Akhlaque Haque

SOCIOECONOMIC CHARACTERISTICS AND MELANOMA INCIDENCE

PURPOSE This investigation examines the relationship between socioeconomic status (SES) and melanoma incidence in counties included in the Surveillance, Epidemiology, and End Results Registry (SEER) in the United States from 1973 to 1993. METHODS Cases included whites, aged at least 15 years, with a morphologic diagnosis of malignant melanoma, residing in one of 199 counties at the time of diagnosis. County level measures of SES including median household income, percentage of high school graduates, and percentage of families below poverty were abstracted from the 1950, 1960, 1970, 1980, and 1990 U.S. Census data. The relationship between SES factors and melanoma rates was examined by hierarchical Poisson regression. RESULTS The percentage of high school graduates was significantly and positively associated with the incidence of melanoma (relative risk (RR), 1.28; 95% confidence interval (CI), 1.21-1.35), after controlling for age at diagnosis, gender, time period, latitude, and percentage of Hispanics in the county. Percentage of families below poverty was significantly inversely associated with the incidence of melanoma (RR, 0.66; 95% CI, 0.55-0.78). When education and poverty were included in the same model, both the positive effects of education (RR, 1.23; 95% CI, 1.16-1.31) and the negative effects of poverty (RR, 0.85; 95% CI, 0.74-0.98) persisted. In contrast, median household income was not associated with melanoma incidence in a similar multivariable model (RR, 1.00; 95% CI, 0.99-1.00). CONCLUSION Whether the effect of education on incidence of melanoma reflects lifestyle behaviors that modify exposure to sunlight or some other factor remains unclear. Nonetheless, the findings of this study suggest that the determinant is primarily related to education, not income.

GIS, Public Service, and the Issue of Democratic Governance

Geographic information systems (GIS) are analytical and decision-making tools that organize, compare, and analyze disparate types of information into one organized system. They have powerful visual display capabilities that present the results of analysis on maps and, in doing so, provide unparalleled power to examine social, economic, and political circumstances. In essence, GIS is the best technology to understand and solve problems related to place and space. The promise of GIS is increasingly reflected in the public administration literature (Brown and Brudney 1998; Masser 1998; Nedovic-Budic and Godschalk 1996; Ventura 1995). However, past observations about GIS have focused more on technique and less on the consequences of those techniques for the public service and democratic society. This article will examine the implications of GIS, which have a bearing on the issue of democratic governance. In doing so, an overview of GIS is followed by an examination of the relationship between this technology and democratic values. GIS: An Overview The heart of GIS is the data and the way they are organized. Generally, two types of data comprise a GIS system: spatial data (pertaining to geography and space) and attribute data (spatially related data, such as population, income, or disease). Spatial data are the cornerstone of GIS: The accurate representation of geography on a computer screen requires a thorough understanding of geography and cartography and the process by which geographic data are transformed into digital maps. Unlike paper maps, digital maps are very flexible in that, by organizing the data differently, the display of the map on the monitor can differ. In essence, GIS is to spatial analysis what statistical packages are to traditional statistical analysis. By the mid-1990s, the worldwide market for GIS products and related services was nearly

Information technology, GIS and democraticvalues: Ethical implications for ITprofessionals in public service

2.5 billion (Korte 1997, 66). While the ultimate power of GIS lies in the data, data dissemination has been much slower than the development of the technology. This is due, in part, to differing data formats used by agencies, reluctance to share data, and a lack of funding to create or buy new data. Once the technology is acquired, local government agencies face roadblocks due to data limitation. To make data widely available under a single format, the federal government has taken several initiatives, including the creation of the Federal Geographic Data Committee.(1) In April 1994, President Clinton signed an executive order (12906), calling for the establishment of the National Spatial Data Infrastructure (NSDI).(2) Prior to the federal governments involvement in data dissemination, local agencies had invested an enormous amount of resources in creating their own GIS. Today, local governments generate approximately 90 percent of GIS data (Hissong and Couret 1999). Therefore, new federal initiatives to create the NSDI have not been welcomed by many federal and local agencies, which believe the council would duplicate work already being done. Additionally, in many cases it would require the conversion of existing data to NSDI standards. As an alternative to federally dominated efforts, some have argued that the private sector could play a significant role in creating a national dataset (Hissong and Couret 1999). However, as has been the case with other new policy initiatives, it would be difficult to unite GIS users into a common front without significant incentives from the federal government. Evidence of GIS in Public-Policy Implementation GIS is considered largely a public-sector technology (Ventura 1995). The technology has significantly influenced the way public administrators implement public policy: GIS is being used for planning and community development, environmental protection, integrated public-safety response, infrastructure management, transportation planning and modeling, assessments, facility siting, vehicle routing, permitting and licensing, election management and parcel/real estate management. …

What Liver Transplant Outcomes can be Expected in the Uninsured who Become Insured via the Affordable Care Act

Information technologies (IT) play a criticalrole in transforming public administration andredefining the role of bureaucracy in ademocratic society. New applications of ITbring great promises for government, but at thesame time raise concerns about administrativepower and its abuse. Using GeographicInformation Systems (GIS) as the centralexample, this paper provides the philosophicalunderpinnings of the role of technology anddiscusses the importance of an ethicaldiscourse in IT for public serviceprofessionals. Such ethical discourse must bebased on upholding the democratic values andpreserving the institutional integrity of ITprofessionals in public office.

Is decedent race an independent predictor of organ donor consent or merely a surrogate marker of socioeconomic status

Our study objective is to measure the survival impact of insurance status following liver transplantation in a cohort of uninsured “charity care” patients. These patients are analogous to the population who will gain insurance via the Affordable Care Act. We hypothesize there will be reduced survival in charity care compared to other insurance strata. We conducted a retrospective study of 898 liver transplants from 2000 to 2010. Insurance cohorts were classified as private (n = 640), public (n = 233) and charity care (n = 23). The 1, 3 and 5‐year survival was 92%, 88% and 83% in private insurance, 89%, 80% and 73% in public insurance and 83%, 72% and 51% in charity care. Compared to private insurance, multivariable regression analyses demonstrated charity care (HR 3.11, CI 1.41–6.86) and public insurance (HR 1.58, CI 1.06–2.34) had a higher 5‐year mortality hazard ratio. In contrast, other measures of socioeconomic status were not significantly associated with increased mortality. The charity care cohort demonstrated the highest incidence of acute rejection and missed clinic appointments. These data suggest factors other than demographic and socioeconomic may be associated with increased mortality. Further investigations are necessary to determine causative predictors of increased mortality in liver transplant patients without private insurance.

Ethics and Administrative Discretion in a Unified Administration A Burkean Perspective

Background Studies have demonstrated that African American race is a strong predictor of nondonation. However, it is often and correctly argued that African American race is a crude explanatory variable that is a surrogate marker of socioeconomic status, education, and access to health care. We hypothesized that, when controlling for these factors, African American race would cease to be a predictor of organ donation. Methods A retrospective review of 1292 Alabama decedents who were approached for organ donation between 2006 and 2009 was performed. Multivariable logistic regression models were constructed to identify the most parsimonious model that could explain the variation in the log odds of obtaining consent. Results Consent for donation was obtained from 49% of the decedents’ families. Household income was a predictor of organ donor consent only in whites. Surprisingly, household income was not statistically different between consented and nonconsented African American decedents (U.S.

Information Technology and Surveillance

25,147 vs. U.S.

Reason, Discretion and Tradition: A Reflection on the Burkean Worldview and Its Implications for Public Administration

26,137, P=0.90). On multivariable analysis, education, urban residence, and shorter distance between the decedent’s residence and donor hospital were significantly associated with obtaining consent for organ donation. On univariate analysis, the odds ratio of donor consent in whites compared with African Americans was 2.76 (95% confidence interval, 2.17–3.57). When controlling for socioeconomic status and access to health care variables, the odds ratio of donor consent increased to 4.36 (95% confidence interval, 2.88–6.61). Conclusions We interpret this result to indicate that there remains unknown but important factor(s) associated with both race and obtaining organ donor consent. Further studies are required to isolate and determine whether this factor(s) is modifiable.

Do trained specialists solicit familial authorization at equal frequency, regardless of deceased donor characteristics?

Lack of public trust and confidence in government can have a significant impact on the future of the public service profession. This study brings to the forefront a normative discussion of administrative behavior and the building of trust as perceived fromthe works of the 18th-century political philosopher Edmund Burke. By exploring Burke’s concept of unified administration, it can be argued that institutionalization of administrative traditions can provide practical guidance for judicial use of administrative discretion. The measurement of success, in large part, will depend on national principles, peer coordination, customs, and institutional commitment.

Governance in the Technology Era: Implications of Actor Network Theory for Social Empowerment in South Asia

The PATRIOT Act of 2001 has introduced significant legislative changes affecting how public managers collect, disseminate, and evaluate information for decision making. The article describes the theoretical underpinnings of information gathering and decision making and argues that more information gathering and subsequent use of sophisticated information gathering tools serves as an important myth promoting greater legitimacy and confidence in the government’s ability to provide security to the citizens. The article suggests that the rational choice approach to security is limited in its ability to evaluate values that are embedded into the decision-making processes. However, being cognizant of the nonrational rulings placed on technology-based policy initiatives, public managers can be guided toward “responsible values” to avoid the dark path of control, surveillance, and the loss of freedom.