Identifying and Reducing Overlap in Farm Program Support

The current debate surrounding the 2012 Farm Act stresses cutting costs while maintaining, or even strengthening, farmers’ “safety net.” One way to cut costs is to reduce or eliminate potential overlap of farm program payments. Using simulations, we explore the interaction between the Average Crop Revenue Election (ACRE) program and a revenue assurance (RA) crop insurance program for corn, soybean, and wheat farmers in IL, MN, and SD. Additionally, we examine whether receiving benefits from multiple programs (an RA program, the Supplemental Revenue (SURE) program, and an ad hoc disaster assistance program) distorts farmers’ business decisions. We find overlap between ACRE and crop insurance, which could lead to budgetary savings if these two programs were to be integrated. Moreover, despite policymakers explicitly incorporating insurance indemnities into SURE payment calculations, access to both programs can alter behavior. Finally, in a counter-factual analysis, we show that removing ad hoc payments from the SURE would likely alter farm behavior.commodity support, average crop revenue election, Supplemental Revenue Assistance, expected utility, corn, wheat, soybeans, Agricultural and Food Policy, Production Economics, Risk and Uncertainty,

Mathematical Model Studies on the Optimal Scheduling of the Treatment of Systemic Malignant Disease by Radiation

The work reported in this thesis deals with mathematical model studies on the optimal scheduling of treatment of systemic malignant disease by radiation. To provide the necessary background to the original aspects of the work reviews of several fields are required. Chapter 1 is a general review of normal tissue radiobiology. Chapter 2 is a review of human tumour radiobiology. Chapter 3 focusses on one particular isoeffect model, the linear-quadratic or LQ model, which is employed throughout this thesis to describe the effects of radiation on normal tissues. These basic radiobiological principles are applied to the clinical modalities of total body irradiation (TBI) and biologically targeted radiotherapy (BTR). Chapter 4 reviews the principles of TBI. Chapter 5 is a review of published data on the in-vitro radiosensitivities of human leukaemia/lymphoma and neuroblastoma, two conditions which require a systemic approach to treatment. Chapter 8 is a review of the principles of BTR. The original work is contained in the appendix to chapter 3, which examines the correspondence between the LQ model and CRE models for continuous radiation exposures with constant and exponentially decaying dose-rates; chapter 6, Which examines the question of whether fractionated or low dose-rate TBI is the superior method of treatment; chapter 7, where the optimal scheduling of fractionated TBI is investigated; chapter 9, where the LQ isoeffect model and a dosimetric approach is used for the evaluation of alternative therapeutic strategies for the treatment of widespread micrornetastatic disease by BTR. Finally, in chapter 10 a simple model is used to investigate optimal scheduling of BTR, TBI and marrow rescue. CONCLUSIONS 1/ Comparison of the LQ model and the CRE model for continuous radiation exposures: for constant dose-rates it is found that, when late-effect parameter values are used in the LQ model, there is a correspondence between the models' predictions. There is no correspondence between models when acute-effect parameter values are used in the LQ model. In the case of exponentially decaying dose-rates the predictions of the CRE and LQ models appear more divergent, although again the use of late rather than acute-effect parameter values in the LQ model gives a closer match to the CRE. 2/ Fractionated TBI is predicted to be preferable to low dose-rate TBI treatment. Although theoretically the methods can be equivalent, low dose-rate treatments would have to be over impractically long treatment times. 3/ In the case of external beam TBI, fractionated low dose-rate treatments do not appear to offer a significant improvement over fractionated high dose-rate treatments. This is because in order to achieve a significant increase in dose or reduction in toxicity impractically long exposure times are required. It is expected that this finding will be true in general for external beam radiotherapy, not just in the case of TBI. 4/ Optimal fractionation schedules for the treatment of leukaemia/lymphoma and neuroblastoma by TBI are predicted to be accelerated and hyperfractionated. It is suggested that a two fraction per day schedule of 10 fractions of 1.3-1.5 Gy is a suitable candidate for clinical evaluation. 5/ It is concluded that knowledge of ratios for tumours and normal tissues is, by itself, insufficient information to enable prediction of optimal schedules. 6/ In the case of BTR, dose-rate effects are predicted to be important for late-responding tissues. Tolerance doses may be greater or less than those for fractionated radiotherapy depending on the effective radionuclide half-life. 7/ When injected activities of targeted radionuclide are restricted by haemopoietic tolerance, curative therapy is unlikely. 131-I appears to be a better radionuclide warhead for therapy of micrometastases than 90-Y. 8/ The use of bone marrow rescue in conjunction with BTR seems to offer curative potential, however reasons are presented why a combined strategy using BTR, TBI and marrow rescue is likely to be preferable. 9/ For optimal scheduling of BTR, TBI and marrow rescue, the main characteristics of BTR which determine curative potential are its specificity and sensitivity. Specificity is defined here as the ratio of initial dose-rate at the tumour cells to that in the dose-limiting tissue. Sensitivity is inversely related to the proportion of tumour cells which escape targeting. Where biological targeting is highly specific but some tumour cells escape, a phenomenon of "overkill" will largely determine the optimal schedules. It is predicted that these are likely to consist of combinations of BTR and external beam TBI with the TBI component being the greatest in terms of radiation dose to the whole body

The Proportion of Women Who Have a Breast 4 Years after Breast Cancer Surgery: A Population-Based Cohort Study.

BACKGROUND: There are numerous pathways in breast cancer treatment, many of which enable women to retain a breast after treatment. We evaluated the proportion of women who have a breast, either through conserving surgery (BCS) or reconstruction, at 4-years after diagnosis, and how this varied by patient group. METHODS AND FINDINGS: We identified women with breast cancer who underwent initial BCS or mastectomy in English National Health Service (NHS) hospitals between January 2008 and December 2009 using the Hospital Episode Statistics (HES) database. Women were assigned into one of four patient groups depending on their age at diagnosis and presence of comorbidities. The series of breast cancer procedure (BCS, mastectomy, immediate, or delayed reconstruction) undergone by each women was identified over four years, and the proportion of women with a breast calculated. Variation was examined across patient groups, and English Cancer Networks. Between 2008 and 2009, 60,959 women underwent BCS or mastectomy. The proportion with a breast at 4 years was 79.3%, and 64.0%, in women less than 70 years without, and with comorbidities. Whilst in women aged 70 and over without, and with comorbidities, proportions were 52.6%, and 38.2%, respectively. Comorbidities were associated with lower proportions of BCS, but had little effect on reconstruction rates unlike age. Networks variation of 15% or more was found within each patient group, and Cancer Networks tended to have either a high or low proportion across all four patient groups. However, while 14% of women under 70 years had undergone reconstruction, less than 2% of women aged 70 or more had this treatment option. CONCLUSION: The proportion of women diagnosed with breast cancer who retain a breast at 4 years is strongly associated with age, and presence of comorbidities. There was significant variation between Cancer Networks indicating that women's experience in England was dependent on their geographical location of treatment

Assessing the feasibility of mobile phones for follow-up of acutely unwell children presenting to village clinics in rural northern Malawi.

BACKGROUND: Patient follow-up is a routine component of clinical practice and valuable for evaluating the effectiveness of interventions, but because of the broad dispersion of health facilities and lack of standardised medical reporting in Malawi, collecting patient outcome data can be challenging. Increasing accessibility and affordability of mobile technology in resource-poor settings may facilitate patient follow-up in the community. The objective of this study was to evaluate the potential utility of mobile phones for collecting follow-up clinical data from parents or caregivers of acutely unwell under-5 children, for intervention evaluation purposes. METHODS: Parents' or caregivers' mobile phone numbers were obtained by health surveillance assistants (HSAs) during study enrollment. Guardians who provided a telephone number were contacted by the study team to establish re-consultations or hospitalisations of their child(ren) within 14 days of recruitment. Health records at village clinics and higher-level health facilities were hand-searched to identify or confirm presentations and abstract clinical data. RESULTS: 87 out of 149 (58.4%) guardians provided a mobile telephone number, of whom the study team could contact 44 (29.5%). Seven guardians stated they took their child for further treatment: three of these returned to village clinics and four presented to secondary care facilities; attendance could only be confirmed from health records for one child. CONCLUSIONS: With continued expansion of cellular network coverage and mobile ownership in Malawi, mobile phones may facilitate collection of patient outcomes for intervention evaluation purposes. Future consideration should also be given to integrating mobile technologies into HSA clinical practice

A Generalist, Automated ALFALFA Baryonic Tully-Fisher Relation

The Baryonic Tully-Fisher Relation (BTFR) has applications in galaxy evolution as a testbed for the galaxy-halo connection and in observational cosmology as a redshift-independent secondary distance indicator. We use the 31,000+ galaxy ALFALFA sample -- which provides redshifts, velocity widths, and HI content for a large number of gas-bearing galaxies in the local universe -- to fit and test an extensive local universe BTFR. This BTFR is designed to be as inclusive of ALFALFA and comparable samples as possible. Velocity widths measured via an automated method and $M_{b}$ proxies extracted from survey data can be uniformly and efficiently measured for other samples, giving this analysis broad applicability. We also investigate the role of sample demographics in determining the best-fit relation. We find that the best-fit relations are changed significantly by changes to the sample mass range and to second order, mass sampling, gas fraction, different stellar mass and velocity width measurements. We use a subset of ALFALFA with demographics that reflect the full sample to measure a robust BTFR slope of $3.30\pm0.06$. We apply this relation and estimate source distances, finding general agreement with flow-model distances as well as average distance uncertainties of $\sim0.17$ dex for the full ALFALFA sample. We demonstrate the utility of these distance estimates by applying them to a sample of sources in the Virgo vicinity, recovering signatures of infall consistent with previous work.Comment: 23 pages, 10 figures, submitted to Ap

Information Quality Frameworks for Digital Health Technologies:Systematic Review

Background: Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The clinical use of digital information for diagnostic, therapeutic, and prognostic purposes has multiple patient safety problems, some of which result from poor information quality (IQ). Objective: This systematic review aims to synthesize an IQ framework that could be used to evaluate the extent to which digital health information is fit for clinical purposes. Methods: The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We searched Embase, MEDLINE, PubMed, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, ProQuest Dissertations and Theses Global, Scopus, and HMIC (the Health Management Information Consortium) from inception until October 2019. Multidimensional IQ frameworks for assessing DHTs used in the clinical context by health care professionals were included. A thematic synthesis approach was used to synthesize the Clinical Information Quality (CLIQ) framework for digital health. Results: We identified 10 existing IQ frameworks from which we developed the CLIQ framework for digital health with 13 unique dimensions: accessibility, completeness, portability, security, timeliness, accuracy, interpretability, plausibility, provenance, relevance, conformance, consistency, and maintainability, which were categorized into 3 meaningful categories: availability, informativeness, and usability. Conclusions: This systematic review highlights the importance of the IQ of DHTs and its relevance to patient safety. The CLIQ framework for digital health will be useful in evaluating and conceptualizing IQ issues associated with digital health, thus forestalling potential patient safety problems. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018097142; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=97142 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-02472

Training community healthcare workers on the use of information and communication technologies: a randomised controlled trial of traditional versus blended learning in Malawi, Africa.

BACKGROUND: Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The 'Introduction to Information and Communication Technology and eHealth' course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach. METHODS: Two questionnaires were developed and tested for face validity and reliability in a pilot course with 20 CHWs. Those were designed to measure CHWs' knowledge of and attitudes towards the use of ICT, before and after each course, as well as their satisfaction with each learning approach. Following validation, a randomised controlled trial was conducted to assess the effectiveness of the two learning approaches. A total of 40 CHWs were recruited, stratified by position, gender and computer experience, and allocated to the traditional or blended learning group using block randomisation. Participants completed the baseline and follow-up questionnaires before and after each course to assess the impact of each learning approach on their knowledge, attitudes, and satisfaction. Per-item, pre-post and between-group, mean differences for each approach were calculated using paired and unpaired t-tests, respectively. Per-item, between-group, satisfaction scores were compared using unpaired t-tests. RESULTS: Scores across all scales improved after attending the traditional and blended learning courses. Self-rated ICT knowledge was significantly improved in both groups with significant differences between groups in seven domains. However, actual ICT knowledge scores were similar across groups. There were no significant differences between groups in attitudinal gains. Satisfaction with the course was generally high in both groups. However, participants in the blended learning group found it more difficult to follow the content of the course. CONCLUSIONS: This study shows that there is no difference between blended and traditional learning in the acquisition of actual ICT knowledge among community healthcare workers in developing countries. Given the human resource constraints in remote resource-poor areas, the blended learning approach may present an advantageous alternative to traditional learning

Superhumps in Cataclysmic Binaries. XXIII. V442 Ophiuchi and RX J1643.7+3402

We report the results of long observing campaigns on two novalike variables: V442 Ophiuchi and RX J1643.7+3402. These stars have high-excitation spectra, complex line profiles signifying mass loss at particular orbital phases, and similar orbital periods (respectively 0.12433 and 0.12056 d). They are well-credentialed members of the SW Sex class of cataclysmic variables. Their light curves are also quite complex. V442 Oph shows periodic signals with periods of 0.12090(8) and 4.37(15) days, and RX J1643.7+3402 shows similar signals at 0.11696(8) d and 4.05(12) d. We interpret these short and long periods respectively as a "negative superhump" and the wobble period of the accretion disk. The superhump could then possibly arise from the heating of the secondary (and structures fixed in the orbital frame) by inner-disk radiation, which reaches the secondary relatively unimpeded since the disk is not coplanar. At higher frequencies, both stars show another type of variability: quasi-periodic oscillations (QPOs) with a period near 1000 seconds. Underlying these strong signals of low stability may be weak signals of higher stability. Similar QPOs, and negative superhumps, are quite common features in SW Sex stars. Both can in principle be explained by ascribing strong magnetism to the white dwarf member of the binary; and we suggest that SW Sex stars are borderline AM Herculis binaries, usually drowned by a high accretion rate. This would provide an ancestor channel for AM Hers, whose origin is still mysterious.Comment: PDF, 41 pages, 4 tables, 16 figures; accepted, in press, to appear December 2002, PASP; more info at http://cba.phys.columbia.edu