scholarly journals Prediction of severe COVID-19 cases requiring intensive care in Osaka, Japan

2021 ◽  
Author(s):  
Junko Kurita ◽  
Tamie Sugawara ◽  
Yasushi Ohkusa
Keyword(s):  
Intensive Care ◽  
Statistical Model ◽  
Coefficient Of Determination ◽  
Testing Methods ◽  
Care Policy ◽  
Care Needs ◽  
Policy Makers ◽  
Explanatory Variables ◽  
Out Of Sample ◽  
Osaka Prefecture

Background: To avoid exhaustion of medical resources by COVID-19 care, policy-makers must predict care needs, specifically estimating the proportion of severe cases likely to require intensive care. In Osaka prefecture, Japan, the number of these severe cases exceeded the capacity of ICU units prepared for COVID-19 from mid-April, 2021. Objective: This study used a statistical model to elucidate dynamics of severe cases in Osaka and validated the model through prospective testing. Methods: The study extended from April 3, 2020 through April 26, 2021 in Osaka prefecture, Japan prefecture. We regressed the number of severe cases on the number of severe cases the day prior and the newly onset patients of more than 21 days prior. Results: We selected the number of severe cases the day prior and the number of newly onset patients on 21 and 28 days prior as explanatory variables for explaining the number of severe cases based on the adjusted determinant coefficient. The adjusted coefficient of determination was greater than 0.995 and indicated good fit. Prospective out of sample three-week prediction forecast the peak date precisely, but the level was not t. Discussion and Conclusion: A reason for the gap in the prospective prediction might be the emergence of variant strains.

scholarly journals Prediction of severe COVID-19 cases requiring a ventilator in Tokyo, Japan

2021 ◽  
Author(s):  
Junko Kurita ◽  
Tamie Sugawara ◽  
Yasushi Ohkusa
Keyword(s):  
Explanatory Variable ◽  
Coefficient Of Determination ◽  
Care Needs ◽  
Policy Makers ◽  
Dummy Variables ◽  
Tokyo Metropolitan Area ◽  
Explanatory Variables ◽  
Number Of Patients ◽  
Effective Policy ◽  
Ventilator Care

SummaryBackgroundTo avoid exhaustion of medical resources by COVID-19, policy-makers must predict care needs, specifically the proportion of severe cases likely to need ventilator care.ObjectiveThis study was designed to use a statistical model to elucidate dynamics of severe cases in Tokyo and to discuss the timing of effective policy activation.MethodsThe study extended from April 27 through October 18, 2020 in Japan’s Tokyo Metropolitan area. Medical exhaustion was defined as use of more than half of the ventilator capacity available before the COVID-19 outbreak. We regressed the number of severe cases on the newly onset patients of more than 14 days prior. As earlier research indicated, the COVID-19 severity changed at the end of May. Therefore, we added dummy variables to reflect changing severity from June and its product with newly onset patients as the explanatory variable. Then we calculated the threshold using R(t): R(t)=0.99 for the number of patients 14 days prior was used as a threshold at which strong countermeasures should be activated to keep to avoid medical exhaustion.ResultsThe critical number signaling medical exhaustion in Tokyo was defined as 655 cases. We selected 15, 30, 60 and 90 days prior as explanatory variables for explaining the number of severe cases. A coefficient of determination larger than 0.95 was inferred as indicating good fit. The threshold was estimated as more than 4500 cases for R(t)=1.1 and monotonically decreasing by R(t) to be 600 cases for R(t)=2.5.Discussion and ConclusionResults showed that newly onset patients reported more than 14 days prior can explain the number of severe cases very well. We also confirmed the threshold number of patients 14 days prior by R(t) for which strong countermeasures should be activated to avoid medical exhaustion with R(t)=0.99. This method is expected to be useful for countermeasure activation policies for Tokyo.

The drivers of corporate governance disclosure: the case of Nifty 500 Index

2018 ◽  
Vol 60 (2) ◽  
pp. 681-700 ◽  
Author(s):  
Androniki Katarachia ◽  
Electra Pitoska ◽  
Grigoris Giannarakis ◽  
Elpida Poutoglidou
Keyword(s):  
Corporate Governance ◽  
Financial Leverage ◽  
Policy Makers ◽  
Content Type ◽  
Explanatory Variables ◽  
Size Number ◽  
Governance Practices ◽  
Board Director ◽  
First Time ◽  
Governance Disclosure

Purpose Based on agency theory, the purpose of this paper is to investigate the determinants on the dissemination level of corporate governance disclosure (CGD). Design/methodology/approach The sample of the study incorporates listed companies in Nifty 500 Index for the period 2009-2014. The Governance Disclosure Score calculated by Bloomberg is used as a proxy for the dissemination level of corporate governance information. In total, eight explanatory variables are uses, namely, board’s size, number of board meetings, CEO duality, presence of women on the board, company’s size, financial performance, Tobin’s Q ratio and financial leverage. Findings The results of study suggest a need for improvement in CGDs by Indian companies, as they fail to comply the majority of the proposed disclosure items. Furthermore, it is revealed that the number of board director, the value of company, the financial leverage and the presence of women affect negatively the dissemination level of corporate governance information. While, the size of company is the only determinant that positively affects the extent of CGD. Practical implications The results are valuable because they reveal the attributes that determines which companies needs less or extra monitoring by shareholders and investors regarding the applied corporate governance practices. In addition, the study can be valuable to policy makers responsible for the regulation of company’s accountability in relation to corporate governance practices. Originality/value The study extents previous studies by incorporating for the first time Bloomberg’s rating approach regarding the dissemination level of CGD in Indian context.

scholarly journals Quantifying within- and between-animal variation and uncertainty associated with counts of Escherichia coli O157 occurring in naturally infected cattle faeces

2008 ◽  
Vol 6 (31) ◽  
pp. 169-177 ◽  
Author(s):  
S.E Robinson ◽  
P.E Brown ◽  
E.J Wright ◽  
C.A Hart ◽  
N.P French
Keyword(s):  
Escherichia Coli ◽  
Statistical Model ◽  
Human Infection ◽  
Microbial Count ◽  
Infected Cattle ◽  
Explanatory Variables ◽  
E Coli ◽  
Fixed And Random Effects ◽  
Cattle Faeces ◽  
Multiple Samples

Cattle faeces are considered the most important reservoir for human infection with Escherichia coli O157. We have previously described shedding of E. coli O157 in the faeces of naturally infected cattle cohorts. However, the data require further investigation to quantify the uncertainty and variability in the estimates previously presented. This paper proposes a method for analysing both the presence and the quantity of E. coli O157 in cattle faecal samples, using two isolation procedures, one of which enumerates E. coli O157. The combination of these two measurements, which are fundamentally different in nature and yet measuring a common outcome, has necessitated the development of a novel statistical model for ascertaining the contribution of the various components of variation (both natural and observation induced) and for judging the influence of explanatory variables. Most of the variation within the sampling hierarchy was attributable to multiple samples from the same animal. The contribution of laboratory-level variation was found to be low. After adjusting for fixed and random effects, short periods of increased intensity of shedding were identified in individual animals. We conclude that within-animal variation is greater than between animals over time, and studies aiming to elucidate the dynamics of shedding should focus resources, sampling more within than between animals. These findings have implications for the identification of persistent high shedders and for assessing their role in the epidemiology of E. coli O157 in cattle populations. The development of this non-standard statistical model may have many applications to other microbial count data.

Αποτίμηση κινδύνων των ευρωπαϊκών τραπεζών και συστήματα έγκαιρης προειδοποίησης

2018 ◽  
Author(s):  
Παντελής Σταυρούλιας
Keyword(s):  
Logistic Regression ◽  
Discriminant Analysis ◽  
Cross Validation ◽  
Multinomial Logistic Regression ◽  
Classification Tree ◽  
Probit Regression ◽  
Macroprudential Policy ◽  
Policy Makers ◽  
Out Of Sample ◽  
Sample Testing

Οι έγκυρες προβλέψεις χρηματοοικονομικών κρίσεων διασφάλιζαν ανέκαθεν την σταθερότητα τόσο ολόκληρου του χρηματοοικονομικού οικοδομήματος γενικότερα, όσο και του τραπεζικού τομέα ειδικότερα. Με την παρούσα διατριβή επιτυγχάνεται η πρόβλεψη συστημικών τραπεζικών κρίσεων για χώρες της EE-14 αρκετά τρίμηνα προτού αυτές γίνουν αντιληπτές με την χρησιμοποίηση των πιο διαδεδομένων μεταβλητών (μακροοικονομικών, τραπεζικών και αγοράς) μέσω δύο προσεγγίσεων, της δυαδικής και της πολυεπίπεδης. Ακολουθώντας τη δυαδική προσέγγιση, εξάγονται μοντέλα ταξινόμησης με την εφαρμογή της Διακριτής Ανάλυσης (Discriminant Analysis), της Γραμμικής Παλινδρόμησης (Linear Regression), της Λογιστικής Παλινδρόμησης (Logistic Regression) και της Παλινδρόμησης Πιθανοομάδας (Probit Regression), για την έγκαιρη πρόβλεψη των κρίσεων -12 έως -7 τρίμηνα πριν την εμφάνισή τους. Επιπροσθέτως, συγκρίνεται η απόδοση της ανωτέρω ανάλυσης χρησιμοποιώντας τις νεότερες και πλέον υποσχόμενες μεθόδους του Δέντρου Ταξινόμησης (Classification Tree), του Τυχαίου Δάσους (Random Forest) και της C5. Ταυτόχρονα προτείνεται ένα νέο μέτρο επιλογής κατωφλίων και απόδοσης προσαρμογής (GoF) των μοντέλων πρόβλεψης και μια νέα συνδυαστική (combined) μέθοδος ταξινόμησης. Προκειμένου να διερευνηθεί η απόδοση της ανωτέρω ανάλυσης, χρησιμοποιείται ο εκτός του δείγματος έλεγχος (out-of-sample testing) με τη μέθοδο της ανά χώρα σταυρωτής επικύρωσης (country-blocked cross validation). Σύμφωνα με τη μέθοδο αυτή, πραγματοποιείται η ανάλυση και εξάγονται τα μοντέλα πρόβλεψης με τη χρήση των δεκατριών από τις δεκατέσσερις χώρες του δείγματος (in-sample), εφαρμόζονται τα εξαγόμενα μοντέλα για την δέκατη τέταρτη χώρα που είχε εξαιρεθεί από το αρχικό δείγμα (out-of-sample) και ελέγχονται τα αποτελέσματα πρόβλεψης με τα πραγματικά δεδομένα της χώρας αυτής. Η παραπάνω διαδικασία επαναλαμβάνεται δεκατέσσερις φορές, αφήνοντας δηλαδή κάθε φορά μια χώρα εκτός δείγματος και τελικά εξάγεται ο μέσος όρος των επαναλήψεων. Στην παρούσα διατριβή, και χρησιμοποιώντας τον εκτός του δείγματος έλεγχο, επιτυγχάνεται η κατά 82.4% σωστή ταξινόμηση (Ακρίβεια – Accuracy), 78.4% ποσοστό Αληθινών Θετικών (Τrue Ρositive Rate - TPR) και 80.6% ποσοστό Θετικής Τιμής Πρόβλεψης (Positive Predictive Value - PPV). Σύμφωνα με την πολυεπίπεδη προσέγγιση, διακρίνονται δύο επίπεδα-περίοδοι πρόβλεψης των Συστημικών Τραπεζικών Κρίσεων. Το πρώτο επίπεδο ονομάζεται έγκαιρη πρόβλεψη (early warning) και αφορά περίοδο -12 έως -7 τρίμηνα πριν την έλευση της κρίσης ενώ το δεύτερο επίπεδο ονομάζεται καθυστερημένη πρόβλεψη (late warning) και αφορά περίοδο -6 έως -1 τρίμηνα πριν την έλευση της κρίσης. Για την πολυεπίπεδη αυτή ταξινόμηση, γίνεται χρήση των Νευρωνικών Δικτύων (Neural Networks), της Πολυωνυμικής Λογιστικής Παλινδρόμησης (Multinomial Logistic Regression) και της Πολυεπίπεδης Γραμμικής Διακριτής Ανάλυσης (Multinomial Discriminant Analysis). Εφαρμόζοντας τον ίδιο εκτός του δείγματος έλεγχο με την πρώτη προσέγγιση επιτυγχάνεται η κατά 85.7% σωστή ταξινόμηση με την βέλτιστη μέθοδο που αποδεικνύεται ότι είναι η Πολυεπίπεδη Γραμμική Διακριτή Ανάλυση. Εφαρμόζοντας την ανωτέρω ανάλυση, οι ενδιαφερόμενοι φορείς άσκησης πολιτικής (policy makers) μπορούν να ανιχνεύσουν την ύπαρξης κρίσης σε βάθος χρόνου έως τριών ετών με τα προτεινόμενα μοντέλα, χρησιμοποιώντας μόνο δεδομένα που υπάρχουν ελεύθερα προσβάσιμα στο κοινό, ασκώντας με τον τρόπο αυτό την κατάλληλη ανά περίπτωση μακροπροληπτική πολιτική (macroprudential policy).

Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit

2020 ◽  
pp. 104990912096997
Author(s):  
Ricardo Diaz Milian
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Quality Care ◽  
Surgical Intensive Care Unit ◽  
Care Needs ◽  
Surgical Intensive Care ◽  
Quality Reporting ◽  
Number Of Patients ◽  
Hospice And Palliative Care

End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.

scholarly journals Does Gender Impact Intensity of Care Provided to Older Medical Intensive Care Unit Patients?

2010 ◽  
Vol 2010 ◽  
pp. 1-8
Author(s):  
Kathleen M. Akgün ◽  
Terrence E. Murphy ◽  
Katy L. B. Araujo ◽  
Peter H. Van Ness ◽  
Margaret Pisani
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Demographic Data ◽  
University Teaching ◽  
Explanatory Variables ◽  
Health Differences ◽  
Medical Intensive Care ◽  
Gender Based

Introduction. Women receive less aggressive critical care than men based on prior studies. No documented studies evaluate whether men and women are treated equally in the medical intensive care unit (MICU). The Therapeutic Intervention Scoring System-28 (TISS-28) has been used to examine gender differences in mixed ICU studies. However, it has not been used to evaluate equivalence of care in older MICU patients. We hypothesize that given nonsignificant, baseline health differences between genders at MICU admission, the level of care provided would be equivalent.Methods. Prospective cohort of 309 patients≥60 years old in the MICU of an urban university teaching hospital. Explanatory variables were demographic data and baseline measures. Primary outcomes were TISS-28 scores and MICU interventions. We compare TISS-28 scores by gender using a statistical test of equivalence.Results. Women were older and had more chronic respiratory failure at MICU admission. Using equivalence limits of±15% on gender-based scores of TISS-28, MICU interventions were equivalent. Supplementary analysis showed no statistically significant association between gender and mortality.Conclusions. In contrast with other reports from the cardiac critical care literature, as measured by the TISS-28, gender-based care delivered to older MICU patients in this cohort was equivalent.

scholarly journals Women: Mental Health Care Needs

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Sunanda. G. T ◽  
Mrs. Ashwini. R ◽  
Dr. Eilean Lazarus Victoria
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Needs ◽  
Media Law ◽  
Care Needs ◽  
Policy Makers ◽  
Professional Interest ◽  
The Family ◽  
Biological Differences

Women mental health needs arise from the biological differences, life situations of women, the stresses of changing society, decreasing social support from family and community and related issues. The broader aspects of meet the needs of women mental health care must need to be strengthen the family support, increase the mental health professional interest on these issues and also sensitize the writers, media, law, policy makers regarding women’s mental health care needs.

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