Variation In Average Rates Research Articles

International variation in dialysis discontinuation in patients with advanced kidney disease.

Decisions about dialysis for advanced kidney disease are often strongly shaped by sociocultural and system-level factors rather than the priorities and values of individual patients. We examined international variation in the uptake of conservative approaches to the care of patients with advanced kidney disease, in particular discontinuation of dialysis. We employed an observational cohort study design using data collected from patients maintained on long-term hemodialysis between 1996 and 2015 in facilities across 12 developed countries participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS). The main outcome was discontinuation of dialysis therapy. We analyzed the association between several patient characteristics and time to dialysis discontinuation by country and phase of study entry. A total of 259 343 DOPPS patients contributed data to the study, of whom 48 519 (18.7%) died during the study period. Of the decedents, 5808 (12.0%) discontinued dialysis before death. Rates of discontinuation were higher within the first few months after initiation of dialysis, among older adults, among those with a greater number of comorbidities and among those living in an institution. After adjustment for age, sex, dialysis duration, diabetes and dialysis era, rates of discontinuation were highest in Canada, the United States and Australia/New Zealand (33.8, 31.4 and 21.5 per 1000/yr, respectively) and lowest in Japan and Italy (< 0.1 per 1000/yr). Crude discontinuation rates were highest in dialysis facilities that were more likely to offer comprehensive conservative renal care to older adults. We found persistent international variation in average rates of dialysis discontinuation not explained by differences in patient case-mix. These differences may reflect physician-, facility- and society-level differences in clinical practice. There may be opportunities for international cross-collaboration to improve support for patients with end-stage renal disease who prefer a more conservative approach.

EFFECTS OF ADJUSTING DISTRIBUTION TABLES FOR FAMILY SIZE

This paper examines how adjusting for family size in distributional analysis affects the distribution of tax burdens. We find that average tax rates for low-income families fall and average tax rates for some high-income families rise when the measured ability to pay is adjusted for family size, and that there is less variation in average rates for middle-income families. We also find that the family size adjustment affects the distribution of certain tax expenditures. In a separate analysis, we measure the equivalence scale for families of four relative to single taxpayers implied by the individual tax code.

Efficient simulation of critical synchronous dataflow graphs

System-level modeling, simulation, and synthesis using electronic design automation (EDA) tools are key steps in the design process for communication and signal processing systems, and the synchronous dataflow (SDF) model of computation is widely used in EDA tools for these purposes. Behavioral representations of modern wireless communication systems typically result in critical SDF graphs : These consist of hundreds of components (or more) and involve complex intercomponent connections with highly multirate relationships (i.e., with large variations in average rates of data transfer or component execution across different subsystems). Simulating such systems using conventional SDF scheduling techniques generally leads to unacceptable simulation time and memory requirements on modern workstations and high-end PCs. In this article, we present a novel simulation-oriented scheduler (SOS) that strategically integrates several techniques for graph decomposition and SDF scheduling to provide effective, joint minimization of time and memory requirements for simulating critical SDF graphs. We have implemented SOS in the advanced design system (ADS) from Agilent Technologies. Our results from this implementation demonstrate large improvements in simulating real-world, large-scale, and highly multirate wireless communication systems (e.g., 3GPP, Bluetooth, 802.16e, CDMA 2000, XM radio, EDGE, and Digital TV).

In vivo measurement of house fly temperature, flight muscle potentials, heartbeat and locomotion during insecticide poisoning

The average heartbeat rate of female adult Musca domestica was near 250 beats/min in vivo at 23°C. However, standard deviation values ranged from ±35 to ±60 depending on the individual house fly. Heartbeat rates in tethered house flies fluctuated between cessation to over 300 beats/min. The heartbeat rate was temperature dependent with a Q 10 of 2.3. Either a bite by the Lynx spider, Peucetia vividans (Hentz), or severing the abdomen from the thorax caused the heartbeat to become extremely steady at near 300 beats/min which gradually decreased over several minutes. Application of lethal doses of Monitor or Lindane to the house fly caused thoracic temperature to increase by at most 3°C in conjunction with increased convulsive activity and increased average heartbeat rate. In late stages of poisoning, the heartbeat was relatively uniform indicating a disruption in cardioregulatory nervous activity. Response of the house fly to carbofuran or its N-thiomethyl analog was similar to that of Monitor and Lindane except in late stages of poisoning where the heartbeat continued to exhibit large variations in average rate.