The main aim of this thesis is to analyse different mortality models regarding the longevity risk. We focus on the well-known stochastic models (Lee-Carter model, Age-period-cohort model by Renshaw and Haberman, Cairns-Blake-Dowd two-factor model) and compare them with relatively new Taiwanese model by Yang, Yue and Huang which is based on principal component analysis. Both the theoretical and also the empirical parts are included. Empirical part evaluates all the models mentioned above on the Czech mortality data from 1970-2000 for individuals aged between 50-100 years. Final mortality predictions are made for next 30 years.

Age, period, and cohort are three temporal dimensions that can make unique contributions to social and epidemiological changes that occur in populations over time. However, while the theoretical underpinnings for each temporal dimension are well established, the statistical techniques to assess the distinctive contributions of age, period and cohort are controversial. Unless questionable assumptions are imposed on the data, traditional linear regression models are incapable of estimating the independent contribution of each temporal dimension due to the linear dependence between age, period and cohort (A=P-C). Two recently developed methods, Hierarchical Age-PeriodCohort (HAPC) and Intrinsic Estimator (IE) models, enable researchers to estimate how all three temporal dimensions contribute to an outcome of interest without resorting to such assumptions. However, some simulation studies suggest that these new methods provide biased estimates of each temporal dimension. In this dissertation, I investigated whether practitioners can avoid biased results by first understanding the structure of the data. In Chapters 2 and 3, I examined whether visual plots of descriptive statistics and model selection statistics could identify various types of data structures through a series of simulation analyses. The results showed that preliminary data analysis is useful for identifying data structures that are compatible with the assumptions of HAPC and IE models. Moreover, when the data satisfied assumptions such as three-dimensionality and slight deviations from perfect functional forms, both HAPC and IE models tended to provide unbiased estimates of age, period and cohort effects. In Chapter 4, I provided a step-by-step demonstration for applying HAPC models by investigating the unique contributions of age, period and cohort to educational inequalities in the health of a large sample of U.S. adults. This study found that age and cohort effects contribute most to variability in health, and also that cross-validation is a useful way to incorporate HAPC models when preliminary analyses do not definitively show that the data structure is three dimensional.

The purpose of this study was to explore the McDaniel College Elementary STEM Instructional Leader (ESIL) pilot cohort's ability to proficiently plan lessons that incorporated the Maryland State STEM Standards of Practice (SOP), targeting integration of STEM content, inquiry learning, students' abilities to collaborate as a STEM team and students' strategic application of technology. Data collection, in the form of reviewing and analyzing study participants' lesson plans and self-reflections, was completed by three independent assessors. The researcher examined the interrater reliability among the three assessors using the Fleiss' kappa statistic. A 0.91 proportion of agreement consensus was documented among the three assessors. A test of hypothetical value was conducted using the nonparametric Wilcoxon-signed-rank Test. Interpretation of the Wilcoxon-signed-rank Test results suggest that the sample population demonstrated proficient planning abilities for the four targeted Maryland State STEM SOP. Findings from this research add to the field's knowledge of elements in the promotion of graduate coursework that leads to elementary in-service teachers' proficiency in planning STEM-centric lessons, however the findings also have broader implications for teacher education at large. The McDaniel College ESIL model could frame K-12 teacher education for both pre-service and in-service teachers. The pragmatic, hybrid experience maximizes flexibility, promotes analytical thinking and self-reflection and builds communication skills. The introduction and development of inquiry and design-based learning through the 7E Learning Cycle develops the teachers' understanding of practices promoted not only within the Maryland State STEM SOP, but also within the Next Generation Science Standards. The McDaniel College ESIL model also builds upon the collective efforts of academia, a non-profit STEM research facility, and local school divisions to align efforts that may lead to transformational changes for education. Essential ingredients for systemic change are embedded within the McDaniel ESIL model. / Ed. D.

Dans le cadre du protocole de Kyoto, la France s’est engagée à diviser par quatre ses émissions de gaz à effet de serre (GES) de 1990 à l'horizon 2050. Le Mexique a pour objectif d’atteindre une réduction de 50% en 2050 par rapport à l’année 2000. En vue du poids croissant du secteur des transport dans les villes d’environ 1 million d’habitants dans le total des émissions de CO2, nous souhaitons vérifier dans quelles mesures les expériences observées dans le Nord (plafonnement de la mobilité, diffusion de nouvelles technologies sur les véhicules) peuvent se répéter dans le Sud. Nous nous sommes pour cela appuyé sur des études de cas en France (Paris et Lille) et au Mexique (Juarez et Puebla). Le premier objectif de cette thèse a été d’identifier les déterminants de la mobilité urbaine. Le deuxième objectif a été d’appliquer le modèle âge-cohorte pour la prévision de la demande de transport, afin de prendre en compte l’évolution de la structure de la population (vieillissement) et les changements de comportement. Finalement, nous avons développé des diagnostics des émissions de GES. En France, nous avons observé des tendances vers une réduction des émissions de GES due à la baisse de la mobilité et aux nouvelles technologies, mais qui est encore loin d'être suffisante pour atteindre les objectifs fixés. Les études de cas du Mexique montrent l’incapacité à inverser la tendance à l'augmentation des émissions de GES ; par conséquent les objectifs de réduction seront difficilement atteints. Le cas du Mexique peut nous donner un aperçu des tendances dans les pays émergents, qui sont très loin d'atteindre un développement durable et resteront face à un grand défi dans le futur. / In the context of the Kyoto Protocol, France has set Greenhouse Gas (GHG) emission reduction targets of 75% below 1990 levels by 2050. More recently, Mexico has set the objective to achieve a 50% reduction by 2050 with respect to the base year 2000. Since the transport sector in urban areas with approximately 1 million inhabitants accounts for most CO2 emissions and will continue to increase its share, we wanted to determine to what extent the experiences observed in cities from developed countries (peak travel, dissemination of new vehicle technologies) may be repeated in urban areas from developing nations. For this purpose, we focus on case studies in France (Paris and Lille) and Mexico (Juarez and Puebla). The first objective of this thesis was to identify the determinants of mobility on each urban region. The second objective was to apply the age-cohort model for the development of long-term travel demand forecasts in order to take into account changes in the population structure (ageing) and in travel behaviour. The last objective was to develop GHG emissions assessments from observed travel demand. The decline in mobility and the dissemination of new vehicle technologies in France led to a reduction in GHG emissions. However, these changes are not sufficient to achieve the GHG reduction targets. The case studies in Mexico show the inability to reverse the trend towards the increase of GHG emissions; therefore the reduction targets will be hardly achieved. The case of Mexico give us an overview of trends in emerging countries, which are very far from achieving sustainable development and will face a major challenge in the coming decades.

L’encéphalopathie spongiforme bovine (ESB) est une maladie neuro-dégénérative fatale affectant les bovins ; elle est également une zoonose à l’origine du variant de la maladie de Creutzfeldt-Jakob. Identifiée pour la première fois au Royaume-Uni en 1986, cette maladie s’est rapidement étendue en Europe, malgré la mise en place de mesures de contrôle. En raison des particularités épidémiologiques de l’ESB (longue période d’incubation, âge précoce à l’infection et diagnostic post-mortem possible uniquement en fin d’incubation), l’évolution temporelle de l’exposition des bovins à l’ESB ne peut être appréhendée qu’à partir de la modélisation. Nous avons utilisé le modèle Age-Période-Cohorte afin de (ré)évaluer, en relation avec les principales mesures de contrôle, l’évolution de l’épizootie d’ESB à la lumière des données de surveillance les plus récente, en France, et dans six autres pays européens : Allemagne, Irlande, Italie, Pays-Bas, Pologne et Royaume-Uni. / Bovine spongiform encephalopathy is a fatal neurodegenerative disease affecting cattle and transmissible to humans as the cause of variant Creutzfeldt-Jakob disease. BSE was first identified in 1986 in United Kingdom, before spreading to European countries despite the implementation of control measures. Due to BSE epidemiological characteristics (long incubation period, early age at infection and post-mortem diagnostic at end stage of incubation period), time trend of BSE cattle exposure can only be estimated by modeling. We used age-period-cohort model in order to (re)evaluate, in relation to the main control measures, the trend of BSE epidemic, using the most recent surveillance data in France and six other European countries: Germany, Ireland, Italy, the Netherlands, Poland and United Kingdom.

為瞭解臺灣地區男女自殺死亡率的差異，本文採用Held and Riebler (2010)所建議的多元年齡-年代-世代模型，同時探討男女性自殺死亡率在年齡、年代及世代三種效應上的差異，我們同時使用非條件概似函數法（或稱對數線性模型法）及條件概似函數法（或稱多項式邏輯模型法）對台灣地區男女自殺死亡資料來配適模型。結果發現在假設世代效應與性別無關的前提下，年齡方面， 女性的自殺死亡率在10歲到24歲時顯著比男性高，在15到19歲這個年齡層差異達到最大，20歲之後差異開始變小，到了25至34歲，兩性則已無顯著差異，35歲之後男性的自殺死亡率開始顯著大於女性，並且隨著年齡增長兩性的差異越大，直到60歲之後差異才開始減小，到70歲時兩性無顯著差異。年代方面，男女的自殺死亡率在1959年到1973年間沒有顯著的差異，在1974到1988年女性的自殺死亡率顯著大於男性並於1979年到1983年來到最低點，也就是差異最大，之後差異開始變小，到了1989年時兩性已無顯著差異，從1994年開始男性的自殺死亡率反而開始顯著大於女性，而且隨著年代增加差異越大，並於2004到2008這個年代層差異達到最大。 / To understand the differences in suicide mortality between men and women in Taiwan, this study uses the Multivariate Age-Period-Cohort model proposed by Held and Riebler (2010), and explores the differences in suicide mortality between men and women on age, period and cohort effects adjusted for the other two. We use both unconditional likelihood function method (or log-linear model) and conditional likelihood function method (or multinomial logit model) to fit the model. Assuming that the cohort effect is independent of the gender, female suicide mortality in the age of 10 to 24 years old appears significantly higher than that of male, and the maximum age difference appears at the age of 15 to 19 years old. The difference is getting smaller after the age of 20, and gender difference is no longer significant between age of 25 to 34. After 35-year-old, male suicide death rate starts to exceed that of female, and the difference increases until the age of 60. After 60 years old, the difference starts to decrease till age of 70 at which there is no significant gender differences. There is no significant gender-specific suicide mortality difference between years 1959 and 1973. From 1974 to 1988 female suicide mortality rate is significantly greater than male. The difference reaches the peak in1979 to 1983. After that, the difference is getting smaller, and gender difference is no longer significant between 1989 and 1993. From 1994, suicide mortality for men begins to be significantly greater than women, and the difference increases with period. This difference reaches the maximum level in 2004 to 2008.

20世紀以來，因為衛生醫療等因素的進步，各年齡死亡率均大幅下降，使得平均壽命大幅延長。壽命延長的效果近年逐漸顯現，其中的人口老化及其相關議題較受重視，因為人口老化已徹底改變國人的生活規劃，死亡率是否會繼續下降遂成為熱門的研究課題。描述死亡率變化的模型很多，近代發展的Age–Period–Cohort模型(簡稱APC模型)，同時考慮年齡、年代與世代三個解釋變數，是近年廣受青睞的模型之一。這個模型將死亡率分成年齡、年代與世代三個效應，常用於流行病學領域，探討疾病、死亡率是否與年齡、年代、世代三者有關，但一般僅作為資料的大致描述，本研究將評估APC模型分析死亡率的可能性。 APC模型最大的問題在於不可甄別(Non–identification)，即年齡、年代與世代三個變數存有共線性的問題，眾多的估計APC模型參數方法因應甄別問題而生。本研究預計比較七種較常見的APC模型估計方法，包括本質估計量(IE)、限制的廣義線性模型(cglim_age、cglim_period與cglim_cohort)、序列法ACP、序列法APC與自我迴歸模型(AR)，以確定哪一種估計方法較為穩定，評估包括電腦模擬與實證分析兩部份。 電腦模擬部份比較各估計方法，衡量何者有較小的年齡別死亡率及APC參數的估計誤差；實證分析則考慮交叉分析，尋找用於死亡率預測的最佳估計方法。另外，也將以蒙地卡羅檢驗APC的模型假設，以確定這個模型的可行性。初步研究發現，以台灣死亡資料做為實證，本研究考量的估計方法在估計年齡別死亡率大致相當，只是在年齡–年代–世代這三者有不同的詮釋，且模型假設並非很符合。交叉分析上，Lee–Cater模型及其延展模型相對於APC模型有較小的預測誤差，整體顯示Lee–Cater 模型較佳。 / Since the beginning of the 20th century, the human beings have been experiencing longer life expectancy and lower mortality rates, which can attributed to constant improvements of factors such as medical technology, economics, and environment. The prolonging life expectancy has dramatically changed the life planning and life style after the retirement. The change would be even more severe if the mortality rates have larger reduction, and thus the study of mortality become popular in recent years. Many methods were proposed to describe the change of mortality rates. Among all methods, the Age-Period-Cohort model (APC) is a popular method used in epidemiology to discuss the relation between diseases, mortality rate, age, period and cohort. Non-identification (i.e. collinearity) is a serious problem for APC model, and many methods used in the procedure included estimation of parameter. In the first part of this paper, we use simulation compare and evaluate popular estimation methods of APC model, such as Intrinsic Estimator (IE), constrained of age, period and cohort in the Generalized Linear Model (c–glim), sequential method, and Auto-regression (AR) Model. The simulation methods considered include Monte-Carlo and cross validation. In addition, the morality data in Taiwan (Data sources: Ministry of Interior), are used to demonstrate the validity and model assumption of these methods. In the second part of this paper, we also apply similar research method to the Lee-Carter model and compare it to the APC model. We found Lee–Carter model have smaller prediction errors than APC models in the cross–validation.

隨著經濟發展與所得水準提升，臺灣地區就業人口由早期的第一級產業－農林漁牧業逐漸移向第二級產業－工業，再由第二級產業轉移至第三級產業－服務業。為瞭解臺灣地區服務業就業之趨勢，國內多數研究僅就蒐集資料以年齡、年代或世代三方面分別作探討，本文則改採流行病學領域中所廣泛使用之年齡－年代－世代模型（Age-Period-Cohort Model），就行政院主計處「人力資源調查」資料來作分析。但年齡、年代與世代三者間存在共線性問題（即世代＝年代－年齡），導致迴歸模型產生無限多組解，為了自其中選出一組較適當之參數估計值，文獻中提供了許多不同形式的解決方法。本文則採用Fu（2000）所提出之本質估計量（Intrinsic Estimator，簡稱IE），這是一種不受參數限制式影響的估計方式。我們除了藉以取得惟一的參數估計值，進而分析年齡、年代及世代效應對服務業就業比率之影響外，並與傳統之受限廣義線性模型估計量（Constrained Generalized Linear Models Estimator，簡稱CGLIME）作一比較，來說明採用本質估計量之優點及方便之處。 / Along with economical development and higher income level, Taiwan area employed population has gradually been switching from farming, forestry, fishing and animal husbandry to goods-producing industries, and then onto services-producing industries. In order to understand the trend of employment in service-producing industries in Taiwan, most domestic studies focus on the aspects of age, period or cohort separately. We, instead, adopt the Age-Period-Cohort (APC) model, which is well recognized in the epidemiology, to analyze the data from “Manpower Surveys” conducted by the Directorate-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C. in this study. However, due to the collinearity among the age, period, and cohort effects, the APC model suffers from the identifiability problem. Some possible solutions have been provided in the literature. Among them, the Constrained Generalized Linear Models Estimator (CGIME) is undoubtedly the most popular choice, while the Intrinsic Estimator (IE) (Fu (2000)), which is invariant to the constraint selected to obtain the parameter estimates, is less well-known. We compare the results obtained from IE with that of CGIME in this study, and discuss the advantages of using the Intrinsic Estimator.

Family policy andreproductive behaviour in the VisegradGroup states after 1990 Abstract In post-communist countries, the fertility decline has been already subjected in many researches. Aim of this diploma thesis is to analyse trends in fertility and family policy in the Visegrad countries. The goal was to find out how the post-1990 approach on family policy and response to changing social conditions differed in the Czech Republic, Hungary, Poland and Slovakia. The study describes settings for each family benefits including the changes in the examined period of 1990-2013. On that basis 5-year periods were defined and assessed. The fertility analysis is focused on the total and completed fertility rate and also by parity and age-specific fertility rates. The period effect was estimated using age-period-cohort (APC) models which decompose fertility rates for age, period and cohort effects. Models were based on fertility of women aged 25-49 years in the Czech Republic, Hungary and Slovakia. Results in all three countries suggest that the decline in fertility in 1995-1999 wasa reaction to the changing socio-economic conditions in 1990-1994. However, the negative effect of this period was mitigated by changes in the distribution of cohorts. The period 2000-2004 has brought many positive changes that were behind...

Introduction: Quality improvement (QI) encompasses a wide range of healthcare studies and activities with the common goal of improving patient outcomes, healthcare system performance, and professional development. QI is characterized by a diversity of definitions, stakeholders, clinical fields and study designs, which creates challenges for rigorous reporting and evaluation of these studies. Understanding and addressing the methodological issues that arise from conducting QI studies from multiple clinical disciplines is critical for generating good evidence for healthcare improvement to tackle health system challenges. Objectives: This thesis addressed three independent objectives: (i) Determine the quality of reporting of QI studies in neonatology. (ii) Compare different statistical methods that can be used to analyze data from a cluster randomized controlled trial with repeated measures data and examine how the estimate of intervention effects varies between these approaches. (iii) Determine the cost-effectiveness of providing timely surgery or timely rehabilitation for patients with hip fracture. Methods: Objective 1: We conducted a systematic survey of quality improvement studies in neonatology to examine the extent to which these publications adhered to SQUIRE 2.0, the guidelines for reporting studies that sought to improve the quality, safety, and value of healthcare. Using the same set of articles, we examined how various methodological attributes, such as stakeholder engagement, outcome measures, and statistical process controls, are reported in these studies. Objective 2: To compare the differences in the statistical estimates of intervention effects between linear mixed models and Generalized Estimating Equations, for the CP@Clinic Program cluster randomized RCT, which contains routinely collected monthly outcome data aggregated at the cluster level. Objective 3: We constructed a Markov cohort model to estimate the cost-effectiveness of receiving timely surgery within 24 hours of admission to the emergency department, receiving immediate admission to inpatient rehabilitation following acute care discharge, receiving both, or none. Results: Objective 1: In our assessment of reporting quality, we found that adherence to SQUIRE 2.0 guidelines was inadequate and that journals should endorse the SQUIRE 2.0 guideline for improvement publications to alleviate this issue. We found that process measures was the most frequently reported methodological attribute (89%), while stakeholder engagement with leadership (32%) or caregivers (10%) were infrequently reported or conducted. Objective 2: In comparing statistical methods for analyzing a cluster randomized controlled trial with correlated data, we found that it was critical to apply a correction to the variance estimator of generalized estimating equations to produce robust estimates of the intervention effects. Objective 3: In our economic evaluation, both timely surgery alone and the combination of timely surgery and timely rehabilitation yielded cost-effective improvements in the quality-adjusted life-years of patients with hip fracture. However, the combination of receiving timely surgery and timely rehabilitation requires a high willingness-to-pay threshold, above $128,000 per quality-adjusted life-years, to be considered cost-effective. Conclusions: Overall, understanding the state of reporting and the broad spectrum of methods and methodologic issues for evaluating quality improvement initiatives will advance its rigorous research, evaluation, reporting, and contribution towards informed decision-making for tackling pressing healthcare issues. / Thesis / Doctor of Philosophy (PhD) / Quality improvement (QI) is a field of healthcare research that can be defined in many ways, and research in this field is conducted by researchers from various medical disciplines. Consequently, challenges may arise in reporting and evaluating QI interventions. Thus, it is important to examine how QI interventions are reported in academic literature and the methods used to evaluate their effectiveness in improving health. The current thesis aims to address these issues through three independent objectives: (1) examine the details reported in QI studies in neonatology, (2) compare different statistical methods that can be used to analyze data from a community paramedicine cluster randomized controlled trial, and (3) investigate whether providing timely surgery and timely hospital-based rehabilitation is a cost-effective way to improve the quality of life of patients who have experienced hip fracture. The findings of these studies will provide insights into the challenges of reporting and evaluating QI interventions, and suggest ways to improve them.