Peer-reviewed Journal Articles

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    Can Latin America Prosper by Reducing the Size of Government?
    (2009) Lizardo, Radhames
    This article examines the effect of government consumption on economic growth in 23 Latin American countries over the years 1974–2003. Employing the Armey Curve, we show that the typical Latin American government is spending beyond the optimal point. Using panel data and a fixed effects (FE) model, we find that increases in government consumption lead to unambiguous decreases in economic growth.
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    The Sustainability of the U.S. Current Account Deficit: Revisiting Mann’s Rule
    (2009) Lizardo, Radhames
    Using quarterly data from 1973 to 2008, we provide evidence that current account (CA) deficits exceeding 4.2% of GDP (“Mann's rule") do have a significant lowering effect on the U.S. dollar value against major currencies. Controlling for inflation, public debt, and a broad trade weighted index, excessive CA deficits have a negative long-run impact on the USD. Along the transition path, much faster speeds of adjustment to long-run equilibrium are found when current account deficits in excess of Mann's rule are considered: 20% of the deviations from the long-run equilibrium are corrected in a month against 8% or 9% without Mann's rule. This suggests that excessive values of the CA deficit are “priced in" in international foreign exchange markets. Contrary to earlier evidence in favor of CA sustainability, we conjecture that economic conditions have made investors more sensitive to bad news for the U.S. dollar.
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    Exchange Rate Volatility in Latin American and the Caribbean Region: Evidence from 1985 to 2005
    (2009) Lizardo, Radhames
    Using a total of 28 Latin American and Caribbean countries, this study finds a negative relationship between trade and exchange rate volatility. The econometric tool for this specific analysis is the widely used gravity model, in a panel data context. A similar condition is detected between inbound foreign direct investment and exchange rate volatility. The results of the study support the hypothesis that significant exchange rate volatility has a negative impact on the economies of the region and that achieving exchange rate stability should be a goal of policy makers in the context of Latin America and the Caribbean.
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    Do Foreign Purchases of U.S. Stocks Help the U.S. Stocks Market?
    (2009) Lizardo, Radhames
    This paper investigates the relationship between the U.S. S&P 500 stock market and purchases of U.S. corporation stocks by foreign investors. Estimations using monthly data from 1978:1 to 2008:7 under various methodologies show that, controlling for asset prices (interest rates and the yield curve) and inflation, purchases of U.S. stocks by foreign investors have a positive and statistically significant impact on the U.S. stock market performance. We also show that their relationship is time variant. In a global world, the demand-side variable captured by the foreign appetite for U.S. stocks attenuates the negative effects associated with the domestic forces.
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    Oil Price Fluctuations and U.S. Dollar Exchange Rates
    (2010) Lizardo, Radhames
    Adding oil prices to the monetary model of exchange rates, we find that oil prices significantly explain movements in the value of the U.S. dollar (USD) against major currencies from the 1970s to 2008. Our long-run and forecasting results are remarkably consistent with an oil-exchange rate relationship. Increases in real oil prices lead to a significant depreciation of the USD against net oil exporter currencies, such as Canada, Mexico, and Russia. On the other hand, the currencies of oil importers, such as Japan, depreciate relative to the USD when the real oil price goes up.
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    The Impact of Chinese Purchases of U.S Government Debt on the Treasury Yield Curve
    (2011) Lizardo, Radhames
    Examining monthly data from May of 1985 to May of 2008, we find that increases in Chinese purchases of U.S government debt lead to decreases in Treasury yields. The effect is stronger as the maturity increases: a one percent increase in purchases of U.S. Treasuries by Chinese investors lowers the two-year (ten-year) Treasury yield by 10 to 38 basis points (39 to 55 basis points) on average, ceteris paribus . Overall, the demand-side variable capturing Chinese purchases of U.S. Treasuries improves the cointegrating properties of U.S. interest rates. In-sample and out-of-sample forecasts reinforce that the model with Chinese purchases greatly outperforms basic models of the yield curve. This study has implications for the business world since we document that Chinese investors contribute to lower U.S. Treasury yields and thus to lower U.S. interest rates in general.
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    Monetary Policy Convergence in the NAFTA Region: Evidence from Cointegration Analysis and Contagion Effects
    (2013) Lizardo, Radhames
    This paper examines the evolving, time-variant, long-run equilibrium relationship among the target interbank interest rates of Canada, the United States and Mexico to assess whether or not monetary policy in the NAFTA region is truly converging, as suggested by the leaders of these countries at a recent meeting in Montebello, Canada. Only recently has is it become feasible to analyze monetary convergence in the NAFTA region, as rolling cointegration analysis requires long-term data, such as that used in this study for the period of 1997 through 2007. We also test for cross-border contagion effects from the financial difficulties faced by Countrywide Financial Corporation during the recent U.S. real estate meltdown. This study of empirical financial and economic phenomena employs multivariate cointegration test and, for robustness, calculates σ-convergence in the NAFTA region. Our findings support the hypothesis of monetary policy convergence in the region. In general, the analysis tends to confirm a broad, ongoing economic convergence in the NAFTA region. We also find support for the proposition of cross border contagion effects from the financial difficulties faced by Countrywide, which adds robustness to the presence of monetary convergence.
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    What Motivates China to Invest so Heavily in U.S. Treasury Securities?
    (2014) Lizardo, Radhames
    This paper attempts to shed light on the question: What motivates China to invest so heavily in U.S. Treasury securities, despite the fact that U.S. Treasuries provide real rates of return that are either close to zero or negative? Such an investment strategy can be perceived as economically irrational. A linkage can be presumed between China’s investment practices and the tactical decision to moderate the United States’ influence on economic, political, and military issues. We hypothesize, however, that China does not have a better investment option because holding an ever-increasing amount of U.S. dollar-based liquid assets gives China the ability to manage the value of the yuan in order to force its desired trade surpluses. In other words, China’s main mechanism to secure a positive trade balance and increase its foreign direct investment is by maintaining an undervalued currency, which requires an ever-increasing foreign-exchange reserve. From what we know, our study is the most comprehensive empirical examination of motivations for China’s heavy purchases of U.S. Treasury securities by analyzing nearly 25 years that begins in 1987 and covers the period over which China dramatically increased its holdings of these instruments.
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    Essential Healthcare Services and Economic Prosperity: Evidence from Cross-sectional and Time-series Data
    (2019) Lizardo, Radhames; David, Benita
    This paper examines the relationship between investments in healthcare services and economic development across the world. The motivation comes from the assertion of the 2015 Lancet Commission that “investment in surgical and anesthesia services is affordable, saves lives, and promotes economic growth” and the 2016 World Health Organization Bulletin 94:201-209F who indicates a strong explanatory power of per capita expenditure on health as a determinant of surgical volume, an essential healthcare service. Using several methodologies, we find support for the hypothesis that investment in surgical, anesthesia, and other essential healthcare services and beyond, promotes economic growth. Our finding suggests that, other things equal, an increase of 1% in healthcare expenditure per capita leads to an increase in economic prosperity varying from 0.22% to 0.88%.
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    Designing a Community-based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities
    (2013) Ashley-West, Atalie A.
    Introduction. Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies. Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.
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    The Effect of Information Technology on Hospital Performance
    (2016) Raffenaud, Amanda
    While healthcare entities have integrated various forms of health information technology (HIT) into their systems due to claims of increased quality and decreased costs, as well as various incentives, there is little available information about which applications of HIT are actually the most beneficial and efficient. In this study, we aim to assist administrators in understanding the characteristics of top performing hospitals. We utilized data from the Health Information and Management Systems Society and the Center for Medicare and Medicaid to assess 1039 hospitals. Inputs considered were full time equivalents, hospital size, and technology inputs. Technology inputs included personal health records (PHR), electronic medical records (EMRs), computerized physician order entry systems (CPOEs), and electronic access to diagnostic results. Output variables were measures of quality, hospital readmission and mortality rate. The analysis was conducted in a two-stage methodology: Data Envelopment Analysis (DEA) and Automatic Interaction Detector Analysis (AID), decision tree regression (DTreg). Overall, we found that electronic access to diagnostic results systems was the most influential technological characteristics; however organizational characteristics were more important than technological inputs. Hospitals that had the highest levels of quality indicated no excess in the use of technology input, averaging one use of a technology component. This study indicates that prudent consideration of organizational characteristics and technology is needed before investing in innovative programs.
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    Work-Family Conflict Among Newly Licensed Registered Nurses: A Structural Equation Model of Antecedents and Outcomes
    (2016) Raffenaud, Amanda
    Conflict between work and family is a human resource management issue that is particularly relevant for nurses. Nursing is a demanding profession, and a high proportion of nurses are women, who tend to have greater family responsibilities than men. Little is known regarding work-family conflict among nurses, and even less is known about how this affects newly licensed registered nurses (NLRNs), who can be stressed from their new jobs and careers. This study empirically tests a model of antecedents and outcomes of work-family and family-work conflict among a sample of NLRNs. We developed a model of the relationships between personal and work environment characteristics, work-family and family-work conflicts, job satisfaction, and intent to leave the job and profession. We used structural equation modeling (Amos, IBM SPSS) to test the model with data from a survey of NLRNs. We examined a number of latent variables, as well as direct and mediating relationships. The measurement models for all latent variables were validated. The final model indicated that age, health, and family responsibilities are antecedents of family-work conflict; job demands lead to work-family conflict; family-work conflict contributes to job difficulties, which lowers job satisfaction, which, in turn, increases the intent to leave the job and profession; and work-family conflict increases the intent to leave the job and profession (but does not directly affect job satisfaction). Policies to help NLRNs with family responsibilities could reduce family-work conflict, which might reduce job difficulties and improve satisfaction and retention. In addition, policies to reduce job demands could reduce work-family conflict and improve retention.
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    Identifying the Readiness of Patients in Implementing Telemedicine in Northern Louisiana for an Oncology Practice
    (2017) Raffenaud, Amanda
    This study identified the readiness factors that may create challenges in the use of telemedicine among patients in northern Louisiana with cancer. To identify these readiness factors, the team of investigators developed 19 survey questions that were provided to the patients or to their caregivers. The team collected responses from 147 respondents from rural and urban residential backgrounds. These responses were used to identify the individuals’ readiness for utilising telemedicine through factor analysis, Cronbach’s alpha reliability test, analysis of variance and ordinary least squares regression. The analysis results indicated that the favourable factor (positive readiness item) had a mean value of 3.47, whereas the unfavourable factor (negative readiness item) had a mean value of 2.76. Cronbach’s alpha reliability test provided an alpha value of 0.79. Overall, our study indicated a positive attitude towards the use of telemedicine in northern Louisiana.
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    Utilizing Telemedicine in Oncology Settings: Patient Favourability Rates and Perceptions of Use Analysis Using Chi-Square and Neural Networks
    (2019) Raffenaud, Amanda
    BACKGROUND: Telemedicine is an alternative to traditional face-to-face doctor-patient office visits. Although telemedicine is becoming more prevalent, few studies have looked at the perceived favorability rate among patients utilizing telemedicine over the traditional office visit to a provider’s office considering data samples from more than 5 clinics in northern Louisiana. OBJECTIVE: This study aims to measure patient favorability of using telemedicine to receive care. This study looks at the perceived positive and negative favorability rates of patients in the oncology settings. The researchers analyzed how age, income level, and education level influenced the perceived patient favorability rates and their willingness to utilize telemedicine. METHODS: The investigators used Chi-Square analysis to identify favorability with respect to age education and income levels. In addition to this Artificial Neural Networks were used to identify the threshold for favorability with respect to age, income, and education. RESULTS: Chi-Square tests of association showed that of the variables analyzed, only education level had a statistically significant relationship with a patient’s favorability rate of telemedicine utilization. While our neural network analysis indicated that the threshold for income, age, and education are $34,999, 66 years, and a college degree. CONCLUSION: In this article the investigators have successfully demonstrated the use of Artificial Neural Networks in identifying favorability of telemedicine used in addition to the traditional statistical methods such as Chi-Square. Thereby, creating a path for future research using advanced computational techniques like Artificial Neural Networks in analyzing human behavior.
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    Prevalence and Risk Factors of Diabetes among Urban Residents in Luzhou City, China
    (2019) Raffenaud, Amanda
    Background: Great variation exists in the prevalence rates of diabetes across different geographic regions in China. The purpose of this study was to examine the prevalence of type 2 diabetes among a Chinese population in Western China and to explore associated risk factors. Methods: Adult residents in Luzhou City in Sichuan Province, China, were selected using a multistage area probability design. A validated questionnaire, physical examination, and lab tests were administered to the participants. Bivariate analysis and multivariate analysis using logistic regression were performed to determine factors that may affect the risk of diabetes. Results: The final study sample included 3513 participants with complete questionnaires (response rate was 97.58%). The prevalence rate of diabetes was 17.76%. Multivariate logistic regression analysis demonstrated that residents who fit within the following categories were associated with higher risk for diabetes after controlling for participant demographic factors and other covariates: age groups 50–59, 60–69, and 70 or above; a monthly income of less than ¥1999; family history of diabetes; using mainly animal fat as cooking oil; having a white collar job; BMI above 28; and hypertriglyceridemia. In addition to identifying risk factors previously reported, this study indicates that dietary intake factors may be important to the development of diabetes. Conclusion: This study contributes to the literature of prevalence and risk factors of diabetes in Western China. Future research is needed to further evaluate these risk factors.
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    A Comparative Analysis of Work-Family Conflict among Staff, Managerial, and Executive Nurses
    (2019) Raffenaud, Amanda
    Background: Nurses frequently are caught between the demands of work and family. While studies have explored this issue among staff nurses, none have compared nurse leaders to staff nurses. This study compares work–family conflict (WFC) and family–work conflict (FWC) among staff, managerial, and executive nurses. Methods: In this survey design, 20% of registered nurses were randomly sampled across Florida with a 9% response rate. Survey questions included personal, professional, and work environment characteristics and perceptions of WFC/FWC. Analyses of variance tested the differences between- and within-group scores for WFC/FWC for staff, managerial, and executive nurses. Ordinary Least Squares regressions tested the relationships between personal, professional and work environment measures, focusing on the three different nursing roles, and WFC/FWC scores. Findings: Nurses experienced more WFC than FWC. Staff nurses experienced significantly less WFC than nurse managers and nurse executives (analysis of variance mean difference −0.881 and −2.693, respectively). Nonwhite nurses experienced more WFC and FWC than white nurses. Longer shift length predicted greater WFC. FWC was lower with paid leave for childbirth. Discussion: Higher WFC among nurse managers and executives may discourage nurses from taking on or staying in leadership roles. Efforts must be taken to decrease WFC/FWC among nurses in these roles.