Diffusion of Competing Innovations: The Effects of Network Structure on the Provision of Healthcare

Medical innovations, in the form of new medication or other clinical practices, evolve and spread through health care systems, impacting on the quality and standards of health care provision, which is demonstrably heterogeneous by geography. Our aim is to investigate the potential for the diffusion of innovation to influence health inequality and overall levels of recommended care. We extend existing diffusion of innovation models to produce agent-based simulations that mimic population-wide adoption of new practices by doctors within a network of influence. Using a computational model of network construction in lieu of empirical data about a network, we simulate the diffusion of competing innovations as they enter and proliferate through a state system comprising 24 geo-political regions, 216 facilities and over 77,000 individuals. Results show that stronger clustering within hospitals or geo-political regions is associated with slower adoption amongst smaller and rural facilities. Results of repeated simulation show how the nature of uptake and competition can contribute to low average levels of recommended care within a system that relies on diffusive adoption. We conclude that an increased disparity in adoption rates is associated with high levels of clustering in the network, and the social phenomena of competitive diffusion of innovation potentially contributes to low levels of recommended care.Innovation Diffusion, Scale-Free Networks, Health Policy, Agent-Based Modelling

Channel Blockade in a Two-Path Triple-Quantum-Dot System

Electronic transport through a two-path triple-quantum-dot system with two source leads and one drain is studied. By separating the conductance of the two double dot paths, we are able to observe double dot and triple dot physics in transport and study the interaction between the paths. We observe channel blockade as a result of inter-channel Coulomb interaction. The experimental results are understood with the help of a theoretical model which calculates the parameters of the system, the stability regions of each state and the full dynamical transport in the triple dot resonances.Comment: 6 pages, 6 figure

Health inequalities and development plans in Iran: An analysis of the past three decades (1984–2010)

Introduction: Reducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues. Methods: This study presents an inequalities assessment of health care expenditures in Iran. We used data from the Household Income and Expenditure Survey (HIES) in Iran from 1984–2010. The analysis included 308,735 urban and 342,532 rural households. Results: The results suggest heightened inequality in health care expenditures in Iran over the past three decades, including an increase in the gap between urban and rural areas. Furthermore, inflation has affected the poor more than the rich. The Kakwani progressivity index in all years is positive, averaging 0.436 in rural and 0.470 in urban areas during the time period of analysis. Compared to inequality in income distribution over the last 30 years, health expenditures continuously show more inequality and progressivity over the same period of time. Conclusions: According to the result of our study, during this period Iran introduced four National Development Plans (NDPs); however, the NDPs failed to provide sustainable strategies for reducing inequalities in health care expenditures. Policies that protect vulnerable groups should be prioritized

Optical photometry of the UCM Lists I and II

We present Johnson B CCD photometry for the whole sample of galaxies of the Universidad Complutense de Madrid (UCM) Survey Lists I and II. They constitute a well-defined and complete sample of galaxies in the Local Universe with active star formation. The data refer to 191 S0 to Irr galaxies at an averaged redshift of 0.027, and complement the already published Gunn r, J and K photometries. In this paper the observational and reduction features are discussed in detail, and the new colour information is combined to search for clues on the properties of the galaxies, mainly by comparing our sample with other surveys.Comment: 14 pages, 7 PostScript figures, accepted for publication in A&AS, also available vi ftp at ftp://cutrex.fis.ucm.es/pub/OUT/pag/PAPERS

Effect of spin-orbit interaction on a magnetic impurity in the vicinity of a surface

We propose a new mechanism for surface-induced magnetic anisotropy to explain the thickness-dependence of the Kondo resistivity of thin films of dilute magnetic alloys. The surface anisotropy energy, generated by spin-orbit coupling on the magnetic impurity itself, is an oscillating function of the distance d from the surface and decays as 1/d^2. Numerical estimates based on simple models suggest that this mechanism, unlike its alternatives, gives rise to an effect of the desired order of magnitude.Comment: 4 pages, 4 figure

Level and length of cyclic solar activity during the Maunder minimum as deduced from the active day statistics

The Maunder minimum (MM) of greatly reduced solar activity took place in 1645-1715, but the exact level of sunspot activity is uncertain as based, to a large extent, on historical generic statements of the absence of spots on the Sun. Here we aim, using a conservative approach, to assess the level and length of solar cycle during the Maunder minimum, on the basis of direct historical records by astronomers of that time. A database of the active and inactive days (days with and without recorded sunspots on the solar disc respectively) is constructed for three models of different levels of conservatism (loose ML, optimum MO and strict MS models) regarding generic no-spot records. We have used the active day fraction to estimate the group sunspot number during the MM. A clear cyclic variability is found throughout the MM with peaks at around 1655--1657, 1675, 1684 and 1705, and possibly 1666, with the active day fraction not exceeding 0.2, 0.3 or 0.4 during the core MM, for the three models. Estimated sunspot numbers are found very low in accordance with a grand minimum of solar activity. We have found, for the core MM (1650-1700), that: (1) A large fraction of no-spot records, corresponding to the solar meridian observations, may be unreliable in the conventional database. (2) The active day fraction remained low (below 0.3-0.4) throughout the MM, indicating the low level of sunspot activity. (3) The solar cycle appears clearly during the core MM. (4) The length of the solar cycle during the core MM appears $9\pm 1$ years, but there is an uncertainty in that. (5) The magnitude of the sunspot cycle during MM is assessed to be below 5-10 in sunspot numbers; A hypothesis of the high solar cycles during the MM is not confirmed.Comment: Accepted to Astron. Astrophy

Regional Yield Insurance for Arable Crops in EU-27

Replaced with revised version of paper 11/18/08.Area yield insurance, index insurance, yield risk, Agricultural Finance, Risk and Uncertainty,

Carers\u27 preferences for the delivery of therapy services for people with disability in rural Australia: Evidence from a discrete choice experiment

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit, private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. Results: A total of 133 carers completed the DCE. The majority of respondents cared for a child with a disability (84%), the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out of pocket cost and travelling up to 4 hours to receive a therapy session (p Conclusion: Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability

Mapping climatic risks in the EU agriculture

Replaced with revised version of paper 11/18/08.Agrometeorological models, climatic risk, European Union, Vegetation indices, Environmental Economics and Policy, Risk and Uncertainty,

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development

Objective: This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas. Methods: Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison. Results: Six attributes that may influence AHPs working with people with disability in rural areas to continue to do so were inductively identified: travel arrangements, work flexibility, professional support, professional development, remuneration, and autonomy of practice. The qualitative research information was combined with a policy review to define these retention factors and ensure that they are amenable to policy changes. Conclusion: The use of various qualitative research methods allowed the development of a policy-relevant DCE questionnaire that was grounded in the experience of the target population (AHPs)