Purpose Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a vol... more Purpose Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a volume monitor decreases patient risks and costs, and is convenient. This study was undertaken to determine if PVP predicts CVP in pediatric patients. Methods With ethical approval and informed consent, 30 pediatric patients aged neonate to 12 yr requiring a central venous line were studied prospectively in a
ABSTRACT This paper examines whether an intra-household externality prevents adoption of a techno... more ABSTRACT This paper examines whether an intra-household externality prevents adoption of a technology with substantial implications for population health and the environment: improved cookstoves. Motivated by a model of intra-household decision-making, the experiment markets stoves to husbands or wives in turn at randomly varying prices. We find that women – who bear disproportionate cooking costs – have stronger preference for healthier stoves, but lack the authority to make purchases. Our findings suggest that if women cannot make independent choices about household resource use, public policy may not be able to exploit gender differences in preferences to promote technology adoption absent broader social change.
The coefficient of variation is often used as a guide of the repeatability of measurements in cli... more The coefficient of variation is often used as a guide of the repeatability of measurements in clinical trials and other medical work. When possible, one makes repeated measurements on a set of individuals to calculate the relative variability of the test with the understanding that a reliable clinical test should give similar results when repeated on the same patient. There are times, however, when repeated measurements on the same patient are not possible. Under these circumstances, to combine results from different clinical trials or test sites, it is necessary to compare the coefficients of variation of several clinical trials. Using the work of Miller, we develop a general statistic for testing the hypothesis that the coefficients of variation are the same for k populations, with unequal sample sizes. This statistic is invariant under the choice of the order of the populations, and is asymptotically chi 2. We provide an example using data from Yang and HayGlass. We compare the size and the power of the test to that of Bennett, Doornbos and Dijkstra and a statistic based on Hedges and Olkin.
Http Dx Doi Org 10 1080 00324728 2014 972432, Dec 13, 2014
Between 1950 and 1980, China experienced the most rapid sustained increase in life expectancy of ... more Between 1950 and 1980, China experienced the most rapid sustained increase in life expectancy of any population in documented global history. We know of no study that has quantitatively assessed the relative importance of the various explanations proposed for this gain in survival. We have created and analysed a new, province-level panel data set spanning the decades between 1950 and 1980 by combining historical information from China's public health archives, official provincial yearbooks, and infant and child mortality records contained in the 1988 National Survey of Fertility and Contraception. Although exploratory, our results suggest that gains in school enrolment and public health campaigns together are associated with 55-70 per cent of China's dramatic reductions in infant and under-5 mortality during our study period. These results underscore the importance of non-medical determinants of population health, and suggest that, in some circumstances, general education of the population may amplify the effectiveness of public health interventions.
Canadian Journal of Surgery Journal Canadien De Chirurgie, Dec 1, 1998
ObjectivesTo review the experience at a children’s hospital of lipoblastoma and liposarcoma and t... more ObjectivesTo review the experience at a children’s hospital of lipoblastoma and liposarcoma and to identify any factors that would differentiate one type of tumour from the other.DesignA retrospective case series.SettingBritish Columbia’s Children’s Hospital a tertiary-care pediatric centre.PatientsAll patients with a pathological diagnosis of lipoblastoma and liposarcoma recorded over 12 years.Main outcome measuresThe frequency of lipoblastoma and liposarcoma, identified from biopsy specimens of pediatric adipose tumours. The clinical, pathological and cytogenetic variables between lipoblastoma and liposarcoma.ResultsOne hundred and forty-nine adipose tumours were recorded. Seven (4.7%) were lipoblastomas and 2 (1.3%) were liposarcomas. All tumours presented as asymptomatic, slow-growing, soft-tissue masses. The children with lipoblastoma tended to be younger, but 29% were over 3 years of age. The liposarcoma patients were aged 9 and 14 years. One liposarcoma was of myxoid type and the other was a round cell variant. Karyotypes were reported for 1 lipoblastoma and 1 liposarcoma. The myxoid liposarcoma karyotype was 46,XY,t(12;16)(q13;p11), and the lipoblastoma was reported as 46,XY,der(8)?t(8q;?),+mar.ConclusionsLipoblastoma is an unusual childhood neoplasm and liposarcoma is very rare in children. Both tumours may present in a similar fashion, and differentiating them histologically can be difficult. Age cannot be relied upon to accurately predict their behaviour. The tumour karyotype is very helpful in differentiating these neoplasms.
The Southeast Asian Journal of Tropical Medicine and Public Health, Sep 1, 2011
We assessed the prevalence of anemia among schoolchildren in western China as determined by seven... more We assessed the prevalence of anemia among schoolchildren in western China as determined by seven cross-sectional surveys involving 12,768 children aged 8-12 years. Subjects were selected randomly from 283 primary schools in 41 economically disadvantaged counties of Ningxia, Qinghai, Shaanxi and Sichuan Provinces. Data were collected through questionnaires and hemoglobin levels were measured. The anemia prevalence was 34% using the WHO hemoglobin cutoff of < 120 g/l. Boarding students and girls were more likely to be anemic. The prevalence of anemia in schoolchildren was high. Iron deficiency is a significant nutrition issue in China.
To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to impro... more To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to improve maternal and neonatal health in Gujarat, India. A household survey (n = 5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5 years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n = 6484 households) were used in parallel analyses. Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: -5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: -2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme. The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study.
Purpose Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a vol... more Purpose Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a volume monitor decreases patient risks and costs, and is convenient. This study was undertaken to determine if PVP predicts CVP in pediatric patients. Methods With ethical approval and informed consent, 30 pediatric patients aged neonate to 12 yr requiring a central venous line were studied prospectively in a
ABSTRACT This paper examines whether an intra-household externality prevents adoption of a techno... more ABSTRACT This paper examines whether an intra-household externality prevents adoption of a technology with substantial implications for population health and the environment: improved cookstoves. Motivated by a model of intra-household decision-making, the experiment markets stoves to husbands or wives in turn at randomly varying prices. We find that women – who bear disproportionate cooking costs – have stronger preference for healthier stoves, but lack the authority to make purchases. Our findings suggest that if women cannot make independent choices about household resource use, public policy may not be able to exploit gender differences in preferences to promote technology adoption absent broader social change.
The coefficient of variation is often used as a guide of the repeatability of measurements in cli... more The coefficient of variation is often used as a guide of the repeatability of measurements in clinical trials and other medical work. When possible, one makes repeated measurements on a set of individuals to calculate the relative variability of the test with the understanding that a reliable clinical test should give similar results when repeated on the same patient. There are times, however, when repeated measurements on the same patient are not possible. Under these circumstances, to combine results from different clinical trials or test sites, it is necessary to compare the coefficients of variation of several clinical trials. Using the work of Miller, we develop a general statistic for testing the hypothesis that the coefficients of variation are the same for k populations, with unequal sample sizes. This statistic is invariant under the choice of the order of the populations, and is asymptotically chi 2. We provide an example using data from Yang and HayGlass. We compare the size and the power of the test to that of Bennett, Doornbos and Dijkstra and a statistic based on Hedges and Olkin.
Http Dx Doi Org 10 1080 00324728 2014 972432, Dec 13, 2014
Between 1950 and 1980, China experienced the most rapid sustained increase in life expectancy of ... more Between 1950 and 1980, China experienced the most rapid sustained increase in life expectancy of any population in documented global history. We know of no study that has quantitatively assessed the relative importance of the various explanations proposed for this gain in survival. We have created and analysed a new, province-level panel data set spanning the decades between 1950 and 1980 by combining historical information from China's public health archives, official provincial yearbooks, and infant and child mortality records contained in the 1988 National Survey of Fertility and Contraception. Although exploratory, our results suggest that gains in school enrolment and public health campaigns together are associated with 55-70 per cent of China's dramatic reductions in infant and under-5 mortality during our study period. These results underscore the importance of non-medical determinants of population health, and suggest that, in some circumstances, general education of the population may amplify the effectiveness of public health interventions.
Canadian Journal of Surgery Journal Canadien De Chirurgie, Dec 1, 1998
ObjectivesTo review the experience at a children’s hospital of lipoblastoma and liposarcoma and t... more ObjectivesTo review the experience at a children’s hospital of lipoblastoma and liposarcoma and to identify any factors that would differentiate one type of tumour from the other.DesignA retrospective case series.SettingBritish Columbia’s Children’s Hospital a tertiary-care pediatric centre.PatientsAll patients with a pathological diagnosis of lipoblastoma and liposarcoma recorded over 12 years.Main outcome measuresThe frequency of lipoblastoma and liposarcoma, identified from biopsy specimens of pediatric adipose tumours. The clinical, pathological and cytogenetic variables between lipoblastoma and liposarcoma.ResultsOne hundred and forty-nine adipose tumours were recorded. Seven (4.7%) were lipoblastomas and 2 (1.3%) were liposarcomas. All tumours presented as asymptomatic, slow-growing, soft-tissue masses. The children with lipoblastoma tended to be younger, but 29% were over 3 years of age. The liposarcoma patients were aged 9 and 14 years. One liposarcoma was of myxoid type and the other was a round cell variant. Karyotypes were reported for 1 lipoblastoma and 1 liposarcoma. The myxoid liposarcoma karyotype was 46,XY,t(12;16)(q13;p11), and the lipoblastoma was reported as 46,XY,der(8)?t(8q;?),+mar.ConclusionsLipoblastoma is an unusual childhood neoplasm and liposarcoma is very rare in children. Both tumours may present in a similar fashion, and differentiating them histologically can be difficult. Age cannot be relied upon to accurately predict their behaviour. The tumour karyotype is very helpful in differentiating these neoplasms.
The Southeast Asian Journal of Tropical Medicine and Public Health, Sep 1, 2011
We assessed the prevalence of anemia among schoolchildren in western China as determined by seven... more We assessed the prevalence of anemia among schoolchildren in western China as determined by seven cross-sectional surveys involving 12,768 children aged 8-12 years. Subjects were selected randomly from 283 primary schools in 41 economically disadvantaged counties of Ningxia, Qinghai, Shaanxi and Sichuan Provinces. Data were collected through questionnaires and hemoglobin levels were measured. The anemia prevalence was 34% using the WHO hemoglobin cutoff of < 120 g/l. Boarding students and girls were more likely to be anemic. The prevalence of anemia in schoolchildren was high. Iron deficiency is a significant nutrition issue in China.
To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to impro... more To evaluate the effect of the Chiranjeevi Yojana programme, a public-private partnership to improve maternal and neonatal health in Gujarat, India. A household survey (n = 5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5 years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n = 6484 households) were used in parallel analyses. Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: -5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: -2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme. The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study.
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Papers by Grant Miller