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Geographic Variation in the Utilization of Antihyperglycemic Therapies in the U.S. Medicaid Program at State-Level Using Geographic Information SystemAlmarhoon, Zahra M., B.S. 18 June 2019 (has links)
No description available.
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Profile Analysis of Regional Variations Among Virginia Winery VisitorsAdams, Christopher Blaine 07 August 2001 (has links)
This research is concerned with examining market segments and regional variations associated with winery visitors in the state of Virginia. The tourism literature published by the state of Virginia for wineries indicates that there are five wine regions. In this research, data were collected from interviews conducted at wineries in each of the five wine regions. The first phase of analysis sought to create market segments using a factor-cluster approach. Segments were created using cluster analysis and multiple discriminant analysis. Three distinct market segments based on benefits sought by the visitor emerged from these data. Regional variations were examined in the second part of this study. The data were classified into individual regions based on the locations of the wineries examined. Distinct differences in the regional profiles were revealed. Weak significant relationships among the segments and regions were also revealed through analysis indicating a spatial component to the segments. This research proposes the use of three regions for market research purposes, while retaining the five existing regions for promoting an organized structure to visiting wineries in the state. / Master of Science
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Patient Preferences, Referral Practices, and Surgeon Enthusiasm for Degenerative Lumbar Spinal SurgeryBederman, S. Samuel 15 April 2010 (has links)
Degenerative disease of the lumbar spine (DDLS) is a common condition for which surgery is beneficial in selected patients. Wide variation in surgical referral and rates of surgery has been observed contributing to unequal access to care.
Our objectives were to examine (1) the variation in preferences for referral and surgery among surgeons, family physicians (FPs) and patients, (2) how FP referral practices compare with preferences and guideline recommendations, and (3) how the ‘enthusiasm’ of patients and physicians influence regional variation in surgical rates.
We used conjoint analysis in a mailed survey to elicit preferences based on clinical vignettes from surgeons, FPs and patients. A Delphi expert panel provided consensus guideline recommendations for surgical referral to compare with actual FP referral practices. Rates of surgery for DDLS, obtained from Ontario hospital discharge data, were used to quantify regional variation and regression models assessed the relationship with patient and physician enthusiasm.
We identified significant differences in preferences for referral and surgery between patients, FPs and surgeons. Surgeons placed high importance on leg-dominant symptoms while patients had high importance for quality of life symptoms (i.e. severity, duration, walking tolerance). Surgical referral practices were poorly predicted by individual FP preferences and guideline recommendations based on clinical factors alone. Variation in Ontario surgical rates was higher than that of hip or knee replacements and was highly associated with the enthusiasm of surgeons (p<0.008), rather than FPs or patients.
By appreciating the variation in preferences between patients and physicians, and exploring other non-clinical factors that influence referrals, we may be able to improve the efficiency of referrals and enhance the shared decision making process. With an understanding of the influence that surgeons have in driving variation in surgical rates, further research may allow us to direct strategies to improve access and allow for a more equitable delivery of care for patients suffering from DDLS.
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Patient Preferences, Referral Practices, and Surgeon Enthusiasm for Degenerative Lumbar Spinal SurgeryBederman, S. Samuel 15 April 2010 (has links)
Degenerative disease of the lumbar spine (DDLS) is a common condition for which surgery is beneficial in selected patients. Wide variation in surgical referral and rates of surgery has been observed contributing to unequal access to care.
Our objectives were to examine (1) the variation in preferences for referral and surgery among surgeons, family physicians (FPs) and patients, (2) how FP referral practices compare with preferences and guideline recommendations, and (3) how the ‘enthusiasm’ of patients and physicians influence regional variation in surgical rates.
We used conjoint analysis in a mailed survey to elicit preferences based on clinical vignettes from surgeons, FPs and patients. A Delphi expert panel provided consensus guideline recommendations for surgical referral to compare with actual FP referral practices. Rates of surgery for DDLS, obtained from Ontario hospital discharge data, were used to quantify regional variation and regression models assessed the relationship with patient and physician enthusiasm.
We identified significant differences in preferences for referral and surgery between patients, FPs and surgeons. Surgeons placed high importance on leg-dominant symptoms while patients had high importance for quality of life symptoms (i.e. severity, duration, walking tolerance). Surgical referral practices were poorly predicted by individual FP preferences and guideline recommendations based on clinical factors alone. Variation in Ontario surgical rates was higher than that of hip or knee replacements and was highly associated with the enthusiasm of surgeons (p<0.008), rather than FPs or patients.
By appreciating the variation in preferences between patients and physicians, and exploring other non-clinical factors that influence referrals, we may be able to improve the efficiency of referrals and enhance the shared decision making process. With an understanding of the influence that surgeons have in driving variation in surgical rates, further research may allow us to direct strategies to improve access and allow for a more equitable delivery of care for patients suffering from DDLS.
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Representation of Northern English and Scots in seventeenth century dramaStewart, Lauren Marie January 2011 (has links)
Early Modern English (c. 1500-‐1700) is a difficult period for dialectological study. A dearth of textual evidence means that no comprehensive account of regional variation for this period can be attempted, and the field has therefore tended to be somewhat neglected. However, some evidence of regional varieties of English is provided by dialect representation in Early Modern drama. The dialogue of certain English and Scottish characters (and of those who impersonate them) is often marked linguistically as different from other characters: morphosyntactic forms, lexical items, and phonological features shown through variant spellings suggest dialectal usage in contrast to Standard English. This evidence, I argue, forms a legitimate basis on which to build at least a partial account of regional variation. The 47 plays analysed in this thesis were all written and/or printed between 1598 and 1705, and all feature examples of either Northern English or Scots dialect representation. From these examples we can build up a picture of some of the main phonological, morphosyntactic, and lexical elements of the seventeenth century dialects spoken in Scotland and northern England. Moreover, this literary evidence can help clarify and contextualise earlier scholarly work on the topic. The content of the plays themselves, along with the dialect representations, also provide sociocultural and sociolinguistic information about the perception of Scots and northerners and of the attitudes towards them across the country. In Chapter 1 I outline my methodology and provide a review of relevant literature, particularly focusing on other studies of dialect representation in drama. Chapter 2 gives an overview of the historical context for my linguistic data in seventeenth century Britain, including discussions of theatrical history in both England and Scotland, and of population movement and dialect contact. The Scottish dialect evidence is presented in Chapters 3 to 6. In Chapter 3, I give a chronological list of 33 plays featuring Scots dialect representation. In order to contextualise the plays, I provide background information about the author, printing, and performance history; a brief summary of the plot and a description of the dialect speaker; my assessment of the dialect representation; and if pertinent, commentary by other critics. I present and analyse the data from dramatic depictions of Scots, focusing on lexical items (Chapter 4), morphosyntactic features (Chapter 5), and phonological features as indicated by variant spellings (Chapter 6). I compare the literary data with linguistic reference works, including modern and historical dialect atlases, dictionaries, and dialect surveys. I also consult additional Early Modern sources and other reference works. The next four chapters focus on representations of dialects of northern England. These chapters follow the same format as the chapters on Scottish dialect: Chapter 7 contains a discussion of 15 seventeenth-‐century plays featuring representations of Northern English. Chapters 8, 9, and 10 mirror the structure of Chapters 4, 5, and 6, respectively, discussing lexical forms, and morphosyntactic and phonological features in representations of Northern English. I offer my conclusions in Chapter 11. With my detailed analysis of the data, I demonstrate that representations of regional usage in seventeenth century drama cannot be dismissed as stereotyped examples of a stage dialect, and that these literary data are worthy of being analysed linguistically. Although the quantity of dialect representation differs from one play to the next, and the quality covers a broad spectrum of linguistic accuracy, it nevertheless provides important information about non-‐standard dialects of northern England and Scotland in the seventeenth century.
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Factors affecting morphometrics and epiphyseal closure of white-tailed deerFlinn, Emily Brooke 07 August 2010 (has links)
Factors affecting morphometrics and epiphyseal closure are important in understanding regional variation and growth of white-tailed deer (Odocoileus virginianus). I compared body and antler growth from birth to 3 years of age in captive, first-generation, male white-tailed deer from three regions with varying soil quality and deer morphometrics. I also determined gender and age effects on epiphyseal closure timing in captive white-tailed deer. I found regional morphological variation present in first-generation male deer, which may be caused by regional genetic variation or lingering maternal effects. Determining cause of regional morphological variation will require data collection through a second-generation of males raised on the controlled diet. Epiphyseal closure timing was associated positively with age. Two of the four epiphyseal plates examined were affected by gender, with females closing prior to males. Morphometric and epiphyseal data confirm that age and gender affect epiphyseal closure timing in white-tailed deer.
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A Corpus-Based Comparison Between Coreferential Direct Object Nominal Clauses and Direct Object Infinitive ComplementsRutter, Ethan C. 18 April 2022 (has links) (PDF)
The objective of this thesis is to analyze the variation between two competing structures--on the one hand, a transitive verb that takes a finite nominal clause as its complement, and on the other hand, a transitive verb that takes an infinitive as its complement. This thesis seeks to address three questions: (1) Which semantic categories are more likely to use coreferential nominal clauses as complements? (2) How do coreferential finite nominal clauses compare with coreferential infinitive complements, in terms of frequency of usage? And (3) do the corpora show any variation among different countries? The corpora CREA and Web/Dialects were used to determine the frequency of usage between these two structures with four different semantic categories of verbs used in the main clause: assertive, dubitative, evaluative, and volitive. The U.S., Spain, Argentina, and Mexico were also used to compare the results by country. The findings show that when the main verb is assertive the use of a subordinate clause is favored, while main clauses with dubitative showed mixed results between the corpora, although Web/Dialects showed that dubitatives favor an infinitive complement. The evaluative verbs lamentar and odiar did not produce any coreferential results with direct object nominal clauses. Volitive verbs never accepted the use of a coreferential finite. The Web/Dialects results indicate that Spain and the U.S were more likely than Argentina and Mexico to use the finite construction after a main clause with a dubitative phrase, while still favoring the infinitive complement.
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Comparing survival from cancer using population-based cancer registry data - methods and applicationsYu, Xue Qin January 2007 (has links)
Doctor of Philosophy / Over the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. The utility of the conclusions from such studies relies heavily on the data quality and the methods used to analyse the data. Interpretation of comparative survival from such data, examining either temporal trends or geographical differences, is generally not easy. The observed differences could be due to methodological and statistical approaches or to real effects. For example, geographical differences in cancer survival could be due to a number of real factors, including access to primary health care, the availability of diagnostic and treatment facilities and the treatment actually given, or to artefact, such as lead-time bias, stage migration, sampling error or measurement error. Likewise, a temporal increase in survival could be the result of earlier diagnosis and improved treatment of cancer; it could also be due to artefact after the introduction of screening programs (adding lead time), changes in the definition of cancer, stage migration or several of these factors, producing both real and artefactual trends. In this thesis, I report methods that I modified and applied, some technical issues in the use of such data, and an analysis of data from the State of New South Wales (NSW), Australia, illustrating their use in evaluating and potentially improving the quality of cancer care, showing how data quality might affect the conclusions of such analyses. This thesis describes studies of comparative survival based on population-based cancer registry data, with three published papers and one accepted manuscript (subject to minor revision). In the first paper, I describe a modified method for estimating spatial variation in cancer survival using empirical Bayes methods (which was published in Cancer Causes and Control 2004). I demonstrate in this paper that the empirical Bayes method is preferable to standard approaches and show how it can be used to identify cancer types where a focus on reducing area differentials in survival might lead to important gains in survival. In the second paper (published in the European Journal of Cancer 2005), I apply this method to a more complete analysis of spatial variation in survival from colorectal cancer in NSW and show that estimates of spatial variation in colorectal cancer can help to identify subgroups of patients for whom better application of treatment guidelines could improve outcome. I also show how estimates of the numbers of lives that could be extended might assist in setting priorities for treatment improvement. In the third paper, I examine time trends in survival from 28 cancers in NSW between 1980 and 1996 (published in the International Journal of Cancer 2006) and conclude that for many cancers, falls in excess deaths in NSW from 1980 to 1996 are unlikely to be attributable to earlier diagnosis or stage migration; thus, advances in cancer treatment have probably contributed to them. In the accepted manuscript, I described an extension of the work reported in the second paper, investigating the accuracy of staging information recorded in the registry database and assessing the impact of error in its measurement on estimates of spatial variation in survival from colorectal cancer. The results indicate that misclassified registry stage can have an important impact on estimates of spatial variation in stage-specific survival from colorectal cancer. Thus, if cancer registry data are to be used effectively in evaluating and improving cancer care, the quality of stage data might have to be improved. Taken together, the four papers show that creative, informed use of population-based cancer registry data, with appropriate statistical methods and acknowledgement of the limitations of the data, can be a valuable tool for evaluating and possibly improving cancer care. Use of these findings to stimulate evaluation of the quality of cancer care should enhance the value of the investment in cancer registries. They should also stimulate improvement in the quality of cancer registry data, particularly that on stage at diagnosis. The methods developed in this thesis may also be used to improve estimation of geographical variation in other count-based health measures when the available data are sparse.
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Comparing survival from cancer using population-based cancer registry data - methods and applicationsYu, Xue Qin January 2007 (has links)
Doctor of Philosophy / Over the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. The utility of the conclusions from such studies relies heavily on the data quality and the methods used to analyse the data. Interpretation of comparative survival from such data, examining either temporal trends or geographical differences, is generally not easy. The observed differences could be due to methodological and statistical approaches or to real effects. For example, geographical differences in cancer survival could be due to a number of real factors, including access to primary health care, the availability of diagnostic and treatment facilities and the treatment actually given, or to artefact, such as lead-time bias, stage migration, sampling error or measurement error. Likewise, a temporal increase in survival could be the result of earlier diagnosis and improved treatment of cancer; it could also be due to artefact after the introduction of screening programs (adding lead time), changes in the definition of cancer, stage migration or several of these factors, producing both real and artefactual trends. In this thesis, I report methods that I modified and applied, some technical issues in the use of such data, and an analysis of data from the State of New South Wales (NSW), Australia, illustrating their use in evaluating and potentially improving the quality of cancer care, showing how data quality might affect the conclusions of such analyses. This thesis describes studies of comparative survival based on population-based cancer registry data, with three published papers and one accepted manuscript (subject to minor revision). In the first paper, I describe a modified method for estimating spatial variation in cancer survival using empirical Bayes methods (which was published in Cancer Causes and Control 2004). I demonstrate in this paper that the empirical Bayes method is preferable to standard approaches and show how it can be used to identify cancer types where a focus on reducing area differentials in survival might lead to important gains in survival. In the second paper (published in the European Journal of Cancer 2005), I apply this method to a more complete analysis of spatial variation in survival from colorectal cancer in NSW and show that estimates of spatial variation in colorectal cancer can help to identify subgroups of patients for whom better application of treatment guidelines could improve outcome. I also show how estimates of the numbers of lives that could be extended might assist in setting priorities for treatment improvement. In the third paper, I examine time trends in survival from 28 cancers in NSW between 1980 and 1996 (published in the International Journal of Cancer 2006) and conclude that for many cancers, falls in excess deaths in NSW from 1980 to 1996 are unlikely to be attributable to earlier diagnosis or stage migration; thus, advances in cancer treatment have probably contributed to them. In the accepted manuscript, I described an extension of the work reported in the second paper, investigating the accuracy of staging information recorded in the registry database and assessing the impact of error in its measurement on estimates of spatial variation in survival from colorectal cancer. The results indicate that misclassified registry stage can have an important impact on estimates of spatial variation in stage-specific survival from colorectal cancer. Thus, if cancer registry data are to be used effectively in evaluating and improving cancer care, the quality of stage data might have to be improved. Taken together, the four papers show that creative, informed use of population-based cancer registry data, with appropriate statistical methods and acknowledgement of the limitations of the data, can be a valuable tool for evaluating and possibly improving cancer care. Use of these findings to stimulate evaluation of the quality of cancer care should enhance the value of the investment in cancer registries. They should also stimulate improvement in the quality of cancer registry data, particularly that on stage at diagnosis. The methods developed in this thesis may also be used to improve estimation of geographical variation in other count-based health measures when the available data are sparse.
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Vocal Flexibility and Regional Variation in Free-Tailed Bat SongSalazar, Israel 07 July 2016 (has links)
While much work has been done on regional vocal variation in birds, relatively few studies have found evidence of similar variation in mammalian vocalizations. This study quantifies individual, colonial, and regional level variation in T. brasiliensis songs in the southeastern United States. Brazilian free-tailed bats (Tadarida brasiliensis) are among a handful of mammals that produce complex, hierarchically structured vocalizations. Their songs are composed of multiple syllables that are combined into three phrases that vary in number and order across renditions. Tadarida brasiliensis songs showed considerable amount of variation, and differed significantly between locations in terms of syllable structure and song syntax. Some of the variation observed was not correlated to geographical distance, and is unlikely to be explained by genetic divergence or differences in habitat use. These results indicate the existence of vocal dialects and a possible role of vocal production learning in dialect formation in this species.
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