest along to customers. We conjecture the structure of the demand and cost functions, assuming customers to have a decreasing marginal aversion to bad quality while both the supplier and the retailer make marginally increasing efforts to avoid bad quality. This allows us to deduce several implicit parameters of a cost model based on observable data, such as the share of the channel margin. Once the parameters of the model are available, we analyze the result of vertical integration. Although we confirm the well-known fact that vertical integration improves the quality perceived by the customer, we characterize the supplier's decision of whether or not to provide a better quality in terms of the individual channel margins. As an alternative, we derive the conditions under which the supplier and the retailer may devise a mutually beneficial transfer contract that simultaneously increases their profit and improves quality.     

Improved model selection criteria for SETAR time series models

The purpose of this paper is threefold. First, we obtain the asymptotic properties of the modified model selection criteria proposed by Hurvich et al. (1990. Improved estimators of Kullback-Leibler information for autoregressive model selection in small samples. Biometrika 77, 709–719) for autoregressive models. Second, we provide some highlights on the better performance of this modified criteria. Third, we extend the modification introduced by these authors to model selection criteria commonly used in the class of self-exciting threshold autoregressive (SETAR) time series models. We show the improvements of the modified criteria in their finite sample performance. In particular, for small and medium sample size the frequency of selecting the true model improves for the consistent criteria and the root mean square error (RMSE) of prediction improves for the efficient criteria. These results are illustrated via simulation with SETAR models in which we assume that the threshold and the parameters are unknown.     

When the Export of Social Problems Is No Longer Possible: Immigration Policies and Unemployment in Switzerland

Throughout the twentieth century, Switzerland has been one of the OECD countries with the highest proportion of immigrants in its population. The aim of this article is to show how institutional factors have shaped the opportunities for change in immigration and immigrant‐employment‐related policies there in the 1990s. Whereas unemployment had remained low in the 1970s and 1980s, there was a marked increase at the beginning of the 1990s. Existing migration policies were considered a central cause of this increase, since the great majority of foreigners who had come and settled in Switzerland in the periods of economic expansion were low‐skilled, and were now over‐represented among the unemployed. The reforms undertaken in the field of immigration and integration policy to respond to these new problems have been determined by specific institutional factors: direct democracy, a defensive migration regime, the development of immigrant rights and the weak autonomy of the central state. These factors account to a large extent for the limited scope and specific pathways of policy reforms in these two domains.     

Measuring credibility of compensatory preference statements when trade-offs are interval determined

This paper studies how an overall fuzzy preference relation can be constructed in the compensatory context of the simple additive difference model, when imprecision on the trade-offs has to be taken into account. Three credibility indices of preferences are analysed and illustrated by a numerical example. Arguments are presented supporting the use of the third index, for which an interesting transitivity property (which was an open problem) is proved.     

Stable and visualizable Gaussian parsimonious clustering models

Gaussian mixture model-based clustering is now a standard tool to determine a hypothetical underlying structure in continuous data. However, many usual parsimonious models, despite either their appealing geometrical interpretation or their ability to deal with high dimensional data, suffer from major drawbacks due to scale dependence or unsustainability of the constraints after projection. In this work we present a new family of parsimonious Gaussian models based on a variance-correlation decomposition of the covariance matrices. These new models are stable when projected into the canonical planes and, so, faithfully representable in low dimension. They are also stable by modification of the measurement units of the data and such a modification does not change the model selection based on likelihood criteria. We highlight all these stability properties by a specific graphical representation of each model. A detailed Generalized EM (GEM) algorithm is also provided for every model inference. Then, on biological and geological data, we compare our stable models to standard ones (geometrical models and factor analyzer models), which underlines all the profit to obtain unit-free models.     

A Stochastic Model to Assess the Effect of Meat Inspection Practices on the Contamination of the Pig Carcasses

The objective of meat inspection is to promote animal and public health by preventing, detecting, and controlling hazards originating from animals. With the improvements of sanitary level in pig herds, the hazards profile has shifted and the inspection procedures no longer target major foodborne pathogens (i.e., not risk based). Additionally, carcass manipulations performed when searching for macroscopic lesions can lead to cross‐contamination. We therefore developed a stochastic model to quantitatively describe cross‐contamination when consecutive carcasses are submitted to classic inspection procedures. The microbial hazard used to illustrate the model was Salmonella, the data set was obtained from Brazilian slaughterhouses, and some simplifying assumptions were made. The model predicted that due to cross‐contamination during inspection, the prevalence of contaminated carcass surfaces increased from 1.2% to 95.7%, whereas the mean contamination on contaminated surfaces decreased from 1 logCFU/cm² to ?0.87 logCFU/cm², and the standard deviations decreased from 0.65 to 0.19. These results are explained by the fact that, due to carcass manipulations with hands, knives, and hooks, including the cutting of contaminated lymph nodes, Salmonella is transferred to previously uncontaminated carcasses, but in small quantities. These small quantities can easily go undetected during sampling. Sensitivity analyses gave insight into the model performance and showed that the touching and cutting of lymph nodes during inspection can be an important source of carcass contamination. The model can serve as a tool to support discussions on the modernization of pig carcass inspection.     

Ridge Regression and Generalized Maximum Entropy: An improved version of the Ridge–GME parameter estimator

In this article, the Ridge–GME parameter estimator, which combines Ridge Regression and Generalized Maximum Entropy, is improved in order to eliminate the subjectivity in the analysis of the ridge trace. A serious concern with the visual inspection of the ridge trace to define the supports for the parameters in the Ridge–GME parameter estimator is the misinterpretation of some ridge traces, in particular where some of them are very close to the axes. A simulation study and two empirical applications are used to illustrate the performance of the improved estimator. A MATLAB code is provided as supplementary material.     

Sexual Beliefs and Sexual Functioning: The Mediating Role of Cognitive Distraction

Dysfunctional sexual beliefs are vulnerability factors for sexual dysfunction. This cross-sectional study aimed to test the mediating role of cognitive distraction on the relationship between dysfunctional sexual beliefs about sexual functioning shared by men and women and sexual function. The authors used a sample of 421 cisgender heterosexual participants involved in a monogamous relationship. The hypothesized mediation model was tested using a bootstrapped cross product of coefficients approach. Results showed a significant negative, indirect effect between dysfunctional sexual beliefs and women's sexual function through cognitive distraction. The discussion of this study highlights the importance of cognitive factors in sexual functioning.     

What Influences the Location of Nonprofit Organizations? A Spatial Analysis in Brazil

What are the local characteristics influencing where new nonprofits will be established? How important are community needs, available resources, or the existence of similar organizations for nonprofits’ location? This paper analyzes how the characteristics of 5562 Brazilian municipalities in the year 2000 help explain the location of nonprofits formed between 2001 and 2010. Based on geographically weighted regressions, results indicate that neither access to resources nor poor socioeconomic indicators are powerful influences on nonprofit location in Brazilian municipalities. The main predictor of nonprofit entry is a high pre-existing density of nonprofits in that area. These findings, however, vary across regions and nonprofit fields of activity. By mapping the effect of key explanatory variables, this paper helps understand nonprofit location. The methodology and findings on nonprofit location presented here are novel and may contribute to research in other countries.