The Modern Census: Evolution, Examples and Evaluation

A national census provides important information on a country's population that is used in government planning and to underpin the national statistical system. Therefore, the quality of such information is paramount but is not as simple as the crude accuracy of population totals. Furthermore, changes in the pace and nature of modern life, such as the growing geographical mobility of the population, increasingly pose challenges to census practice and data quality. More recently, even the need for a census has been questioned on grounds of financial austerity and widespread availability of alternative population information sources. This article reviews how the modern census originated and how it evolved to confront these challenges, driven by indicators of quality and needs of users, and provides reflections on the future of the census within the national statistical infrastructure. To illustrate our discussions, we use case studies from a diverse range of national contexts. We demonstrate the implications that a country's needs, circumstances and experiences have on the census approach and practice while identifying the fundamental demographic assumptions

The orientations of molecular clouds in the outer Galaxy: Evidence for the scale of the turbulence driver ?

Supernova explosions inject a considerable amount of energy into the interstellar medium (ISM) in regions with high to moderate star formation rates. In order to assess whether the driving of turbulence by supernovae is also important in the outer Galactic disk, where the star formation rates are lower, we study the spatial distribution of molecular cloud (MC) inclinations with respect to the Galactic plane. The latter contains important information on the nature of the mechanism of energy injection into the ISM. We analyze the spatial correlations between the position angles (PAs) of a selected sample of MCs (the largest clouds in the catalogue of the outer Galaxy published by Heyer et al. 2001). Our results show that when the PAs of the clouds are all mapped to values into the [0,90]degrees interval, there is a significant degree of spatial correlation between the $PA$s on spatial scales in the range of 100-800 pc. These scales are of the order of the sizes of individual SN shells in low density environments such as those prevailing in the outer Galaxy and where the metallicity of the ambient gas is of the order of the solar value or smaller. These findings suggest that individual SN explosions, occurring in the outer regions of the Galaxy and in likewise spiral galaxies, albeit at lower rates, continue to play an important role in shaping the structure and dynamics of the ISM in those regions. The SN explosions we postulate here are likely associated with the existence of young stellar clusters in the far outer regions of the Galaxy and the UV emission and low levels of star formation observed with the GALEX satellite in the outer regions of local galaxies.Comment: Accepted to MNRAS main journal. Additional discussion and and one figure with error estimates is added. 7 pages, 7 figures. Main conclusions unchange

Valuing air transportation and sustainability from a public perspective: Evidence from the United Kingdom and the United States

AbstractOne issue with air transportation and sustainability is that although aviation could be considered economically and socially sustainable, it does generate environmental concerns. The aim of this paper is to examine public attitudes towards air transportation and sustainability, in order to determine how individuals value sustainability in relation to air travel. This empirical paper is based on two large survey data sets, one from the East Midlands region of the United Kingdom and one from the East Coast of the United States. After an initial review of relevant literature and policy, a range of attitudinal statements from the surveys are examined. These statements cover the economic and social benefits of air transportation, the contribution of air travel to climate change, and environmental responses. The analysis demonstrates the high value individuals put on the economic and social sustainability aspects of air transportation. Although many acknowledge aviation's contribution to climate change, few are willing to respond in terms of paying more to offset the negative environmental effects of aviation or to fly less. When analysing the value of sustainability by population sub-group, flight frequency and gender are highlighted as key variables in terms of environmental attitudes

Increase in computed tomography in Australia driven mainly by practice change: A decomposition analysis

Background: Publicly funded computed tomography (CT) procedure descriptions in Australia often specify the body site, rather than indication for use. This study aimed to evaluate the relative contribution of demographic versus non-demographic factors in driving the increase in CT services in Australia. Methods: A decomposition analysis was conducted to assess the proportion of additional CT attributable to changing population structure, CT use on a per capita basis (CPC, a proxy for change in practice) and/or cost of CT. Aggregated Medicare usage and billing data were obtained for selected years between 1993/4 and 2012/3. Results: The number of billed CT scans rose from 33 per annum per 1000 of population in 1993/94 (total 572,925) to 112 per 1000 by 2012/13 (total 2,540,546). The respective cost to Medicare rose from $145.7 million to$790.7 million. Change in CPC was the most important factor accounting for changes in CT services (88%) and cost (65%) over the study period. Conclusions: While this study cannot conclude if the increase is appropriate, it does represent a shift in how CT is used, relative to when many CT services were listed for public funding. This ‘scope shift’ poses questions as to need for and frequency of retrospective/ongoing review of publicly funded services, as medical advances and other demand- or supply-side factors change the way health services are used

Making tax and social security decisions: lean and deskilling in the UK Civil Service

Lean working has had a significant impact on the work skills of civil servants. This study examines the impact of lean specifically focusing on ‘decision-makers’, those civil servants engaged in deciding tax and social security claims. Using qualitative data from trade union members and stewards in two major government departments, this study found significant evidence of deskilling often in the face of dealing with potentially complex legal and factual issues. Using Mashaw's framework of administrative justice, the article argues that management's use of lean was evidence of an accelerated shift to a managerial model of administering tax and benefits where the administrative processes of decision-making become paramount at the expense of the quality of the decisions made

From design to operations: a process management life-cycle performance measurement system for Public-Private Partnerships

YesPublic–Private Partnerships (PPPs) have become a critical vehicle for delivering infrastructure worldwide. Yet, the use of such a procurement strategy has received considerable criticism, as they have been prone to experiencing time/cost overruns and during their operation poorly managed. A key issue contributing to the poor performance of PPPs is the paucity of an effective and comprehensive performance measurement system. There has been a tendency for the performance of PPPs to be measured based on their ex-post criteria of time, cost and quality. Such criteria do not accommodate the complexities and lifecycle of an asset. In addressing this problem, the methodology of sequential triangulation is used to develop and examine the effectiveness of a ‘Process Management Life Cycle Performance Measurement System’. The research provides public authorities and private-sector entities embarking on PPPs with a robust mechanism to effectively measure, control and manage their projects’ life cycle performances, ensuring the assets are ‘future proofed’

Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme

Background Ambulance service quality measures have focused on response times and a small number of emergency conditions, such as cardiac arrest. These quality measures do not reflect the care for the wide range of problems that ambulance services respond to and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme sought to address this. Objectives The aim was to develop new ways of measuring the impact of ambulance service care by reviewing and synthesising literature on prehospital ambulance outcome measures and using consensus methods to identify measures for further development; creating a data set linking routinely collected ambulance service, hospital and mortality data; and using the linked data to explore the development of case-mix adjustment models to assess differences or changes in processes and outcomes resulting from ambulance service care. Design A mixed-methods study using a systematic review and synthesis of performance and outcome measures reported in policy and research literature; qualitative interviews with ambulance service users; a three-stage consensus process to identify candidate indicators; the creation of a data set linking ambulance, hospital and mortality data; and statistical modelling of the linked data set to produce novel case-mix adjustment measures of ambulance service quality. Setting East Midlands and Yorkshire, England. Participants Ambulance services, patients, public, emergency care clinical academics, commissioners and policy-makers between 2011 and 2015. Interventions None. Main outcome measures Ambulance performance and quality measures. Data sources Ambulance call-and-dispatch and electronic patient report forms, Hospital Episode Statistics, accident and emergency and inpatient data, and Office for National Statistics mortality data. Results Seventy-two candidate measures were generated from systematic reviews in four categories: (1) ambulance service operations (n = 14), (2) clinical management of patients (n = 20), (3) impact of care on patients (n = 9) and (4) time measures (n = 29). The most common operations measures were call triage accuracy; clinical management was adherence to care protocols, and for patient outcome it was survival measures. Excluding time measures, nine measures were highly prioritised by participants taking part in the consensus event, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to refine and prioritise measures and 20 measures scored ≥ 8/9 points, which indicated good consensus. Eighteen patient and public representatives attending a consensus workshop identified six measures as important: time to definitive care, response time, reduction in pain score, calls correctly prioritised to appropriate levels of response, proportion of patients with a specific condition who are treated in accordance with established guidelines, and survival to hospital discharge for treatable emergency conditions. From this we developed six new potential indicators using the linked data set, of which five were constructed using case-mix-adjusted predictive models: (1) mean change in pain score; (2) proportion of serious emergency conditions correctly identified at the time of the 999 call; (3) response time (unadjusted); (4) proportion of decisions to leave a patient at scene that were potentially inappropriate; (5) proportion of patients transported to the emergency department by 999 emergency ambulance who did not require treatment or investigation(s); and (6) proportion of ambulance patients with a serious emergency condition who survive to admission, and to 7 days post admission. Two indicators (pain score and response times) did not need case-mix adjustment. Among the four adjusted indicators, we found that accuracy of call triage was 61%, rate of potentially inappropriate decisions to leave at home was 5–10%, unnecessary transport to hospital was 1.7–19.2% and survival to hospital admission was 89.5–96.4% depending on Clinical Commissioning Group area. We were unable to complete a fourth objective to test the indicators in use because of delays in obtaining data. An economic analysis using indicators (4) and (5) showed that incorrect decisions resulted in higher costs. Limitations Creation of a linked data set was complex and time-consuming and data quality was variable. Construction of the indicators was also complex and revealed the effects of other services on outcome, which limits comparisons between services. Conclusions We identified and prioritised, through consensus processes, a set of potential ambulance service quality measures that reflected preferences of services and users. Together, these encompass a broad range of domains relevant to the population using the emergency ambulance service. The quality measures can be used to compare ambulance services or regions or measure performance over time if there are improvements in mechanisms for linking data across services. Future work The new measures can be used to assess different dimensions of ambulance service delivery but current data challenges prohibit routine use. There are opportunities to improve data linkage processes and to further develop, validate and simplify these measures. Funding The National Institute for Health Research Programme Grants for Applied Research programme