Large Regional Variations Research Articles

Modelling of nitrate and ammonium-containing aerosols in presence of sea salt

Abstract. A thermodynamical model for treatment of gas/aerosol partitioning of semi volatile inorganic aerosols has been implemented in a global chemistry and aerosol transport model (Oslo CTM2). The sulphur cycle and sea salt particles have been implemented earlier in the Oslo CTM2 and the focus of this study is on nitrate partitioning to the aerosol phase and if particulate nitrate is expected to form in fine or coarse mode aerosols. Modelling of the formation of fine mode nitrate particles is complicated since it depends on other aerosol components and aerosol precursors as well as meteorological condition. The surface concentrations from the model are compared to observed surface concentrations at around 20 sites around Europe for nitrate and ammonium. The agreement for nitrate is good but the modelled values are somewhat underestimated compared to observations at high concentrations, whereas for ammonium the agreement is very good. However, we underscore that such a comparison is not of large importance for the aerosol optical depth of particulate nitrate since the vertical profile of aerosol components and their precursors are so important. Fine mode nitrate formation depends on vertical profiles of both ammonia/ammonium and sulphate. The model results show that fine mode particulate nitrate play a non-negligible role in the total aerosol composition in certain industrialized regions and therefore have a significant local radiative forcing. On a global scale the aerosol optical depth of fine mode nitrate is relatively small due to limited availability of ammonia and loss to larger sea salt particles. Inclusion of sea salt in the calculations reduces the aerosol optical depth and burden of fine mode nitrate by 25% on a global scale but with large regional variations.

Regional Variation in Outpatient Antibiotic Prescribing in Germany

According to recent surveys, outpatient antibiotic prescribing in Germany has been comparatively low among European countries. We assessed regional variation in outpatient antibiotic use within Germany both for overall use as well as for specific antibiotic drug classes. Prescription data for the year 2003 covering approximately 90% of the total population were analysed using the ATC/WHO defined daily dose (DDD) methodology. Data were expressed in DDD per 1,000 persons covered by the insurance and day (DID). Outpatient antibiotic prescribing in 2003 was 13.6 DID and ranged between 9.2 and 17.9 DID in the different regions examined. Low consumption regions were eastern and southern states. High consumption areas were in the west near the French and Belgian border. This regional prescribing pattern was similar for children and adults. Penicillins were the most frequent prescribed drugs, but their use density showed a relatively large regional variation (factor 3.5), with relatively low prescription frequency in the eastern states. In almost all regions quinolones were used more often than trimethoprim-sulfamethoxazole. The regional variation in recent outpatient antibiotic prescribing in Germany is substantial. The relatively high antibiotic use in the western part of the country is remarkable, remains unexplained and requires further study.

Competition between Intercity Rail and Road Transport in India: External and Social Costs

ABSTRACT The paper makes some estimates of the external and social costs of intercity transport for both passenger and freight traffic in India. Eight representative sections have been chosen where the two modes are in competition and the cost implications studied of intermodal shifts of equivalent volumes of traffic. The derived accident cost per unit of traffic movement shows large regional variation for rail, but generally it is lower in comparison with road. The same result holds in the case of some preliminary estimates of health damage costs of transport emissions. In the final analysis, when external costs are integrated with financial costs to arrive at the social costs of transport, it is found that these are always lower for the rail mode. Given therefore a case for modal substitution, some policy measures are discussed for enhancing the share of the rail mode in intercity transport.

NIKE: a new clinical tool for establishing levels of indications for cataract surgery

The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.

Assessment of spatial functionality of old forest in Sweden as habitat for virtual species

Old forest stands comprise a very small proportion of the managed forested landscapes of Scandinavia today compared with the preindustrial era. Therefore, it is important to develop conservation measures for old forest remnants and temporarily available old stands in managed forests in the most optimal way. This study examines the spatial functionality of old spruce-dominated forest in several regions of Sweden through the perspective of organisms with different ecologies, in terms of their area requirements and mobility. Instead of real species, virtual species were used representing a gradient of these two ecological traits. The main tool was habitat suitability modelling. Countrywide estimates of forest variables derived from the satellite data and field data from the National Forest Inventory using the k-nearest neighbour method were used as sources of habitat distribution data. There was large regional variation in old spruce forest functionality depending on natural conditions and forest history. The relationship between functionality and amount was largely curvilinear. Areas with > 10% of old spruce forest generally had high levels of spatial functionality, whereas high variation in functionality was observed in areas with little old spruce forest cover. This method for multiple-scale assessment of old forest functionality, using virtual species, may be helpful in regional forest biodiversity planning.

A Hierarchical Model for Regional Analysis of Population Change Using Christmas Bird Count Data, with Application to the American Black Duck

Abstract Analysis of Christmas Bird Count (CBC) data is complicated by the need to account for variation in effort on counts and to provide summaries over large geographic regions. We describe a hierarchical model for analysis of population change using CBC data that addresses these needs. The effect of effort is modeled parametrically, with parameter values varying among strata as identically distributed random effects. Year and site effects are modeled hierarchically, accommodating large regional variation in number of samples and precision of estimates. The resulting model is complex, but a Bayesian analysis can be conducted using Markov chain Monte Carlo techniques. We analyze CBC data for American Black Ducks (Anas rubripes), a species of considerable management interest that has historically been monitored using winter surveys. Over the interval 1966–2003, Black Duck populations showed distinct regional patterns of population change. The patterns shown by CBC data are similar to those shown by the Midwinter Waterfowl Inventory for the United States.

A Hierarchical Model for Regional Analysis of Population Change Using Christmas Bird Count Data, with Application to the American Black Duck

Abstract Analysis of Christmas Bird Count (CBC) data is complicated by the need to account for variation in effort on counts and to provide summaries over large geographic regions. We describe a hierarchical model for analysis of population change using CBC data that addresses these needs. The effect of effort is modeled parametrically, with parameter values varying among strata as identically distributed random effects. Year and site effects are modeled hierarchically, accommodating large regional variation in number of samples and precision of estimates. The resulting model is complex, but a Bayesian analysis can be conducted using Markov chain Monte Carlo techniques. We analyze CBC data for American Black Ducks (Anas rubripes), a species of considerable management interest that has historically been monitored using winter surveys. Over the interval 1966–2003, Black Duck populations showed distinct regional patterns of population change. The patterns shown by CBC data are similar to those shown by the M...

Potential Entrepreneurship in Japan

The aim of this paper is to investigate the potential for entrepreneurship in Japan using the Employment Status Survey, which is the only government-administered survey that includes questions about the desire to become an entrepreneur. We find that there are still a number of potential entrepreneurs in Japan, despite a recent decline in the number of new firms being established. We also find that there is a large regional variation in the distribution of entrepreneurial potential, with clustering into a few regions and the level in Tokyo being exceptional. Further, using panel data on 47 prefectures from 1982 to 1997, we examine the determinants of entrepreneurial potential. The estimation results show that the price-cost margin, market size, market growth and the unemployment rate have positive effects on the potential for entrepreneurship.

Future Area Burned in Canada

Historical relationships between weather, the Canadian fire weather index (FWI) system components and area burned in Canadian ecozones were analysed on a monthly basis in tandem with output from the Canadian and the Hadley Centre GCMs to project future area burned. Temperature and fuel moisture were the variables best related to historical monthly area burned with 36-64% of the variance explained depending on ecozone. Our results suggest significant increases in future area burned although there are large regional variations in fire activity. This was especially true for the Canadian GCM where some ecozones show little change in area burned, however area burned was not projected to decrease in any of the ecozones modelled. On average, area burned in Canada is projected to increase by 74-118% by the end of this century in a 3 × CO2 scenario. These estimates do not explicitly take into account any changes in vegetation, ignitions, fire season length, and human activity (fire management and land use activities) that may influence area burned. However, the estimated increases in area burned would have significant ecological, economic and social impacts for Canada.

Salinity distribution of seashore concrete structures in Korea

For concrete structures immersed in seawater, the concentration of chloride used to estimate the chloride diffusion coefficient can be defined as the seawater chloride concentration. However, for seashore concrete structures that are not coming into direct contact with seawater, establishing the interface concentration of chloride becomes delicate. In addition, concrete structures are greatly affected by salt attack primarily due to airborne sea salt like it can be seen through the corrosion of rebar. This study intends to investigate salt attack by airborne sea salt in terms of the distance from the seashore through measurements conducted at 73 spots and 27 areas during 1 year in the Eastern, Western and Southern coasts of South Korea. Results revealed large regional variations of salinity in coastal regions with significant seasonal effects caused by seasonal winds. Moreover, the salinity is seen to diminish as the distance from the seashore increases at a rate corresponding to the function y = a x - b .

Impacts of oral disorders in the United Kingdom and Australia

Surveys of oral health have not previously compared national adult populations using measures of subjective oral health. To compare subjective oral health of adults in the UK and Australian populations. Cross sectional studies were conducted of people aged 18+ years in the 1998 UK Adult Dental Health Survey and the 1999 Australian National Dental Telephone Interview Survey. Subjective oral health was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14). Among dentate people, the percentage reporting impacts 'fairly often' or 'very often' was marginally greater in Australia (18.2%, 95% confidence interval (CI) = 16.2-20.2) than the UK (15.9%, 95%CI = 14.4-17.4). There were larger regional variations in prevalence within populations, ranging from 14.8% to 22.3% among Australian states/ territories, and from 13.6% to 19.8% among countries within the UK. However, the mean number of impacts and rated severity of impacts was significantly greater in Australia than the UK. While the percentage of adults reporting adverse impacts of oral health was similar, Australians reported a larger number of impacts and more severe impacts than dentate people in the UK. Differences in the number and severity of impacts between the two populations may be an artifact of different data collection methods or may reflect relatively subtle socio-cultural differences in subjective oral health between these populations.

Perceived oral health in the UK and Australia

Background Surveys of oral health have not previously compared national adult populations using measures of subjective oral health. Aims To compare subjective oral health of adults in the UK and Australian populations. Methods Cross sectional studies were conducted of people aged 18+ years in the 1998 UK Adult Dental Health Survey and the 1999 Australian National Dental Telephone Interview Survey. Subjective oral health was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14). Results Among dentate people, the percentage reporting impacts 'fairly often' or 'very often' was marginally greater in Australia (18.2%, 95% confidence interval (CI) = 16.2–20.2) than the UK (15.9%, 95%CI = 14.4–17.4). There were larger regional variations in prevalence within populations, ranging from 14.8% to 22.3% among Australian states/ territories, and from 13.6% to 19.8% among countries within the UK. However, the mean number of impacts and rated severity of impacts was significantly greater in Australia than the UK Conclusions While the percentage of adults reporting adverse impacts of oral health was similar, Australians reported a larger number of impacts and more severe impacts than dentate people in the UK. Differences in the number and severity of impacts between the two populations may be an artifact of different data collection methods or may reflect relatively subtle socio-cultural differences in subjective oral health between these populations.

Mapping of climatic data in Northeast Thailand: Rainfall

Interpolation of rainfall databases of Northeast Thailand of daily measurements at rain stations over 20 years were mapped with GIS tools. Various maps clearly visualized the characteristics of rainfall in this area. Annual and mid-rainy season rainfall showed a descending trend from the northeastern area to the southwestern area, probably due to the southwest monsoon and mountains in Laos and between Central and Northeast Thailand. Yearly variation in annual rainfall in this area was not particularly high, suggesting that its general image as a drought-prone area may be caused by the undulating topography and predominance of sandy soils in this area, which contribute to its vulnerability to flooding and drought. Both mean rainfall amount per rainy day and the number of rainy days in the rainy season showed large regional and yearly variation, but mean rainfall per rainy day was correlated to annual rainfall, whereas the number of rainy days was not strongly correlated to annual rainfall. Large regional variation in the number of rainy days in the rainy season suggests large regional variations in agricultural productivity in this area. The fact that areas near many of the provincial capitals have a high number of rainy days in the rainy season with small yearly variation may indicate relatively high and stable agricultural productivity in such areas that probably supported the establishment of those cities in early days. The duration, onset and end of the rainy season showed small yearly variation, suggesting that these parameters are not solely responsible for the unstable and erratic rainfall in Northeast Thailand.

Linking ocean biogeochemical cycles and ecosystem structure and function: results of the complex SWAMCO-4 model

We present results obtained with SWAMCO-4, a complex model of the marine planktonic system calculating C, N, P, Si, Fe cycling within the upper ocean, the export production and the exchange of CO 2 between the ocean and atmosphere. The model, constrained by physical, chemical and biological (grazing, lysis) controls, explicitly details the dynamics of four relevant phytoplankton functional groups with respect to C, N, P, Si, Fe cycling and climate change. Those are diatoms, pico/nano phytoplankton, coccolithophorids, and Phaeocystis spp. whose growth regulation by light, temperature and nutrients has been obtained based on a comprehensive analysis of literature reviews on these taxonomic groups. The performance of SWAMCO-4 is first evaluated in a 1D physical frame throughout its cross application in provinces with contrasted key species dominance, export production, CO 2 air-sea fluxes and where biogeochemical time-series data are available for model initialisation and comparison of results. These are: (i) the ice-free Southern Ocean Time Series station KERFIX (50°40S, 68°E) for the period 1993–1994 (diatom-dominated); (ii) the sea-ice associated Ross Sea domain (Station S; 76°S, 180°W) of the Antarctic Environment and Southern Ocean Process Study AESOPS in 1996–1997 ( Phaeocystis-dominated); and (iii) the North Atlantic Bloom Experiment NABE (60°N, 20°W) in 1991 (coccolithophorids). We then explore and compare the ocean response to increased atmospheric CO 2 by running SWAMCO-4 at the different locations over the last decade. Results show that at all tested latitudes the prescribed increase of atmospheric CO 2 enhances the carbon uptake by the ocean. However, the amplitude of the predicted atmospheric CO 2 sinks displays large regional and interannual variations due to the actual meteorological forcing that drives the local hydrodynamics. This is particularly true in the marginal ice zone of the Ross Sea (AESOPS) where the magnitude of the predicted annual CO 2 sink is positively related to the length of the surface ocean ice-cover period which determines the iron surface concentration at the time of ice melting.

Prenatal diagnostic procedures used in pregnancies with congenital malformations in 14 regions of Europe

To investigate outcomes of ultrasound investigations (US) and invasive diagnostic procedures in cases of congenital malformations (CM), and to compare the use of invasive prenatal test techniques (amniocentesis (AC) versus chorionic villus sampling (CVS)) among European populations. Analysis of data from population-based registries of CM. 25 400 cases of CM recorded by 14 EUROCAT registries covering a total population of 1,013,352 births 1995-99. US were performed in 91% of cases, and positively detected CM in 35% of cases. AC was performed in 24% of the cases and CVS in 3% of cases. Thirty-eight percent of invasive tests gave positive results. Fifty-two percent of cases with maternal age > or = 35 years had an invasive test performed compared to 20% of cases with younger mothers. Considerable variation was found between registries in the uptake rate of invasive tests in cases with older maternal age and on the use of invasive tests with only four regions employing CVS techniques in at least a third of the cases having invasive tests. For chromosomal anomalies US gave positive results in 46% of cases with maternal age < 35 years with US performed and in 36% of cases with maternal age > or = 35 years with US performed. Prenatal US was performed in 91% of all pregnancies with CM but the test was only positive in a third of the cases. There was large regional variation in the uptake rate of invasive tests with maternal age of 35 years or more. For every CVS carried out there were nine AC tests. US is an important tool in the prenatal diagnosis of chromosomal anomalies in Europe.

How health policy and health services researchers are compensated: analysis of a nationwide salary survey.

The membership of Academy Health, a professional organization, was invited to complete an anonymous Web-based survey in 2002. Responses were received from 1,140 of 2,633 surveyed (43 percent). Fifty-six percent worked in academic institutions or teaching hospitals, 34 percent in the private sector or foundations, and 10 percent in government. Most (96 percent) had at least one advanced degree, and the diversity of educational backgrounds was pronounced. The median annual salary was $99,000. Salaries were highest in the private sector, followed by academic and government settings. There were large regional variations, with higher salaries in the Mid-Atlantic and New England regions. Adjusted data suggested these higher regional salaries were inadequate to compensate for higher local cost of living. Among academic respondents, nonadjusted salaries increased with advancing faculty job titles, but this seniority effect was inconsistent across geographic regions. Junior faculty salaries, when adjusted for cost of living, were more similar across regions than salaries at the full professor level.

Shared decision-making and surgical treatment for breast cancer

556 Background: Persistent high rates of mastectomy (mast) use for breast cancer have motivated lingering concerns about over-treatment. Policy makers have suggested that large regional variation in patterns of treatment is evidence of failure to involve women about the treatment they prefer. To address these issues, we examined the relationship between patient involvement in decision-making and receipt of surgical treatment for women with breast cancer. Methods: All women with DCIS and a 20% random sample of women with invasive breast cancer aged 79 and younger diagnosed in 2002 and reported to the Detroit and Los Angeles metropolitan SEER registries were identified and surveyed shortly after receipt of surgical treatment. Response rate was 74.3% (N=1489). Results: The mean age was 59.9 years; 68.7% were Caucasian, 17.0% were African American and 14.3% were of other ethnic groups. Overall, 26.4% of women received mast as initial treatment (23.6% of Caucasians, 30.2% of African Americans and 34.6% of other ethnic groups). One fifth of patients reported that their surgeon made the decision; 37.9% that the decision was shared; and 41.0% said they made the decision. The table below shows percent of patients (stages 0–2) who received mast by perceived levels of involvement and race, controlling for stage, tumor size, histologic grade, contra-indication to lumpectomy, age, and education. Patient involvement was positively associated with receipt of mast as initial surgical treatment. However, this was observed largely for Caucasian women (p=.01). Conclusions: Most women reported that they made or shared the decision about surgical treatment. Results suggest that patient preferences may partly explain persistently high rates of mastectomy and regional variation in surgical treatment. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration NCI RO1 CA8837-A1

Shared decision-making and surgical treatment for breast cancer

556 Background: Persistent high rates of mastectomy (mast) use for breast cancer have motivated lingering concerns about over-treatment. Policy makers have suggested that large regional variation in patterns of treatment is evidence of failure to involve women about the treatment they prefer. To address these issues, we examined the relationship between patient involvement in decision-making and receipt of surgical treatment for women with breast cancer. Methods: All women with DCIS and a 20% random sample of women with invasive breast cancer aged 79 and younger diagnosed in 2002 and reported to the Detroit and Los Angeles metropolitan SEER registries were identified and surveyed shortly after receipt of surgical treatment. Response rate was 74.3% (N=1489). Results: The mean age was 59.9 years; 68.7% were Caucasian, 17.0% were African American and 14.3% were of other ethnic groups. Overall, 26.4% of women received mast as initial treatment (23.6% of Caucasians, 30.2% of African Americans and 34.6% of other ethnic groups). One fifth of patients reported that their surgeon made the decision; 37.9% that the decision was shared; and 41.0% said they made the decision. The table below shows percent of patients (stages 0–2) who received mast by perceived levels of involvement and race, controlling for stage, tumor size, histologic grade, contra-indication to lumpectomy, age, and education. Patient involvement was positively associated with receipt of mast as initial surgical treatment. However, this was observed largely for Caucasian women (p=.01). Conclusions: Most women reported that they made or shared the decision about surgical treatment. Results suggest that patient preferences may partly explain persistently high rates of mastectomy and regional variation in surgical treatment. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration NCI RO1 CA8837-A1

Bayesian spatial and ecological models for small-area accident and injury analysis

In this article, recently developed Bayesian spatial and ecological regression models are applied to analyse small-area variation in accident and injury. This study serves to demonstrate how Bayesian modelling techniques can be implemented to assess potential risk factors measured at group (e.g. area) level. Presented here is a unified modelling framework that enables thorough investigations into associations between injury rates and regional characteristics, residual variation and spatial autocorrelation. Using hospital separation data for 83 local health areas in British Columbia (BC), Canada, in 1990–1999, we explore and examine ecological/contextual determinants of motor vehicle accident injury (MVAI) among male children and youth aged 0–24 and for those of six age groups (<1, 1–4, 5–9, 10–14, 15–19 and 20–24). Eighteen local health area characteristics are studied. They include a broad spectrum of socio-economic indicators, residential environment indicators (roads and parks), medical services availability and utilisation, population health, proportion of recent immigrants, crime rates, rates of speeding charge and rates of seatbelt violation. Our study indicates a large regional variation in MVAI in males aged 0–24 in British Columbia, Canada, in 1990–1999, and that adjusting for appropriate risk factors eliminates nearly all the variation observed. Socio-economic influence on MVAI was profoundly apparent in young males of all ages with the injury being more common in communities of lower socio-economic status. High adult male crime rates were significantly associated with high injury rates of boys aged 1–14. Seatbelt violations and excess speeding charges were found to be positively associated with the injury rates of young men aged 20–24. This and similar ecological studies shed light on reasons for regional variations in accident occurrence as well as in the resulting injuries and hospital utilisation. Thereby they are potentially useful in identifying priority areas for injury/accident prevention and in informing regional health planning and policy development.

The Impact of Sector‐Specific and Economy‐Wide Policy Reforms on the Agricultural Sector in Brazil: 1980–98

This article analyzes the impact of policy reforms and changing macroeconomic conditions on the Brazilian agricultural sector. It stresses four issues: events outside of agriculture were central to the performance of the sector and to the timing and sequence of policy reform; reform involved far more than trade liberalization; the impact of reform on input markets and productivity was key for understanding the period; and policy reform had a highly differentiated impact on the sector. As a result of the reforms, agriculture became the most dynamic sector of the Brazilian economy in the 1990s. Policies still in need of reform are identified. (JEL O13, Q18)