Using Simulated Data to Examine the Determinants of Acute Hospital Demand at the Small Area Level

The aim of this article is to establish whether spatial variation exists in acute hospital utilization in Ireland and, if it does, to identify the microlevel factors influencing this variation. First, an alignment process is used to calibrate the acute inpatient attendance and nights spent in hospital variables produced by a spatial microsimulation model at both the national and the subnational levels. Comparing the results of the national and subnational alignment allows us to examine whether spatial variation exists. Second, after establishing that hospital utilization displays a significant spatial pattern, we use a nationally representative survey to determine which individual‐level factors significantly affect inpatient attendance and the number of nights spent in hospitals. Using the calibrated data from the aforementioned spatial microsimulation model, we examine whether the spatial patterns of those variables found to influence hospital utilization match the spatial pattern of actual hospital utilization rates at the small area, electoral division level. That is, are the individuals/areas with the highest demand for acute hospital services utilizing acute hospital services? Finally, the results of this research are discussed in relation to both the national and international literature. El objetivo de este artículo es determinar si existe variación espacial en la utilización aguda y urgente (acute) de hospitales en Irlanda, y de ser así, identificar los factores microeconómicos que influyen en esta variación. En primer lugar, se utiliza un proceso de alineación para calibrar las variables de concurrencia (asistencia) de pacientes hospitalizados con casos agudos y de noches de estancia en el hospital, producidas por un modelo microsimulación espacial, tanto para niveles nacionales como subnacionales. Comparar los resultados de alineación de los niveles nacionales y subnacionales nos permite examinar si existe variación espacial. En segundo lugar, después de establecer que la utilización de hospitales muestra un patrón espacial significativo, empleamos una encuesta (un censo) nacional representativa para determinar qué factores a nivel individual afectan significativamente la concurrencia de pacientes hospitalizados y el número de noches de estancia en los hospitales. Al usar los datos calibrados del ya mencionado modelo de microsimulación espacial, analizamos si los patrones espaciales de esas variables que influyen en la utilización de hospitales concuerdan con el patrón espacial de las tasas reales (existentes) de utilización hospitalaria al nivel de las áreas pequeñas de división electoral (DE). En otras palabras, ¿Son las/los individuos/áreas con la mayor demanda de casos agudos de servicios de hospitalización las/los que están utilizados los servicios de hospitalización aguda? Finalmente, los resultados de esta investigación se analizan (discuten) en relación a la literatura especializada nacional e internacional. 本文的研究目的在于通过建立模型以检验爱尔兰急症医院的利用是否存在空间分异。如果存在空间分异,则识别影响其空间分异的微观尺度的驱动因子。首先,在国家和地方两个尺度,通过空间微观模型对所要构建模型的求诊人数及他们花费的夜间数进行校正和调整,并通过对比国家与地方两个尺度的校准结果,来检验其是否存在空间分异。其次,通过建立的模型检验出急诊医院的利用具有显著的空间模式,利用一份具有全国代表性的调查以确定哪些个体层面因素显著影响着求诊人数与在医院花费的夜间数。利用上述空间微观模拟模型检测影响医院利用的那些变量的空间模式,与实际的医院利用率的空间模式在被划分的小区域尺度上是否匹配。也就是说,这些对急症医院服务具有最大需求的个体或区域是否真正实际在使用着这些服务。最后,将本文结果与国内和国际文献进行了相关探讨。.     

Imagined productive communities: Industrial rationalisation and cultural crisis in 1930s France

This article discusses the French interwar movement in favour of the rationalisation of work and its ideas for a new industrial order. It argues that these ideas were shaped by anxieties about the social consequences of mass production and that a preoccupation with the (re-)creation of productive communities was central to the rationalisation project in France. Rather than embracing American-style mass production as the only model for modernisation, the French modernisers discussed here sought to map out a distinctive route: they sought ways in which goods could be produced on a mass scale, while workers were organised on a human scale, or even returned to the land. Such ambitions gesture just as much towards the passéisme of the Révolution nationale as to the model of Fordist America or the postwar transformation of France.     

Between Large-N and Small-N Analyses: Historical Comparison of Thirty Insurgency Case Studies

Abstract

The authors study the 30 insurgencies occurring between 1978 and 2008 using four methods crossing the qualitative/quantitative divide. The four approaches are narrative, bivariate comparison, comparative qualitative analysis, and K-medoids clustering. The quantification of qualitative data allows the authors to compare more cases than they could “hold in their heads” under a traditional small-n qualitative approach, improving the quality of the overall narrative and helping to ensure that the quantitative analyses respected the nuance of the detailed case histories. Structured data-mining reduces the dimensionality of possible explanatory factors relative to the available observations to expose patterns in the data in ways more common in large-n studies. The four analytic approaches produced similar and mutually supporting findings, leading to robust conclusions.     

The Local Implications of Major Job Transformations in the City: A Spatial Microsimulation Approach

The changing dynamics of regional and local labor markets during the last decades have led to an increasing labor market segmentation and socioeconomic polarization and to a rise of income inequalities at the regional, urban, and intraurban level. These problems call for effective social and local labor market policies. However, there is also a growing need for methods and techniques capable of efficiently estimating the likely impact of social and economic change at the local level. For example, the common methodologies for estimating the impacts of large firm openings or closures operate at the regional level. The best of these models disaggregate the region to the city (Armstrong 1993; Batey and Madden 1983). This paper demonstrates how spatial microsimulation modeling techniques can be used for local labor market analysis and policy evaluation to assess these impacts (and their multiplier effects) at the local level‐to measure the effects on individuals and their neighborhood services. First, we review these traditional macroscale and mesoscale regional modeling approaches to urban and regional policy analysis and we illustrate their merits and limitations. Then, we examine the potential of spatial microsimulation modeling to create a new framework for the formulation, analysis and evaluation of social and local labor market policies at the individual or household level. Outputs from a local labor market microsimulation model for Leeds are presented. We show how first it is possible to investigate the interdependencies between individual's or households labor market attributes at the microscale and to model their accessibilities to job opportunities in different localities. From this base we show how detailed what‐if microspatial analysis can be performed to estimate the impact of major changes in the local labor market through job losses or gains, including local multiplier effects.     

A mbassador of Israel: Peace for Peace

[Israeli Ambassador to the United States Zalman Shoval spoke in Milwaukee, Wisconsin, on May 20, 1992. The ambassador's presentation was a session in the Wisconsin International Trade Conference at the Pfister Hotel.]     

Protecting the citizen body: The commonwealth's role in shaping and defending an ‘Australian’ population

This article traces the activities of the Commonwealth in shaping a population that it felt comfortable with and capable of governing successfully from 1901 to 1962. We argue that the body of desirable Australian citizens was defined negatively by who was to be excluded, in particular ‘aboriginal natives’. This quickly became an area of administrative rather than legislative concern. A close examination of the archival record illuminates the bureaucratic image of the desirable Australian and the modes by which that image was generated. The administrative activities increasingly focused on the ‘hard cases’, particularly those of the so‐called ‘half‐castes’. A narrow reasoning process, propensity to make expedient changes to established practice, and the metaphorical language in which the issue was discussed shaped the administration's thinking on citizenship policy.