Economic implications of poor access to antenatal care in rural and remote Western Australian Aboriginal communities: An individual sampling model of pregnancy

Background

Australian Aboriginal women attend antenatal care less frequently and experience poorer pregnancy outcomes than non-Aboriginal women. Improving access to antenatal care is recognised as a means to improve pregnancy outcomes for mother and baby.

Objective

To estimate the costs of inadequate antenatal care and provide baseline measurements and implications for policy that targets improving access to care in rural and remote Western Australian (WA) Aboriginal communities.

Methods

An individual sampling model of pregnancy was developed that simulated hypothetical women with pregnancy events and outcomes observed in the WA Aboriginal population. Weekly pregnancy events were modelled via logistic regression according to maternal characteristics, events during pregnancy and current gestation, with adequate and inadequate care (?4 and <4 antenatal visits) to reflect differences in outcomes reported in the literature. The pregnancy model simulated clinical management including antenatal visits, hospitalisations, and transfers to tertiary care.

Results

The mean cost of pregnancy was AUD$8985, with a large difference depending on access to antenatal care (AUD$7635 and AUD$10,216 for adequate and inadequate care respectively). The main difference in costs resulted from neonatal care (AUD$1021 vs AUD$3205 for adequate and inadequate care respectively). In a rural community with 150 births per year, up to AUD$123,082 may be spent to improve access to care at no extra cost to the total current expenditure (AUD$1,347,733).

Conclusions

The large difference in pregnancy costs between those receiving adequate and inadequate care demonstrates that additional expenditure on improving access to antenatal care may be cost-effective and should be further investigated.     

Error graphs and the reconstruction of elements in groups

Packing and covering problems for metric spaces, and graphs in particular, are of essential interest in combinatorics and coding theory. They are formulated in terms of metric balls of vertices. We consider a new problem in graph theory which is also based on the consideration of metric balls of vertices, but which is distinct from the traditional packing and covering problems. This problem is motivated by applications in information transmission when redundancy of messages is not sufficient for their exact reconstruction, and applications in computational biology when one wishes to restore an evolutionary process. It can be defined as the reconstruction, or identification, of an unknown vertex in a given graph from a minimal number of vertices (erroneous or distorted patterns) in a metric ball of a given radius r around the unknown vertex. For this problem it is required to find minimum restrictions for such a reconstruction to be possible and also to find efficient reconstruction algorithms under such minimal restrictions.In this paper we define error graphs and investigate their basic properties. A particular class of error graphs occurs when the vertices of the graph are the elements of a group, and when the path metric is determined by a suitable set of group elements. These are the undirected Cayley graphs. Of particular interest is the transposition Cayley graph on the symmetric group which occurs in connection with the analysis of transpositional mutations in molecular biology [P.A. Pevzner, Computational Molecular Biology: An Algorithmic Approach, MIT Press, Cambridge, MA, 2000; D. Sankoff, N. El-Mabrouk, Genome rearrangement, in: T. Jiang, T. Smith, Y. Xu, M.Q. Zhang (Eds.), Current Topics in Computational Molecular Biology, MIT Press, 2002]. We obtain a complete solution of the above problems for the transposition Cayley graph on the symmetric group.     

Open core and small groups in dense pairs of topological structures

Dense pairs of geometric topological fields have tame open core, that is, every definable open subset in the pair is already definable in the reduct. We fix a minor gap in the published version of van den Dries's seminal work on dense pairs of o-minimal groups, and show that every definable unary function in a dense pair of geometric topological fields agrees with a definable function in the reduct, off a small definable subset, that is, a definable set internal to the predicate.For certain dense pairs of geometric topological fields without the independence property, whenever the underlying set of a definable group is contained in the dense-codense predicate, the group law is locally definable in the reduct as a geometric topological field. If the reduct has elimination of imaginaries, we extend this result, up to interdefinability, to all groups internal to the predicate.     

Convexity considerations and spatial behavior for the harmonic vibrations in thermoelastic plates

In this paper we study the spatial behavior of the steady-state solutions for the approach of thin thermoelastic plates developed by Lagnese and Lions [J.E. Lagnese, J.-L. Lions, Modelling, Analysis and Control of Thin Plates, Collection RMA, vol. 6, Masson, Paris, 1988]. The model leads to a coupled complex system of partial differential equations, one of fourth order in terms of the amplitude of the vertical deflection and the other of second-order in terms of the amplitude of temperature field. Coupling in an appropriate way the two equations in an integral identity we are able to identify some cross-sectional line integral measures associated with the amplitudes of the vertical deflection and temperature vibrations, provided that the exciting frequency is less than a certain critical frequency. Furthermore, we are able to establish a second-order differential inequality whose integration furnishes a Saint-Venant type decay estimate for a bounded strip and an alternative of Phragmén-Lindelöf type for a semi-infinite strip. The critical frequency is individuated by means of the use of some Wirtinger and Knowles inequalities.     

Populations with individual variation in dispersal in heterogeneous environments: Dynamics and competition with simply diffusing populations

We consider a model for a population in a heterogeneous environment, with logistic-type local population dynamics, under the assumption that individuals can switch between two different nonzero rates of diffusion. Such switching behavior has been observed in some natural systems. We study how environmental heterogeneity and the rates of switching and diffusion affect the persistence of the population. The reactiondiffusion systems in the models can be cooperative at some population densities and competitive at others. The results extend our previous work on similar models in homogeneous environments. We also consider competition between two populations that are ecologically identical, but where one population diffuses at a fixed rate and the other switches between two different diffusion rates. The motivation for that is to gain insight into when switching might be advantageous versus diffusing at a fixed rate. This is a variation on the classical results for ecologically identical competitors with differing fixed diffusion rates, where it is well known that "the slower diffuser wins".     

Monogenic functions and representations of nilpotent Lie groups in quantum mechanics

We describe several different representations of nilpotent step two Lie groups in spaces of monogenic Clifford‐valued functions. We are inspired by the classic representation of the Heisenberg group in the Segal–Bargmann space of holomorphic functions. Connections with quantum mechanics are described. Copyright © 1999 John Wiley & Sons, Ltd.     

优质猪肉供应链中养猪场的行为选择机理及其优化策略研究

实施供应链管理是优质猪肉生产的有效途径,养猪场行为是决定猪肉产品质量安全的关键.本文依据博弈理论和方法,分析了优质猪肉供应链中养猪场和公司行为选择的机理,导出了双方行为选择的混合战略纳什均衡点.研究表明:降低风险偏好、监督成本和违约超常收益,增加违约惩罚、违约潜在损失、违约信用损失、供应链内外收益差和合作期限,是优化养猪场行为选择的有效途径,据此从强制性和诱致性两种作用入手提出了6种基本优化策略.     

Adaptive expectations and dynamic adjustment in noncooperative games with incomplete information

This paper is concerned with the analysis of a Nash equilibrium of a noncooperative game. It can be shown that, without complete information about the other players' objectives or interests, the group of players, as a whole, can reach a Nash equilibrium by adopting a class of adaptive expectation and dynamic adjustment processes. It is shown that, if the expectation and adjustment processes are made continuously, the stability of the overall dynamic process is independent of the specific mechanisms of the expectation and the adjustment, but depends on the properties of each player's objective or payoff function. If, however, expectation and adjustment processes are made at discrete time intervals, the stability of the discrete process depends on the speed of adjustment chosen by each player.This research was supported by ONR Contract No. N00014-75-C-0738. The authors are indebted to the referee for several valuable comments and suggestions for improvement.     

统计在生命科学中的实践与认识(Ⅵ) 临床试验(上)

本文回顾了临床试验发展的简史、随机临床试验的主要特征、临床试验实践中所面临的问题和困难，介绍了有关临床试验研究和应用的近展     

Elliptic and parabolic problems in unbounded domains

We consider elliptic and parabolic problems in unbounded domains. We give general existence and regularity results in Besov spaces and semi‐explicit representation formulas via operator‐valued fundamental solutions which turn out to be a powerful tool to derive a series of qualitative results about the solutions. We give a sample of possible applications including asymptotic behavior in the large, singular perturbations, exact boundary conditions on artificial boundaries and validity of maximum principles. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Impact of correlation crises in risk theory: Asymptotics of finite-time ruin probabilities for heavy-tailed claim amounts when some independence and stationarity assumptions are relaxed

In the renewal risk model, several strong hypotheses may be found too restrictive to model accurately the complex evolution of the reserves of an insurance company. In the case where claim sizes are heavy-tailed, we relax the independence and stationarity assumptions and extend some asymptotic results on finite-time ruin probabilities, to take into account possible correlation crises like the one recently bred by the sub-prime crisis: claim amounts, in general assumed to be independent, may suddenly become strongly positively dependent. The impact of dependence and non-stationarity is analyzed and several concrete examples are given.