Wearing Out -- The Decline in Health

The acquisition of chronic diseases and lifestyle choices are key aspect i the decline in health. Case and Deaton (2005) examine the importance of manual work in altering both the level of and rate of decline in health status with age. Using data from Canada, our paper extends this analysis by investigating the interaction of manual work with chronic conditions and lifestyle on the aging process. To our surprise the independent importance of manual work remains even after one accounts for the large role of lifestyle and chronic diseases.Morbidity, Aging Chronic Disease

Prior Conditions, Age and the Impact of Insurance

Health insurance coverage reduces the price perceived by the insured and consequently increases the quantity of health care demanded. We consider vision care insurance because this provides a unique opportunity to observe the differential response to insurance coverage by those with and without a prior medical condition. The results show that there is a response by both groups and the response is larger for those with a prior condition. We also find that vision care insurance is poorly matched in time to the patterns of vision care needsHealth Insurance, Vision Care, Prior Conditions

The Effectiveness of Anti-Smoking Campaigns over the Life-Cycle and the Role of Information

Our study documents the effectiveness of anti-smoking campaigns on various age groups and attempts to shed some light on the mechanism by which community interventions operate and affect smokers. We re-examine evidence from a large scale National Cancer Institute community-wide intervention study entitled `The Community Intervention Trial for Smoking Cessation' (COMMIT). Our empirical results show that this intervention has differential effects on the quit rates of smokers. This variation has not been observed in the earlier literature on anti-smoking campaigns and was not noticed by previous studies using the COMMIT data. The quit rates in the intervention group are found to be significantly higher for individuals aged 30 to 37 and those aged 60 and up, but lower for those younger than 30. The various channels of the COMMIT study were developed to create an awareness and recognition that smoking is a public health problem, and to change the social acceptability of smoking. In light of the age variation uncovered, we argue that the public information channel may play a crucial role in affecting change. In particular, public awareness about the negative health consequences of smoking is likely to be responsible for the increased quits among older smokers in the treatment group.Anti-Smoking Campaigns, Smoking, Tobacco, Tobacco Control

The Collective Marriage Matching Model: Identification, Estimation and Testing

We develop and estimate an empirical collective model with endogenous marriage formation, participation, and family labor supply. Intra-household transfers arise endogenously as the transfers that clear the marriage market. The intra-household allocation can be recovered from observations on marriage decisions. Introducing the marriage market in the collective model allows us to independently estimate transfers from labor supplies and from marriage decisions. We estimate a semi-parametric version of our model using 2000 US Census data. Estimates of the model using marriage data are much more consistent with the theoretical predictions than estimates derived from labor supply.collective model, marriage matching, intrahousehold allocations

Marriage matching, risk sharing and spousal labor supplies

This paper develops the collective marriage matching model, a behavioral and empirically flexible framework that incorporates both marriage matching and intrahousehold allocations. The model shows how marriage market equilibrium and bargaining power within the family are simultaneously determined. The framework provides a solution to the problem of incorporating substitute sex ratios in empirical models of spousal labor supplies. Using data from the US 2000 census, the empirical results show that changes in marriage market tightness, the ratio of unmarried men to unmarried women, have large estimated effects on spousal labor force participation rates, and smaller effects on hours of work and hours in home production. Controlling for variation in labor market conditions across marriage markets has substantive implications for the parameter estimates.marriage matching, intrahousehold allocations, spousal labor supplies, collective model, Choo Siow

Matching Function Equilibria with Partial Assignment: Existence, Uniqueness and Estimation

In this paper, we argue that models coming from a variety of fields share a common structure that we call matching function equilibria with partial assignment. This structure revolves around an aggregate matching function and a system of nonlinear equations. This encompasses search and matching models, matching models with transferable, non-transferable and imperfectly transferable utility, and matching with peer effects. We provide a proof of existence and uniqueness of an equilibrium as well as an efficient algorithm to compute it. We show how to estimate parametric versions of these models by maximum likelihood. We also propose an approach to construct counterfactuals without estimating the matching functions for a subclass of models. We illustrate our estimation approach by analyzing the impact of the elimination of the Social Security Student Benefit Program in 1982 on the marriage market in the United States

Synthesis of superparamagnetic nanostructures and their magnetic resonance imaging applications

Ph.DDOCTOR OF PHILOSOPH

Évaluation d’un programme de recherche canadien pour les résidents en anesthésiologie par rapport aux normes nationales à l’aide d’un modèle logique : une étude d’amélioration de la qualité

Background: Canadian specialty training programs are expected to deliver curriculum content and assess competencies related to the CanMEDS Scholar role. We evaluated our residency research program and benchmarked it against national norms for quality improvement purposes. Methods: In 2021, we reviewed departmental curriculum documents and surveyed current and recently graduated residents.  We applied a logic model framework to assess if our program’s inputs, activities, and outputs addressed the relevant CanMeds Scholar competencies.  We then descriptively benchmarked our results against a 2021 environmental scan of Canadian anesthesiology resident research programs. Results: Local program content was successfully mapped to competencies.  The local survey response rate was 40/55 (73%).  In benchmarking, our program excelled in providing milestone-related assessments, research funding, administrative, supervisory, and methodologic support, and requiring a literature review, proposal presentation, and local abstract submission as output.  Acceptable activities to meet research requirements vary greatly among programs.  Balancing competing clinical and research responsibilities was a frequently reported challenge.   Conclusions: The logic model framework was easily applied and demonstrated our program benchmarked well against national norms.  National level dialogue is needed to develop specific, consistent scholar role activities and competency assessments to bridge the gap between expected outcome standards and education practice.Contexte : Les programmes de spécialité canadiens doivent proposer un contenu de formation en lien avec le rôle CanMEDS d’érudit et évaluer les compétences qui s’y attachent. Nous avons évalué notre programme de résidence en recherche par rapport aux normes nationales en la matière à des fins d’amélioration de la qualité. Méthodes : En 2021, nous avons examiné les documents du programme d’études du département et interrogé des résidents et des médecins récemment diplômés. Nous avons utilisé un modèle logique pour déterminer si les intrants, les activités et les extrants de notre programme couvraient adéquatement les compétences pertinentes liées au rôle CanMeds d’érudit. Nous avons ensuite comparé de façon descriptive nos résultats à une analyse du milieu des programmes de résidence canadiens en recherche en anesthésiologie effectuée la même année. Résultats : Nous avons établi une correspondance entre le contenu du programme local et les compétences. Le taux de réponse à l’enquête était de 40/55 (73 %). D’après l’analyse comparative, notre programme se démarque par l’offre d’évaluations d’étape, de fonds de recherche, de soutien administratif, de supervision, d’orientation méthodologique, et, en ce qui concerne les extrants, par l’exigence d’une analyse documentaire, de la présentation d’une proposition et de la soumission d’un résumé à l’université. Les activités admissibles pour répondre aux exigences de la recherche varient considérablement d’un programme à l’autre. De nombreux répondants ont signalé la difficulté de concilier les responsabilités cliniques et de recherche. Conclusions : L’application du modèle logique a été aisée et elle a permis de montrer que notre programme respecte les normes nationales. Un dialogue au niveau national est nécessaire pour définir de manière précise et cohérente les activités et les évaluations des compétences en lien avec le rôle d’érudit afin de combler le fossé entre les normes quant aux résultats attendus et les pratiques des programmes

Intérêt d’un score de la qualité de l'évaluation pour l'apprentissage pour évaluer la rétroaction écrite dans la formation postdoctorale en anesthésiologie : étude de généralisabilité et de décision

Background: Competency based residency programs depend on high quality feedback from the assessment of entrustable professional activities (EPA). The Quality of Assessment for Learning (QuAL) score is a tool developed to rate the quality of narrative comments in workplace-based assessments; it has validity evidence for scoring the quality of narrative feedback provided to emergency medicine residents, but it is unknown whether the QuAL score is reliable in the assessment of narrative feedback in other postgraduate programs. Methods: Fifty sets of EPA narratives from a single academic year at our competency based medical education post-graduate anesthesia program were selected by stratified sampling within defined parameters [e.g. resident gender and stage of training, assessor gender, Competency By Design training level, and word count (≥17 or <17 words)]. Two competency committee members and two medical students rated the quality of narrative feedback using a utility score and QuAL score. We used Kendall’s tau-b co-efficient to compare the perceived utility of the written feedback to the quality assessed with the QuAL score. The authors used generalizability and decision studies to estimate the reliability and generalizability coefficients. Results: Both the faculty’s utility scores and QuAL scores (r = 0.646, p < 0.001) and the trainees’ utility scores and QuAL scores (r = 0.667, p < 0.001) were moderately correlated. Results from the generalizability studies showed that utility scores were reliable with two raters for both faculty (Epsilon=0.87, Phi=0.86) and trainees (Epsilon=0.88, Phi=0.88). Conclusions: The QuAL score is correlated with faculty- and trainee-rated utility of anesthesia EPA feedback. Both faculty and trainees can reliability apply the QuAL score to anesthesia EPA narrative feedback. This tool has the potential to be used for faculty development and program evaluation in Competency Based Medical Education. Other programs could consider replicating our study in their specialty.Contexte : La qualité de la rétroaction à la suite de l’évaluation d’activités professionnelles confiables (APC) est d’une importance capitale dans les programmes de résidence fondés sur les compétences. Le score QuAL (Quality of Assessment for Learning) est un outil développé pour évaluer la qualité de la rétroaction narrative dans les évaluations en milieu de travail. Sa validité a été démontrée dans le cas des commentaires narratifs fournis aux résidents en médecine d'urgence, mais sa fiabilité n’a pas été évaluée dans d'autres programmes de formation postdoctorale. Méthodes : Cinquante ensembles de commentaires portant sur des APC d'une seule année universitaire dans notre programme postdoctoral en anesthésiologie – un programme fondé sur les compétences – ont été sélectionnés par échantillonnage stratifié selon des paramètres préétablis [par exemple, le sexe du résident et son niveau de formation, le sexe de l'évaluateur, le niveau de formation en Compétence par conception, et le nombre de mots (≥17 ou <17 mots)]. Deux membres du comité de compétence et deux étudiants en médecine ont évalué la qualité de la rétroaction narrative à l'aide d'un score d'utilité et d'un score QuAL. Nous avons utilisé le coefficient tau-b de Kendall pour comparer l'utilité perçue de la rétroaction écrite et sa qualité évaluée à l’aide du score QuAL. Les auteurs ont utilisé des études de généralisabilité et de décision pour estimer les coefficients de fiabilité et de généralisabilité. Résultats : Les scores d'utilité et les scores QuAL des enseignants (r = 0,646, p < 0,001) et ceux des étudiants (r = 0,667, p < 0,001) étaient modérément corrélés. Les résultats des études de généralisabilité ont montré qu’avec deux évaluateurs les scores d'utilité étaient fiables tant pour les enseignants (Epsilon=0,87, Phi=0,86) que pour les étudiants (Epsilon=0,88, Phi=0,88). Conclusions : Le score QuAL est en corrélation avec l'utilité de la rétroaction sur les APC en anesthésiologie évaluée par les enseignants et les étudiants. Les uns et les autres peuvent appliquer de manière fiable le score QuAL aux commentaires narratifs sur les APC en anesthésiologie. Cet outil pourrait être utilisé pour le perfectionnement professoral et l'évaluation des programmes dans le cadre d’une formation médicale fondée sur les compétences. D'autres programmes pourraient envisager de reproduire notre étude dans leur spécialité

Novel positioning sensor with real-time feedback for improved postoperative positioning: pilot study in control subjects

Introduction: Repair of retinal detachment frequently requires use of intraocular gas. Patients are instructed to position themselves postoperatively to appose the intraocular bubble to the retinal break(s). We developed a novel wearable wireless positioning sensor, which provides real-time audiovisual feedback on the accuracy of positioning. Methods: Eight healthy volunteers wore the wireless sensor for 3 hours while instructed to maintain their head tilted toward the 2 o’clock meridian with no audiovisual feedback. Positioning accuracy was recorded. The subjects repeated the experiment for 3 hours with the audiovisual feedback enabled. Results: With no audiovisual feedback, the percentage of time greater than 10° out of position varied from 8.9% to 93.9%. With audiovisual feedback enabled, these percentages ranged from 9.4% to 65%. Three subjects showed significant improvement in their time out of position (P<0.01, Fisher’s exact test). Four subjects demonstrated a nonsignificant improvement, and one subject had a significant increase in time out of position with feedback (P<0.01). When pooled, all subjects demonstrated a statistically significant decrease in degrees out of position (P<0.001, Wilcoxon test) and a statistically significant improvement in total time out of position (P<0.001). Conclusion: The novel positioning sensor showed improved positioning compliance in half of the healthy volunteers during our short pilot study. Other subjects derived little benefit from the feedback. The causes for this observation are unclear. However, given the significant improvement as a group, this new technology could be beneficial to patients who struggle with postoperative positioning