Understanding the Economic Consequences of Shifting Trends in Population Health

The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy – with a concomitant decrease in the public-sector’s annuity burden – but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10% higher in the Medicaid program, and 7% higher for Medicare.disability, health care costs, social security, microsimulation

International Differences in Longevity and Health and their Economic Consequences

In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.disability, mortality, international comparisons, microsimulation

Patient perspectives on an intervention after suicide attempt: The need for patient centred and individualized care.

Many types of intervention exist for suicide attempters, but they tend not to sufficiently consider patient's views. To identify useful components of a previously evaluated intervention after a suicide attempt from the patient's views and to better understand the process of recovery. Forty-one interviews with suicide attempters were qualitatively analysed. Views of participants (i) on the components of the intervention (nurse case-management, joint crisis plan, meetings with relatives/network and follow-up calls) and (ii) their recovery were explored. The material was analysed by means of thematic analysis with a deductive-inductive approach. Participants valued the human and professional qualities of the nurse case-manager, and appreciated follow-up calls and meetings. However, their views diverged regarding for instance frequency of phone calls, or disclosing information or lack thereof. Interpersonal relationship, suicide attempters' own resources and life changes emerged as core recovery factors. The study highlights the figure of an engaged clinician, with both professional and human commitment, aware that some suicide attempters put more emphasis on their own resources than on delivered health care. Interventions should consider the clinician as the cornerstone of the tailored care valued by suicide attempters

Bayesian Non-Exhaustive Classification A Case Study: Online Name Disambiguation using Temporal Record Streams

The name entity disambiguation task aims to partition the records of multiple real-life persons so that each partition contains records pertaining to a unique person. Most of the existing solutions for this task operate in a batch mode, where all records to be disambiguated are initially available to the algorithm. However, more realistic settings require that the name disambiguation task be performed in an online fashion, in addition to, being able to identify records of new ambiguous entities having no preexisting records. In this work, we propose a Bayesian non-exhaustive classification framework for solving online name disambiguation task. Our proposed method uses a Dirichlet process prior with a Normal * Normal * Inverse Wishart data model which enables identification of new ambiguous entities who have no records in the training data. For online classification, we use one sweep Gibbs sampler which is very efficient and effective. As a case study we consider bibliographic data in a temporal stream format and disambiguate authors by partitioning their papers into homogeneous groups. Our experimental results demonstrate that the proposed method is better than existing methods for performing online name disambiguation task.Comment: to appear in CIKM 201

Observational study of suicide in Switzerland: comparison between psychiatric in- and outpatients.

In Switzerland, suicide is a major cause of years of potential life lost. Among people who died by suicide, a significant number suffered from mental illness and were treated by psychiatric care institutions. Psychiatric patients are thus a specific target for suicide prevention. Based on data from a clinical committee reviewing every death by suicide of psychiatric patients in the Canton of Vaud (Switzerland), this observational study aimed to gain knowledge on sociodemographic and clinical characteristics of psychiatric patients who died by suicide by comparing in- and outpatients. Sociodemographic and clinical characteristics of patients who died by suicide in our department from January 2007 to December 2019 were analysed. In- and outpatients were compared. The sample included 153 patients (64.7% males, n = 99). Three quarters (76.4%, n = 81) of the patients had at least one previous suicide attempt. In- and outpatients did not differ significantly in terms of sociodemographics data, psychiatric diagnosis or method of suicide. Almost all (97.2%) of the outpatients had at least one past psychiatric hospitalisation. We found gender disparities for several variables and a lower male/female suicide ratio than in the general Swiss population. Seventy-two percent of the outpatients (n = 49) had a last personal contact with clinicians less than a week before their suicide and 38.8 % of those less than 24 hours (28% of outpatients, n = 19). Patients dying by suicide present most of the time a serious psychiatric history. In- and outpatients seem to have a similar clinical and sociodemographic profile and suicide prevention should thus not be addressed differently in these two groups. The time between death of outpatients and last contact with a therapist was shorter than expected

Analysis of location uncertainty for a microearthquake cluster: A case study

In many reservoirs, an increase in permeability and conductivity is achieved by hydraulic fracturing/stimulations which open cracks and fractures that then act as pathways for fluids to navigate in the subsurface. Mapping, localization, and general characterization of these fracture systems is of key importance in oil, gas, and geothermal energy production. The location of the microseismic events triggered during hydraulic fracturing or stimulation can help to characterize the properties of the fracture system. There are many different methods for localizing microearthquakes and, in general, these methods yield different locations, velocity models, and event origin times, due to differences in algorithms and input models. Here we focus on studying location confidence intervals associated with two localization methods, classical (triangulation) and Double-Difference, where uncertainties due to origin times can be marginalized away, thus decreasing uncertainties in the event locations. We relocate events using these two methods and three different velocity models. Of the two methods used here, Double-Difference produces smallest confidence regions. We also illustrate that, for our dataset in particular, marginalizing away the influence of the unknown origin times also improves the confidence intervals

Xylem surfactants introduce a new element to the cohesion-tension theory

Vascular plants transport water under negative pressure without constantly creating gas bubbles that would disable their hydraulic systems. Attempts to replicate this feat in artificial systems almost invariably result in bubble formation, except under highly controlled conditions with pure water and only hydrophilic surfaces present. In theory, conditions in the xylem should favor bubble nucleation even more: there are millions of conduits with at least some hydrophobic surfaces, and xylem sap is saturated or sometimes supersaturated with atmospheric gas and may contain surface-active molecules that can lower surface tension. So how do plants transport water under negative pressure? Here, we show that angiosperm xylem contains abundant hydrophobic surfaces as well as insoluble lipid surfactants, including phospholipids, and proteins, a composition similar to pulmonary surfactants. Lipid surfactants were found in xylem sap and as nanoparticles under transmission electron microscopy in pores of intervessel pit membranes and deposited on vessel wall surfaces. Nanoparticles observed in xylem sap via nanoparticle-tracking analysis included surfactant-coated nanobubbles when examined by freeze-fracture electron microscopy. Based on their fracture behavior, this technique is able to distinguish between dense-core particles, liquid-filled, bilayer-coated vesicles/liposomes, and gas-filled bubbles. Xylem surfactants showed strong surface activity that reduces surface tension to low values when concentrated as they are in pit membrane pores. We hypothesize that xylem surfactants support water transport under negative pressure as explained by the cohesion-tension theory by coating hydrophobic surfaces and nanobubbles, thereby keeping the latter below the critical size at which bubbles would expand to form embolisms

Suicides in Psychiatric Patients: Identifying Health Care-Related Factors through Clinical Practice Reviews.

The objective of this study was to identify health care-related factors associated with death by suicide in psychiatric patients and to gain insight into clinician views on how to deal with suicidality. The study material derived from a clinician committee in a psychiatric department reviewing every outpatient and inpatient suicide in a standardized way. Reports' conclusions and corresponding plenary discussion minutes regarding 94 suicides were analyzed using inductive thematic content analysis. Health care-related factors were categorized into 4 themes: patient evaluation, patient management, clinician training, and involvement of relevant non-clinical partners. Clinician views on the themes were expressed through statements (i) promoting or restricting an aspect of care (here called recommendations), which mainly followed existing guidelines and were consensual and (ii) without precise indication (here called comments), which departed from mainstream opinions or addressed topics not covered by existing policy. Involvement of non-clinical partners emerged as a new key issue for suicide prevention in psychiatric departments and should be openly discussed with patients. Clinicians preferred balanced conclusions when they reviewed suicide cases