Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Most formal models of international relations rely on the notion of expected utility. While expected utility is a useful theoretical and mathematical tool, it is often operaionalized in simplistic terms that ignore important aspects of international affairs. In particular calculations of expected utility often focus on material capabilities while ignoring social factors. As this paper shows, social considerations can reverse the expected relation reaction of actors to an increase in cost, or a decrease in their expected utility. The paper introduces snob, bandwagon, Veblen, and anti-Veblen effects as four types of socially driven distortions that can affect expected utility calculations. In order to examine the implications of these distortions, the paper surveys few prominent formal models used in the study of international relations and shows how the exclusion of social capacities created bias in their conclusions. In addition it reviews a set of behaviors are deemed 'irrational' under a materialistic reading of expected utility but are readily explainable within a wider and more socially sensitive reading of expected utility.

Publication Type: Abstract
Abstract: BACKGROUND: There is substantial heterogeneity among individuals in preferences for health states. Results from many studies suggest that there is little systematic difference in the underlying preference structure for health states among different socio-demographic groups. However, other studies suggest that there may be systematic differences. The Health Utilities Index Mark 3 (HUI3) is a generic, multi-attribute, preference-based health-related quality of life (HRQL) measure widely used as a measure for describing health outcomes for patients and the general population and for economic evaluation of healthcare interventions. HUI3 includes 8 attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain), with 5 or 6 levels for each attribute. In the development of the original HUI3 scoring function, approximately 90% of the sample rated the “all-worst HUI3 health state” as worse than dead (Group A), while 10% rated “dead” as the least preferred state (Group B). Are there differences in the structure of preferences between Groups A and B? To date, a direct comparison of HUI3 multi-attribute utility functions (MAUF) derived from populations with potentially different preferences toward dead has not yet been attempted.

AIM: To assess the generalizability of the HUI3 MAUF by estimating and comparing two HUI3 MAUFs: MAUF(A) (for Group A) and MAUF(B) (for Group B). Two research questions were investigated: (1) is there any difference in estimated MAUFs, (2) do any observed parameter differences in the two MAUFs affect the valuations of health states in applications?

METHODS: A decomposed approach was used to estimate two HUI3 MAUFs, one each for Groups A (n=193) and B (n=22). Data come from the original HUI3 MAUF estimation project. Parameters in two MAUFs were compared. Further, agreement between predicted HUI3 scores for the two MAUFs was examined using several criterion: mean differences (MD), mean absolute differences (MAD), standard deviation of the differences (SDD) and agreement (intra-class correlation, ICC) using 217 unique health states selected from Statistics Canada 1996/97 National Population Health Survey Microdata to cover a range of morbidity burdens from mild through severe.

RESULTS: Additive utility form was strongly rejected in favor of a multiplicative form for both MAUFs. Both groups demonstrated preference complementarity among the HUI3 attributes. The importance of hearing, speech, ambulation and emotion differed between the two MAUFs. Agreement between overall HUI3 scores from the two MAUFs was poor (MD=MAD=0.5, SDD=0.3, ICC=0.35). Stratified analyses showed moderate agreement for health states with mild burdens (HUI3>0.88; ICC=0.43) and poor agreement for health states with moderate to severe burdens (HUI3<0.89; ICC=0.32). The weighted MD (217 health states, each weighted by its prevalence) is 0.01, less than a clearly clinically important difference of 0.03.

CONCLUSIONS: Estimated scoring functions and valuations for health states importantly differed between the two groups. An implication is that in future preference elicitation surveys it may be important to over-sample Group B to gain precision. However, when the 217 health states were adjusted for their prevalence, there was no important mean difference in utility scores derived from functions from the two groups.

Publication Type: Abstract
Abstract: Rationale and Objectives. Estimated multi-attribute utility functions have relied on linear additive or multiplicative functional forms that assume respectively a lack of preference interactions among attributes or only one type of preference interaction. Are there quantitatively important and statistically significant interactions in preferences among attributes in the Health Utilities Index Mark 3 (HUI3) system? How would the performance of the less restrictive multi-linear model compare to the performance of the multiplicative model?

Methodology. HUI3 has 8 attributes, vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain, with 5 or 6 levels per attribute. A preference survey was conducted of a random sample of the general population (n = 256) using a one-half 2 to the eight power fractional factorial design plan. The same survey provided scores for the estimation of a multiplicative multi-attribute utility function. A parallel survey (n = 248) provided directly measured standard gamble utility scores for 73 HUI3 health states. The fractional factorial design permits the identification of all 8 main effects, 26 of 28 two-way interactions, and 4 of 56 three-way interactions terms. The estimated equation was forced to pass through 0 (for the health state with all attributes at lowest functional level) and 1 (all attributes at highest level). Agreement between directly measured scores from the second sample and scores from the multi-linear and multiplicative utility functions was assessed using an intra-class correlation coefficient.

Results. For the multi-linear model, the adjusted R-squared was 0.63. All 8 main effects were quantitatively important (coefficient >0.024) and statistically significant (p < 0.10). Two-way interaction terms indicating preference complementarity were quantitatively important and statistically significant in 18 cases and insignificant in 2 cases. Two-way interaction terms indicating preference substitutes were important and significant in 4 cases and insignificant in 2 cases. All 4 three-way interaction terms were important and significant. Agreement between directly measured scores and scores from the multiplicative function was much higher than agreement between directly measured scores and scores from the multi-linear function.

Conclusions. There are quantitatively important and statistically significant interactions in preferences among attributes of health status. These results call into question the use of linear additive multi-attribute utility functions. The multiplicative function out performed the multi-linear function in out-of-sample prediction. The omnibus interaction term of the multiplicative function indicates preference complementarity and appears to handle the preference interactions more than adequately.

Publication Type: Abstract
Abstract: Objectives: Describe and evaluate a required two-week new student orientation. Methods: A 1 credit hour, two-week new pharmacy student orientation was offered 2 weeks before the start of the academic year. The course covered: Professional Expectations, Involvement, and Organization, Technology Training, Initial Assessments, Overview of Experiential Education, preparation for the White Coat Ceremony. Course objectives were to provide a broad foundation of the general expectations of the profession and school of pharmacy, assist in the identification of the major parts of ethical dilemmas, and determine basic Top 200 drug, medical terminology, and HIPAA knowledge. Students participated in a professional organizational showcase and workshops designed to explore issues related to advocacy, citizenship, and activism. Each activity was designed to support the introduction of the professional culture sought within the School’s professionalization plan. Results: Students completed pre and post surveys for each activity and for the course. Surveys revealed two major themes - students felt well informed and prepared to meet the expectations of their first year and confirmed that being involved in the profession is an expectation of the program. Greater than 90% stated their experience with the orientation was "very satisfied" to "extremely satisfied". Implications: A two-week new student orientation assisted the school in laying the foundation of a professional culture prior to the official start of the academic year. Future incorporation of pharmacy students will assist in the growth of the mentorship program, leadership development, the professional socialization process, and student engagement in the programmatic offerings of the School.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Multiple regression is used to explore democracy's association with the share of GDP devoted to public health care spending, the utilization of basic health care and other social services, and under-5 mortality. The data come from 104 developing countries observed in 1990. Controls are included for geographic, demographic, cultural, and economic factors. The analysis finds that long-term democratic experience, but not short-term democratic practice, is associated significantly with lower under-5 mortality. The association between long-term democratic experience and lower under-5 mortality is mediated by the provision of basic health and education services, but not by the share of GDP devoted to public health care spending.