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Sample records for external costs related

  1. Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

    PubMed

    van der Kamp, Jonathan; Bachmann, Till M

    2015-03-01

    "Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making. PMID:25664763

  2. Assessing Air Pollutant-Induced, Health-Related External Costs in the Context of Nonmarginal System Changes: A Review.

    PubMed

    Bachmann, Till M

    2015-08-18

    Marginal analysis is the usual approach to environmental economic assessment, for instance, of health-related external costs due to energy-associated air pollutant emissions. However, nonlinearity exists in all steps of their assessment, i.e., atmospheric dispersion, impact assessment, and monetary valuation. Dedicated assessments thus appear necessary when evaluating large systems or their changes such as in green accounting or the implications of economy-wide energy transitions. Corresponding approaches are reviewed. Tools already exist that allow assessing a marginal change (e.g., one power plant's emissions) for different background emission scenarios that merely need to be defined and implemented. When assessing nonmarginal changes, the top-down approach is considered obsolete, and four variants of the bottom-up approach with different application domains were identified. Variants 1 and 2 use precalculated external cost factors with different levels of sophistication, suitable for energy systems modeling, optimizing for social (i.e., private and external) costs. Providing more reliable results due to more detailed modeling, emission sources are assessed individually or jointly in variants 3 and 4, respectively. Aiming at considering nonlinearity more fully and simultaneously following marginal analysis principles, I propose a variant 3-based approach, subdividing an aggregate (i.e., a nonmarginal change) into several smaller changes. Its strengths and drawbacks, notably the associated effort, are discussed. PMID:26237285

  3. High-resolution modelling of health impacts and related external cost from air pollution over 36 years using the integrated model system EVA

    NASA Astrophysics Data System (ADS)

    Brandt, Jørgen; Andersen, Mikael S.; Bønløkke, Jakob; Christensen, Jesper H.; Geels, Camilla; Hansen, Kaj M.; Hertel, Ole; Im, Ulas; Jensen, Steen S.; Ketzel, Matthias; Nielsen, Ole-Kenneth; Plejdrup, Marlene S.; Sigsgaard, Torben

    2016-04-01

    A high-resolution assessment of health impacts from air pollution and related external cost has been conducted for Denmark using the integrated EVA model system. The EVA system is based on the impact-pathway methodology, where the site-specific emissions will result, via atmospheric transport and chemistry, in a concentration distribution, which together with detailed population data, is used to estimate the population-level exposure. Using exposure-response functions and economic valuations, the exposure is transformed into impacts on human health and related external costs. In this study we have used a coupling of two chemistry transport models to calculate the air pollution concentration at different domain and scales; the Danish Eulerian Hemispheric Model (DEHM) to calculate the air pollution levels in the Northern Hemisphere with a resolution down to 5.6 km x 5.6 km and the Urban Background Model (UBM) to further calculate the air pollution in Denmark at 1 km x 1 km resolution using results from DEHM as boundary conditions. Both the emission data as well as the population density has been represented in the model system with the same high resolution. Previous health impact assessments related to air pollution have been made on a lower resolution. In this study, the integrated model system, EVA, has been used to estimate the health impacts and related external cost for Denmark at a 1 km x 1 km resolution. New developments of the integrated model system will be presented as well as the development of health impacts and related external costs in Europe and Denmark over a period of 36 years (1979-2014). Acknowledgements This work was funded by: DCE - National Centre for Environment and Energy. Project: "Health impacts and external costs from air pollution in Denmark over 25 years" and NordForsk under the Nordic Programme on Health and Welfare. Project: "Understanding the link between air pollution and distribution of related health impacts and welfare in the

  4. Cost of external fixation vs external fixation then nailing in bone infection

    PubMed Central

    Emara, Khaled Mohamed; Diab, Ramy Ahmed; Ghafar, Khaled Abd EL

    2015-01-01

    AIM: To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment transfer. METHODS: Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria (26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence from school or work were calculated and compared between both groups. RESULTS: The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care (surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc.) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM nail. CONCLUSION: Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities. PMID:25621219

  5. External Communities of Practice and Relational Capital

    ERIC Educational Resources Information Center

    Dewhurst, Frank W.; Navarro, Juan G. Cegarra

    2004-01-01

    External communities of practice are groups formed by company clients and employees based on common interests, commitment, mutual trust and collaboration whose members regularly share knowledge and learning. This paper examines how external communities of practice contribute to the creation of relational capital through an empirical investigation…

  6. Externalities.

    ERIC Educational Resources Information Center

    Zicht, Barbara, Ed.; And Others

    1982-01-01

    This issue explains the concept of externalities (benefits or burdens which accrue to society when there is a difference between the private cost or benefit of an action and the social cost or benefit of that action). These external or social costs of individual actions are often referred to as spillover costs. Three brief teaching units follow…

  7. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false External restructuring costs. 231.205-70 Section 231.205-70 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial...

  8. Transaction costs, externalities and information technology in health care.

    PubMed

    Ferguson, B; Keen, J

    1996-01-01

    This paper discusses some of the economic issues which underpin the rationale for investment in information and communications technologies (ICTs). Information imperfections lead to significant transaction costs (search, negotiating and monitoring) which in turn confer a negative externality on parties involved in exchange. This divergence in private and social costs leads to a degree of resource misallocation (efficiency loss) which, uncorrected, results in a sub-optimal outcome. Traditional solutions to this problem are to rely upon direct government action to reduce the costs of transacting between market agents, or to employ tax/subsidy measures and other legislative action to achieve the desired market outcome. Three key policy questions are raised in the context of the NHS purchaser/provider relationship. Firstly, what is the optimum level of transaction costs; secondly, can ICTs assist in lowering the level of transaction costs to the optimum level; thirdly, who should bear the investment cost in reducing the level of transaction costs? The issue of property rights in different information systems is discussed and raises interesting policy questions about how much investment should be undertaken centrally rather than devolved to a more local level. In some ways this economic framework offers a post hoc justification of why different ICT systems have been introduced at various levels of the NHS. Essentially this reduces to the problem of externalities: providing good information confers a positive externality: not providing relevant, timely and accurate information confers a negative externality, by increasing further the level of transaction costs. The crucial role which ICT systems can play lies in attempting to reduce the level of transaction costs and driving the market towards what Dahlman has described as the transaction-cost-constrained equilibrium. PMID:8653190

  9. Applying environmental externalities to US Clean Coal Technologies for Asia. [Including external environmental costs

    SciTech Connect

    Szpunar, C.B.; Gillette, J.L.

    1993-01-01

    The United States is well positioned to play an expanding role in meeting the energy technology demands of the Asian Pacific Basin, including Indonesia, Thailand, and the Republic of China (ROC-Taiwan). The US Department of Energy Clean Coal Technology (CCT) Demonstration Program provides a proving ground for innovative coal-related technologies that can be applied domestically and abroad. These innovative US CCTs are expected to satisfy increasingly stringent environmental requirements while substantially improving power generation efficiencies. They should also provide distinct advantages over conventional pulverized coal-fired combustors. Finally, they are expected to be competitive with other energy options currently being considered in the region. This paper presents potential technology scenarios for Indonesia, Thailand, and the ROC-Taiwan and considers an environmental cost-benefit approach employing a newly developed method of applying environmental externalities. Results suggest that the economic benefits from increased emission control can indeed be quantified and used in cost-benefit comparisons, and that US CCTs can be very cost effective in reducing emissions.

  10. The external costs of a sedentary life-style.

    PubMed Central

    Keeler, E B; Manning, W G; Newhouse, J P; Sloss, E M; Wasserman, J

    1989-01-01

    Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise. PMID:2502036

  11. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... determining cost allowability in accordance with FAR part 31 shall apply. (5) Restructuring savings means cost... costs are allowable in accordance with FAR part 31 and DFARS part 231; (2) An audit of...

  12. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... determining cost allowability in accordance with FAR part 31 shall apply. (5) Restructuring savings means cost... costs are allowable in accordance with FAR part 31 and DFARS part 231; (2) An audit of...

  13. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... determining cost allowability in accordance with FAR part 31 shall apply. (5) Restructuring savings means cost... costs are allowable in accordance with FAR part 31 and DFARS part 231; (2) An audit of...

  14. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... determining cost allowability in accordance with FAR part 31 shall apply. (5) Restructuring savings means cost... costs are allowable in accordance with FAR part 31 and DFARS part 231; (2) An audit of...

  15. Comparative analysis of monetary estimates of external environmental costs associated with combustion of fossil fuels

    SciTech Connect

    Koomey, J.

    1990-07-01

    Public utility commissions in a number of states have begun to explicitly treat costs of environmental externalities in the resource planning and acquisition process (Cohen et al. 1990). This paper compares ten different estimates and regulatory determinations of external environmental costs associated with fossil fuel combustion, using consistent assumptions about combustion efficiency, emissions factors, and resource costs. This consistent comparison is useful because it makes explicit the effects of various assumptions. This paper uses the results of the comparison to illustrate pitfalls in calculation of external environmental costs, and to derive lessons for design of policies to incorporate these externalities into resource planning. 38 refs., 2 figs., 10 tabs.

  16. Relations between Internalizing and Externalizing Problems in Early Childhood

    ERIC Educational Resources Information Center

    Stone, Lisanne L.; Otten, Roy; Engels, Rutger C. M. E.; Kuijpers, Rowella C. W. M.; Janssens, Jan M. A. M.

    2015-01-01

    Background: Childhood internalizing and externalizing problems are closely related and often co-occur. Directional models have been employed to test how these problems are related, while few studies have tested a third variables model. Objective: This study investigates whether internalizing and externalizing problems are reciprocally or…

  17. Defensive externality and its relation to academic performance.

    PubMed

    Prociuk, T J; Breen, L J

    1975-03-01

    This study examined the relationship between locus of control and academic performance by evaluating the academic achievement of defensive externals, which has been considered a confounding factor in previous research. A further objective was an examination of the effect of two mediating variables in their relation to locus of control and academic performance. One hundred sixty college students were administered the Internal, Powerful Others, and Chance scales, the Fear of Negative Evaluation scale, and the Achievement via Independence/via Conformance scales. Obtained results demonstrated that internals were academically superior to both defensive and congruent externals. Defensive externals were shown to have higher grade point averages than congruent externals, and female defensive externals achieved greater academic success than their male counterparts. Further results suggested that the relationship between locus of control and academic performance may not be a direct one but may be modified by specific mediating variables. PMID:1151611

  18. Cost and Effectiveness of Decontamination Strategies in Radiation Contaminated Areas in Fukushima in Regard to External Radiation Dose

    PubMed Central

    Yasutaka, Tetsuo; Naito, Wataru; Nakanishi, Junko

    2013-01-01

    The objective of the present study is to evaluate the cost and effectiveness of decontamination strategies in the special decontamination areas in Fukushima in regard to external radiation dose. A geographical information system (GIS) was used to relate the predicted external dose in the affected areas to the number of potential inhabitants and the land use in the areas. A comprehensive review of the costs of various decontamination methods was conducted as part of the analysis. The results indicate that aerial decontamination in the special decontamination areas in Fukushima would be effective for reducing the air dose rate to the target level in a short period of time in some but not all of the areas. In a standard scenario, analysis of cost and effectiveness suggests that decontamination costs for agricultural areas account for approximately 80% of the total decontamination cost, of which approximately 60% is associated with storage. In addition, the costs of decontamination per person per unit area are estimated to vary greatly. Appropriate selection of decontamination methods may significantly decrease decontamination costs, allowing more meaningful decontamination in terms of the limited budget. Our analysis can help in examining the prioritization of decontamination areas from the viewpoints of cost and effectiveness in reducing the external dose. Decontamination strategies should be determined according to air dose rates and future land-use plans. PMID:24069398

  19. Cost and effectiveness of decontamination strategies in radiation contaminated areas in Fukushima in regard to external radiation dose.

    PubMed

    Yasutaka, Tetsuo; Naito, Wataru; Nakanishi, Junko

    2013-01-01

    The objective of the present study is to evaluate the cost and effectiveness of decontamination strategies in the special decontamination areas in Fukushima in regard to external radiation dose. A geographical information system (GIS) was used to relate the predicted external dose in the affected areas to the number of potential inhabitants and the land use in the areas. A comprehensive review of the costs of various decontamination methods was conducted as part of the analysis. The results indicate that aerial decontamination in the special decontamination areas in Fukushima would be effective for reducing the air dose rate to the target level in a short period of time in some but not all of the areas. In a standard scenario, analysis of cost and effectiveness suggests that decontamination costs for agricultural areas account for approximately 80% of the total decontamination cost, of which approximately 60% is associated with storage. In addition, the costs of decontamination per person per unit area are estimated to vary greatly. Appropriate selection of decontamination methods may significantly decrease decontamination costs, allowing more meaningful decontamination in terms of the limited budget. Our analysis can help in examining the prioritization of decontamination areas from the viewpoints of cost and effectiveness in reducing the external dose. Decontamination strategies should be determined according to air dose rates and future land-use plans. PMID:24069398

  20. External costs of coastal beach pollution: an hedonic approach

    SciTech Connect

    Wilman, E.A.

    1984-01-01

    A technique for inputing a monetary value to the loss in beach recreational services that would result from a hypothetical oil spill in the Georges Bank area combines an oil-spill risk analysis model with a hedonic pricing model of the market for tourist accommodations on Cape Cod and Martha's Vineyard. The estimate of beach pollution costs associated with offshore oil development allows a rational judgment of whether the benefits of developing offshore oil outweigh the costs. The method is an effort to improve the economic efficiency of coastal zone management. The report concludes with a discussion of the many sources of uncertainty and suggestions for overcoming them. Five appendices present information on the models, variables, questionnaire responses, beaches, and factor patterns. 7 figures, 27 tables.

  1. Pricing landfill externalities: Emissions and disamenity costs in Cape Town, South Africa

    SciTech Connect

    Nahman, Anton

    2011-09-15

    Highlights: > The paper estimates landfill externalities associated with emissions, disamenities and transport. > Transport externalities vary from 24.22 to 31.42 Rands per tonne. > Costs of emissions (estimated using benefits transfer) vary from 0.07 to 28.91 Rands per tonne. > Disamenities (estimated using hedonic pricing) vary from 0.00 to 57.46 Rands per tonne. > Overall, external costs for urban landfills exceed those of a regional landfill. - Abstract: The external (environmental and social) costs of landfilling (e.g. emissions to air, soil and water; and 'disamenities' such as odours and pests) are difficult to quantify in monetary terms, and are therefore not generally reflected in waste disposal charges or taken into account in decision making regarding waste management options. This results in a bias against alternatives such as recycling, which may be more expensive than landfilling from a purely financial perspective, but preferable from an environmental and social perspective. There is therefore a need to quantify external costs in monetary terms, so that different disposal options can be compared on the basis of their overall costs to society (financial plus external costs). This study attempts to estimate the external costs of landfilling in the City of Cape Town for different scenarios, using the benefits transfer method (for emissions) and the hedonic pricing method (for disamenities). Both methods (in particular the process of transferring and adjusting estimates from one study site to another) are described in detail, allowing the procedures to be replicated elsewhere. The results show that external costs are currently R111 (in South African Rands, or approximately US$16) per tonne of waste, although these could decline under a scenario in which energy is recovered, or in which the existing urban landfills are replaced with a new regional landfill.

  2. Relative Costs of Various Types of Assessments.

    ERIC Educational Resources Information Center

    Wheeler, Patricia H.

    Issues of the relative costs of multiple choice tests and alternative types of assessment are explored. Before alternative assessments in large-scale or small-scale programs are used, attention must be given to cost considerations and the resources required to develop and implement the assessment. Major categories of cost to be considered are…

  3. Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations

    PubMed Central

    Lacy, Kyle; Cooke, Chris; Cooke, Pat; Schupbach, Justin; Vaidya, Rahul

    2015-01-01

    Traumatic dislocations of the shoulder commonly present to emergency departments (EDs). Immediate closed reduction of both anterior and posterior glenohumeral dislocations is recommended and is frequently performed in the ED. Recurrence of dislocation is common, as anteroinferior labral tears (Bankart lesions) are present in many anterior shoulder dislocations.14,15,18,23 Immobilization of the shoulder following closed reduction is therefore recommended; previous studies support the use of immobilization with the shoulder in a position of external rotation, for both anterior and posterior shoulder dislocations.7–11,19 In this study, we present a technique for assembling a low-cost external rotation shoulder brace using materials found in most hospitals: cotton roll, stockinette, and shoulder immobilizers. This brace is particularly suited for the uninsured patient, who lacks the financial resources to pay for a pre-fabricated brace out of pocket. We also performed a cost analysis for our low-cost external rotation shoulder brace, and a cost comparison with pre-fabricated brand name braces. At our institution, the total materials cost for our brace was $19.15. The cost of a pre-fabricated shoulder brace at our institution is $150 with markup, which is reimbursed on average at $50.40 according to our hospital billing data. The low-cost external rotation shoulder brace is therefore a more affordable option for the uninsured patient presenting with acute shoulder dislocation. PMID:25671019

  4. Environmental policy making: liability for externalities in the presence of transaction costs

    SciTech Connect

    Bird, P.J.W.N.

    1980-07-01

    Environmental law that favors the victim of pollution against the polluter has some theoretical justification. For depletable externalities, this originates from the important asymmetries between free riding and holding out and from the physical nature of several externality problems. For a large class of pollution examples, however, where the externality is undepletable, no market can achieve a Pareto optimal allocation. Market solutions are useless in these cases if efficiency is the criterion for the allocation of liability. In a real-world context, very high transaction costs remove the justification for any rule, and the possibility of asymmetry in pollution costs could be used to support laws that favor the polluter. The efforts of policymakers should be directed towards more careful assessment of the likely costs and benefits of polluting activities and of the distributional and ethical dimensions. 13 references, 3 figures.

  5. Commercial Aircraft Maintenance Experience Relating to Engine External Hardware

    NASA Technical Reports Server (NTRS)

    Soditus, Sharon M.

    2006-01-01

    Airlines are extremely sensitive to the amount of dollars spent on maintaining the external engine hardware in the field. Analysis reveals that many problems revolve around a central issue, reliability. Fuel and oil leakage due to seal failure and electrical fault messages due to wire harness failures play a major role in aircraft delays and cancellations (D&C's) and scheduled maintenance. Correcting these items on the line requires a large investment of engineering resources and manpower after the fact. The smartest and most cost effective philosophy is to build the best hardware the first time. The only way to do that is to completely understand and model the operating environment, study the field experience of similar designs and to perform extensive testing.

  6. Changes in kinematics, metabolic cost and external work during walking with a forward assistive force.

    PubMed

    Zirker, Christopher A; Bennett, Bradford C; Abel, Mark F

    2013-08-01

    We examined how the application of a forward horizontal force applied at the waist alters the metabolic cost, kinematics, and external work of gait. Horizontal assist forces of 4%, 8% and 12% of a subject's body weight were applied via our testing apparatus while subjects walked at comfortable walking speed on a level treadmill. Kinematic and metabolic parameters were measured using motion capture and ergospirometry respectively on a group of 10 healthy male subjects. Changes in kinematic and metabolic parameters were quantified and found similar to walking downhill at varying grades. A horizontal assist force of 8% resulted in the greatest reduction of metabolic cost. Changes in recovery factor, external work, and center of mass (COM) movement did not correlate with changes in metabolic rate and therefore were not driving the observed reductions in cost. The assist force may have performed external work by providing propulsion as well as raising the COM as it pivots over the stance leg. Assist forces may decrease metabolic cost by reducing the concentric work required for propulsion while increasing the eccentric work of braking. These findings on the effects of assist forces suggest novel mobility aids for individuals with gait disorders and training strategies for athletes. PMID:23183216

  7. [Cost benefits of intensive insulin therapy using injections, external pumps and implantable pumps].

    PubMed

    Selam, J L; Haardt, M J; Berne, C; Dorange, C; Lanoe, J L; Bethoux, J P; Slama, G

    1993-12-01

    Since feasibility is now proven, cost-efficacy of external sub-cutaneous (EXT) and implantable programmable (IMP) insulin pumps needs to be compared to those of intensified conventional insulin therapy (CONV). Only metabolic efficacy and short-term direct costs are easily evaluable. We (WHO-CSII Study) and others have shown that glycemic control and severe hypoglycemia risk are slightly improved, while ketoacidosis risk and costs are aggravated with EXT vs CONV. We (CEDIT Study) and others have shown that glycemic control, mild and severe hypoglycemic risks are improved, with no increase in ketoacidosis rates although a doubling in costs with IMP vs CONV. Rigid interpretation of the above data would limit indications of insulin pumps to patients experiencing frequent hypoglycemias while on intensified conventional insulin therapy. PMID:8206188

  8. Assessment of external costs for transport project evaluation: Guidelines in some European countries

    SciTech Connect

    Petruccelli, Umberto

    2015-09-15

    Many studies about the external costs generated by the transport system have been developed in the last twenty years. To standardize methodologies and assessment procedures to be used in the evaluation of the projects, some European countries recently have adopted specific guidelines that differ from each other in some aspects even sensibly. This paper presents a critical analysis of the British, Italian and German guidelines and is aimed at cataloguing the external cost types regarded and the assessment methods indicated as well as to highlight the differences of the results, in terms of applicability and reliability. The goal is to contribute to a European standardization process that would lead to the drafting of guidelines suited for all EU countries. - Highlights: • The analyzed guidelines agree on the methods to evaluate costs from air pollution, greenhouse gases and accidents. • They recommend respectively: dose-resp. approach; costs to reduce/permit emissions; whole direct, indirect and social costs. • For noise, DE guide indicates defensive expenditure or SP methods; IT guide, SP method; UK guide, the hedonic prices one. • For on territory impact, DE guide regards only the barrier effect; the IT one, also the soil consumption and system effects. • British guide proposes a qualitative methodology to estimate the impact on various landscapes and environments.

  9. Leading multiple teams: average and relative external leadership influences on team empowerment and effectiveness.

    PubMed

    Luciano, Margaret M; Mathieu, John E; Ruddy, Thomas M

    2014-03-01

    External leaders continue to be an important source of influence even when teams are empowered, but it is not always clear how they do so. Extending research on structurally empowered teams, we recognize that teams' external leaders are often responsible for multiple teams. We adopt a multilevel approach to model external leader influences at both the team level and the external leader level of analysis. In doing so, we distinguish the influence of general external leader behaviors (i.e., average external leadership) from those that are directed differently toward the teams that they lead (i.e., relative external leadership). Analysis of data collected from 451 individuals, in 101 teams, reporting to 25 external leaders, revealed that both relative and average external leadership related positively to team empowerment. In turn, team empowerment related positively to team performance and member job satisfaction. However, while the indirect effects were all positive, we found that relative external leadership was not directly related to team performance, and average external leadership evidenced a significant negative direct influence. Additionally, relative external leadership exhibited a significant direct positive influence on member job satisfaction as anticipated, whereas average external leadership did not. These findings attest to the value in distinguishing external leaders' behaviors that are exhibited consistently versus differentially across empowered teams. Implications and future directions for the study and management of external leaders overseeing multiple teams are discussed. PMID:24274582

  10. Hangover hyperthermia in rats: relation to tolerance and external stimuli.

    PubMed

    Sinclair, J D; Taira, T

    1988-01-01

    The recent finding of rebound hyperthermia in rats on the day after a single IP injection or oral intubation of ethanol was confirmed. In our studies, body temperature measured by rectal probe was significantly decreased for 8 h after 2.5 g/kg ethanol IP and was then significantly elevated 16-24 h after injection; increased vocalization during handling at 24 h was also found. However, rats isolated in a sound-attenuation chamber with remote temperature measurement showed no hyperthermia even though they were hypothermic during intoxication. The results do not support the hypothesis that rebound hyperthermia was caused by either a disruption of circadian rhythms, or by a mild abstinence syndrome alone. Instead, it appears that external stimuli, perhaps related to stress or associated with ethanol administration, are necessary on the day after a moderate dose of ethanol to produce the hyperthermia. Like hangover in humans, hyperthermia was reduced in rats made tolerant to ethanol: both the hypothermia and the rebound hyperthermia were significantly lower on the day after the 12th alternate-day ethanol injection than after the first injection. The aftereffects in rats of acute intoxication are, by definition, hangover signs, and they resemble hangover in humans in several ways, but their relevance as an animal model of hangover remains to be determined. PMID:3127841

  11. 48 CFR 31.205-21 - Labor relations costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Labor relations costs. 31....205-21 Labor relations costs. (a) Costs incurred in maintaining satisfactory relations between the... costs of shop stewards, labor management committees, employee publications, and other related...

  12. 48 CFR 31.205-21 - Labor relations costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Labor relations costs. 31....205-21 Labor relations costs. (a) Costs incurred in maintaining satisfactory relations between the... costs of shop stewards, labor management committees, employee publications, and other related...

  13. 48 CFR 31.205-21 - Labor relations costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Labor relations costs. 31....205-21 Labor relations costs. (a) Costs incurred in maintaining satisfactory relations between the... costs of shop stewards, labor management committees, employee publications, and other related...

  14. Cost effectiveness of external hip protectors in the hospital setting: a modeling study.

    PubMed

    Stollenwerk, Björn; Waldeyer, Regina; Klein-Meding, Christiane; Müller, Dirk; Stock, Stephanie

    2014-01-01

    Chronic illnesses, for which many patients are admitted to hospitals, substantially increase the risk of falling, and hence the likelihood of incurring a hip fracture. Hip fractures not only have devastating consequences on an individual's quality of life but may also affect a hospital's reputation in the community. In addition, hospitals may face litigation claims and increased costs for patients who fall and suffer a major injury as a consequence. External hip protectors are comparable to padded undergarments and shield the trochanter, reducing the detrimental effects and force impacting the bone during a fall. Screening for patients at high risk of falling and providing high-risk patients with hip protectors as a preventive measure to avoid hip fractures, not only improves public health, but can also save hospitals care and litigation costs. PMID:24834633

  15. Some Simple Arguments about Cost Externalization and its Relevance to the Price of Fusion Energy

    SciTech Connect

    Budny, R.; Winfree, R.

    1999-09-27

    The primary goal of fusion energy research is to develop a source of energy that is less harmful to the environment than are the present sources. A concern often expressed by critics of fusion research is that fusion energy will never be economically competitive with fossil fuels, which in 1997 provided 75% of the world's energy. And in fact, studies of projected fusion electricity generation generally project fusion costs to be higher than those of conventional methods. Yet it is widely agreed that the environmental costs of fossil fuel use are high. Because these costs aren't included in the market price, and furthermore because many governments subsidize fossil fuel production, fossil fuels seem less expensive than they really are. Here we review some simple arguments about cost externalization which provide a useful background for discussion of energy prices. The collectively self-destructive behavior that is the root of many environmental problems, including fossil fuel use, was termed ''the tragedy of the commons'' by the biologist G. Hardin. Hardin's metaphor is that of a grazing commons that is open to all. Each herdsman, in deciding whether to add a cow to his herd, compares the benefit of doing so, which accrues to him alone, to the cost, which is shared by all the herdsmen using the commons, and therefore adds his cow. In this way individually rational behavior leads to the collective destruction of the shared resource. As Hardin pointed out, pollution is one kind of tragedy of the commons. CO{sub 2} emissions and global warming are in this sense classic tragedies.

  16. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Cost-sharing in enrollment-related costs. 422.6 Section 422.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM General Provisions § 422.6 Cost-sharing in enrollment-related costs....

  17. Evaluation of activity-based costing versus resource-based relative value costing.

    PubMed

    Berlin, Mark F; Smith, Tommy H

    2004-01-01

    Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided. PMID:15018372

  18. 40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe...

  19. 40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe...

  20. 40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe...

  1. 40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe...

  2. 40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe...

  3. Sex Differences in the Longitudinal Relations among Family Risk Factors and Childhood Externalizing Symptoms

    ERIC Educational Resources Information Center

    Blatt-Eisengart, Ilana; Drabick, Deborah A. G.; Monahan, Kathryn C.; Steinberg, Laurence

    2009-01-01

    Despite potential sex differences in base rates, predictors, and maintaining processes for children's externalizing behaviors, little prospective research has examined sex differences in the relations between concurrent, proximal family risk factors and children's externalizing behaviors. The current study examined the relations among maternal…

  4. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Cost related to patient care. 413.9 Section 413.9... PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... Rules § 413.9 Cost related to patient care. (a) Principle. All payments to providers of services must...

  5. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Cost related to patient care. 413.9 Section 413.9... PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... Rules § 413.9 Cost related to patient care. (a) Principle. All payments to providers of services must...

  6. Information and issues related to the quantification of environmental externalities for new powerplants

    SciTech Connect

    Lee, A.D.; Callaway, J.M.; Glantz, C.S.; Baechler, M.C.; Foley, L.O.

    1990-10-01

    This report provides background information for the Bonneville Power Administration (Bonneville) in its efforts to quantify the environmental externalities associated with new electricity resources. A more detailed companion document has been provided to Bonneville for internal use. This report defines what is meant by externalities, particularly in the context of electricity resources. It outlines the economics issues associated with assigning an economic value, such as cents per kilowatt hour, to the residual environmental impacts of electricity powerplants. It examines two generic theoretical approaches for estimating such values and discusses their advantages and disadvantages. The report also addresses the need to include relevant stages in the fuel cycle in estimating the costs of externalities. The fuel-cycle concept is defined and its importance is discussed. The approaches used by several states to quantify externalities are described. A review of the valuation efforts of various states and utilities indicates that three states have actually developed methodologies for assigning economic values to externalities. Information that Bonneville may need to request from resource developers to quantify externalities is discussed, and an appendix presents suggested forms for obtaining the required information. Summary information also is presented on models for analyzing the dispersion of powerplant plumes for the purpose of estimating environmental externality costs. 34 refs., 1 fig., 4 tabs.

  7. The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder.

    PubMed

    Ramos, Vera; Canta, Guilherme; de Castro, Filipa; Leal, Isabel

    2016-01-01

    The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions. PMID:27583810

  8. Conscientiousness and externalizing psychopathology: overlap, developmental patterns, and etiology of two related constructs.

    PubMed

    Roberts, Brent W; Jackson, Joshua J; Berger, Jessica M; Burger, Jessica; Trautwein, Ulrich

    2009-01-01

    The present paper focuses on the trait domain of conscientiousness, its development, and its relation to psychopathology. The definition of conscientiousness and its interface with specific forms of psychopathology, such as externalizing psychopathology, are discussed first. Then an overview of the known developmental changes in conscientiousness across the life course is provided, as well as the potential shared developmental etiology of conscientiousness and externalizing psychopathology. Given the lack of data, testing etiological factors that may contribute to the development of both conscientiousness and externalizing disorders, we report on three studies examining the childhood experiences associated with both conscientiousness and externalizing behaviors. Last, future directions are discussed. PMID:19583888

  9. Mathematics Achievement and Anxiety and Their Relation to Internalizing and Externalizing Behaviors

    ERIC Educational Resources Information Center

    Wu, Sarah S.; Willcutt, Erik G.; Escovar, Emily; Menon, Vinod

    2014-01-01

    Although behavioral difficulties are well documented in reading disabilities, little is known about the relationship between math ability and internalizing and externalizing behaviors. Here, we use standardized measures to investigate the relation among early math ability, math anxiety, and internalizing and externalizing behaviors in a group of…

  10. Dogmatism and Externality in Locus of Control As Related to Counselor Trainee Skill in Facilitative Responding.

    ERIC Educational Resources Information Center

    Carlozzi, Alfred F.; And Others

    1982-01-01

    Hypothesized that dogmatism and externality in locus of control are inversely related to skill in facilitative responding. Dogmatism and externality were measured by the Opinion Scale, and skill in facilitative responding was determined with the Gross Rating of Facilitative Interpersonal Functioning Scale. Results supported the hypothesis. (Author)

  11. Reciprocal Relations between Student-Teacher Conflict, Children's Social Skills and Externalizing Behavior

    ERIC Educational Resources Information Center

    Skalická, Vera; Stenseng, Frode; Wichstrøm, Lars

    2015-01-01

    Research suggests that the relation between student-teacher conflict and children's externalizing behavior might be reciprocal, and possibly also between student-teacher conflict and children's social skills. Because children with externalizing behavior also tend to display low levels of social skills, we do not know if one or both of these…

  12. Are Externalizing and Internalizing Difficulties of Young Children with Spelling Impairment Related to Their ADHD Symptoms?

    ERIC Educational Resources Information Center

    Rietz, Chantal Sabrina; Hasselhorn, Marcus; Labuhn, Andju Sara

    2012-01-01

    Children with literacy difficulties often suffer from a variety of co-occurring externalizing and internalizing difficulties, as well as comorbid ADHD. Therefore, these externalizing and internalizing problems might be more related to comorbid ADHD, rather than being a correlate of literacy difficulties per se. In the present study, we…

  13. Environmental externalities: Applying the concept to Asian coal-based power generation. [Includes external environmental and societal costs and methods of evaluating them

    SciTech Connect

    Szpunar, C.B.; Gillette, J.L.

    1993-03-01

    This report examines the concept of environmental externality. It discusses various factors -- the atmospheric transformations, relationship of point-source emissions to ambient air quality, dose-response relationships, applicable cause-and-effect principles, and risk and valuation research -- that are considered by a number of state utilities when they apply the environmental externality concept to energy resource planning. It describes a methodology developed by Argonne National Laboratory for general use in resource planning, in combination with traditional methods that consider the cost of electricity production. Finally, it shows how the methodology can be applied in Indonesia, Thailand, and Taiwan to potential coal-fired power plant projects that will make use of clean coal technologies.

  14. Managing External Relations: The Lifeblood of Mission Success

    NASA Technical Reports Server (NTRS)

    Dumbacher, Daniel L.

    2007-01-01

    The slide presentation examines the role of customer and stakeholder relations in the success of space missions. Topics include agency transformation; an overview of project and program experience with a discussion of positions, technical accomplishments, and management lessons learned; and approaches to project success with emphasis on communication. Projects and programs discussed include the Space Shuttle Main Engine System, DC-XA Flight Demonstrator, X-33 Flight Demonstrator, Space Launch Initiative/2nd Generation Reusable Launch Vehicle, X-37 Flight Demonstrator, Constellation (pre Dr. Griffin), Safety and Mission Assurance, and Exploration Launch Projects.

  15. Sex Differences in the Longitudinal Relations Among Family Risk Factors and Childhood Externalizing Symptoms

    PubMed Central

    Blatt-Eisengart, Ilana; Drabick, Deborah A. G.; Monahan, Kathryn C.; Steinberg, Laurence

    2013-01-01

    Despite potential sex differences in base rates, predictors, and maintaining processes for children’s externalizing behaviors, little prospective research has examined sex differences in the relations between concurrent, proximal family risk factors and children’s externalizing behaviors. The current study examined the relations among maternal depressive symptoms, maternal parenting behaviors (i.e., negativity and low warmth), and child externalizing symptoms at 24 months and first grade in a community-based sample of 1,364 children enrolled in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Structural equation modeling revealed that maternal depression and negative parental behaviors were associated with concurrent externalizing behaviors, though maternal depression may be differentially linked to boys’ and girls’ externalizing problems. The relation between depression and boys’ externalizing symptoms was more pronounced at 24 months, and over time, the relation between maternal depression and boys’ externalizing symptoms decreased in magnitude, whereas this relation increased among girls. PMID:19271833

  16. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing in enrollment-related costs. 422.6 Section 422.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM General Provisions § 422.6 Cost-sharing...

  17. 42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Cost-sharing in beneficiary education and enrollment-related costs. 423.6 Section 423.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT General Provisions § 423.6 Cost-sharing...

  18. The mediational role of parenting on the longitudinal relation between child personality and externalizing behavior.

    PubMed

    Prinzie, Peter; van der Sluis, Cathy M; de Haan, Amaranta D; Deković, Maja

    2010-08-01

    Building on prior cross-sectional work, this longitudinal study evaluated the proposition that maternal and paternal overreactive and authoritative parenting mediates the effect of child personality characteristics on externalizing behavior. Data from the Flemish Study on Parenting, Personality, and Problem Behavior were used in a moderated mediation analysis (N=434). Teachers rated children's Big Five characteristics, fathers and mothers rated their parenting, and 3 years later, children rated their externalizing behavior. Mediational analysis revealed both direct and indirect effects. Higher levels of Extraversion and lower levels of Benevolence were related directly to higher levels of child externalizing behavior. Higher levels of paternal authoritative parenting and lower levels of maternal overreactivity were related to lower scores on externalizing behavior. In addition, the relation between Benevolence, Emotional Stability, and externalizing behavior was partially mediated by parental overreactivity. Conscientiousness had an indirect effect on externalizing behavior through paternal authoritative parenting. Relations were not moderated by child gender. This study is of theoretical interest because the results demonstrate that parenting is a mediating mechanism that accounts for associations between personality and externalizing behavior. PMID:20545815

  19. Autonomic Functioning Moderates the Relations between Contextual Factors and Externalizing Behaviors among Inner-city Children

    PubMed Central

    Bubier, Jennifer L.; Drabick, Deborah A. G.; Breiner, Tyler

    2009-01-01

    Although previous research has identified various child-specific and contextual risk factors associated with externalizing behaviors, there is a dearth of literature examining child × context interactions in the prospective prediction of externalizing behaviors. To address this gap, we examined autonomic functioning as a moderator of the relation between contextual factors (i.e., neighborhood cohesion and harsh parental behaviors) and externalizing behaviors. Participants were an ethnic minority, inner-city sample of first through fourth grade children (N = 57, 50% male) and their primary caregivers who participated in two assessments approximately 1 year apart. Results indicated that baseline sympathetic functioning moderated the relation between (a) neighborhood cohesion and externalizing behaviors and (b) harsh parental behaviors and externalizing behaviors. Post-hoc probing of these interactions revealed that higher levels of neighborhood cohesion prospectively predicted (a) higher levels of externalizing behaviors among children with heightened baseline sympathetic functioning, and (b) lower levels of externalizing behaviors among children with attenuated baseline sympathetic functioning. In addition, among children with heightened baseline sympathetic functioning, higher levels of harsh parental behaviors prospectively predicted higher levels of externalizing behaviors. PMID:19685985

  20. Externalizing symptoms, effortful control, and intrusive parenting: A test of bidirectional longitudinal relations during early childhood.

    PubMed

    Eisenberg, Nancy; Taylor, Zoe E; Widaman, Keith F; Spinrad, Tracy L

    2015-11-01

    At approximately 30, 42, and 54 months of age (N = 231), the relations among children's externalizing symptoms, intrusive maternal parenting, and children's effortful control (EC) were examined. Both intrusive parenting and low EC have been related to psychopathology, but children's externalizing problems and low EC might affect the quality of parenting and one another. Mothers' intrusive behavior with their children was assessed with observations, children's EC was measured with mothers' and caregivers' reports, and children's externalizing symptoms were assessed with mothers', fathers', and caregivers' reports. In a structural equation panel model, bidirectional relations between intrusive parenting and EC were found: EC at 30 and 42 months predicted low levels of intrusive parenting a year later, controlling for prior levels of parenting and vice versa. Moreover, high levels of children's externalizing problems at both 30 and 42 months negatively predicted EC a year later, controlling for prior levels of EC. Although externalizing problems positively predicted high EC over time, this appeared to be a suppression effect because these variables had a strong negative pattern in the zero-order correlations. Moreover, when controlling for the stability of intrusive parenting, EC, and externalizing (all exhibited significant stability across time) and the aforementioned cross-lagged predictive paths, EC and externalizing problems were still negatively related within the 54-month assessment. The findings are consistent with the view that children's externalizing behavior undermines their EC and contributes to intrusive mothering and that relations between intrusive parenting and EC are bidirectional across time. Thus, interventions that focus on modifying children's externalizing problems (as well as the quality of parenting) might affect the quality of parenting they receive and, hence, subsequent problems with adjustment. PMID:26439056

  1. Relations Among Internalizing and Externalizing Symptoms and Drinking Frequency During Adolescence

    PubMed Central

    Jun, Hyun-Jin; Sacco, Paul; Bright, Charlotte Lyn; Camlin, Elizabeth A. S.

    2016-01-01

    Background In adolescence, internalizing (e.g., anxious, depressive, and withdrawn) and externalizing (e.g., aggressive, oppositional, delinquent, and hyper-active) symptoms are related with alcohol use. However, the directionality among internalizing symptoms, externalizing symptoms, and alcohol use during adolescence is equivocal. Moreover, gender differences and similarities among these behaviors are not definitive in existing literature. Objectives This study examined longitudinal relationships between internalizing and externalizing symptoms and past-month alcohol use among adolescent boys and girls. Methods Using longitudinal survey data from a study of community-dwelling adolescents (n = 724), we estimated cross-lagged structural equation models to test relations between internalizing and externalizing symptoms (as measured by the Youth Self Report, YSR [Achenbach, 1991]) and self-report alcohol use in the past month among adolescents. Gender differences were tested in a multiple group structural equation model. Results Alcohol use at age 12 was a predictor of internalizing and externalizing symptoms at age 15 for both boys and girls. With regard to gender differences, girls demonstrated an association between internalizing symptoms and drinking at age 12, whereas boys showed a stronger association between externalizing symptoms and drinking at age 18. Conclusions/Importance Early alcohol use is problematic for youth, and results of this study lend support to prevention programs for youth. Preventing or curbing early drinking may offset later externalizing and internalizing symptoms, as well as ongoing alcohol use, regardless of gender. PMID:26646723

  2. Characterization of a Low-Cost Optical Flow Sensor When Using an External Laser as a Direct Illumination Source

    PubMed Central

    Font, Davinia; Tresanchez, Marcel; Pallejà, Tomàs; Teixidó, Mercè; Palacín, Jordi

    2011-01-01

    In this paper, a low cost optical flow sensor is combined with an external laser device to measure surface displacements and mechanical oscillations. The measurement system is based on applying coherent light to a diffuser surface and using an optical flow sensor to analyze the reflected and transferred light to estimate the displacement of the surface or the laser spot. This work is focused on the characterization of this measurement system, which can have the optical flow sensor placed at different angles and distances from the diffuser surface. The results have shown that the displacement of the diffuser surface is badly estimated when the optical mouse sensor is placed in front of the diffuser surface (angular orientation >150°) while the highest sensitivity is obtained when the sensor is located behind the diffuser surface and on the axis of the laser source (angular orientation 0°). In this case, the coefficient of determination of the measured displacement, R2, was very high (>0.99) with a relative error of less than 1.29%. Increasing the distance between the surface and the sensor also increased the sensitivity which increases linearly, R2 = 0.99. Finally, this measurement setup was proposed to measure very low frequency mechanical oscillations applied to the laser device, up to 0.01 Hz in this work. The results have shown that increasing the distance between the surface and the optical flow sensor also increases the sensitivity and the measurement range. PMID:22247696

  3. Utility planning using least-cost principles and the role of externalities - staff report on a Keystone policy dialogue

    SciTech Connect

    1996-05-01

    For over two years, The Keystone Center facilitated a two-phase dialogue on Utility Planning Using Least-Cost Principles and, in the second phase, on the role of Externalities. The intent of this report is to assist policy-makers faced with decisions about changes to traditional utility regulation and planning. This report is not a consensus document, rather it is staff written summary of two years of discussion on the issues. As a concept, least-cost planning has been discussed since the 1970`s and many states have implemented such programs since the mid-1980`s. Yet, the actual goals and objectives of least-cost planning remain a source of controversy between affected interest groups. Some industry observers believe that least-cost planning can help reconcile the often conflicting demands between increased capacity requirements and concerns about the external costs of power production. In traditional utility regulation practices, capital investments are rewarded and revenue is a direct function of sales. However, a number state public utility commissions have altered their practices to allow for returns on investments in more efficient end-use equipment (also known as ratebasing conservation) and adjusting revenues to account for sales lost due to utility conservation programs. Other states are planning these types of changes. Still others are observing the impacts of the changes before they commit.

  4. Reducing prospective memory error and costs in simulated air traffic control: External aids, extending practice, and removing perceived memory requirements.

    PubMed

    Loft, Shayne; Chapman, Melissa; Smith, Rebekah E

    2016-09-01

    In air traffic control (ATC), forgetting to perform deferred actions-prospective memory (PM) errors-can have severe consequences. PM demands can also interfere with ongoing tasks (costs). We examined the extent to which PM errors and costs were reduced in simulated ATC by providing extended practice, or by providing external aids combined with extended practice, or by providing external aids combined with instructions that removed perceived memory requirements. Participants accepted/handed-off aircraft and detected conflicts. For the PM task, participants were required to substitute alternative actions for routine actions when accepting aircraft. In Experiment 1, when no aids were provided, PM errors and costs were not reduced by practice. When aids were provided, costs observed early in practice were eliminated with practice, but residual PM errors remained. Experiment 2 provided more limited practice with aids, but instructions that did not frame the PM task as a "memory" task led to high PM accuracy without costs. Attention-allocation policies that participants set based on expected PM demands were modified as individuals were increasingly exposed to reliable aids, or were given instructions that removed perceived memory requirements. These findings have implications for the design of aids for individuals who monitor multi-item dynamic displays. (PsycINFO Database Record PMID:27608067

  5. Parenting Practices and Adolescent Internalizing and Externalizing Problems: Moderating Effects of Socially Demanding Kin Relations

    ERIC Educational Resources Information Center

    Taylor, Ronald D.; Lopez, Elizabeth I.; Budescu, Mia; McGill, Rebecca Kang

    2012-01-01

    Association of socially demanding kin relations, mother's emotional support, behavioral control/monitoring, family organization and psychological control with adolescent's internalizing and externalizing problems were assessed in 200 economically disadvantaged, African American mothers and adolescents. Demanding kin relations and mother's…

  6. Managing Corporate External Relations: Changing Perspectives and Responses. Report No. 679.

    ERIC Educational Resources Information Center

    McGrath, Phyllis S.

    Because of their direct or indirect impact on a company, relations with its publics have long been a preoccupation of management. This study, based on information received from more than 500 executives representing 368 companies, documents the complex of issues and publics that shapes contemporary corporate external relations efforts and probes…

  7. The economic cost of farm-related fatalities in Australia.

    PubMed

    Pollock, K S; Griffith, G R; Fragar, L J

    2012-01-01

    Farm-related fatalities are a significant problem in Australian agriculture. Over the period 2001-2004, there were 404 fatalities that occurred as a direct consequence of visiting, residing, or working on a farm. This study employed a human capital approach to establish the economic costs of farm-related fatalities to the Australian economy. Modeling of direct and indirect costs associated with farm-related fatalities estimated that the 404 traumatic deaths over the period 2001-2004 cost the Australian economy $650.6 million in 2008 Australian dollars (AUD). This equates to 2.7% of the 2008 farm gross domestic product (GDP) due to potentially preventable farm accidents and injuries. Farm-related deaths are a significant economic cost to the Australian economy. Greater resources need to be directed to farm health and safety interventions to increase their effectiveness at reducing the risk exposure of those visiting, residing, and working on Australian farms. PMID:22458013

  8. Societal costs of air pollution-related health hazards: A review of methods and results

    PubMed Central

    Pervin, Tanjima; Gerdtham, Ulf-G; Lyttkens, Carl Hampus

    2008-01-01

    This paper aims to provide a critical and systematic review of the societal costs of air pollution-related ill health (CAP), to explore methodological issues that may be important when assessing or comparing CAP across countries and to suggest ways in which future CAP studies can be made more useful for policy analysis. The methodology includes a systematic search based on the major electronic databases and the websites of a number of major international organizations. Studies are categorized by origin – OECD countries or non-OECD countries – and by publication status. Seventeen studies are included, eight from OECD countries and nine from non-OECD countries. A number of studies based on the ExternE methodology and the USA studies conducted by the Institute of Transportation are also summarized and discussed separately. The present review shows that considerable societal costs are attributable to air pollution-related health hazards. Nevertheless, given the variations in the methodologies used to calculate the estimated costs (e.g. cost estimation methods and cost components included), and inter-country differences in demographic composition and health care systems, it is difficult to compare CAP estimates across studies and countries. To increase awareness concerning the air pollution-related burden of disease, and to build links to health policy analyses, future research efforts should be directed towards theoretically sound and comprehensive CAP estimates with use of rich data. In particular, a more explicit approach should be followed to deal with uncertainties in the estimations. Along with monetary estimates, future research should also report all physical impacts and source-specific cost estimates, and should attempt to estimate 'avoidable cost' using alternative counterfactual scenarios. PMID:18786247

  9. Cost of crashes related to road conditions, United States, 2006.

    PubMed

    Zaloshnja, Eduard; Miller, Ted R

    2009-10-01

    This is the first study to estimate the cost of crashes related to road conditions in the U.S. To model the probability that road conditions contributed to the involvement of a vehicle in the crash, we used 2000-03 Large Truck Crash Causation Study (LTCCS) data, the only dataset that provides detailed information whether road conditions contributed to crash occurrence. We applied the logistic regression results to a costed national crash dataset in order to calculate the probability that road conditions contributed to the involvement of a vehicle in each crash. In crashes where someone was moderately to seriously injured (AIS-2-6) in a vehicle that harmfully impacted a large tree or medium or large non-breakaway pole, or if the first harmful event was collision with a bridge, we changed the calculated probability of being road-related to 1. We used the state distribution of costs of fatal crashes where road conditions contributed to crash occurrence or severity to estimate the respective state distribution of non-fatal crash costs. The estimated comprehensive cost of traffic crashes where road conditions contributed to crash occurrence or severity was $217.5 billion in 2006. This represented 43.6% of the total comprehensive crash cost. The large share of crash costs related to road design and conditions underlines the importance of these factors in highway safety. Road conditions are largely controllable. Road maintenance and upgrading can prevent crashes and reduce injury severity. PMID:20184840

  10. The cost of applying current helicopter external noise reduction methods while maintaining realistic vehicle performance

    NASA Technical Reports Server (NTRS)

    Bowes, M. A.

    1978-01-01

    Analytical methods were developed and/or adopted for calculating helicopter component noise, and these methods were incorporated into a unified total vehicle noise calculation model. Analytical methods were also developed for calculating the effects of noise reduction methodology on helicopter design, performance, and cost. These methods were used to calculate changes in noise, design, performance, and cost due to the incorporation of engine and main rotor noise reduction methods. All noise reduction techniques were evaluated in the context of an established mission performance criterion which included consideration of hovering ceiling, forward flight range/speed/payload, and rotor stall margin. The results indicate that small, but meaningful, reductions in helicopter noise can be obtained by treating the turbine engine exhaust duct. Furthermore, these reductions do not result in excessive life cycle cost penalties. Currently available main rotor noise reduction methodology, however, is shown to be inadequate and excessively costly.

  11. The Relation between Dimensions of Attachment and Internalizing or Externalizing Problems during Adolescence

    ERIC Educational Resources Information Center

    Ronnlund, Michael; Karlsson, Erika

    2006-01-01

    The authors examined the relation between dimensions of attachment and internalizing and externalizing problems in 15- to 16-year-old adolescents (n = 62) who completed the Attachment Style Questionnaire (ASQ; J. Feeney, P. Noller, & M. Hanrahan, 1994) and the Youth Self-Report (YSR; T. M. Achenbach, 1991). In total, the ASQ dimensions accounted…

  12. Social Problem-Solving and Mild Intellectual Disabilities: Relations with Externalizing Behavior and Therapeutic Context

    ERIC Educational Resources Information Center

    van Nieuwenhuijzen, Maroesjka; de Castro, Bram Orobio; Wijnroks, Lex; Vermeer, Adri; Matthys, Walter

    2009-01-01

    Relations among externalizing behavior, therapeutic context (community care vs. residential care), and social problem-solving by children with mild intellectual disabilities or borderline intelligence were examined. Participants were 186 children (12 to 14 years of age) who responded to a video-based social problem-solving task. Of these, 130…

  13. Externalizing and Internalizing Problems in Relation to Autonomic Function: A Population-Based Study in Preadolescents

    ERIC Educational Resources Information Center

    Dietrich, Andrea; Riese, Harriette; Sondeijker, Frouke E. P. L.; Greaves-Lord, Kirstin; van Roon, Arie M.; Ormel, Johan; Neeleman, Jan; Rosmalen, Judith G. M.

    2007-01-01

    Objective: To investigate whether externalizing and internalizing problems are related to lower and higher heart rate (HR), respectively, and to explore the relationship of these problems with respiratory sinus arrhythmia (RSA) and baroreflex sensitivity (BRS). Moreover, to study whether problems present at both preschool and preadolescent age…

  14. Testing Links between Childhood Positive Peer Relations and Externalizing Outcomes through a Randomized Controlled Intervention Study

    ERIC Educational Resources Information Center

    Witvliet, Miranda; van Lier, Pol A. C.; Cuijpers, Pim; Koot, Hans M.

    2009-01-01

    In this study, the authors used a randomized controlled trial to explore the link between having positive peer relations and externalizing outcomes in 758 children followed from kindergarten to the end of 2nd grade. Children were randomly assigned to the Good Behavior Game (GBG), a universal classroom-based preventive intervention, or a control…

  15. Air Quality Criteria for Ozone and Related Photochemical Oxidants (First External Review Draft)

    EPA Science Inventory

    This first external review draft of the Air Quality Criteria for Ozone and Related Photochemical Oxidants (Ozone Criteria Document) is being released in January 2005 for public comment and for review by EPA's Clean A...

  16. Air Quality Criteria for Ozone and Related Photochemical Oxidants (Second External Review Draft)

    EPA Science Inventory

    This second external review draft of the Air Quality Criteria for Ozone and Related Photochemical Oxidants, Volumes I-III (Ozone Criteria Document) is being released for public comment and for review by EPA's Clean Air Scientific Advisory Committee (CASAC) r...

  17. Integrated Science Assessment of Ozone and Related Photochemical Oxidants (First External Review Draft)

    EPA Science Inventory

    EPA announced that the First External Review Draft of the Integrated Science Assessment for Ozone and Related Photochemical Oxidants has been made available for independent peer review and public review. This draft document represents a concise synthesis and evaluation of ...

  18. Integrated Science Assessment of Ozone and Related Photochemical Oxidants (Second External Review Draft)

    EPA Science Inventory

    EPA has released the Integrated Science Assessment of Ozone and Related Photochemical Oxidants (Second External Review Draft) for independent peer review and public review. This draft document represents a concise synthesis and evaluation of the most policy-relevant scienc...

  19. Integrated Science Assessment of Ozone and Related Photochemical Oxidants (Third External Review Draft)

    EPA Science Inventory

    EPA has released the Integrated Science Assessment of Ozone and Related Photochemical Oxidants (Third External Review Draft) for independent peer review and public review. This draft document represents a concise synthesis and evaluation of the most policy-relevant science...

  20. Influences of external vs. core-shell mixing on aerosol optical properties at various relative humidities.

    PubMed

    Ramachandran, S; Srivastava, Rohit

    2013-05-01

    Aerosol optical properties of external and core-shell mixtures of aerosol species present in the atmosphere are calculated in this study for different relative humidities. Core-shell Mie calculations are performed using the values of radii, refractive indices and densities of aerosol species that act as core and shell, and the core-shell radius ratio. The single scattering albedo (SSA) is higher when the absorbing species (black carbon, BC) is the core, while for a sulfate core SSA does not vary significantly as the BC in the shell dominates the absorption. Absorption gets enhanced in core-shell mixing of absorbing and scattering aerosols when compared to their external mixture. Thus, SSA is significantly lower for a core-shell mixture than their external mixture. SSA is more sensitive to core-shell ratio than mode radius when BC is the core. The extinction coefficient, SSA and asymmetry parameter are higher for external mixing when compared to BC (core)-water soluble aerosol (shell), and water soluble aerosol (core)-BC (shell) mixtures in the relative humidity range of 0 to 90%. Spectral SSA exhibits the behaviour of the species which acts as a shell in core-shell mixing. The asymmetry parameter for an external mixture of water soluble aerosol and BC is higher than BC (core)-water soluble aerosol (shell) mixing and increases as function of relative humidity. The asymmetry parameter for the water soluble aerosol (core)-BC (shell) is independent of relative humidity as BC is hydrophobic. The asymmetry parameter of the core-shell mixture decreases when BC aerosols are involved in mixing, as the asymmetry parameter of BC is lower. Aerosol optical depth (AOD) of core-shell mixtures increases at a higher rate when the relative humidity exceeds 70% in continental clean and urban aerosol models, whereas AOD remains the same when the relative humidity exceeds 50% in maritime aerosol models. The SSA for continental aerosols varies for core-shell mixing of water soluble

  1. The Feasibility of a Land Ferry System to Reduce Highway Maintenance Cost and Associated Externalities.

    PubMed

    Merrill, Steve J; Paz, Alexander; Molano, Victor; Shrestha, Pramen P; Maheshwari, Pankaj; Stephen, Haroon; de la Fuente-Mella, Hanns

    2016-01-01

    This study provides an economic evaluation for a Land Ferry, which is a rail system capable of carrying trucks and all other types of vehicles, passengers, and cargo. The Land Ferry system involves a sliding loading system to roll heavy loads onto a flatbed; as a result, loading and unloading of all vehicles and cargo could be accomplished simultaneously. The evaluation for this system included (1) the design of a new track alignment over which the Land Ferry system would run, (2) evaluation of various sources of power, (3) estimation of how many local jobs the Land Ferry would generate, and (4) a benefit-cost analysis. It was estimated that the Land Ferry would create over 45,788 temporary jobs in Nevada during the three-year construction period and 318 permanent jobs during operation. The majority of the benefits were attributed to savings in travel time ($356.4 M), vehicle operating costs ($1000.4 M), reduction of accidents ($544.6 M), and pavement maintenance ($503.2 M). These benefits would be a consequence of the shift of trucks from the highway, thus resulting in higher speeds, decrease fuel consumption, and decrease vehicle maintenance costs. The overall benefit-cost ratio of 1.7 implies a cost-effective project. PMID:27419201

  2. The Feasibility of a Land Ferry System to Reduce Highway Maintenance Cost and Associated Externalities

    PubMed Central

    Merrill, Steve J.; Paz, Alexander; Molano, Victor; Shrestha, Pramen P.; Maheshwari, Pankaj; Stephen, Haroon

    2016-01-01

    This study provides an economic evaluation for a Land Ferry, which is a rail system capable of carrying trucks and all other types of vehicles, passengers, and cargo. The Land Ferry system involves a sliding loading system to roll heavy loads onto a flatbed; as a result, loading and unloading of all vehicles and cargo could be accomplished simultaneously. The evaluation for this system included (1) the design of a new track alignment over which the Land Ferry system would run, (2) evaluation of various sources of power, (3) estimation of how many local jobs the Land Ferry would generate, and (4) a benefit-cost analysis. It was estimated that the Land Ferry would create over 45,788 temporary jobs in Nevada during the three-year construction period and 318 permanent jobs during operation. The majority of the benefits were attributed to savings in travel time ($356.4 M), vehicle operating costs ($1000.4 M), reduction of accidents ($544.6 M), and pavement maintenance ($503.2 M). These benefits would be a consequence of the shift of trucks from the highway, thus resulting in higher speeds, decrease fuel consumption, and decrease vehicle maintenance costs. The overall benefit-cost ratio of 1.7 implies a cost-effective project. PMID:27419201

  3. Relations of Parenting to Adolescent Externalizing and Internalizing Distress Moderated by Perception of Neighborhood Danger.

    PubMed

    Goldner, Jonathan S; Quimby, Dakari; Richards, Maryse H; Zakaryan, Arie; Miller, Steve; Dickson, Daniel; Chilson, Jessica

    2016-01-01

    Parental monitoring and warmth have traditionally been studied in the context of White, middle-class families. This article explores optimal levels of these parenting behaviors in preventing adolescent psychopathology in impoverished, urban high-crime areas while accounting for child perceptions of neighborhood danger. In this study, data were collected longitudinally at 2 time points 1 year apart from a sample of 254 African American young adolescents (T1: M age = 12.6 years, 41% male) and their parents. Parental monitoring and warmth, child perception of neighborhood danger, and child internalizing and externalizing behaviors were measured using questionnaires. Child internalizing behaviors were also measured using a time sampling technique capturing in vivo accounts of daily distress. Findings indicated associations between parental monitoring and children's externalizing behaviors along with linear and quadratic associations between parental monitoring and internalizing behaviors. Monitoring and warmth were differentially related to symptoms depending on neighborhood danger level. When children perceived less danger, more monitoring related to less externalizing. When children perceived more danger, more warmth related to less internalizing. In addition, adolescents' perceptions of neighborhood danger emerged as equally strong as monitoring and warmth in predicting symptoms. This study underscores the influence of carefully considering parenting approaches and which techniques optimally prevent adolescents' externalizing, as well as prevent internalizing difficulties. It also highlights how context affects mental health, specifically how perceptions of danger negatively influence adolescents' psychopathology, emphasizing the importance of initiatives to reduce violence in communities. PMID:25425100

  4. A relative shift in cloacal location repositions external genitalia in amniote evolution.

    PubMed

    Tschopp, Patrick; Sherratt, Emma; Sanger, Thomas J; Groner, Anna C; Aspiras, Ariel C; Hu, Jimmy K; Pourquié, Olivier; Gros, Jérôme; Tabin, Clifford J

    2014-12-18

    The move of vertebrates to a terrestrial lifestyle required major adaptations in their locomotory apparatus and reproductive organs. While the fin-to-limb transition has received considerable attention, little is known about the developmental and evolutionary origins of external genitalia. Similarities in gene expression have been interpreted as a potential evolutionary link between the limb and genitals; however, no underlying developmental mechanism has been identified. We re-examined this question using micro-computed tomography, lineage tracing in three amniote clades, and RNA-sequencing-based transcriptional profiling. Here we show that the developmental origin of external genitalia has shifted through evolution, and in some taxa limbs and genitals share a common primordium. In squamates, the genitalia develop directly from the budding hindlimbs, or the remnants thereof, whereas in mice the genital tubercle originates from the ventral and tail bud mesenchyme. The recruitment of different cell populations for genital outgrowth follows a change in the relative position of the cloaca, the genitalia organizing centre. Ectopic grafting of the cloaca demonstrates the conserved ability of different mesenchymal cells to respond to these genitalia-inducing signals. Our results support a limb-like developmental origin of external genitalia as the ancestral condition. Moreover, they suggest that a change in the relative position of the cloacal signalling centre during evolution has led to an altered developmental route for external genitalia in mammals, while preserving parts of the ancestral limb molecular circuitry owing to a common evolutionary origin. PMID:25383527

  5. Mathematics achievement and anxiety and their relation to internalizing and externalizing behaviors.

    PubMed

    Wu, Sarah S; Willcutt, Erik G; Escovar, Emily; Menon, Vinod

    2014-01-01

    Although behavioral difficulties are well documented in reading disabilities, little is known about the relationship between math ability and internalizing and externalizing behaviors. Here, we use standardized measures to investigate the relation among early math ability, math anxiety, and internalizing and externalizing behaviors in a group of 366 second and third graders. Math achievement was significantly correlated with attentional difficulties and social problems but not with internalizing symptoms. The relation between math achievement and externalizing behavioral problems was stronger in girls than in boys. Math achievement was not correlated with trait anxiety but was negatively correlated with math anxiety. Critically, math anxiety differed significantly between children classified as math learning disabled (MLD), low achieving (LA), and typically developing (TD), with math anxiety significantly higher in the MLD and LA groups compared to the TD group. Our findings suggest that, even in nonclinical samples, math difficulties at the earliest stages of formal math learning are associated with attentional difficulties and domain-specific anxiety. These findings underscore the need for further examination of the shared cognitive, neural, and genetic influences underlying problem solving and nonverbal learning difficulties and accompanying internalizing and externalizing behaviors. PMID:23313869

  6. Externalizing Behavior and Substance Use Related Problems at 15 Years in Prenatally Cocaine Exposed Adolescents

    PubMed Central

    Min, Meeyoung O.; Minnes, Sonia; Lang, Adelaide; Weishampel, Paul; Short, Elizabeth J.; Yoon, Susan; Singer, Lynn T.

    2014-01-01

    The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β=.15, p=.02). Adolescents with PCE were also 2.8 times (95% CI=1.38–5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive or foster care (n=44) and PCE adolescents in maternal/relative care (n=139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems. PMID:24636687

  7. Prospective payment for hospital costs using diagnosis-related groups: will cost inflation be reduced?

    PubMed

    Keith, S N

    1983-06-01

    In response to rapidly rising costs in the medical care industry, especially for inpatient hospital charges, the Reagan administration has sent the first component of a plan for prospective payment of medical care to Congress. This first phase would involve changing reimbursement for hospital charges under Medicare using a system of predetermined rates for particular illnesses. Reimbursement rates have been set for 467 patient-illness categories, or diagnosis-related groups (DRGs), in an attempt to eliminate the variance in hospital costs and stem inflation under Medicare for patients with similar illnesses. But such a system is still subject to manipulation by hospitals that seek to increase reimbursement either to meet costs not covered by the appropriate DRG or to increase profit. The DRG reimbursement system does not prevent cost shifting to private insurance patients and does not involve physicians in efforts to improve cost efficiency. Although the DRG approach may seem conceptually appropriate, implementation will be difficult and the dampening effect on rapidly rising medical care costs may be overestimated. An alteration in the reimbursement mechanism for all medical care may be indicated to reduce significantly the inflation in medical care costs. PMID:6410079

  8. Dispersion relations of externally and thermally excited dust lattice modes in 2D complex plasma crystals

    SciTech Connect

    Yang Xuefeng; Cui Jian; Zhang Yuan; Liu Yue

    2012-07-15

    The dispersion relations of the externally and thermally (naturally) excited dust lattice modes (both longitudinal and transverse) in two-dimensional Debye-Yukawa complex plasma crystals are investigated. The dispersion relations are calculated numerically by taking the neutral gas damping effects into account and the numerical results are in agreement with the experimental data given by Nunomura et al.[Phys. Rev. E 65, 066402 (2002)]. It is found that for the mode excited by an external disturbance with a real frequency, the dispersion properties are changed at a critical frequency near where the group velocity of the mode goes to zero. Therefore, the high frequency branch with negative dispersion cannot be reached. In contrast, for the thermally excited mode, the dispersion curve can extend all the way to the negative dispersion region, while a 'cut-off' wave number exists at the long wavelength end of the dispersion in the transverse mode.

  9. The Relation among Sleep, Routines, and Externalizing Behavior in Children with an Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Henderson, Jill A.; Barry, Tammy D.; Bader, Stephanie H.; Jordan, Sara Sytsma

    2011-01-01

    The present study examined relations among sleep, routines, and externalizing behavior (based on parent report) in 115 children ages 6 to 12 years in two groups: 58 children with an autism spectrum disorder (age M = 9.0, SD = 2.09) and 57 non-ASD children (age M = 8.25, SD = 1.98). Within the ASD group, sleep hygiene and sleep quality were related…

  10. Development and application of performance and cost models for the externally-fired combined cycle. Task 1, Volume 2. Topical report, June 1995

    SciTech Connect

    Agarwal, P.; Frey, H.; Rubin, E.S.

    1995-07-01

    Increasing restrictions on emission of pollutants from conventional pulverized coal fired steam (PCFS) plant generating electrical power is raising capital and operating cost of these plants and at the same time lowering plant efficiency. This is creating a need for alternative technologies which result in lower emissions of regulated pollutants and which are thermally more efficient. Natural gas-fired combined cycle power generation systems have lower capital cost and higher efficiencies than conventional coal fired steam plants, and at this time they are the leading contender for new power plant construction in the U.S. But the intermediate and long term cost of these fuels is high and there is uncertainty regarding their long-term price and availability. Coal is a relatively low cost fuel which will be abundantly available in the long term. This has motivated the development of advanced technologies for power production from coal which will have advantages of other fuels. The Externally Fired Combined Cycle (EFCC) is one such technology. Air pollution control/hot gas cleanup issues associated with this technology are described.

  11. Relations of parenting and temperament to Chinese children's experience of negative life events, coping efficacy, and externalizing problems.

    PubMed

    Zhou, Qing; Wang, Yun; Deng, Xianli; Eisenberg, Nancy; Wolchik, Sharlene A; Tein, Jenn-Yun

    2008-01-01

    The relations of parenting and temperament (effortful control and anger/frustration) to children's externalizing problems were examined in a 3.8-year longitudinal study of 425 native Chinese children (6-9 years) from Beijing. Children's experience of negative life events and coping efficacy were examined as mediators in the parenting- and temperament-externalizing relations. Parents reported on their own parenting. Parents and teachers rated temperament. Children reported on negative life events and coping efficacy. Parents, teachers, children, or peers rated children's externalizing problems. Authoritative and authoritarian parenting and anger/frustration uniquely predicted externalizing problems. The relation between authoritarian parenting and externalizing was mediated by children's coping efficacy and negative school events. The results suggest there is some cross-cultural universality in the developmental pathways for externalizing problems. PMID:18489409

  12. Relations of Parenting and Temperament to Chinese Children’s Experience of Negative Life Events, Coping Efficacy, and Externalizing Problems

    PubMed Central

    Zhou, Qing; Wang, Yun; Deng, Xianli; Eisenberg, Nancy; Wolchik, Sharlene A.; Tein, Jenn-Yun

    2009-01-01

    The relations of parenting and temperament (effortful control and anger/frustration) to children’s externalizing problems were examined in a 3.8-year longitudinal study of 425 native Chinese children (6 – 9 years) from Beijing. Children’s experience of negative life events and coping efficacy were examined as mediators in the parenting and temperament-externalizing relations. Parents reported on their own parenting. Parents and teachers rated temperament. Children reported on negative life events and coping efficacy. Parents, teachers, children, or peers rated children’s externalizing problems. Authoritative and authoritarian parenting and anger/frustration uniquely predicted externalizing problems. The relation between authoritarian parenting and externalizing was mediated by children’s coping efficacy and negative school events. The results suggest there is some cross-cultural universality in the developmental pathways for externalizing problems. PMID:18489409

  13. Internal and external green-blue agricultural water footprints of nations, and related water and land savings through trade

    NASA Astrophysics Data System (ADS)

    Fader, M.; Gerten, D.; Thammer, M.; Heinke, J.; Lotze-Campen, H.; Lucht, W.; Cramer, W.

    2011-01-01

    The need to increase food production for a growing world population makes an assessment of global agricultural water productivities and virtual water flows important. Using the hydrology and agro-biosphere model LPJmL, we quantify at 0.5° resolution the blue (irrigation water) and green (precipitation water) virtual water content, i.e. the inverse of water productivity, for 11 of the world's major crop types. Based on these, we also quantify the water footprints (WFP) of all countries, for the period 1998-2002, distinguishing internal and external WFP (virtual water imported from other countries) and their blue and green components, respectively. Moreover, we calculate water savings and losses, and for the first time also land savings and losses, through international trade with these products. The consistent separation of blue and green water flows and footprints, which is needed due to the different sources and opportunity costs of these two water pools, shows that green water globally dominates both the internal and external WFP (84% of the global WFP and 94% of the external WFP rely on green water). Accordingly, some of the major exporters of the crops considered here (e.g. Argentina, Canada) export mainly green virtual water, but traditional rice exporters such as India and Pakistan mainly export blue virtual water. The external WFPs are found to be relatively small (6% of the total global blue WFP, 16% of the total global green WFP). Nevertheless, current trade saves significant water volumes and land areas (~263 km3 and ~41 Mha, respectively, equivalent to 5% of the sowing area of the crops considered here and 3.5% of the annual precipitation on this area). Linking the proportions of external to internal blue/green WFP with the per capita WFPs allows recognizing that only a few countries consume more water from abroad than from their own territory and have at the same time above average WFPs. Thus, countries with high levels of per capita water consumption

  14. Differential relations between youth internalizing/externalizing problems and cortisol responses to performance vs. interpersonal stress.

    PubMed

    Laurent, Heidemarie; Vergara-Lopez, Chrystal; Stroud, Laura R

    2016-09-01

    Efforts to define hypothalamic-pituitary-adrenal (HPA) axis profiles conferring risk for psychopathology have yielded inconclusive results, perhaps in part due to limited assessment of the stress response. In particular, research has typically focused on HPA responses to performance tasks, while neglecting the interpersonal stressors that become salient during adolescence. In this study we investigated links between psychosocial adjustment - youth internalizing and externalizing problems, as well as competence - and HPA responses to both performance and interpersonal stressors in a normative sample of children and adolescents. Participants (n = 59) completed a set of performance (public speaking, mental arithmetic, mirror tracing) and/or interpersonal (peer rejection) tasks and gave nine saliva samples, which were assayed for cortisol. Hierarchical linear models of cortisol response trajectories in relation to child behavior checklist (CBCL) scores revealed stressor- and sex-specific associations. Whereas internalizing problems related to earlier peaking, less dynamic cortisol responses to interpersonal stress (across males and females), externalizing problems related to lower, earlier peaking and less dynamic cortisol responses to performance stress for males only, and competence-related to later peaking cortisol responses to interpersonal stress for females only. Implications for understanding contextual stress profiles underlying different forms of psychopathology are discussed. PMID:27470923

  15. Sequence Effect in Parkinson's Disease Is Related to Motor Energetic Cost.

    PubMed

    Tinaz, Sule; Pillai, Ajay S; Hallett, Mark

    2016-01-01

    Bradykinesia is the most disabling motor symptom of Parkinson's disease (PD). The sequence effect (SE), a feature of bradykinesia, refers to the rapid decrement in amplitude and speed of repetitive movements (e.g., gait, handwriting) and is a major cause of morbidity in PD. Previous research has revealed mixed results regarding the role of dopaminergic treatment in the SE. However, external cueing has been shown to improve it. In this study, we aimed to characterize the SE systematically and relate this phenomenon to the energetic cost of movement within the context of cost-benefit framework of motor control. We used a dynamic isometric motor task with auditory pacing to assess the SE in motor output during a 15-s task segment in PD patients and matched controls. All participants performed the task with both hands, and without and with visual feedback (VF). Patients were also tested in "on"- and "off"-dopaminergic states. Patients in the "off" state did not show higher SE compared to controls, partly due to large variance in their performance. However, patients in the "on" state and in the absence of VF showed significantly higher SE compared to controls. Patients expended higher total motor energy compared to controls in all conditions and regardless of their medication status. In this experimental situation, the SE in PD is associated with the cumulative energetic cost of movement. Dopaminergic treatment, critical for internal triggering of movement, fails to maintain the motor vigor across responses. The high motor cost may be related to failure to incorporate limbic/motivational cues into the motor plan. VF may facilitate performance by shifting the driving of movement from internal to external or, alternatively, by functioning as a motivational cue. PMID:27252678

  16. Practical and fast quantum random number generation based on photon arrival time relative to external reference

    SciTech Connect

    Nie, You-Qi; Zhang, Jun Pan, Jian-Wei; Zhang, Hong-Fei; Wang, Jian; Zhang, Zhen; Ma, Xiongfeng

    2014-02-03

    We present a practical high-speed quantum random number generator, where the timing of single-photon detection relative to an external time reference is measured as the raw data. The bias of the raw data can be substantially reduced compared with the previous realizations. The raw random bit rate of our generator can reach 109 Mbps. We develop a model for the generator and evaluate the min-entropy of the raw data. Toeplitz matrix hashing is applied for randomness extraction, after which the final random bits are able to pass the standard randomness tests.

  17. Gender and relational differences in sensitivity to internal and external cues at 12 months.

    PubMed

    Watson, John S; Futo, Judit; Fonagy, Peter; Gergely, Gyorgy

    2011-03-01

    Gender differences favoring women in relation to awareness of the subjective (internal) world are well demonstrated but their origins are poorly understood. We trained 173 12-month-olds to visually fixate a video image in response to an internal cue (opening own mouth), external cue (seeing a face open its mouth), or both cues. Female infants showed significantly greater sensitivity than males to the internal cues suggesting that prioritization of internally accessible experience is already evident at one year of age. PMID:21500960

  18. Does Gender Moderate the Relations Between Externalizing Behavior and Key Emergent Literacy Abilities? Evidence From a Longitudinal Study.

    PubMed

    Allan, Nicholas P; Joye, Shauna W; Lonigan, Christopher J

    2013-11-26

    Objective: There is a significant negative relation between externalizing behavior and emergent literacy skills among preschool children. Method: The purpose of this study was to examine the impact of gender on the predictive relation of externalizing behavior and emergent literacy in a group of 178 preschool children (mean age = 48.50 months, SD = 3.66; 48% boys). Results: Externalizing behaviors predicted emergent literacy over time. Distinct patterns of predictive associations dependent on gender were found. Girls with higher levels of externalizing behaviors experienced less change in their vocabulary skills compared with the vocabulary change shown by girls with lower levels of these problem behaviors. Conclusion: The results suggest that early identification programs that include externalizing behavior problems and their relation with emergent literacy development should account for potential gender differences. A theoretical framework in which girls with behavior problems receive less opportunity for vocabulary acquisition is presented. (J. of Att. Dis. XXXX; XX(X) X-XX). PMID:24282144

  19. Age- and sex-related changes in the normal human external nose.

    PubMed

    Sforza, Chiarella; Grandi, Gaia; De Menezes, Marcio; Tartaglia, Gianluca M; Ferrario, Virgilio F

    2011-01-30

    The objective of this study was to measure: (1) normal sex-related dimensions of external nose (linear distances, ratios, angles, volume and surface area); and (2) growth changes between childhood and old age. The three-dimensional coordinates of several soft-tissue landmarks on the external nose were obtained by a non-invasive, computerized digitizer in 519 male and 340 female healthy subjects aged 4-73 years. The subjects were divided into 11 non-overlapping age groups: for children and preadolescent subjects, 2-year spans were used, while larger intervals were used for adolescent and adult subjects. From the landmarks, nasal volume and external surface area; nasal and alar base widths, nasal height, nasal bridge length, philtrum length, nasal tip protrusion, right and left nostril lengths, superior and inferior nostril widths; nasal tip protrusion-to-nasal height, and nasal width-to-nasal height ratios; nasal convexity, alar slope, and nasal tip angles were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. On average, men had larger nasal external volume and area, linear distances and nasal width-to-height ratio than women (p<0.01); no sex differences were found for the angles and the nasal tip protrusion-to-nasal height ratio. Age significantly influenced all analyzed measurements (p<0.001): nasal volume, area, linear distances increased from childhood to old age, while the nasal tip angle decreased as a function of age. No consistent age related patterns were found for the ratios and the nasal convexity and alar slope angles. Men and women had different age related patterns, with significant sex by age interactions (p<0.001). Overall, in most occasions male increments in nasal dimensions were larger than female ones. Data collected in the present investigation could serve as a database for the quantitative description of human nasal morphology during normal growth, development and aging. Forensic

  20. Technical Aspects of Interfacing MUMPS to an External SQL Relational Database Management System

    PubMed Central

    Kuzmak, Peter M.; Walters, Richard F.; Penrod, Gail

    1988-01-01

    This paper describes an interface connecting InterSystems MUMPS (M/VX) to an external relational DBMS, the SYBASE Database Management System. The interface enables MUMPS to operate in a relational environment and gives the MUMPS language full access to a complete set of SQL commands. MUMPS generates SQL statements as ASCII text and sends them to the RDBMS. The RDBMS executes the statements and returns ASCII results to MUMPS. The interface suggests that the language features of MUMPS make it an attractive tool for use in the relational database environment. The approach described in this paper separates MUMPS from the relational database. Positioning the relational database outside of MUMPS promotes data sharing and permits a number of different options to be used for working with the data. Other languages like C, FORTRAN, and COBOL can access the RDBMS database. Advanced tools provided by the relational database vendor can also be used. SYBASE is an advanced high-performance transaction-oriented relational database management system for the VAX/VMS and UNIX operating systems. SYBASE is designed using a distributed open-systems architecture, and is relatively easy to interface with MUMPS.

  1. Greater externalizing personality traits predict less error-related insula and anterior cingulate cortex activity in acutely abstinent cigarette smokers

    PubMed Central

    Carroll, Allison J.; Sutherland, Matthew T.; Salmeron, Betty Jo; Ross, Thomas J.; Stein, Elliot A.

    2014-01-01

    Attenuated activity in performance-monitoring brain regions following erroneous actions may contribute to the repetition of maladaptive behaviors such as continued drug use. Externalizing is a broad personality construct characterized by deficient impulse control, vulnerability to addiction, and reduced neurobiological indices of error processing. The insula and dorsal anterior cingulate cortex (dACC) are regions critically linked with error processing as well as the perpetuation of cigarette smoking. As such, we examined the interrelations between externalizing tendencies, erroneous task performance, and error-related insula and dACC activity in overnight-deprived smokers (n=24) and nonsmokers (n=20). Participants completed a self-report measure assessing externalizing tendencies (Externalizing Spectrum Inventory) and a speeded Flanker task during fMRI scanning. We observed that higher externalizing tendencies correlated with the occurrence of more performance errors among smokers but not nonsmokers. Suggesting a neurobiological contribution to such sub-optimal performance among smokers, higher externalizing also predicted less recruitment of the right insula and dACC following error commission. Critically, this error-related activity fully mediated the relationship between externalizing traits and error rates. That is, higher externalizing scores predicted less error-related right insula and dACC activity and, in turn, less error-related activity predicted more errors. Relating such regional activity with a clinically-relevant construct, less error-related right insula and dACC responses correlated with higher tobacco craving during abstinence. Given that inadequate error-related neuronal responses may contribute to continued drug use despite negative consequences, these results suggest that externalizing tendencies and/or compromised error processing among subsets of smokers may be relevant factors for smoking cessation success. PMID:24354662

  2. Sequence Effect in Parkinson’s Disease Is Related to Motor Energetic Cost

    PubMed Central

    Tinaz, Sule; Pillai, Ajay S.; Hallett, Mark

    2016-01-01

    Bradykinesia is the most disabling motor symptom of Parkinson’s disease (PD). The sequence effect (SE), a feature of bradykinesia, refers to the rapid decrement in amplitude and speed of repetitive movements (e.g., gait, handwriting) and is a major cause of morbidity in PD. Previous research has revealed mixed results regarding the role of dopaminergic treatment in the SE. However, external cueing has been shown to improve it. In this study, we aimed to characterize the SE systematically and relate this phenomenon to the energetic cost of movement within the context of cost–benefit framework of motor control. We used a dynamic isometric motor task with auditory pacing to assess the SE in motor output during a 15-s task segment in PD patients and matched controls. All participants performed the task with both hands, and without and with visual feedback (VF). Patients were also tested in “on”- and “off”-dopaminergic states. Patients in the “off” state did not show higher SE compared to controls, partly due to large variance in their performance. However, patients in the “on” state and in the absence of VF showed significantly higher SE compared to controls. Patients expended higher total motor energy compared to controls in all conditions and regardless of their medication status. In this experimental situation, the SE in PD is associated with the cumulative energetic cost of movement. Dopaminergic treatment, critical for internal triggering of movement, fails to maintain the motor vigor across responses. The high motor cost may be related to failure to incorporate limbic/motivational cues into the motor plan. VF may facilitate performance by shifting the driving of movement from internal to external or, alternatively, by functioning as a motivational cue. PMID:27252678

  3. Relating costs to the user value of farmland biodiversity measurements.

    PubMed

    Targetti, S; Herzog, F; Geijzendorffer, I R; Pointereau, P; Viaggi, D

    2016-01-01

    The impact of agricultural management on global biodiversity highlights the need for farm-scale monitoring programmes capable of determining the performance of agriculture practices. Yet the identification of appropriate indicators is a challenging process and one that involves considering a number of different aspects and requirements. Besides the attention given to scientific effectiveness, relevant but less studied issues related to biodiversity measurements include the economic feasibility of monitoring programmes and the relevance of indicators for different end-users. In this paper, we combine an analytic assessment of costs and a stakeholder-based evaluation of the usefulness of a set of biodiversity-related parameters (habitat mapping, vegetation, bees, earthworms, spiders, and a farmer questionnaire) tested for scientific consistency in 12 European case studies and on more than 14,000 ha of farmland. The results point to the possibility of meeting the expectations of different end-users (administrators, farmers and consumers) with a common indicator set. Combining costs and usefulness also suggests the possibility of designing more efficient monitoring approaches involving private agencies and networks of volunteers and farmers for the field data collection at different stages of a monitoring programme. Although complex, such an approach would make it possible to enhance the effectiveness of available funds for farmland biodiversity monitoring. PMID:26457535

  4. The costs of work-related musculoskeletal disorders in automotive manufacturing.

    PubMed

    Punnett, L

    1999-01-01

    Inadequate application of ergonomic principles to the design of workplaces and individual jobs has adverse consequences for worker health and safety, especially in terms of strains, sprains, and other musculoskeletal disorders. In addition to the human pain and suffering, other losses are externalized to workers, with adverse financial and psychosocial impacts. There are also costs to employers through workers' compensation claims, scrap, and decreased production quality, medical insurance premiums, labor turnover, and adverse impacts on labor relations, although many of these are not linked by traditional accounting methods to ergonomic problems per se. Data collected in five plants of two major U.S. automotive manufacturing companies in the last decade have been used to estimate some of the costs associated with work-related musculoskeletal disorders (MSDs), only some of which resulted in workers compensation claims. In one plant in 1984-85, the payroll cost of all back and shoulder disorders was at least $320 per year per worker, not including workers' compensation premiums or claims paid. A large proportion of these costs were accrued by "unreported" cases, that is, cases that either had never been reported to the plant clinic or had been reported in the past and were considered administratively to have recovered. In the other four plants, annual costs associated with in-plant medical visits for MSDs in 1989-93 were almost as high as those resulting from compensation claims. At least one-half of these disorders were estimated to be attributable to physical ergonomic exposures in the workplace and thus preventable. These data are consistent with estimates by others that the real costs to employers are at least two to three times the amount paid in workers' compensation cases, and that at least 50 percent of all work-related musculoskeletal disorders among the working population could be prevented by appropriate ergonomic job design. Furthermore, recent

  5. Longitudinal relations between parental media monitoring and adolescent aggression, prosocial behavior, and externalizing problems.

    PubMed

    Padilla-Walker, Laura M; Coyne, Sarah M; Collier, Kevin M

    2016-01-01

    The current study examined longitudinal relations between parental media monitoring and adolescent behavior, and explored indirect effects via sympathy and self-regulation. A sample of adolescents and their mothers from Northwestern and Mountain West cities in the USA participated in a study at three time points, approximately one year apart (N = 681; M age of child at Time 3 = 13.33, SD = 1.06; 51% female; 73% European American, 9% African American, 17% Multi-ethnic). Though findings varied by reporter, results suggested that restrictive and active media monitoring were indirectly associated with adolescents' prosocial behavior, aggression, and externalizing behavior, with restrictive monitoring being somewhat maladaptive and active monitoring adaptive. The discussion focuses on the need to examine multiple aspects of media monitoring, and highlights implications of findings for parents. PMID:26641307

  6. ICU director data: using data to assess value, inform local change, and relate to the external world.

    PubMed

    Murphy, David J; Ogbu, Ogbonna C; Coopersmith, Craig M

    2015-04-01

    Improving value within critical care remains a priority because it represents a significant portion of health-care spending, faces high rates of adverse events, and inconsistently delivers evidence-based practices. ICU directors are increasingly required to understand all aspects of the value provided by their units to inform local improvement efforts and relate effectively to external parties. A clear understanding of the overall process of measuring quality and value as well as the strengths, limitations, and potential application of individual metrics is critical to supporting this charge. In this review, we provide a conceptual framework for understanding value metrics, describe an approach to developing a value measurement program, and summarize common metrics to characterize ICU value. We first summarize how ICU value can be represented as a function of outcomes and costs. We expand this equation and relate it to both the classic structure-process-outcome framework for quality assessment and the Institute of Medicine's six aims of health care. We then describe how ICU leaders can develop their own value measurement process by identifying target areas, selecting appropriate measures, acquiring the necessary data, analyzing the data, and disseminating the findings. Within this measurement process, we summarize common metrics that can be used to characterize ICU value. As health care, in general, and critical care, in particular, changes and data become more available, it is increasingly important for ICU leaders to understand how to effectively acquire, evaluate, and apply data to improve the value of care provided to patients. PMID:25846533

  7. Major Trends and Portents Related to Information Costs.

    ERIC Educational Resources Information Center

    Wilson, John H., Jr.

    Managers' having to account for cost of information activities is here to stay. Budgeting is going to become more stringent and imaginative. Costs should not be equated with human values--psychological and subjective--which apparently many managers do, feeling that having to cost information activities is degrading. Some trends are: Buy products…

  8. State Medicaid Pharmacy Payments and Their Relation to Estimated Costs

    PubMed Central

    Adams, E. Kathleen; Kreling, David H.; Gondek, Kathleen

    1994-01-01

    Although prescription drugs do not appear to be a primary source of recent surges in Medicaid spending, their share of Medicaid expenditures has risen despite efforts to control costs. As part of a general concern with prescription drug policy, Congress mandated a study of the adequacy of Medicaid payments to pharmacies. In this study, several data sources were used to develop 1991 estimates of average pharmacy ingredient and dispensing costs. A simulation was used to estimate the amounts States pay. Nationally, simulated payments averaged 96 percent of estimated costs overall but were lower for dispensing costs (79 percent) and higher for ingredient costs (102 percent). PMID:10137796

  9. Validity of the Externalizing Spectrum Inventory in a Criminal Offender Sample: Relations with Disinhibitory Psychopathology, Personality, and Psychopathic Features

    PubMed Central

    Venables, Noah C.; Patrick, Christopher J.

    2013-01-01

    The Externalizing Spectrum Inventory (ESI; Krueger, Markon, Patrick, Benning, & Kramer, 2007) provides a self-report based method for indexing a range of correlated problem behaviors and traits in the domain of deficient impulse control. The ESI organizes lower-order behaviors and traits of this kind around higher-order factors encompassing general disinhibitory proneness, callous-aggression, and substance abuse. The current study used data from a male prisoner sample (N = 235) to evaluate the validity of ESI total and factor scores in relation to external criterion measures consisting of externalizing disorder symptoms (including child and adult antisocial deviance and substance-related problems) assessed via diagnostic interview, personality traits assessed by self-report, and psychopathic features as assessed by both interview and self-report. Results provide evidence for the validity of the ESI measurement model and point to its potential utility as a referent for research on the neurobiological correlates and etiological bases of externalizing proneness. PMID:21787091

  10. A regulatory focus perspective on eating behavior: how prevention and promotion focus relates to emotional, external, and restrained eating

    PubMed Central

    Pfattheicher, Stefan; Sassenrath, Claudia

    2014-01-01

    By applying regulatory focus theory (RFT) to the context of eating behavior, the present research examines the relations between individual differences in the two motivational orientations as conceptualized in RFT, that is, prevention-focused and promotion-focused self-regulation and emotional, external, and restrained eating. Building on a representative study conducted in the Netherlands (N = 4,230), it is documented that individual differences in prevention focus are positively related to emotional eating whereas negligible associations are found in regards to external and restrained eating. Individual differences in promotion focus are positively related to external eating whereas negligible associations are found in regards to emotional and restrained eating. In relating RFT to different eating styles we were able to document significant relations of basic self-regulatory orientations with regard to essential daily behavior associated with health and well-being. The implications for changing eating styles are discussed. PMID:25477840

  11. External Visual Representations in Science Learning: The case of relations among system components

    NASA Astrophysics Data System (ADS)

    Eilam, Billie; Poyas, Yael

    2010-11-01

    How do external visual representations (e.g., graph, diagram) promote or constrain students' ability to identify system components and their interrelations, to reinforce a systemic view through the application of the STS approach? University students (N = 150) received information cards describing cellphones' communication system and its subsystem components. One group (n = 82) received a display of cards presenting this information in rich and diverse visual representations and a few text cards. Another group (n = 68) received a single representation display, of text only. Using these card sets, students were asked to identify the cellular systems' components and relations, and to construct new interrelations. Findings showed that, mostly, multimedia enabled better identification and construction of relations of higher component diversity, accuracy, description, and novelty, using a larger number of information cards than did the textual display. Generally, findings suggested that components' saliency and distinctiveness in the visual display afforded a better systemic view. However, curriculum designers and teachers should be aware of cases in which rich multimedia constrained performance.

  12. 28 CFR 100.15 - Disallowed costs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) COST RECOVERY REGULATIONS, COMMUNICATIONS...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management,...

  13. 28 CFR 100.15 - Disallowed costs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) COST RECOVERY REGULATIONS, COMMUNICATIONS...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management,...

  14. Cost Accounting: Problems and Research Related to Cost Definitions and Collection of Data

    ERIC Educational Resources Information Center

    Lyons, John M.

    1978-01-01

    Recent evidence suggests that traditional cost analysis may not be the most appropriate way to justify educational budgets. This article suggests that using constructed cost models to develop operating budget requests can help ensure that the distinction between legitimate information needs and managerial autonomy is maintained. (LBH)

  15. Epidemiology and costs of hypertension-related disorders.

    PubMed

    Leone, Aldo; Landini, Linda; Leone, Aurelio

    2011-01-01

    Epidemiological surveys demonstrate undoubtedly that cardiovascular disorders caused or associated with hypertension are at a high risk of non-fatal or fatal events and occurring with a great rate. Ischaemic heart disease with effort angina and myocardial infarction, often unrecognized myocardial infarction, stroke and transient ischaemic attack may be observed more frequently than other cardiovascular disorders in hypertensive patients. Large-scale trials do not support the hypothesis that effective benefits are reached by current non-pharmacological or pharmacological prevention which need enormous costs to public health. Lowering blood pressure is the main target to reach in an attempt to reduce cardiovascular complications in hypertensive patients. Therefore, the costs-benefit ratio, which estimates public health costs, needs yet marked improvement since the public health expenses are heaviest with results that do not support the economic effort. Statistically, quantitative measures to modify the current regimen need to better evaluate both public health costs and reached benefits. PMID:21861839

  16. Longitudinal Relations of Children's Effortful Control, Impulsivity, and Negative Emotionality to Their Externalizing, Internalizing, and Co-Occurring Behavior Problems

    ERIC Educational Resources Information Center

    Eisenberg, Nancy; Valiente, Carlos; Spinrad, Tracy L.; Cumberland, Amanda; Liew, Jeffrey; Reiser, Mark; Zhou, Qing; Losoya, Sandra H.

    2009-01-01

    The purpose of the study was to examine the relations of effortful control (EC), impulsivity, and negative emotionality to at least borderline clinical levels of symptoms and change in maladjustment over four years. Children's (N = 214; 77% European American; M age = 73 months) externalizing and internalizing symptoms were rated by parents and…

  17. EPA's Reanalysis of Key Issues Related to Dioxin Toxicity and Response to NAS Comments (External Review Draft)

    EPA Science Inventory

  1. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false FEHBP public relations and... COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-70 FEHBP public relations and advertising costs. (a) The cost of media messages that are directed at advising current...

  2. 48 CFR 231.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... advertising costs. 231.205-1 Section 231.205-1 Federal Acquisition Regulations System DEFENSE ACQUISITION... PROCEDURES Contracts With Commercial Organizations 231.205-1 Public relations and advertising costs. (e) See... public relations and advertising costs also include monies paid to the Government associated with...

  3. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true FEHBP public relations and... COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-70 FEHBP public relations and advertising costs. (a) The cost of media messages that are directed at advising current...

  4. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... organization; (ii) A substantial part of its business activity of the type carried on with the provider is... control and there is an open, competitive market for the type of services, facilities, or...

  5. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES...) A substantial part of its business activity of the type carried on with the provider is transacted... and there is an open, competitive market for the type of services, facilities, or supplies...

  6. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... organization; (ii) A substantial part of its business activity of the type carried on with the provider is... control and there is an open, competitive market for the type of services, facilities, or...

  7. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... organization; (ii) A substantial part of its business activity of the type carried on with the provider is... control and there is an open, competitive market for the type of services, facilities, or...

  8. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... organization; (ii) A substantial part of its business activity of the type carried on with the provider is... control and there is an open, competitive market for the type of services, facilities, or...

  9. 77 FR 36534 - Third External Review Draft Integrated Science Assessment for Ozone and Related Photochemical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... of EPA's air quality criteria. On September 29, 2008 (73 FR 56581), EPA formally initiated its... (74 FR 54562). In August 2010, EPA held a workshop to discuss, with invited scientific experts, initial draft materials prepared in the development of the ISA (75 FR 42085). The first external...

  10. Developmental Changes in the Relations between Inhibitory Control and Externalizing Problems during Early Childhood

    ERIC Educational Resources Information Center

    Utendale, William T.; Hastings, Paul D.

    2011-01-01

    Deficits in executive function, and in particular, reduced capacity to inhibit a dominant action, are a risk factor for externalizing problems (EP). Inhibitory control (IC) develops in the later preschool and early childhood periods, such that IC might not regulate EP in toddlers and younger preschoolers. Aggression was observed during peer play…

  11. The Relations between Autonomy and Control in the Management of External Consultants and Organizational Learning.

    ERIC Educational Resources Information Center

    Halvari, Hallgeir; Johansen, Are; Sorhaug, Tore

    1998-01-01

    Sources of organizational learning were studied for 131 employees, 109 of whom were managers, who participated in projects with external consultants in a large public-transport company in Norway. A multiple regression analysis explained 69% of organizational learning as a function of attitude toward learning. Differences between managers and other…

  12. External Visual Representations in Science Learning: The Case of Relations among System Components

    ERIC Educational Resources Information Center

    Eilam, Billie; Poyas, Yael

    2010-01-01

    How do external visual representations (e.g., graph, diagram) promote or constrain students' ability to identify system components and their interrelations, to reinforce a systemic view through the application of the STS approach? University students (N = 150) received information cards describing cellphones' communication system and its subsystem…

  13. Relationship between the P3 Event-Related Potential, Its Associated Time-Frequency Components, and Externalizing Psychopathology

    PubMed Central

    Gilmore, Casey S.; Malone, Stephen M.; Bernat, Edward M.; Iacono, William G.

    2009-01-01

    P3 amplitude reduction (P3-AR) is associated with biological vulnerability to a spectrum of externalizing disorders, such as ADHD, conduct disorder, and substance use disorders. P3, however, is generally characterized as a broad activation involving multiple neurophysiological processes. One approach to separating P3-related processes is time-frequency (TF) analysis. The current study used a novel PCA-based TF analysis method to investigate relationships between P3, its associated TF components, and externalizing in a community-based sample of adolescent males. Results showed that 1) alone, P3 and each TF-PCA derived component could successfully discriminate diagnostic groups from controls, and 2) delta components in specific time ranges accounted for variance beyond that accounted for by P3. One delta component was associated with all diagnostic groups, suggesting it may represent a more parsimonious endophenotype for externalizing than P3-AR. PMID:19674392

  14. Relations Among Positive Parenting, Children’s Effortful Control, and Externalizing Problems: A Three-Wave Longitudinal Study

    PubMed Central

    Eisenberg, Nancy; Zhou, Qing; Spinrad, Tracy L.; Valiente, Carlos; Fabes, Richard A.; Liew, Jeffrey

    2005-01-01

    In a 3-wave longitudinal study (with assessments 2 years apart) involving 186 early adolescents (M ages of approximately 9.3, 11.4, and 13.4), the hypothesis that parental warmth/positive expressivity predicts children’s effortful control (EC) (a temperamental characteristic contributing to emotion regulation) 2 years later, which in turn predicts low levels of externalizing problems another 2 years later, was examined. The hypothesis that children’s EC predicts parenting over time was also examined. Parents were observed interacting with their children; parents and teachers reported children’s EC and externalizing problems; and children’s persistence was assessed behaviorally. Children’s EC mediated the relation between positive parenting and low levels of externalizing problems (whereas there was no evidence that children’s EC predicted parenting). PMID:16150002

  15. Reciprocal Relations Between Parents’ Physical Discipline and Children’s Externalizing Behavior During Middle Childhood and Adolescence

    PubMed Central

    Lansford, Jennifer E.; Criss, Michael M.; Laird, Robert D.; Shaw, Daniel S.; Pettit, Gregory S.; Bates, John E.; Dodge, Kenneth A.

    2010-01-01

    Using data from two long-term longitudinal projects, we investigated reciprocal relations between maternal reports of physical discipline and teacher and self ratings of child externalizing behavior, accounting for continuity in both discipline and externalizing over time. In Study 1, which followed a community sample of 562 boys and girls from age 6–9, high levels of physical discipline in a given year predicted high levels of externalizing behavior in the next year, and externalizing behavior in a given year predicted high levels of physical discipline in the next year. In Study 2, which followed an independent sample of 290 lower income, higher risk boys from age 10–15, mother-reported physical discipline in a given year predicted child ratings of antisocial behavior in the next year, but child antisocial behavior in a given year did not predict parents’ use of physical discipline in the next year. In neither sample was there evidence that associations between physical discipline and child externalizing changed as the child aged, and findings were not moderated by gender, race, socioeconomic status, or the severity of the physical discipline. Implications for the reciprocal nature of the socialization process and the risks associated with physical discipline are discussed. PMID:21262050

  16. External forcing as a source for the observed multi-decadal relation between AMV and the Indian summer monsoon

    NASA Astrophysics Data System (ADS)

    Svendsen, Lea; Luo, Feifei; Sankar, Syam; Gao, Yongqi; Keenlyside, Noel; Vareed Joseph, Porathur; Johannessen, Ola

    2016-04-01

    The instrumental records show a significant positive correlation between the Atlantic multi-decadal variability (AMV) and the Indian summer monsoon (ISM) rainfall, where a positive (negative) AMV is associated with more (less) ISM rainfall. We have used both proxy reconstruction and twelve models from the Coupled Model Intercomparison Project Phase 5 (CMIP5) to investigate if the observed AMV-ISM relation is a persistent internal climate signal or externally forced. A comparison of several annual resolution proxy records both from the Atlantic and for the ISM show that the multi-decadal variability in both indices is persistent, but the link between them is not. The correlation between the two regions is weak, and even negative in some periods, before the instrumental time period. The analysis of CMIP5 simualtions is consistent with these results. While none of the CMIP5 models investigated simulate the significant AMV-ISM connection in the pre-industrial control simulations with fixed external forcing, three of the models reproduce the relation in the 20th century historical simulations with transient forcing. In these models external forcing is linked to the mid-to-upper tropospheric temperature pattern with a strengthened land-ocean contrast over South Asia, consistent with an enhanced ISM, as well as the evolution of AMV. We conclude that the significant AMV-ISM relation found in the observations after the industrial revolution may be associated with external forcing, rather than being internal climate variability.

  17. The relative cost of Medicaid enrollees and the commercially insured in HMOs.

    PubMed

    Welch, W P; Wade, M

    1995-01-01

    Under several national health care reform proposals in 1994, many Medicaid beneficiaries would have enrolled in health maintenance organizations (HMOs) with other persons. Several states already enroll Medicaid beneficiaries in HMOs with commercial enrollees. This DataWatch examines the cost of Medicaid enrollees in HMOs relative to the cost of commercial enrollees. Data from nine HMOs indicate that, on average, Aid to Families with Dependent Children (AFDC) and poverty-related Medicaid enrollees cost 13 percent more than commercial enrollees cost. If one adjusts for enrollees' age and sex, Medicaid costs are 23 percent higher than commercial costs. PMID:7657242

  18. The relation between mothers' hostile attribution tendencies and children's externalizing behavior problems: the mediating role of mothers' harsh discipline practices.

    PubMed

    Nix, R L; Pinderhughes, E E; Dodge, K A; Bates, J E; Pettit, G S; McFadyen-Ketchum, S A

    1999-01-01

    This study examined relations among mothers' hostile attribution tendencies regarding their children's ambiguous problem behaviors, mothers' harsh discipline practices, and children's externalizing behavior problems. A community sample of 277 families (19% minority representation) living in three geographic regions of the United States was followed for over 4 years. Mothers' hostile attribution tendencies were assessed during the summer prior to children's entry into kindergarten through their responses to written vignettes. Mothers' harsh discipline practices were assessed concurrently through ratings by interviewers and reports by spouses. Children's externalizing behavior problems were assessed concurrently through written questionnaires by mothers and fathers and in the spring of kindergarten and first, second, and third grades through reports by teachers and peer sociometric nominations. Results of structural equations models demonstrated that mothers' hostile attribution tendencies predicted children's future externalizing behavior problems at school and that a large proportion of this relation was mediated by mothers' harsh discipline practices. These results remained virtually unchanged when controlling for initial levels of children's prekindergarten externalizing behavior problems at home. PMID:10446725

  19. The Cost of Cancer-Related Physician Services to Medicare

    PubMed Central

    Maroongroge, Sean; Kim, Simon P.; Mougalian, Sarah; Johung, Kimberly; Decker, Roy H.; Soulos, Pamela R.; Long, Jessica B.; Gross, Cary P.; Yu, James B.

    2015-01-01

    Although physician services represent a substantial portion of cancer care costs, little is known about trends in the costs of physician cancer services in the fee-for-service Medicare program. We analyzed aggregated data from all Part B Medicare claims for physician and supplier services attributed to cancer patients from 1999 to 2012 to characterize how billing and payments have changed over time for the most common cancer types. Billing and expenditure data are from the Medicare Statistical Supplement, and age-adjusted incidence data are from SEER. Physician services for cancer patients grew from $7.6 billion in 1999 to $12.3 billion in 2012 (60 percent increase). Reimbursements for physician and supplier services for cancer treatment in Medicare Part B beneficiaries steadily grew from 1999 to 2005 and then plateaued through 2012, led by a decrease in reimbursements for prostate cancer care. These trends may reflect shifts toward hospital-based care or changes in aggressiveness of care. PMID:26029009

  20. 48 CFR 231.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Public relations and... PROCEDURES Contracts With Commercial Organizations 231.205-1 Public relations and advertising costs. (e) See... public relations and advertising costs also include monies paid to the Government associated with...

  1. Longitudinal relations among exuberance, externalizing behaviors, and attentional bias to reward: the mediating role of effortful control.

    PubMed

    Morales, Santiago; Pérez-Edgar, Koraly; Buss, Kristin

    2016-09-01

    The present study examined the associations between temperamental exuberance during toddlerhood (20 months), attention bias towards reward at the end of kindergarten (76 months), and externalizing behaviors across the kindergarten year. Moreover, we examined the role of effortful control at 48 months on the relation between early exuberance and attention bias. Attention bias towards reward was positively predicted by exuberance, negatively predicted by effortful control, and positively related to externalizing problems. Finally, the longitudinal path between exuberance and attention bias to reward was mediated by effortful control - such that higher toddler exuberance led to increased attention bias towards reward by way of lower effortful control. These results extend the attention bias and socioemotional functioning literature and have implications for the identification of children at risk for behavioral problems. PMID:26077132

  2. Trajectories of Religious Coping from Adolescence into Early Adulthood: Their Form and Relations to Externalizing Problems and Prosocial Behavior

    PubMed Central

    Eisenberg, Nancy; Castellani, Valeria; Panerai, Laura; Eggum, Natalie D.; Cohen, Adam B.; Pastorelli, Concetta; Caprara, Gian Vittorio

    2011-01-01

    Little is known about changes in religious coping and their relations to adolescents’ and young adults’ functioning. In 686 Italian youths, trajectories of religious coping were identified from age 16–17 years to age 22–23 years; cohorts of youths reported at three of the four assessments. Four trajectories of religious coping were identified: decreasing, low stable, high stable, and increasing. A decline in religious coping was associated with high levels of externalizing problems at age 16–17, whereas an increase in religious coping was associated with higher externalizing problems at ages 18–19 and 20–21 years, and with relatively high involvement with deviant peers. High stable religious copers were high in prosocial behavior at three ages; low stable religious copers were higher than people undergoing change in their religious coping from mid-adolescence into early adulthood. These results can expand our current thinking about religious coping and adolescent adjustment. PMID:21682728

  3. Effects of response sets on NEO-PI-R scores and their relations to external criteria.

    PubMed

    Caldwell-Andrews, A; Baer, R A; Berry, D T

    2000-06-01

    Validity scales indicate the extent to which the results of a self-report inventory are a valid indicator of the test taker's psychological functioning. Validity scales generally are designed to detect the common response sets of positive impression management (underreporting, or faking good), negative impression management (overreporting, or faking bad), and random responding. The revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992b) is a popular personality assessment tool based on the 5-factor model of personality and is used in a variety of settings. The NEO-PI-R does not include objective validity scales to screen for positive or negative impression management. The purpose of this study was to examine the utility of recently proposed validity scales for detecting these response sets on the NEO-PI-R (Schinka, Kinder, & Kremer, 1997) and to examine the effects of positive and negative impression management on correlations between the NEO-PI-R and external criteria (the Interpersonal Adjective Scale-Revised-B5 [Wiggins & Trapnell, 1997] and the NEO-PI-R Form R). The validity scales discriminated with reasonable accuracy between standard responding and the 2 response sets. Additionally, most correlations between the NEO-PI-R and external criteria were significantly lower when participants were dissimulating than when responding to standard instructions. It appears that response sets of positive and negative impression management may pose a significant threat to the external validity of the NEO-PI-R and that validity scales for their detection might be a useful addition to the inventory. PMID:10900573

  4. Relation between chirp and linewidth reduction in external Bragg reflector semiconductor lasers

    SciTech Connect

    Olsson, N.A.; Henry, C.H.; Kazarinov, R.F.; Lee, H.J.; Johnson, B.H.

    1987-07-13

    A 1.5-..mu..m single longitudinal mode semiconductor laser, formed by butt coupling an external Bragg reflector to a standard Fabry--Perot laser, is shown to have greatly reduced wavelength chirp and emission linewidth. The linewidth reduction is found to be proportional to the square of the chirp reduction, in agreement with a previous theoretical prediction. The linewidth and chirp reduction factor can be varied by changing the operating point of the laser. With a 3-mm-long Bragg reflector, a linewidth of 1 MHz at 5 mW has been achieved.

  5. Constipation-related direct medical costs in 16 887 patients newly diagnosed with chronic constipation

    PubMed Central

    Dik, Vincent K.; Siersema, Peter D.; Joseph, Alain; Hodgkins, Paul; Smeets, Hugo M.

    2014-01-01

    Background Chronic constipation is a common condition, but the exact impact on healthcare budgets in Western Europe is poorly documented. Objectives The aim of this study was to (a) investigate chronic constipation-related direct medical costs in patients with newly diagnosed chronic constipation and (b) study differences in costs according to natural history. Patients and methods We identified 16 887 patients newly diagnosed with chronic constipation in a Dutch health insurance database (∼1.3 million patients) in 2006–2009. Individuals with chronic constipation were selected on the basis of chronic laxative use (≥90 days/year) and diagnostic related groups for chronic constipation. On the basis of the episodes of laxative use and diagnostic related groups, individuals were categorized as having persistent, episodic, and nonrecurrent disease. Unadjusted costs for laxatives and hospital care for chronic constipation and constipation-related comorbidities were assessed and compared between patients with nonrecurrent, episodic, and persistent disease. Factors associated with costs were identified using Cox regression analyses. Results The mean total chronic constipation-related direct medical costs in the first year after diagnosis were €310±845 and consisted of laxatives (45%) and hospital care for chronic constipation (26%) as well as constipation-related comorbidities (29%). Costs were highest in patients with persistent disease (€367±882) compared with patients with episodic (€292±808) and nonrecurrent (€263±613) disease (P<0.01). Male sex was associated with higher costs, whereas increasing age, diabetes, and use of opioids were associated with lower costs. Conclusion Pharmacy costs and hospital care costs for chronic constipation-related comorbidities were the largest cost drivers for total constipation-related direct medical costs in patients with newly diagnosed chronic constipation. Direct medical costs differed according to patient

  6. Relating external compressing pressure to mean arterial pressure in non-invasive blood pressure measurements.

    PubMed

    Chin, K Y; Panerai, R B

    2015-01-01

    Arterial volume clamping uses external compression of an artery to provide continuous non-invasive measurement of arterial blood pressure. It has been assumed that mean arterial pressure (MAP) corresponds to the point where unloading leads to the maximum oscillation of the arterial wall as reflected by photoplethysmogram (PPG), an assumption that has been challenged. Five subjects were recruited for the study (three males, mean age (SD) = 32 (15) years). The PPG waveform was analysed to identify the relationship between the external compressing pressure, PPG pulse amplitude and MAP. Two separate tests were carried out at compression step intervals of 10 mmHg and 2 mmHg, respectively. No significant differences were found between the two tests. The bias between the compressing pressure and the MAP was -4.7 ± 5.63 mmHg (p < 0.001) showing a normal distribution. Further research is needed to identify optimal algorithms for estimation of MAP using PPG associated with arterial compression. PMID:25429784

  7. Launching Payloads Into Orbit at Relatively Low Cost

    NASA Technical Reports Server (NTRS)

    Wilcox, Brian

    2007-01-01

    A report proposes the development of a system for launching payloads into orbit at about one-fifth the cost per unit payload weight of current systems. The PILOT system was a solid-fuel, aerodynamically spun and spin-stabilized, five-stage rocket with onboard controls including little more than an optoelectronic horizon sensor and a timer for triggering the second and fifth stages, respectively. The proposal calls for four improvements over the PILOT system to enable control of orbital parameters: (1) the aerodynamic tipover of the rocket at the top of the atmosphere could be modeled as a nonuniform gyroscopic precession and could be controlled by selection of the initial rocket configuration and launch conditions; (2) the attitude of the rocket at the top of the first-stage trajectory could be measured by use of radar tracking or differential Global Positioning System receivers to determine when to trigger the second stage; (3) the final-stage engines could be configured around the payload to enhance spin stabilization during a half-orbit coast up to apoapsis where the final stage would be triggered; and (4) the final payload stage could be equipped with a "beltline" of small thrusters for correcting small errors in the trajectory as measured by an off-board tracking subsystem.

  8. The Relative Efficiency of Charter Schools: A Cost Frontier Approach

    ERIC Educational Resources Information Center

    Gronberg, Timothy J.; Jansen, Dennis W.; Taylor, Lori L.

    2012-01-01

    Charters represent an expansion of public school choice, offering free, publicly funded educational alternatives to traditional public schools. One relatively unexplored research question concerning charter schools asks whether charter schools are more efficient suppliers of educational services than are traditional public schools. The potential…

  9. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Public relations and... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 2131.205-1 Public relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the...

  10. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Public relations and... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 2131.205-1 Public relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the...

  11. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... assistance program) and section 1860D-1(c) of the Act (relating to dissemination of enrollment information... which enrollment is effected or coordinated under section 1851 of the Act. (d) Collection of fees—(1... under title XVIII. (f) Assessment methodology. (1) The amount of the applicable portion of the user...

  12. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... counseling and assistance program) and section 1860D-1(c) of the Act (relating to dissemination of enrollment...—(1) Timing of collection. CMS collects the fees over 9 consecutive months beginning with January of... under title XVIII. (f) Assessment methodology. (1) The amount of the applicable portion of the user...

  13. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... counseling and assistance program) and section 1860D-1(c) of the Act (relating to dissemination of enrollment...—(1) Timing of collection. CMS collects the fees over 9 consecutive months beginning with January of... under title XVIII. (f) Assessment methodology. (1) The amount of the applicable portion of the user...

  14. Development of Relativization in Korean as a Foreign Language: The Noun Phrase Accessibility Hierarchy in Head-Internal and Head-External Relative Clauses

    ERIC Educational Resources Information Center

    Jeon, K. Seon; Kim, Hae-Young

    2007-01-01

    This study examines how Keenan and Comrie's (1977) noun phrase accessibility hierarchy (NPAH) intersects with the typological characteristics of Korean in the acquisition of relative clauses (RCs). Korean has two types of RC constructions: head-external and head-internal. The head-external relative has its head to the right of the RC, whereas the…

  15. Direct and indirect costs associated with ankylosing spondylitis and related disease activity scores in Turkey.

    PubMed

    Akkoç, Nurullah; Direskeneli, Haner; Erdem, Hakan; Gül, Ahmet; Kabasakal, Yasemin; Kiraz, Sedat; Balkan Tezer, Dilara; Hacıbedel, Başak; Hamuryudan, Vedat

    2015-09-01

    This study assessed quality of life, direct and indirect healthcare costs related to ankylosing spondylitis (AS). This study included 650 prevalent AS patients visiting seven centers at tertiary healthcare institutions in Turkey who were interviewed using a standard questionnaire to determine annual direct and indirect healthcare costs. Eligible patients were age ≥18 years with AS for at least 12 months. Direct costs were categorized as inpatient, outpatient and pharmacy, and AS-related consultation. Indirect costs were categorized as workday loss, additional AS-related costs, and caregiver costs. Clinical outcome measures were obtained, including Patients' Global Disease Activity (Pt-GDA); visual analog scale (Pain-VAS) for pain; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Functional Index (BASFI), and Metrology Index (BASMI) scores, and EuroQoL 5 dimension (EQ-5D) health status survey scores. Mean (€,335.20) and median (€5,671.00) annual costs per patient were calculated. Pharmacy costs (€4,032.73) were highest among overall expenditures, followed by additional AS-related consultation (€2,480.38), outpatient (€225.02), and inpatient costs (€29.98). Over half of AS patients (54.8 %) experienced work loss. Related average annual costs were €414.16, based on income level. 10.3 % of AS patients incurred an additional €2,008.07 in 1 year. 6.8 % of patients required caregivers and incurred €778.70 in average annual patient paid costs. Mean Pt-GDA, Pain-VAS, EQ-5D, BASDAI, BASFI, and BASMI scores were 4.4, 40.5, 62.7, 3.6, 3.1, and 2.9, respectively. Direct and indirect AS-related costs are high and represent a considerable economic burden on Turkish AS patients. PMID:25749712

  16. Perceived health status and environmental quality in the assessment of external costs of waste disposal facilities. An empirical investigation.

    PubMed

    Giaccaria, Sergio; Frontuto, Vito

    2012-08-01

    Taxation for urban waste management has been reformed in Italy by the introduction of an environmental law in 2006. In the planning phase of waste management, externalities generated by new facilities remain widely unaccounted, with a consequent distortion for prices, often raising local conflicts. The paper presents a survey based on the choice modelling methodology, aimed to evaluate on a monetary scale the disamenity effect perceived by incinerator and landfills in an Italian urban context: the city of Turin. In a random utility framework the behaviour of respondents, whose choices are found to be driven by the endowment of information about technological options, socio-economic characteristics as income, education, family composition, and also by their health status was modelled. Furthermore, empirical evidence that the behaviour in residential location choices is affected by different aspects of the respondent life and in particular by the health status was found. Distinct estimates of willingness to accept compensation for disamenity effects of incinerator (Euro 2670) and landfill (Euro 3816) are elicited. The effect of health status of the respondents, their level of information about the waste disposal infrastructure, the presence of a subjective strong aversion (NIMBY) and the actual endowment and concentration of infrastructures are demonstrated to be significant factors determining the choice behaviour, but differentiated and specific for incinerators and landfills. PMID:22588111

  17. Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

    PubMed Central

    Afulani, Patience; Coleman-Jensen, Alisha; Harrison, Gail G.

    2015-01-01

    Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ2 test and multivariate logistic regression with interaction terms. Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households. PMID:26270308

  18. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Public relations and advertising costs. 31.205-1 Section 31.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 31.205-1 Public...

  19. 48 CFR 970.3102-05-47 - Costs related to legal and other proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Costs related to legal and other proceedings. 970.3102-05-47 Section 970.3102-05-47 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Contract Cost Principles and Procedures 970.3102-05-47...

  20. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  1. PERC Handbook (Program Effectiveness and Related Costs). Empire State College Research Series.

    ERIC Educational Resources Information Center

    Palola, Ernest G.; And Others

    This handbook is a "how to do it" set of definitions, instruments, and procedures based on program effectiveness and related costs (PERC) evaluation at Empire State College (Saratoga Springs, New York) and four other cooperating institutions. The handbook focuses first on program effectiveness and then considers program costs. It utilizes a…

  2. 42 CFR 457.224 - FFP: Conditions relating to cost sharing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP: Conditions relating to cost sharing. 457.224 Section 457.224 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... or could be provided under a State CHIP program— (1) Any cost sharing amounts that...

  3. 42 CFR 457.224 - FFP: Conditions relating to cost sharing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false FFP: Conditions relating to cost sharing. 457.224 Section 457.224 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... or could be provided under a State CHIP program— (1) Any cost sharing amounts that...

  4. 42 CFR 457.224 - FFP: Conditions relating to cost sharing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false FFP: Conditions relating to cost sharing. 457.224 Section 457.224 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... or could be provided under a State CHIP program— (1) Any cost sharing amounts that...

  5. 42 CFR 457.224 - FFP: Conditions relating to cost sharing.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false FFP: Conditions relating to cost sharing. 457.224 Section 457.224 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... or could be provided under a State CHIP program— (1) Any cost sharing amounts that...

  6. 48 CFR 231.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Public relations and advertising costs. 231.205-1 Section 231.205-1 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES...

  7. 48 CFR 231.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Public relations and advertising costs. 231.205-1 Section 231.205-1 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES...

  8. 48 CFR 231.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Public relations and advertising costs. 231.205-1 Section 231.205-1 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES...

  9. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... general health and fitness or encouraging healthful lifestyles; (2) The costs of the contractor's messages... in advance of the policy year. (b) Costs of media messages that inform enrollees about the FEGLI... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Public relations...

  10. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... general health and fitness or encouraging healthful lifestyles; (2) The costs of the contractor's messages... in advance of the policy year. (b) Costs of media messages that inform enrollees about the FEGLI... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Public relations...

  11. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... general health and fitness or encouraging healthful lifestyles; (2) The costs of the contractor's messages... in advance of the policy year. (b) Costs of media messages that inform enrollees about the FEGLI... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Public relations...

  12. Beam related response of in vivo diode detectors for external radiotherapy

    NASA Astrophysics Data System (ADS)

    Baci, Syrja; Telhaj, Ervis; Malkaj, Partizan

    2016-03-01

    In Vivo Dosimetry (IVD) is a set of methods used in cancer treatment clinics to determine the real dose of radiation absorbed by target volume in a patient's body. IVD has been widely implemented in radiotherapy treatment centers and is now recommended part of Quality Assurance program by many International health and radiation organizations. Because of cost and lack of specialized personnel, IVD has not been practiced as yet, in Albanian radiotherapy clinics. At Hygeia Hospital Tirana, patients are irradiated with high energy photons generated by Elekta Synergy Accelerators. We have recently started experimenting with the purpose of establishing an IVD practice at this hospital. The first set of experiments was aimed at calibration of diodes that are going to be used for IVD. PMMA, phantoms by PTW were used to calibrate p - type Si, semiconductor diode dosimeters, made by PTW Freiburg for entrance dose. Response of the detectors is affected by energy of the beam, accumulated radiation dose, dose rate, temperature, angle against the beam axis, etc. Here we present the work done for calculating calibration factor and correction factors of source to surface distance, field size, and beam incidence for the entrance dose for both 6 MV photon beam and 18 MV photon beam. Dependence of dosimeter response was found to be more pronounced with source to surface distance as compared to other variables investigated.

  13. Cost of work-related injuries in insured workplaces in Lebanon.

    PubMed Central

    Fayad, Rim; Nuwayhid, Iman; Tamim, Hala; Kassak, Kassem; Khogali, Mustafa

    2003-01-01

    OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. FINDINGS: The median cost per injury was US dollars 83 (mean, US dollars 198; range, US dollars 0-16,401). The overall cost for all 3748 injuries was US dollars 742,100 (76% of this was medical costs). Extrapolated to all injuries within insured workplaces, the overall cost was US dollars 4.5 million a year; this increased to US dollars 10 million-13 million when human value cost (pain and suffering) was accounted for. Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the overall costs and hospitalized injuries (245, 6.5%) for 45%. Cost per injury was highest among older workers and for injuries that involved falls and vehicle incidents. Medical, but not compensation, costs were higher among female workers. CONCLUSION: The computed costs of work injuries--a fraction of the real burden of occupational injuries in Lebanon--represent a considerable economic loss. This calls for a national policy to prevent work injuries, with a focus on preventing the most serious injuries. Options for intervention and research are discussed. PMID:12973643

  14. Remission of Maternal Depression: Relations to Family Functioning and Youth Internalizing and Externalizing Symptoms

    ERIC Educational Resources Information Center

    Foster, Cynthia Ewell; Webster, Melissa C.; Weissman, Myrna M.; Pilowsky, Daniel J.; Wickramaratne, Priya J.; Talati, Ardesheer; Rush, A. John; Hughes, Carroll W.; Garber, Judy; Malloy, Erin; Cerda, Gabrielle; Kornstein, Susan G.; Alpert, Jonathan E.; Wisniewski, Stephen R.; Trivedi, Madhukar H.; Fava, Maurizio; King, Cheryl A.

    2008-01-01

    Family functioning and parenting were hypothesized to mediate the relation between remission of maternal depression and children's psychosocial adjustment. Participants were 114 mother-child dyads participating in the Sequenced Treatment Alternatives to Relieve Depression Child 3-month follow-up. All mothers had been diagnosed with major…

  15. The Relation of Attachment Security to Adolescents' Paternal and Peer Relationships, Depression, and Externalizing Behavior

    ERIC Educational Resources Information Center

    Allen, Joseph P.; Porter, Maryfrances; McFarland, Christy; McElhaney, Kathleen Boykin; Marsh, Penny

    2007-01-01

    The relation of attachment security to multiple domains of psychosocial functioning was examined in a community sample of 167 early adolescents. Security of attachment organization, assessed using the Adult Attachment Interview, was linked to success in establishing autonomy while maintaining a sense of relatedness both with fathers and with…

  16. FRTR COST AND PERFORMANCE REMEDIATION CASE STUDIES AND RELATED INFORMATION, FOURTH EDITION

    EPA Science Inventory

    The CD-ROM contains over 350 cost and performance technology case study reports and other publications related to the work by the Federal Remediation Technologies Roundtable. The reports were compiled from previously published case studies developed by federal agencies.

  17. FRTR COST & PERFORMANCE REMEDIATION CASE STUDIES AND RELATED INFORMATION, 3RD EDITION

    EPA Science Inventory

    The CD contains over 320 cost and performance technology case study reports and other publications related to the work by the Federal Remediation Technologies Roundtable. The reports compiled were previously published by the member agencies.

  18. The Role of Gender and Race in the Relation between Adolescent Distress Tolerance and Externalizing and Internalizing Psychopathology

    PubMed Central

    Daughters, Stacey B.; Gorka, Stephanie M.; Magidson, Jessica F.; MacPherson, Laura; Seitz-Brown, C.J.

    2013-01-01

    Distress tolerance (DT) is an established construct contributing to the onset and maintenance of psychopathology in adulthood; however, few studies have examined the role of DT in older adolescent psychopathology. Emerging data suggest that gender and race may influence this relation. Therefore, the current study examined the relation between gender, race, and DT on parent-reported internalizing and externalizing DSM-oriented symptoms among a community sample of 128, 14 to 18 year old adolescents. Results indicated a moderating effect of gender on affective problems, such that females with low DT, but not males, displayed significantly greater affective problems. Findings also indicated a significant moderating effect of race, such that Caucasians with low DT, but not African Americans, displayed significantly higher somatic, oppositional defiant, and conduct problems. These findings suggest that DT is an important clinical variable in older adolescence, particularly among Caucasians and females. PMID:24215952

  19. A Facile and Low-Cost Method to Enhance the Internal Quantum Yield and External Light-Extraction Efficiency for Flexible Light-Emitting Carbon-Dot Films

    PubMed Central

    Jiang, Z. C.; Lin, T. N.; Lin, H. T.; Talite, M. J.; Tzeng, T. T.; Hsu, C. L.; Chiu, K. P.; Lin, C. A. J.; Shen, J. L.; Yuan, C. T.

    2016-01-01

    Solution-processed, non-toxic carbon dots (CDs) have attracted much attention due to their unique photoluminescence (PL) properties. They are promising emissive layers for flexible light-emitting devices. To this end, the CDs in pristine aqueous solutions need to be transferred to form solid-state thin films without sacrificing their original PL characteristics. Unfortunately, solid-state PL quenching induced by extra non-radiative (NR) energy transfer among CDs would significantly hinder their practical applications in optoelectronics. Here, a facile, low-cost and effective method has been utilized to fabricate high-performance CD/polymer light-emitting flexible films with submicron-structured patterns. The patterned polymers can serve as a solid matrix to disperse and passivate CDs, thus achieving high internal quantum yields of 61%. In addition, they can act as an out-coupler to mitigate the waveguide-mode losses, approximately doubling the external light-extraction efficiency. Such CD/polymer composites also exhibit good photo-stability, and thus can be used as eco-friendly, low-cost phosphors for solid-state lighting. PMID:26822337

  20. The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in the German population.

    PubMed

    Tscheulin, Dieter K; Drevs, Florian

    2010-04-01

    recipients of the screening program (i.e. survivors of a typically fatal condition), the impact of age and gender on the results of a cost-comparison analysis of colorectal cancer screening are presented and discussed. Our study shows that colorectal cancer screening generates individual cost savings in the social security system up to a life expectancy of 60 years. Beyond that age, the balance between a recipient's social security contributions and insurance system expenditure is negative. The paper clarifies the relevance of healthcare costs not related to the prevented disease to the economic evaluation of prevention programs, particularly in the case of fatal diseases such as colorectal cancer. The results of the study imply that, from an economic perspective, the participation of at-risk individuals in disease prevention programs should be promoted. PMID:19449159

  1. Using an External Exposome Framework to Examine Pregnancy-Related Morbidities and Mortalities: Implications for Health Disparities Research

    PubMed Central

    Oyana, Tonny J.; Matthews-Juarez, Patricia; Cormier, Stephania A.; Xu, Xiaoran; Juarez, Paul D.

    2015-01-01

    Objective: We have conducted a study to assess the role of environment on the burden of maternal morbidities and mortalities among women using an external exposome approach for the purpose of developing targeted public health interventions to decrease disparities. Methods: We identified counties in the 48 contiguous USA where observed low birthweight (LBW) rates were higher than expected during a five-year study period. The identification was conducted using a retrospective space-time analysis scan for statistically significant clusters with high or low rates by a Discrete Poisson Model. Results: We observed statistically significant associations of LBW rate with a set of predictive variables. However, in one of the two spatiotemporal models we discovered LBW to be associated with five predictive variables (teen birth rate, adult obesity, uninsured adults, physically unhealthy days, and percent of adults who smoke) in two counties situated in Alabama after adjusting for location changes. Counties with higher than expected LBW rates were similarly associated with two environmental variables (ozone and fine particulate matter). Conclusions: The county-level predictive measures of LBW offer new insights into spatiotemporal patterns relative to key contributory factors. An external framework provides a promising place-based approach for identifying “hotspots” with implications for designing targeted interventions and control measures to reduce and eliminate health disparities. PMID:26703702

  2. Examining the Developmental History of Child Maltreatment, Peer Relations, and Externalizing Problems among Adolescents with Symptoms of Paranoid Personality Disorder

    PubMed Central

    Natsuaki, Misaki N.; Cicchetti, Dante; Rogosch, Fred A.

    2013-01-01

    This study examined the childhood history of maltreatment, peer relations, and externalizing problems among individuals who manifested low, moderate, or high symptom levels of paranoid personality disorder (PPD) in adolescence. Participants included 174 children who attended a longitudinal summer camp research program between the ages of 9 to 12. Multiple sources of information (self-, peer-, and counselor-reports) were utilized. Subsequently, they participated in a personality disorder assessment during adolescence (Mean age =15.30). The results indicated that children who manifested higher levels of PPD symptoms in adolescence had higher odds of having a history of child maltreatment. Children who manifested high levels of PPD symptoms in adolescence showed a faster growth rate for peer bullying and externalizing problems in childhood. In addition, their peers rated them as less cooperative, less likely to be leaders, and more likely to initiate fights. These finding suggested that children who manifested elevated PPD symptoms in adolescence had shown early signs of behavioral disturbances in childhood, some of which gradually worsened as they approach adolescence. PMID:19825263

  3. Cost-of-illness and disease burden of food-related pathogens in the Netherlands, 2011.

    PubMed

    Mangen, Marie-Josée J; Bouwknegt, Martijn; Friesema, Ingrid H M; Haagsma, Juanita A; Kortbeek, Laetitia M; Tariq, Luqman; Wilson, Margaret; van Pelt, Wilfrid; Havelaar, Arie H

    2015-03-01

    To inform risk management decisions on control and prevention of food-related disease, both the disease burden expressed in Disability Adjusted Life Years (DALY) and the cost-of-illness of food-related pathogens are estimated and presented. Disease burden of fourteen pathogens that can be transmitted by food, the environment, animals and humans was previously estimated by Havelaar et al. (2012). In this paper we complement these by cost-of-illness estimates. Together, these present a complete picture of the societal burden of food-related diseases. Using incidence estimates for 2011, community-acquired non-consulting cases, patients consulting their general practitioner, hospitalized patients and the incidence of sequelae and fatal cases, estimates were obtained for DALYs, direct healthcare costs (e.g. costs for doctor's fees, hospitalizations and medicines), direct non-healthcare costs (e.g. travel costs to and from the doctor), indirect non-healthcare costs (e.g. productivity loss, special education) and total costs. The updated disease burden for 2011 was equal to 13,940 DALY/year (undiscounted) or 12,650 DALY/year (discounted at 1.5%), and was of the same magnitude as previous estimates. At the population-level thermophilic Campylobacter spp., Toxoplasma gondii and rotavirus were associated with the highest disease burden. Perinatal listeriosis infection was associated with the highest DALY per symptomatic case. The total cost-of-illness in 2011 of fourteen food-related pathogens and associated sequelae was estimated at € 468 million/year, if undiscounted, and at € 416 million/year if discounted by 4%. Direct healthcare costs accounted for 24% of total costs, direct non-healthcare costs for 2% and indirect non-healthcare costs for 74% of total costs. At the population-level, norovirus had the highest total cost-of-illness in 2011 with € 106 million/year, followed by thermophilic Campylobacter spp. (€ 76 million/year) and rotavirus (€ 73 million

  4. Obesity-related hospitalization costs to the U.S. Navy, 1993 to 1998.

    PubMed

    Bradham, D D; South, B R; Saunders, H J; Heuser, M D; Pane, K W; Dennis, K E

    2001-01-01

    The objective of this work was to estimate the cost to the U.S. Navy for obesity-related hospital admissions by examining (1) inpatient utilization associated with obesity; (2) the rank order, probability, and total facility costs of obesity-related diagnosis-related groups (DRGs); and (3) expected inpatient expenses. The frequency and probability of inpatient events in the Navy's active duty population were derived from the Department of Defense's Retrospective Case Mix Analysis System. Medicare-based facility costs per DRG were estimated. These measures were combined in a decision-analytic model. Expected facility costs per obesity-related admission for active duty Navy personnel increased by age group from $3,328 for 18 to 24 year olds to $5,746 for 45 to 64 year olds. The annual avoidable inpatient cost for the Navy was estimated to be $5,842,627 for the top 10 obesity-related DRGs. Improvements to the Navy Physical Readiness Program and other interventions that may reduce obesity, obesity-related health care use, and the public economic burden should be pursued. PMID:11197088

  5. The relation of potassium and sodium intakes to diet cost among U.S. adults.

    PubMed

    Drewnowski, A; Rehm, C D; Maillot, M; Monsivais, P

    2015-01-01

    The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines. PMID:24871907

  6. Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands.

    PubMed

    Scholten, Annemieke C; Polinder, Suzanne; Panneman, Martien J M; van Beeck, Ed F; Haagsma, Juanita A

    2015-08-01

    The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies. Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model. Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (-4%) for all injuries, showing a strong decrease in children (-36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0-24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15-64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged

  7. Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury.

    PubMed

    Ryan, Nicholas P; Catroppa, Cathy; Beare, Richard; Coleman, Lee; Ditchfield, Michael; Crossley, Louise; Beauchamp, Miriam H; Anderson, Vicki A

    2015-03-01

    The purpose of the present investigation was to evaluate the contribution of age-at-insult and brain pathology on longitudinal outcome and recovery of pragmatic language in a sample of children and adolescents with traumatic brain injury (TBI). Children and adolescents with mild to severe TBI (n=112) were categorized according to timing of brain insult: (i) Middle Childhood (5-9 years; n=41); (ii) Late Childhood (10-11 years; n=39); and (iii) Adolescence (12-15 years; n=32) and group-matched for age, gender and socio-economic status (SES) to a typically developing (TD) control group (n=43). Participants underwent magnetic resonance imaging (MRI) including a susceptibility weighted imaging (SWI) sequence 2-8 weeks after injury and were assessed on measures of pragmatic language and behavioural functioning at 6- and 24-months after injury. Children and adolescents with TBI of all severity levels demonstrated impairments in these domains at 6-months injury before returning to age-expected levels at 2-years post-TBI. However, while adolescent TBI was associated with post-acute disruption to skills that preceded recovery to age-expected levels by 2-years post injury, the middle childhood TBI group demonstrated impairments at 6-months post-injury that were maintained at 2-year follow up. Reduced pragmatic communication was associated with frontal, temporal and corpus callosum lesions, as well as more frequent externalizing behaviour at 24-months post injury. Findings show that persisting pragmatic language impairment after pediatric TBI is related to younger age at brain insult, as well as microhemorrhagic pathology in brain regions that contribute to the anatomically distributed social brain network. Relationships between reduced pragmatic communication and more frequent externalizing behavior underscore the need for context-sensitive rehabilitation programs that aim to increase interpersonal effectiveness and reduce risk for maladaptive behavior trajectories into the

  8. Health-related economic costs of the Three-Mile Island accident.

    PubMed

    Hu, T W; Slaysman, K S

    1984-01-01

    On March 1979, a nuclear power station at Three-Mile Island (TMI) near Harrisburg, Pennsylvania, had a major breakdown. During the two-week period of the accident, about 150,000 residents were evacuated for reasons associated with safety and health. Many residents during and after the accident, regardless of whether they left or stayed, made mental and physical adjustments due to this accident. This paper is to estimate the economic costs incurred by individuals or communities as a result of a change in physical or mental health status and/or a change in health care services due to the TMI accident. The findings indicate that stress symptoms caused by the accident did affect the health-related behaviors of area residents. Of the costs examined, the economic costs of work days lost and physician visits are the largest cost items. There were some increases in consumption of alcohol, cigarettes, and tranquilizers immediately following the accident. PMID:10268833

  9. A study of the relative effectiveness and cost of computerized information retrieval in the interactive mode

    NASA Technical Reports Server (NTRS)

    Smetana, F. O.; Furniss, M. A.; Potter, T. R.

    1974-01-01

    Results of a number of experiments to illuminate the relative effectiveness and costs of computerized information retrieval in the interactive mode are reported. It was found that for equal time spent in preparing the search strategy, the batch and interactive modes gave approximately equal recall and relevance. The interactive mode however encourages the searcher to devote more time to the task and therefore usually yields improved output. Engineering costs as a result are higher in this mode. Estimates of associated hardware costs also indicate that operation in this mode is more expensive. Skilled RECON users like the rapid feedback and additional features offered by this mode if they are not constrained by considerations of cost.

  10. Trajectories of Externalizing Behavior from Age 2 to Age 9: Relations with Gender, Temperament, Ethnicity, Parenting, and Rater

    ERIC Educational Resources Information Center

    Miner, Jennifer L.; Clarke-Stewart, K. Alison

    2008-01-01

    Trajectories of children's externalizing behavior were examined using multilevel growth curve modeling of data from the NICHD Study of Early Child Care and Youth Development. According to ratings by both mothers and caregivers/teachers when children were 2, 3, 4, 7, and 9 years old, externalizing behavior declined with age. However, mothers rated…

  11. Prospects for cost reductions from relaxing additional cross-border measures related to livestock trade.

    PubMed

    Hop, G E; Mourits, M C M; Slager, R; Oude Lansink, A G J M; Saatkamp, H W

    2013-05-01

    Compared with the domestic trade in livestock, intra-communal trade across the European Union (EU) is subject to costly, additional veterinary measures. Short-distance transportation just across a border requires more measures than long-distance domestic transportation, while the need for such additional cross-border measures can be questioned. This study examined the prospects for cost reductions from relaxing additional cross-border measures related to trade within the cross-border region of the Netherlands (NL) and Germany (GER); that is, North Rhine Westphalia and Lower Saxony. The study constructed a deterministic spread-sheet cost model to calculate the costs of both routine veterinary measures (standard measures that apply to both domestic and cross-border transport) and additional cross-border measures (extra measures that only apply to cross-border transport) as applied in 2010. This model determined costs by stakeholder, region and livestock sector, and studied the prospects for cost reduction by calculating the costs after the relaxation of additional cross-border measures. The selection criteria for relaxing these measures were (1) a low expected added value on preventing contagious livestock diseases, (2) no expected additional veterinary risks in case of relaxation of measures and (3) reasonable cost-saving possibilities. The total cost of routine veterinary measures and additional cross-border measures for the cross-border region was €22.1 million, 58% (€12.7 million) of which came from additional cross-border measures. Two-thirds of this €12.7 million resulted from the trade in slaughter animals. The main cost items were veterinary checks on animals (twice in the case of slaughter animals), export certification and control of export documentation. Four additional cross-border measures met the selection criteria for relaxation. The relaxation of these measures could save €8.2 million (€5.0 million for NL and €3.2 million for GER) annually

  12. Long-term dynamics of a tidewater outlet glacier in West Greenland and its relation to external forcing

    NASA Astrophysics Data System (ADS)

    Vieli, Andreas; Luethi, Martin; Moreau, Luc; Reisser, Moritz; Ian, Joughin

    2015-04-01

    Dynamic changes of ocean-terminating outlet glaciers such as terminus retreat and flow acceleration are responsible for about half of the current mass loss of the Greenland ice sheet. Although these changes seem related to the general warming in recent decades, the detailed link between external forcing from the atmosphere and/or ocean and glacier response is not well understood. Further, existing observations of tidewater outlet glacier change also show strong temporal fluctuations and are mostly limited to the last two decades of satellite observations. It is therefore difficult to derive and interpret long-term trends in outlet glacier change which is relevant in the context of century scale predictions. Here we present and analyse a detailed long-term record of flow and geometry evolution of Eqi Sermia, a ocean terminating outlet glacier in West Greenland. This record starts in 1912 and has, due to its proximity to the main access route for early expeditions to the ice sheet, a decadal and smaller resolution. This historic record is supplemented by data from satellites and ground based radar interferometry for deriving front positions and flow velocities in the two recent decades. The front and flow speed of Eqi Sermia was more or less stable between 1912 with aslow retreat phase between 1920 to the 1960, followed by a slight readvance in the 1980s. In 2007 the terminus started to retreat very rapidly, retreated 3 km since and in a step wise fashion and almost quadrupled its flow speed at the terminus. A comparison with surface mass balance and temperature records suggests a close relation of the long-term evolution of Egi Sermia to atmospheric forcing rather than oceanic, perhaps reflecting the relatively shallow fjord depths. In contrast, the recent rapid retreat and acceleration may be due to a changing regime in the calving process and geometric effects.

  13. Relative Costs and Benefits of Work and Children to Professional and Non-Professional Women.

    ERIC Educational Resources Information Center

    Beckman, Linda J.

    This study investigated the relative rewards and costs of parenthood and working as perceived by 63 professional and 60 nonprofessional women between the ages of 28 and 39 who were childless, had small families, or had large families. A social exchange theory was suggested as the general theoretical framework for the study. The overall pattern of…

  14. The Deductibility of Work-Related Higher Education Costs: The Saga Continues

    ERIC Educational Resources Information Center

    Segal, Mark A.; Bird, Bruce M.

    2011-01-01

    Whether a taxpayer's work-related higher education costs are deductible under IRC (Internal Revenue Code) Section 162 is an issue highly dependent upon facts and circumstances. The regulations pursuant to IRC Section 162 and the emergence of case law on this topic constitute important elements to consider in making this determination.

  15. 42 CFR 457.224 - FFP: Conditions relating to cost sharing.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false FFP: Conditions relating to cost sharing. 457.224 Section 457.224 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES General Administration-Reviews and...

  16. The burden of smoking-related diseases in Brazil: mortality, morbidity and costs.

    PubMed

    Pinto, Márcia Teixeira; Pichon-Riviere, Andres; Bardach, Ariel

    2015-06-01

    Advances in tobacco control in Brazil can be reflected in the decrease in prevalence over the past two decades. Death statistics and the occurrence of events and direct costs attributable to tobacco-related diseases have not been frequently estimated in the country. The goal of this article is to estimate the burden of smoking in 2011 regarding mortality, morbidity and medical care costs of the main tobacco-related diseases. A probabilistic microsimulation health economic model was built. The model incorporates the natural history, costs and quality of life of all the tobacco-related adult-specific diseases. Smoking was accountable for 147,072 deaths, 2.69 million years of life lost, 157,126 acute myocardial infarctions, 75,663 strokes, and 63,753 cancer diagnoses. The direct cost for the health system was of BRL 23.37 billion. The monitoring of tobacco-related burden is an important strategy to guide decision-makers and to strenghten health public policies. PMID:26200375

  17. Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti

    PubMed Central

    Jacquet, Vary; Morose, Willy; Schwartzman, Kevin; Oxlade, Olivia; Barr, Graham; Grimard, Franque; Menzies, Dick

    2006-01-01

    Background Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives. Methods Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$. Results Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion. Conclusion A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion. PMID:16911786

  18. Genetic and treatment-related risk factors associated with external apical root resorption (EARR) concurrent with orthodontia

    PubMed Central

    Dempsey, J.; Falcão-Alencar, G.; Mason, A.; Jacobson, E.; Kluemper, G. T.; Macri, J. V.; Hartsfield, J. K.

    2016-01-01

    Objective As genetic variation accounts for two-thirds of the variation in external apical root resorption (EARR) concurrent with orthodontic treatment, we analyzed the association of selected genetic and treatment-related factors with EARR concurrent with orthodontic treatment. Setting and sample population This case–control study of 134 unrelated, orthodontically treated Caucasian individuals was conducted in part at an Indiana Private Practice, Indiana University and the University of Kentucky. Methods Utilizing a research data bank containing information from ~1450 orthodontically treated patients, pre- and post-treatment radiographs from 460 individuals were evaluated for EARR of the four permanent maxillary incisors. Sixty-seven unrelated Caucasians with moderate to severe EARR were identified and were age-/sex-matched with orthodontically treated Caucasian controls yielding 38 females and 29 males per group. Factors tested for an association with EARR included the following: 1) treatment duration, 2) extraction of maxillary premolars, 3) numerous cephalometric measurements, and 4) DNA polymorphisms within/near candidate genes in a pathway previously implicated in EARR such as the purinergic-receptor-P2X, ligand-gated ion channel 7 (P2RX7; rs208294, rs1718119, and rs2230912), caspase-1 (CASP1; rs530537, rs580253, and rs554344), interleukin-1 beta (IL1B; rs1143634), interleukin-1 alpha (IL1A; rs1800587), and interleukin-1 receptor antagonist (IL1RA; rs419598) genes. Stepwise logistic regression was utilized to identify the factors significantly associated (significance taken at or less than the layered Bonferroni correction alpha) with the occurrence of EARR. Results A long length of treatment and the presence of specific genotypes for P2RX7 SNP rs208294 were significantly associated with EARR. Conclusion EARR occurrence was associated with both genetic and treatment-related variables, which together explained 25% of the total variation associated with EARR

  19. Robust, low-cost data loggers for stream temperature, flow intermittency, and relative conductivity monitoring

    USGS Publications Warehouse

    Chapin, Thomas; Todd, Andrew S.; Zeigler, Matthew P.

    2014-01-01

    Water temperature and streamflow intermittency are critical parameters influencing aquatic ecosystem health. Low-cost temperature loggers have made continuous water temperature monitoring relatively simple but determining streamflow timing and intermittency using temperature data alone requires significant and subjective data interpretation. Electrical resistance (ER) sensors have recently been developed to overcome the major limitations of temperature-based methods for the assessment of streamflow intermittency. This technical note introduces the STIC (Stream Temperature, Intermittency, and Conductivity logger); a robust, low-cost, simple to build instrument that provides long-duration, high-resolution monitoring of both relative conductivity (RC) and temperature. Simultaneously collected temperature and RC data provide unambiguous water temperature and streamflow intermittency information that is crucial for monitoring aquatic ecosystem health and assessing regulatory compliance. With proper calibration, the STIC relative conductivity data can be used to monitor specific conductivity.

  20. [Impact of characteristics related to patients and interventions on revenues and costs of hospitals].

    PubMed

    Iserloh, M; Kox, W J

    2015-01-01

    Since introduction of the German refined DRG system, the, in relation to other countries, relatively long hospital stay has been reduced significantly. The analyses presented here examine the hypothesis that only few impact factors allow for good hospital management and that length of stay is a performance indicator. The analyses were based on remuneration data of 20 German hospitals for 2007-2009, comprising details of 963 923 patient cases, and cost data for 2007-2010. Using simple and multiple linear regressions, the impact of hospital length of stay and case-based factors on case mix index (CMI) and cost categories were explained. The variance of the case mix index was best explained by the length of hospital stay, showing an adjusted regression coefficient β=0.488 (p<0.001), followed by the number of coded procedures (β=0.35, p<0.001). Other predictors played a minor role. The regression coefficient was higher for conservative (non-operative) than for surgery (operative) departments. In the regression on costs, the length of hospital stay explained the variance of total costs by β=0.391 (p<0.001), among these personnel costs of the nursing staff correlated most highly (β=0.595, p<0.001). The analyses confirm the working hypothesis with length of stay impacting CMI and costs most significantly. Treatment effort and complexity level, mortality rate, patient age or gender are well discussed factors but their joint impact on the CMI is minor. Consequently, cockpits for operational length of stay management comprising key data and ratios should be introduced on the department level. PMID:24566837

  1. Relative costs of offspring sex and offspring survival in a polygynous mammal.

    PubMed

    Froy, Hannah; Walling, Craig A; Pemberton, Josephine M; Clutton-Brock, Tim H; Kruuk, Loeske E B

    2016-09-01

    Costs of reproduction are expected to be ubiquitous in wild animal populations and understanding the drivers of variation in these costs is an important aspect of life-history evolution theory. We use a 43 year dataset from a wild population of red deer to examine the relative importance of two factors that influence the costs of reproduction to mothers, and to test whether these costs vary with changing ecological conditions. Like previous studies, our analyses indicate fitness costs of lactation: mothers whose calves survived the summer subsequently showed lower survival and fecundity than those whose calves died soon after birth, accounting for 5% and 14% of the variation in mothers' survival and fecundity, respectively. The production of a male calf depressed maternal survival and fecundity more than production of a female, but accounted for less than 1% of the variation in either fitness component. There was no evidence for any change in the effect of calf survival or sex with increasing population density. PMID:27601725

  2. Cost of diseases related to alcohol consumption in the Brazilian Unified Health System

    PubMed Central

    Coutinho, Evandro Silva Freire; Bahia, Luciana; Barufaldi, Laura Augusta; Abreu, Gabriela de Azevedo; Malhão, Thainá Alves; Pepe, Camila Ribeiro; Araujo, Denizar Vianna

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society. PMID:27305403

  3. A Standardized Relative Resource Cost Model for Medical Care: Application to Cancer Control Programs

    PubMed Central

    2013-01-01

    Medicare data represent 75% of aged and permanently disabled Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option, but the data omit 25% of beneficiaries enrolled in Medicare Advantage health maintenance organizations (HMOs). Little research has examined how longitudinal patterns of utilization differ between HMOs and FFS. The Burden of Cancer Study developed and implemented an algorithm to assign standardized relative costs to HMO and Medicare FFS data consistently across time and place. Medicare uses 15 payment systems to reimburse FFS providers for covered services. The standardized relative resource cost algorithm (SRRCA) adapts these various payment systems to utilization data. We describe the rationale for modifications to the Medicare payment systems and discuss the implications of these modifications. We applied the SRRCA to data from four HMO sites and the linked Surveillance, Epidemiology, and End Results–Medicare data. Some modifications to Medicare payment systems were required, because data elements needed to categorize utilization were missing from both data sources. For example, data were not available to create episodes for home health services received, so we assigned costs per visit based on visit type (nurse, therapist, and aide). For inpatient utilization, we modified Medicare’s payment algorithm by changing it from a flat payment per diagnosis-related group to daily rates for diagnosis-related groups to differentiate shorter versus longer stays. The SRRCA can be used in multiple managed care plans and across multiple FFS delivery systems within the United States to create consistent relative cost data for economic analyses. Prior to international use of the SRRCA, data need to be standardized. PMID:23962514

  4. Cost-Utility Analyses of Cataract Surgery in Advanced Age-Related Macular Degeneration

    PubMed Central

    Ma, Yingyan; Huang, Jiannan; Zhu, Bijun; Sun, Qian; Miao, Yuyu; Zou, Haidong

    2016-01-01

    ABSTRACT Purpose To explore the cost-utility of cataract surgery in patients with advanced age-related macular degeneration (AMD). Methods Patients who were diagnosed as having and treated for age-related cataract and with a history of advanced AMD at the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, were included in the study. All of the participants underwent successful phacoemulsification with foldable posterior chamber intraocular lens implantation under retrobulbar anesthesia. Best-corrected visual acuity (BCVA) and utility value elicited by time trade-off method from patients at 3-month postoperative time were compared with those before surgery. Quality-adjusted life years (QALYs) gained in a lifetime were calculated at a 3% annual discounted rate. Costs per QALY gained were calculated using the bootstrap method, and probabilities of being cost-effective were presented using a cost-effectiveness acceptability curve. Sensitivity analyses were performed to test the robustness of the results. Results Mean logarithm of the minimum angle of resolution BCVA in the operated eye increased from 1.37 ± 0.5 (Snellen, 20/469) to 0.98 ± 0.25 (Snellen, 20/191) (p < 0.001); BCVA in the weighted average from both eyes (=75% better eye + 25% worse eye) was changed from 1.13 ± 0.22 (Snellen, 20/270) to 0.96 ± 0.17 (Snellen, 20/182) (p < 0.001). Utility values from both patients and doctors increased significantly after surgery (p < 0.001 and p = 0.007). Patients gained 1.17 QALYs by cataract surgery in their lifetime. The cost per QALY was 8835 Chinese yuan (CNY) (1400 U.S. dollars [USD]). It is cost-effective at the threshold of 115,062 CNY (18,235 USD) per QALY in China recommended by the World Health Organization. The cost per QALY varied from 7045 CNY (1116 USD) to 94,178 CNY (14,925 USD) in sensitivity analyses. Conclusions Visual acuity and quality of life assessed by utility value improved significantly after surgery

  5. The relation between maternal phenotype and offspring size, explained by overhead material costs of reproduction.

    PubMed

    Filin, Ido

    2015-01-01

    Variation in offspring size with female size and other aspects of the maternal phenotype is commonly observed and taxonomically widespread. However, life history theory predicts that optimal offspring size should not depend on maternal size or total reproductive effort. This incongruity persists despite various modifications to theory, that nonetheless, either are limited in their applicability or fail to alter the prediction of fixed offspring size. I demonstrate that the persistence of this theoretical outcome stems from an ideal assumption that reproductive effort relates only to direct material costs, and therefore, equal or proportional to clutch mass or the product of offspring size and number. A major innovation in my study is to explicitly distinguish between direct and overhead components of the costs of reproduction. When overhead energetic costs of reproduction are explicitly incorporated, I readily obtain variation in optimal offspring size with maternal phenotype. This consequence of overhead costs of reproduction has not been demonstrated before. I identify functional forms of such overhead costs that facilitate variation in optimal offspring size. In particular, costs that are more sensitive to offspring size than to offspring number are most effective in causing variation in offspring size. The novelty of the model lies in succeeding to resolve the above incongruity both within the framework of traditional models of optimal offspring size and within more dynamic description of the lifecycle (addressing simultaneously both offspring and maternal performance), including stochastic effects, difference between reserves and structural components of size, and distinction between starvation and extrinsic mortality. My predictions explain several patterns of variation in size and body composition of offspring, with respect to both environmental conditions and maternal phenotype. PMID:25219621

  6. A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs.

    PubMed

    Krol, Marieke; Papenburg, Jocé; Tan, Siok Swan; Brouwer, Werner; Hakkaart, Leona

    2016-05-01

    Productivity costs can strongly impact cost-effectiveness outcomes. This study investigated the impact in the context of expensive hospital drugs. This study aimed to: (1) investigate the effect of productivity costs on cost-effectiveness outcomes, (2) determine whether economic evaluations of expensive drugs commonly include productivity costs related to paid and unpaid work, and (3) explore potential reasons for excluding productivity costs from the economic evaluation. We conducted a systematic literature review to identify economic evaluations of 33 expensive drugs. We analysed whether evaluations included productivity costs and whether inclusion or exclusion was related to the study population's age, health and national health economic guidelines. The impact on cost-effectiveness outcomes was assessed in studies that included productivity costs. Of 249 identified economic evaluations of expensive drugs, 22 (9 %) included productivity costs related to paid work. One study included unpaid productivity. Mostly, productivity cost exclusion could not be explained by the study population's age and health status, but national guidelines appeared influential. Productivity costs proved often highly influential. This study indicates that productivity costs in economic evaluations of expensive hospital drugs are commonly and inconsistently ignored in economic evaluations. This warrants caution in interpreting and comparing the results of these evaluations. PMID:25876834

  7. Case studies of energy information systems and related technology: Operational practices, costs, and benefits

    SciTech Connect

    Motegi, Naoya; Piette, Mary Ann; Kinney, Satkartar; Dewey, Jim

    2003-09-02

    Energy Information Systems (EIS), which can monitor and analyze building energy consumption and related data throughout the Internet, have been increasing in use over the last decade. Though EIS developers describe the capabilities, costs, and benefits of EIS, many of these descriptions are idealized and often insufficient for potential users to evaluate cost, benefit and operational usefulness. LBNL has conducted a series of case studies of existing EIS and related technology installations. This study explored the following questions: (1) How is the EIS used in day-to-day operation? (2) What are the costs and benefits of an EIS? (3) Where do the energy savings come from? This paper reviews the process of these technologies from installation through energy management practice. The study is based on interviews with operators and energy managers who use EIS. Analysis of energy data trended by EIS and utility bills was also conducted to measure the benefit. This paper explores common uses and findings to identify energy savings attributable to EIS, and discusses non-energy benefits as well. This paper also addresses technologies related to EIS that have been demonstrated and evaluated by LBNL.

  8. Thyroid cancer in the Marshallese: relative risk of short-lived internal emitters and external radiation exposure

    SciTech Connect

    Lessard, E.T.; Brill, A.B.; Adams, W.H.

    1985-01-01

    In a study of the comparative effects of internal versus external irradiation of the thyroid in young people, we determined that the dose from internal irradiation of the thyroid with short-lived internal emitters produced several times less thyroid cancer than did the same dose of radiation given externally. We determined this finding for a group of 85 Marshall Islands children, who were less than 10 years of age at the time of exposure and who were accidentially exposed to internal and external thyroid radiation at an average level of 1400 rad. The external risk coefficient ranged between 2.5 and 4.9 cancers per million person-rad-years at risk, and thus, from our computations, the internal risk coefficient for the Marshallese children was estimated to range between 1.0 and 1.4 cancers per million person-rad-years at risk. In contrast, for individual more than 10 years of age at the time of exposure, the dose from internal irradiation of the thyroid with short-lived internal emitters produced several times more thyroid cancer than did the same dose of radiation given externally. The external risk coefficients for the older age groups were reported in the literature to be in the range of 1.0 to 3.3 cancers per million person-rad-years-at risk. We computed internal risk coefficients of 3.3 to 8.1 cancers per million person-rad-years at risk for adolescent and adult groups. This higher sensitivity to cancer induction in the exposed adolescents and adults, is different from that seen in other exposed groups. 14 refs., 8 tabs.

  9. Impact of Measurement Invariance on Construct Correlations, Mean Differences, and Relations with External Correlates: An Illustrative Example Using Big Five and RIASEC Measures

    ERIC Educational Resources Information Center

    Schmitt, Neal; Golubovich, Juliya; Leong, Frederick T. L.

    2011-01-01

    The impact of measurement invariance and the provision for partial invariance in confirmatory factor analytic models on factor intercorrelations, latent mean differences, and estimates of relations with external variables is investigated for measures of two sets of widely assessed constructs: Big Five personality and the six Holland interests…

  10. A Longitudinal Examination of the Relation between Parental Expressed Emotion and Externalizing Behaviors in Children and Adolescents with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Bader, Stephanie H.; Barry, Tammy D.

    2014-01-01

    The current study explored the longitudinal relation between parental expressed emotion, a well-established predictor of symptom relapse in various other disorders (e.g., schizophrenia) with externalizing behaviors in 84 children, ages 8-18 (at Time 2), with autism spectrum disorder (ASD). It was found that parental expressed emotion, specifically…

  11. The Internal/External Frame of Reference Model of Self-Concept and Achievement Relations: Age-Cohort and Cross-Cultural Differences

    ERIC Educational Resources Information Center

    Marsh, Herbert W.; Abduljabbar, Adel Salah; Parker, Philip D.; Morin, Alexandre J. S.; Abdelfattah, Faisal; Nagengast, Benjamin; Möller, Jens; Abu-Hilal, Maher M.

    2015-01-01

    The internal/external frame of reference (I/E) model and dimensional comparison theory posit paradoxical relations between achievement (ACH) and self-concept (SC) in mathematics (M) and verbal (V) domains; ACH in each domain positively affects SC in the matching domain (e.g., MACH to MSC) but negatively in the nonmatching domain (e.g., MACH to…

  12. Multimethod Assessment of Psychopathy in Relation to Factors of Internalizing and Externalizing from the Personality Assessment Inventory: The Impact of Method Variance and Suppressor Effects

    ERIC Educational Resources Information Center

    Blonigen, Daniel M.; Patrick, Christopher J.; Douglas, Kevin S.; Poythress, Norman G.; Skeem, Jennifer L.; Lilienfeld, Scott O.; Edens, John F.; Krueger, Robert F.

    2010-01-01

    Research to date has revealed divergent relations across factors of psychopathy measures with criteria of "internalizing" (INT; anxiety, depression) and "externalizing" (EXT; antisocial behavior, substance use). However, failure to account for method variance and suppressor effects has obscured the consistency of these findings across distinct…

  13. Control of Rhagoletis indifferents using Thiamethoxam and Spinosad baits under external fly pressure and its relation to rapidity of kill and residual bait activity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Control of western cherry fruit fly (Rhagoletis indifferens Curran) using thiamethoxam in sucrose bait and spinosad bait in cherry orchards under external fly pressure and its relation to rapidity of kill and residual bait activity were studied in Washington and Utah in 2010 and 2011. Thiamethoxam ...

  14. Potential escalation of heat-related working costs with climate and socioeconomic changes in China.

    PubMed

    Zhao, Yan; Sultan, Benjamin; Vautard, Robert; Braconnot, Pascale; Wang, Huijun J; Ducharne, Agnes

    2016-04-26

    Global climate change will increase the frequency of hot temperatures, impairing health and productivity for millions of working people and raising labor costs. In mainland China, high-temperature subsidies (HTSs) are allocated to employees for each working day in extremely hot environments, but the potential heat-related increase in labor cost has not been evaluated so far. Here, we estimate the potential HTS cost in current and future climates under different scenarios of socioeconomic development and radiative forcing (Representative Concentration Pathway), taking uncertainties from the climate model structure and bias correction into account. On average, the total HTS in China is estimated at 38.6 billion yuan/y (US $6.22 billion/y) over the 1979-2005 period, which is equivalent to 0.2% of the gross domestic product (GDP). Assuming that the HTS standards (per employee per hot day) remain unchanged throughout the 21st century, the total HTS may reach 250 billion yuan/y in the 2030s and 1,000 billion yuan/y in 2100. We further show that, without specific adaptation, the increased HTS cost is mainly determined by population growth until the 2030s and climate change after the mid-21st century because of increasingly frequent hot weather. Accounting for the likely possibility that HTS standards follow the wages, the share of GDP devoted to HTS could become as high as 3% at the end of 21st century. PMID:27044089

  15. Potential escalation of heat-related working costs with climate and socioeconomic changes in China

    PubMed Central

    Zhao, Yan; Sultan, Benjamin; Vautard, Robert; Braconnot, Pascale; Wang, Huijun J.; Ducharne, Agnes

    2016-01-01

    Global climate change will increase the frequency of hot temperatures, impairing health and productivity for millions of working people and raising labor costs. In mainland China, high-temperature subsidies (HTSs) are allocated to employees for each working day in extremely hot environments, but the potential heat-related increase in labor cost has not been evaluated so far. Here, we estimate the potential HTS cost in current and future climates under different scenarios of socioeconomic development and radiative forcing (Representative Concentration Pathway), taking uncertainties from the climate model structure and bias correction into account. On average, the total HTS in China is estimated at 38.6 billion yuan/y (US $6.22 billion/y) over the 1979–2005 period, which is equivalent to 0.2% of the gross domestic product (GDP). Assuming that the HTS standards (per employee per hot day) remain unchanged throughout the 21st century, the total HTS may reach 250 billion yuan/y in the 2030s and 1,000 billion yuan/y in 2100. We further show that, without specific adaptation, the increased HTS cost is mainly determined by population growth until the 2030s and climate change after the mid-21st century because of increasingly frequent hot weather. Accounting for the likely possibility that HTS standards follow the wages, the share of GDP devoted to HTS could become as high as 3% at the end of 21st century. PMID:27044089

  16. The Relation of Maternal Sensitivity to Children's Internalizing and Externalizing Problems within the Context of Maternal Depressive Symptoms

    ERIC Educational Resources Information Center

    Garai, Emily Priscilla; Forehand, Rex L.; Colletti, Christina J. M.; Reeslund, Kristen; Potts, Jennifer; Compas, Bruce

    2009-01-01

    Maternal depression has been linked to deficits in parenting that contribute to youth's development of externalizing and/or internalizing problems. Maternal sensitivity has been implicated within the infant literature as a foundational aspect of parenting contributing to a child's adjustment. This study examines the main and moderating effects of…

  17. High Antenatal Maternal Anxiety Is Related to ADHD Symptoms, Externalizing Problems, and Anxiety in 8- and 9-Year-Olds

    ERIC Educational Resources Information Center

    Van den Bergh, Bea R.H.; Marcoen, Alfons

    2004-01-01

    Associations between antenatal maternal anxiety, measured with the State Trait Anxiety Inventory, and disorders in 8- and 9-year-olds were studied prospectively in 71 normal mothers and their 72 firstborns. Clinical scales were completed by the mother, the child, the teacher, and an external observer. Hierarchical multiple regression analyses…

  18. Defensive Dysregulation in Preschool Children's Attachment Story Narratives and Its Relation to Attachment Classification and Externalizing Behaviour

    ERIC Educational Resources Information Center

    Stacks, Ann M.

    2007-01-01

    This study examines the relationship between disorganized attachment representations, defensive dysregulation in preschool children's doll play story narratives and child externalizing behaviour. Preschool children (n = 53) participated in the George and Solomon (1990, 1996, 2000) "Six-Year Attachment Doll Play Procedure" and their mothers…

  19. Costs of work-related musculoskeletal disorders (MSDs) in developing countries: Colombia case.

    PubMed

    Piedrahita, Hugo

    2006-01-01

    The real burden of occupational diseases, specifically work-related musculoskeletal disorders (MSDs), and its impact on workers' productivity is not known. The situation is critical in developing countries where only cases that cause workers' disability are recorded. In this study, the incidence of MSDs in Colombia was estimated by using the age and gender specific double incidence rate of repetitive strain injuries diseases in Finland for 2002. The results showed that the estimated number of MSDs recorded in Colombia during 2005 was 23,477 cases at the rate of 11.6 cases per 10,000 workers. The estimated total cost of these MSD cases relative to workers' productivity was 171.7 million US Dollars, representing around 0.2% of Colombia's Gross Domestic Product for 2005. The systematic appraisal of the incidence of MSDs and their associated cost on workers' productivity are necessary in developing countries to reduce the costly impact on productivity and to increase workers' well-being. PMID:17156613

  20. Guide to resource conservation and cost savings opportunities in the soap, detergents and related products sector

    SciTech Connect

    1998-10-01

    This guide was prepared to help those involved in the manufacturing of soap, detergent, and related products to identify potential process improvements that will reduce production costs and conserve resources. The guide offers a series of generic process descriptions and checklists of improvement opportunities specific to each of five major processes used in the industry: Soap production, surfactant production, solid cake product formulation, liquid product formulation, and granulated powdered product formulation. The checklists identify thermal, electrical, environmental, water use, and low- or no-cost measures that can be implemented, as well as retrofit technology options. A variety of new technologies that may exhibit future potential are also described. Appendices include a glossary, background information on the Ontario soap/detergent industry, and description of the four major categories of ingredients used in the industry.

  1. A study on bicycle-related injuries and their costs in Shanghai, China.

    PubMed

    Li, Yan-Hong; Rahim, Yousif; Zhou, De-Ding

    2011-01-01

    China is known as the Bicycle Kingdom, but the nature, extent, and costs of bicycle-related injuries remain largely unknown. The authors' findings showed that the bicycle-related mortality rate increased 99% from 1992 to 2004, and it increased with age, from 0.64 per 100,000 population in the 0-14 age group to 5.93 per 100,000 population in the 65 and older age group. Labor force groups represented the majority of fatalities (70.8%) and nonfatal injuries (81.5%). The male mortality rate was 2.4 times higher than the female mortality rate. Head injuries accounted for 71.9% of fatalities and 33.1% of the hospitalizations. People with lower levels of education had higher injury rates. The poorer districts located in the countryside had the highest mortality rates compared to those located in the central, wealthier regions. The total annual cost of bicycle-related injuries was 1.1 billion CHY (Chinese Yuan) (over $137 million U.S.). To reduce bicycle-related injuries, mandatory helmet legislations, environmental modifications, and representative monitoring systems in China are required. PMID:21306091

  2. The impact of external donor support through the U.S. President’s Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004–2011

    PubMed Central

    Pitman, John P.; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J.; Basavaraju, Sridhar V.; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A.; Lowrance, David W.; Sibinga, Cees Th. Smit

    2015-01-01

    Background External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004–2011, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. Material and methods A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004–2009) and the 2 years in which PEPFAR support began to decline (2010–2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Results Between 2004–2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. Discussion PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are

  3. The role of external pressure and support on teacher choices related to evolution curriculum in the secondary biology classroom

    NASA Astrophysics Data System (ADS)

    Oschman, Scot

    The scientific community strongly and virtually universally supports the teaching of biological evolution in our public schools. However, there are many in the general public who object to the teaching of biological evolution in our nation's science classrooms. Groups such as Answers in Genesis and the Discovery Institute, along with parents, students, school boards, and school administrators are alleged by many in the scientific and science education communities to be pressuring teachers in a variety of ways regarding the teaching of evolution. The purpose of this study was to examine the sources of, extent of, and ways in which science teachers deal with external influences that attempt to alter their science curriculum related to the teaching of the theory of biological evolution in order to support it, deemphasize it or remove it from their classrooms. It also attempted to determine the impact these outside influences have on evolution education in the classroom. Internal influences were examined in order to ascertain other possible reasons why teachers might or might not de-emphasize, omit, or teach evidence contrary to evolution. Two thousand cover letters were sent out to high school biology teachers selected at random from three states in the U.S. Registry of Teachers, directing them to a web site where they could complete the questionnaire online. One hundred seventy eight teachers responded to the survey. The statistical analyses used in this study to examine the results included analysis of variance (ANOVA), independent samples t tests for means comparisons, as well as a variety of descriptive statistics. This study found that 59% of the teachers who responded had experienced some form of pressure related to their evolution curriculum, and that the majority of this pressure came from students, groups or individuals not affiliated with their school district, and parents. The most common manifestations of pressure were to teach that evolution was "only" a

  4. Environmentally related diseases and the possibility of valuation of their social costs.

    PubMed

    Hajok, Ilona; Marchwińska, Ewa; Dziubanek, Grzegorz; Kuraszewska, Bernadeta; Piekut, Agata

    2014-01-01

    The risks of the morbidity of the asbestos-related lung cancer was estimated in the general population of Poles as the result of increased exposure to asbestos fibers during the removal of asbestos-cement products and the possibility of the valuation of the social costs related to this risk. The prediction of the new incidences was made using linear regression model. The forecast shows that to the end of 2030 about 3,500 new cases of lung cancer can be expected as a result of occupational exposure to asbestos in the past which makes together with paraoccupational exposure about 14.000 new cases. The forecast shows the increasing number of asbestos-related lung cancer in Poland and indicates the priority areas where preventive action should be implemented. PMID:25374934

  5. Environmentally Related Diseases and the Possibility of Valuation of Their Social Costs

    PubMed Central

    Hajok, Ilona; Marchwińska, Ewa; Dziubanek, Grzegorz; Kuraszewska, Bernadeta; Piekut, Agata

    2014-01-01

    The risks of the morbidity of the asbestos-related lung cancer was estimated in the general population of Poles as the result of increased exposure to asbestos fibers during the removal of asbestos-cement products and the possibility of the valuation of the social costs related to this risk. The prediction of the new incidences was made using linear regression model. The forecast shows that to the end of 2030 about 3,500 new cases of lung cancer can be expected as a result of occupational exposure to asbestos in the past which makes together with paraoccupational exposure about 14.000 new cases. The forecast shows the increasing number of asbestos-related lung cancer in Poland and indicates the priority areas where preventive action should be implemented. PMID:25374934

  6. Longitudinal Relations of Children’s Effortful Control, Impulsivity, and Negative Emotionality to Their Externalizing, Internalizing, and Co-Occurring Behavior Problems

    PubMed Central

    Eisenberg, Nancy; Valiente, Carlos; Spinrad, Tracy L.; Cumberland, Amanda; Liew, Jeffrey; Reiser, Mark; Zhou, Qing; Losoya, Sandra H.

    2009-01-01

    The purpose of the study was to examine the relations of effortful control (EC), impulsivity, and negative emotionality to at least borderline clinical levels of symptoms and change in maladjustment over four years. Children’s (N = 214; 77% European American; M age = 73 months) externalizing and internalizing symptoms were rated by parents and teachers at 3 times, 2 years apart (T1, T2, and T3) and were related to children’s adult-rated EC, impulsivity, and emotion. In addition, the authors found patterns of change in maladjustment were related to these variables at T3 while controlling for the T1 predictor. Externalizing problems (pure or co-occurring with internalizing problems) were associated with low EC, high impulsivity, and negative emotionality, especially anger, and patterns of change also related to these variables. Internalizing problems were associated with low impulsivity and sadness and somewhat with high anger. Low attentional EC was related to internalizing problems only in regard to change in maladjustment. Change in impulsivity was associated with change in internalizing primarily when controlling for change in externalizing problems. PMID:19586175

  7. Internal and External Factors Related to Burnout among Iron and Steel Workers: A Cross-Sectional Study in Anshan, China

    PubMed Central

    Guo, Haiqiang; Guo, Huifang; Yang, Yilong; Sun, Baozhi

    2015-01-01

    Background Burnout is a syndrome of emotional exhaustion, cynicism and reduced professional efficacy, which can result from long-term work stress. Although the burnout level is high among iron and steel workers, little is known concerning burnout among iron and steel worker. This study aimed to evaluate the burnout and to explore its associated internal and external factors in iron and steel workers. Methods A cross-sectional survey was conducted in iron and steel workers at the Anshan iron-steel complex in Anshan, northeast China. Self-administered questionnaires were distributed to 1,600 workers, and finally 1,300 questionnaires were returned. Burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS). Effort-reward imbalance (ERI), perceived organizational support (POS), and psychological capital (PsyCap) were measured anonymously. A hierarchical regression model was applied to explore the internal and external factors associated with burnout. Results Mean MBI-GS scores were 13.11±8.06 for emotional exhaustion, 6.64±6.44 for cynicism, and 28.96±10.39 for professional efficacy. Hierarchical linear regression analysis showed that ERI and POS were the most powerful predictors for emotional exhaustion and cynicism, and PsyCap was the most robust predictor for high professional efficacy. Conclusions Chinese iron and steel workers have a high level of burnout. Burnout might be associated with internal and external factors, including ERI, POS, and PsyCap. Further studies are recommended to develop an integrated model including both internal and external factors, to reduce the level of ERI, and improve POS and workers’ PsyCap, thereby alleviating the level of burnout among iron and steel workers. PMID:26575031

  8. Colistin and tigecycline for management of external ventricular device-related ventriculitis due to multidrug-resistant Acinetobacter baumannii.

    PubMed

    Shrestha, Gentle Sunder; Tamang, Sushil; Paneru, Hem Raj; Shrestha, Pramesh Sunder; Keyal, Niraj; Acharya, Subhash Prasad; Marhatta, Moda Nath; Shilpakar, Sushil

    2016-01-01

    Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular device (EVD). It is frequently multidrug resistant (MDR), carries a poor outcome, and is difficult to treat. We report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable. PMID:27365967

  9. Colistin and tigecycline for management of external ventricular device-related ventriculitis due to multidrug-resistant Acinetobacter baumannii

    PubMed Central

    Shrestha, Gentle Sunder; Tamang, Sushil; Paneru, Hem Raj; Shrestha, Pramesh Sunder; Keyal, Niraj; Acharya, Subhash Prasad; Marhatta, Moda Nath; Shilpakar, Sushil

    2016-01-01

    Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular device (EVD). It is frequently multidrug resistant (MDR), carries a poor outcome, and is difficult to treat. We report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable. PMID:27365967

  10. Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars

    PubMed Central

    Olsen, K R; Christensen, J; Wenzel, A

    2014-01-01

    Objectives: The aim of this prospective clinical study was to derive the absolute and relative costs of cone beam CT (CBCT) and panoramic imaging before removal of an impacted mandibular third molar. Furthermore, the study aimed to analyse the influence of different cost-setting scenarios on the outcome of the absolute and relative costs and the incremental costs related to surgery. Methods: A randomized clinical trial compared complications following surgical removal of a mandibular third molar, where the pre-operative diagnostic method had been panoramic imaging or CBCT. The resources implied in the two methods were measured with health economic tools. The primary outcome was total costs defined as the sum of absolute imaging costs and incremental surgery-related costs. The basic variables were capital costs, operational costs, radiological costs, radiographic costs, overheads and patient resource utilization. Differences in resources used for surgical and post-surgical management were calculated for each patient. Results: Converted to monetary units, the total costs for panoramic imaging equalized €49.29 and for CBCT examination €184.44. Modifying effects on this outcome such as differences in surgery time, treatment time for complications, pre- and post-surgical medication, sickness absence, specialist treatment and hospitalization were not statistically significant between the two diagnostic method groups. Conclusions: Costs for a CBCT examination were approximately four times the costs for panoramic imaging when used prior to removal of a mandibular third molar. The use of CBCT did not change the resources used for surgery, post-surgical treatment and patient complication management. PMID:24922557

  11. An overview of the patterns of prescription opioid use, costs and related harms in Australia

    PubMed Central

    Blanch, Bianca; Pearson, Sallie-Anne; Haber, Paul S

    2014-01-01

    Aims To report Australian population trends in subsidized prescribed opioid use, total costs to the Australian government to subsidize these medicines and opioid-related harms based on hospitalizations and accidental poisoning deaths. Methods We utilized three national aggregated data sources including dispensing claims from the Pharmaceutical Benefits Scheme, opioid-related hospitalizations from the National Hospital Morbidity Database and accidental poisoning deaths from the Australian Bureau of Statistics. Results Between 1992 and 2012, opioid dispensing episodes increased 15-fold (500 000 to 7.5 million) and the corresponding cost to the Australian government increased 32-fold ($8.5 million to $271 million). Opioid-related harms also increased. Opioid-related hospitalizations increased from 605 to 1464 cases (1998–2009), outnumbering hospitalizations due to heroin poisonings since 2001. Deaths due to accidental poisoning (pharmaceutical opioids and illicit substances combined) increased from 151 to 266 (2002–2011), resulting in a rise in the death rate of 0.78 to 1.19 deaths/100 000 population over 10 years. Death rates increased 1.8 fold in males and 1.4 fold in females. Conclusions The striking increase in opioid use and related harms in Australia is consistent with trends observed in other jurisdictions. Further, there is no evidence to suggest these increases are plateauing. There is currently limited evidence in Australia about individual patterns of opioid use and the associated risk of adverse events. Further research should focus on these important issues so as to provide important evidence supporting effective change in policy and practice. PMID:24962372

  12. 78 FR 17300 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-21

    ... Cooperative Agreements; Cost Principles and Administrative Requirements (Including Single Audit Act) AGENCY...; Cost Principles and Administrative Requirements (Including Single Audit Act) published February 1,...

  13. 15 CFR 717.4 - Report of inspection-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS...), costs of producing records, and costs associated with shutting down chemical production or...

  14. Comparing treatments for age-related macular degeneration: safety, effectiveness and cost.

    PubMed

    Maguire, Maureen G

    2012-06-01

    Comparative effectiveness research (CER) has received widespread attention and federal funding because of its potential to inform and improve treatment decisions. Since 2005, patients and their ophthalmologists have faced a dilemma in treating age-related macular degeneration (AMD)--the leading cause of blindness in the United States. Two closely related drugs have produced dramatic improvements in vision; one has been rigorously tested for use in AMD patients, while the other has been rigorously tested for use in cancer patients, but is now widely used to treat AMD. One drug costs 40 times as much as the other. This Issue Brief summarizes a CER study comparing these drugs head-to-head, and provides the most definitive evidence to date about the safety and effectiveness of the two alternatives. PMID:22754971

  15. Environmental impacts and costs of energy.

    PubMed

    Rabl, Ari; Spadaro, Joseph V

    2006-09-01

    Environmental damage is one of the main justifications for continued efforts to reduce energy consumption and to shift to cleaner sources such as solar energy. In recent years there has been much progress in the analysis of environmental damages, in particular thanks to the ExternE (External Costs of Energy) Project of the European Commission. This article presents a summary of the methodology and key results for the external costs of the major energy technologies. Even though the uncertainties are large, the results provide substantial evidence that the classical air pollutants (particles, No(x), and SO(2)) from fossil fuels impose significant public health costs, comparable to the cost of global warming from CO(2) emissions. The total external costs are relatively low for natural gas (in the range of about 0.5-1 eurocents/kWh for most EU countries), but much higher for coal and lignite (in the range of about 2-6 eurocents/kWh for most EU countries). By contrast, the external costs of nuclear, wind, and photovoltaics are very low. The external costs of hydro are extremely variable from site to site, and the ones of biomass depend strongly on the specific technologies used and can be quite large for combustion. PMID:17119229

  16. Externalities of oil imports revisited

    SciTech Connect

    Lemon, R.

    1980-09-01

    A re-analysis of the externalities associated with oil imports reaffirms the major findings of an earlier study: (1) The current externalities of oil imports are large even after several favorable assumptions are made, including the existence of a large buffer stock and enlightened monetary and fiscal policy. (2) The large externalities of oil imports call for increased domestic supplies, including conservation, if they are cost-effective and based on marginal social costs. (3) A corrective public policy could involve oil-import taxes and the subsidization of new domestic energy sources without large government externalities. 20 references.

  17. Feature-Based Attention and Conflict Monitoring in Criminal Offenders: Interactive Relations of Psychopathy with Anxiety and Externalizing

    PubMed Central

    Zeier, Joshua D.; Newman, Joseph P.

    2013-01-01

    As predicted by the response modulation model, psychopathic offenders are insensitive to potentially important inhibitory information when it is peripheral to their primary focus of attention. To date, the clearest tests of this hypothesis have manipulated spatial attention to cue the location of goal-relevant versus inhibitory information. However, the theory predicts a more general abnormality in selective attention. In the current study male prisoners performed a conflict-monitoring task, which included a feature-based manipulation (i.e., color) that biased selective attention toward goal-relevant stimuli and away from inhibitory distracters on some trials but not others. Paralleling results for spatial cuing, feature-based cuing resulted in less distracter interference, particularly for participants with primary psychopathy (i.e., low anxiety). This study also investigated the moderating effect of externalizing on psychopathy. Participants high in psychopathy but low in externalizing performed similarly to primary psychopathic individuals. These results demonstrate that the abnormal selective attention associated with primary psychopathy is not limited to spatial attention but, instead, applies to diverse methods for establishing attentional focus. Furthermore, they demonstrate a novel method of investigating psychopathic subtypes using continuous analyses. PMID:24016017

  18. Cost-related Nonadherence by Medication Type among Medicare Part D Beneficiaries with Diabetes

    PubMed Central

    Williams, Jessica; Steers, W. Neil; Ettner, Susan L.; Mangione, Carol M.; Duru, O. Kenrik

    2013-01-01

    Background Despite the rollout of Medicare Part D, cost-related non-adherence (CRN) among older adults remains a problem. Objectives To examine the rate and correlates of self-reported CRN among a population of older persons with diabetes. Research Design Cross-sectional. Subjects 1,264 Part D patients with diabetes, who entered the coverage gap in 2006. Measures Initial administrative medication lists were verified in computer-assisted telephone interviews, in which participants brought their medication bottles to the phone. Medications were classified into cardiometabolic (diabetes, hypertension, cholesterol-lowering), symptom relief, and “other.” Participants were asked if they had any cost-related non-adherence during 2006, and if so to which medication/s. We used the person-medication dyad as the unit of analysis, and tested a multivariate random effects logistic regression model to analyze the correlates of CRN. Results Approximately 16% of participants reported any CRN. CRN was more frequent for cholesterol-lowering medications [Relative risk 1.54, 95%CI 1.01-2.32] compared to medications taken for symptom relief. CRN was reported less frequently with increasing age above 75 years, compared to patients between 65 and 69. In addition, compared to those with incomes >$40,000, CRN risk for those with incomes <$25,000 was markedly higher [RR 3.05, 95%CI 1.99-4.65]. Conclusions In summary, we found high rates of CRN among Medicare beneficiaries with diabetes, particularly those with lower incomes. We observed more frequent CRN for cholesterol-lowering medications as compared to medications for symptom relief. Efforts to ensure medication affordability for this population will be important in boosting adherence to key medications. PMID:23032359

  19. A System-Level Comparison of Cost-Efficiency and Return on Investment Related to Online Course Delivery

    ERIC Educational Resources Information Center

    Ramage, Thomas

    2005-01-01

    This study compared costs and revenues of Illinois community colleges related specifically to online delivery systems in order, first, to determine cost-efficiency and second, to compare the results among online courses at selected community colleges in Illinois. The research question to be answered was: "To what extent are online courses…

  20. 25 CFR 39.160 - Does ISEF provide supplemental funding for extraordinary costs related to a school's geographic...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... remains in its present location, will be awarded an additional cost factor of 12.5 WSU. ... costs related to a school's geographic isolation? 39.160 Section 39.160 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School...

  1. Differences in metabolic costs of terrestrial mobility in two closely related species of albatross.

    PubMed

    Kabat, Alexander P; Phillips, Richard A; Croxall, John P; Butler, Patrick J

    2007-08-01

    Black-browed albatrosses Thalassarche melanophrys typically colonise steeper habitats than grey-headed albatrosses T. chrysostoma. The present study investigated the effect of colony philopatry on terrestrial locomotory ability in these two species, to determine: (1) if there is a difference in terrestrial locomotory ability between these two closely related species, and (2) what physiological or behavioural adaptations may account for any differences identified. We examined the metabolic cost, mechanical efficiency on an incline, and gait characteristics of terrestrial locomotion of these two species on both level and inclined planes. T. chrysostoma were able to perform at a significantly greater speed than T. melanophrys without reaching a significantly different maximal rate of oxygen consumption (V(O(2))). Conversely, T. melanophrys were able to move up a significantly steeper incline than T. chrysostoma while maintaining a similar maximal V(O(2)). Each species demonstrates stride length, force production (behavioural) and leg length (morphological) adaptations that minimise the cost of traversing their chosen colonies, indicating a clear relationship between terrestrial performance and local topography. However, it is not possible to determine if the difference in locomotory ability results from differences in colony topography, or if choice of colony site is dictated by the ability of the species to traverse different terrain. PMID:17690233

  2. Molecular Genetics External Quality Assessment Pilot Scheme for Irinotecan-Related UGT1A1 Genotyping in China

    PubMed Central

    Zhang, Kuo; Wang, Lunan; Zhang, Rui; Xie, Jiehong; Li, Jinming

    2016-01-01

    Irinotecan is widely used in the treatment of solid tumors, especially in colorectal cancer and lung cancer. Molecular testing for UGT1A1 genotyping is increasingly required in China for optimum irinotecan administration. In order to determine the performance of laboratories with regard to the whole testing process for UGT1A1 to ensure the consistency and accuracy of the test results, the National Center for Clinical Laboratories conducted an external quality assessment program for UGT1A1*28 genotyping in 2015. The panel, which comprised of four known mutational samples and six wild-type samples, was distributed to 45 laboratories that test for the presence of UGT1A1*28 polymorphisms. Participating laboratories were allowed to perform polymorphism analysis by using their routine methods. The accuracy of the genotyping and reporting of results was analyzed. Other information from the individual laboratories, including the number of samples tested each month, accreditation/certification status, and test methodology, was reviewed. Forty-four of the 45 participants reported the correct results for all samples. There was only one genotyping error, with a corresponding analytical sensitivity of 99.44% (179/180 challenges; 95% confidence interval: 96.94−99.99%) and an analytical specificity of 100% (270/270 challenges; 95% confidence interval: 98.64−100%). Both commercial kits and laboratory development tests were commonly used by the laboratories, and pyrosequencing was the main methodology used (n = 26, 57.8%). The style of the written reports showed large variation, and many reports showed a shortage of information. In summary, the first UGT1A1 genotyping external quality assessment result demonstrated that UGT1A1 genotype analysis of good quality was performed in the majority of pharmacogenetic testing centers that were investigated. However, greater education on the reporting of UGT1A1 genetic testing results is needed. PMID:26820647

  3. Observational study on external social and lifestyle related factors and their role in pathogenesis of premature ageing and stress

    PubMed Central

    Deole, Yogesh S.; Thakar, Anup B.; Chandola, Harimohan; Ravishankar, B.

    2012-01-01

    In the present era of stress, when lifestyle disorders are high on rise, premature ageing is also one of the most prevalent disorders. It is needed to study the external environmental psychological causative factors in premature ageing and stress. An observational study was carried out to evaluate the relationship of lifestyle, occupational and social factors and mental makeup in individuals diagnosed with premature ageing. A total of 108 patients of premature ageing and stress fulfilling the criteria of inclusion as per ageing scale were selected from outpatient Department of Panchakarma and Manasa Roga, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar. The diagnosed patients of premature ageing were subjected to specialized proforma enlisting all the factors as well as ageing scale, Manasa Bhava Pariksha, and Manasa Vibhrama Pariksha. The method of survey was by a questionnaire about the points regarding the lifestyle causative factors. Maximum patients had shown signs of premature ageing with Mana-Buddhi-Smriti-Bhakti Vibhrama (100% each) and involvement of negative Manasa Bhava. The 78.70% patients in this study felt of having excess responsibility on them in family. The 52.77% patients had average good relationship with their family members, while remaining 47.22% narrated history of disturbed relationship. The center of stress was found to be at personal level in all patients; at family level in 73.14%; at professional or work level in 64.81%. Various external, occupational, social and familial factors play significant role in the pathology of premature ageing by disturbing the overall psychological status. This proves the link of Manasa affecting Sharira and vice versa with reference to modern contemporary concept of psycho-neuro endocrinology. PMID:23723645

  4. The Yale Cost Model and cost centres: servant or master?

    PubMed

    Rigby, E

    1993-01-01

    Cost accounting describes that aspect of accounting which collects, allocates and controls the cost of producing a service. Costing information is primarily reported to management to enable control of costs and to ensure the financial viability of units, departments and divisions. As costing studies continue to produce estimates of Diagnosis Related Group (DRG) costs in New South Wales hospitals, as well as in other states, costs for different hospitals are being externally compared, using a tool which is usually related to internal management and reporting. Comparability of costs is assumed even though accounting systems differ. This paper examines the cost centre structures at five major teaching hospitals in Sydney. It describes the similarities and differences in how the cost centres were constituted, and then details the line items of expenditure that are charged to each cost centre. The results of a comparative study of a medical specialty are included as evidence of different costing methodologies in the hospitals. The picture that emerged from the study is that the hospitals are constituting their cost centres to meet their internal management needs, that is, to know the cost of running a ward or nursing unit, a medical specialty, department and so on. The rationale for the particular cost centre construction was that cost centre managers could manage and control costs and assign responsibility. There are variations in procedures for assigning costs to cost centres, and the question is asked 'Do these variations in procedures make a material difference to our ability to compare costs per Diagnosis Related Group at the various hospitals?' It is contended that the accounting information, which is produced as a result of different practices, is primarily for internal management, not external comparison. It would be better for hospitals to compare their estimated costs per Diagnosis Related Group to an internal standard cost rather than the costs from other

  5. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients.

    PubMed

    Philbeck, T E; Whittington, K T; Millsap, M H; Briones, R B; Wight, D G; Schroeder, W J

    1999-11-01

    Pressure ulcers, a devastating and costly healthcare problem, often occur in home healthcare settings. We sought to determine if these and other chronic wounds treated at home with negative pressure wound therapy close faster and reduce treatment costs compared to conventional therapies. Records for 1,032 Medicare home healthcare patients with 1,170 wounds that failed to respond to previous interventions--and were subsequently treated with negative pressure wound therapy--were reviewed. Reductions in wound area and volume were compared to rates reported by Ferrell in 1993, and costs were analyzed. Ferrell reported trochanteric and trunk pressure ulcers averaging 4.3 cm2, treated with a low-air-loss surface and saline-soaked gauze closed at an average of 0.090 cm2 per day. For comparison to Ferrell's outcomes, we analyzed our Stage III and IV trochanteric and trunk wounds treated with low-air-loss and negative pressure wound therapy. Ours averaged 22.2 cm2 in area and closed at an average of 0.23 cm2 per day. The average 22.2 cm2 wound in our study, treated as described by Ferrell, would take 247 days to heal and cost $23,465. Using negative pressure wound therapy, the wound would heal in 97 days and cost $14,546. The study concluded that negative pressure wound therapy is an efficacious and economical treatment modality for a variety of chronic wounds. PMID:10687657

  6. Costs of Foraging Predispose Animals to Obesity-Related Mortality when Food Is Constantly Abundant

    PubMed Central

    McNamara, John M.; Houston, Alasdair I.; Higginson, Andrew D.

    2015-01-01

    Obesity is an important medical problem affecting humans and animals in the developed world, but the evolutionary origins of the behaviours that cause obesity are poorly understood. The potential role of occasional gluts of food in determining fat-storage strategies for avoiding mortality have been overlooked, even though animals experienced such conditions in the recent evolutionary past and may follow the same strategies in the modern environment. Humans, domestic, and captive animals in the developed world are exposed to a surplus of calorie-rich food, conditions characterised as ‘constant-glut’. Here, we use a mathematical model to demonstrate that obesity-related mortality from poor health in a constant-glut environment should equal the average mortality rate in the ‘pre-modern’ environment when predation risk was more closely linked with foraging. It should therefore not be surprising that animals exposed to abundant food often over-eat to the point of ill-health. Our work suggests that individuals tend to defend a given excessive level of reserves because this level was adaptive when gluts were short-lived. The model predicts that mortality rate in constant-glut conditions can increase as the assumed health cost of being overweight decreases, meaning that any adaptation that reduced such health costs would have counter-intuitively led to an increase in mortality in the modern environment. Taken together, these results imply that efforts to reduce the incidence of obesity that are focussed on altering individual behaviour are likely to be ineffective because modern, constant-glut conditions trigger previously adaptive behavioural responses. PMID:26545121

  7. Calculation of Costs of Pregnancy- and Puerperium-related Care: Experience from a Hospital in a Low-income Country

    PubMed Central

    Medin, E.; Gazi, R.; Koehlmoos, T.P.; Rehnberg, C.; Saifi, R.; Bhuiya, A.; Khan, J.

    2010-01-01

    Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services. PMID:20635637

  8. GHG Mitigation potential and cost in tropical forestry - Relative role for agroforestry

    SciTech Connect

    Makundi, Willy R.; Sathaye, Jayant A.

    2004-01-01

    This paper summarizes studies of carbon mitigation potential (MP) and costs of forestry options in seven developing countries with a focus on the role of agroforestry. A common methodological approach known as comprehensive mitigation assessment process (COMAP) was used in each study to estimate the potential and costs between 2000 and 2030. The approach requires the projection of baseline and mitigation land-use scenarios derived from the demand for forest products and forestland for other uses such as agriculture and pasture. By using data on estimated carbon sequestration, emission avoidance, costs and benefits, the model enables one to estimate cost effectiveness indicators based on monetary benefit per t C, as well as estimates of total mitigation costs and potential when the activities are implemented at equilibrium level. The results show that about half the MP of 6.9 Gt C (an average of 223 Mt C per year) between 2000 and 2030 in the seven countries could be achieved at a negative cost, and the other half at costs not exceeding $100 per t C. Negative cost indicates that non-carbon revenue is sufficient to offset direct costs of about half of the options. The agroforestry options analyzed bear a significant proportion of the potential at medium to low cost per t C when compared to other options. The role of agroforestry in these countries varied between 6% and 21% of the MP, though the options are much more cost effective than most due to the low wage or opportunity cost of rural labor. Agroforestry options are attractive due to the large number of people and potential area currently engaged in agriculture, but they pose unique challenges for carbon and cost accounting due to the dispersed nature of agricultural activities in the tropics, as well as specific difficulties arising from requirements for monitoring, verification, leakage assessment and the establishment of credible baselines.

  9. Mitigation potential and cost in tropical forestry - relative role for agroforestry

    SciTech Connect

    Makundi, Willy R.; Sathaye, Jayant A.

    2004-01-01

    This paper summarizes studies of carbon mitigation potential (MP) and costs of forestry options in seven developing countries with a focus on the role of agroforestry. A common methodological approach known as comprehensive mitigation assessment process (COMAP) was used in each study to estimate the potential and costs between 2000 and 2030. The approach requires the projection of baseline and mitigation land-use scenarios derived from the demand for forest products and forestland for other uses such as agriculture and pasture. By using data on estimated carbon sequestration, emission avoidance, costs and benefits, the model enables one to estimate cost effectiveness indicators based on monetary benefit per t C, as well as estimates of total mitigation costs and potential when the activities are implemented at equilibrium level. The results show that about half the MP of 6.9 Gt C (an average of 223 Mt C per year) between 2000 and 2030 in the seven countries could be achieved at a negative cost, and the other half at costs not exceeding $100 per t C. Negative cost indicates that non-carbon revenue is sufficient to offset direct costs of about half of the options. The agroforestry options analyzed bear a significant proportion of the potential at medium to low cost per t C when compared to other options. The role of agroforestry in these countries varied between 6% and 21% of the MP, though the options are much more cost effective than most due to the low wage or opportunity cost of rural labor. Agroforestry options are attractive due to the large number of people and potential area currently engaged in agriculture, but they pose unique challenges for carbon and cost accounting due to the dispersed nature of agricultural activities in the tropics, as well as specific difficulties arising from requirements for monitoring, verification, leakage assessment and the establishment of credible baselines.

  10. Breast Cancer–Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care

    PubMed Central

    Pfalzer, Lucinda A.; Springer, Barbara; Levy, Ellen; McGarvey, Charles L.; Danoff, Jerome V.; Gerber, Lynn H.; Soballe, Peter W.

    2012-01-01

    Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer–related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This perspective article compares a prospective surveillance model with a traditional model of impairment-based care and examines direct treatment costs associated with each program. Intervention and supply costs were estimated based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast cancer who were receiving interval prospective surveillance, assuming that one third would develop early-stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the paradigm of physical therapy toward a prospective surveillance model is warranted. PMID:21921254

  11. Direct Medical Cost of Influenza-Related Hospitalizations among Severe Acute Respiratory Infections Cases in Three Provinces in China

    PubMed Central

    Zhu, Xiaoping; Gao, Lidong; Li, Zhong; Feng, Ao; Jin, Hui; Wang, Shiyuan; Su, Qiru; Xu, Zhen; Feng, Zijian

    2013-01-01

    Background Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. Methods Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI) sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital’s Hospital Information System (HIS) and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range) and median (interquartile range [IQR]) costs were calculated and compared among children (≤15 years), adults (16–64 years) and elderly (≥65 years) groups. Factors influencing cost were analyzed. Results A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range) direct medical cost was $1,797 ($80–$27,545) for all hospitalizations, and the median (IQR) direct medical cost was $231 ($164), $854 ($890), and $2,263 ($7,803) for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. Conclusion Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies. PMID:23717485

  12. Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

    SciTech Connect

    Kim, Hayeon; Rajagopalan, Malolan S.; Beriwal, Sushil; Huq, M. Saiful; Smith, Kenneth J.

    2015-03-01

    Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100

  13. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., stockholders, creditors, and customers; and (iii) Conducting general liaison with news media and Government... of ceremonies such as (i) corporate celebrations and (ii) new product announcements. (5) Costs...

  14. 15 CFR 716.9 - Report of inspection-related costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS... records, and costs associated with shutting down chemical production or processing during inspections,...

  15. 15 CFR 716.9 - Report of inspection-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS... records, and costs associated with shutting down chemical production or processing during inspections,...

  16. Age in Relation to Worker Compensation Costs in the Construction Industry

    PubMed Central

    Schwatka, Natalie V.; Butler, Lesley M.; Rosecrance, John C.

    2015-01-01

    Background A better understanding of how workers’ compensation (WC) costs are affected by an aging US workforce is needed, especially for physically demanding industries, such as construction. Methods The relationship between age and injury type on claim costs was evaluated using a database of 107,064 Colorado WC claims filed between 1998 and 2008 among construction workers. Results Mean WC costs increased with increasing age for total cost (P < 0.0001), medical costs (P < 0.0001), and indemnity costs (P < 0.0001). For each one-year increase in age, indemnity, and medical costs increased by 3.5% and 1.1%, respectively. For specific injury types, such as strains and contusions, the association between age and indemnity costs was higher among claimants aged ≥65 compared to claimants aged 18–24. Conclusions Our findings suggest that specific injury types may be partially responsible for the higher indemnity costs among older construction workers, compared with their younger coworkers. PMID:22782837

  17. Switch Costs Occur at Lemma Stage When Bilinguals Name Digits: Evidence from Language-Switching and Event-Related Potentials

    PubMed Central

    Chang, Song; Xie, Jiushu; Li, Li; Wang, Ruiming; Liu, Ming

    2016-01-01

    Switch costs are generally found in language switching tasks. However, the locus where switch costs occur during bilingual language production remains unclear. Several studies that used a cued language-switching paradigm have attempted to investigate this question in bilingual language production, but researchers have not reached a consensus. Moreover, we are interested in where switch costs occur when language selection occurs after lemma activation. Previous studies have not investigated this question because most previous studies presented language cues before or along with the stimuli. Therefore, we used a modified cued language-switching paradigm with a combined event-related potentials (ERPs) technique to explore the locus of switch costs during bilingual language production. The cue and stimulus were separated and presented in two different presentation sequences in which Indonesian–Chinese bilingual speakers were instructed to name digits in their L1 or L2 according to the color of the cue. The ERPs related to the cue and stimulus for two presentation sequences were measured. In the stimulus-cue sequence, the analysis that was time-locked to cues revealed a reversed switch cost as early as 220 ms after the cue onset; furthermore, a switch cost was shown in L1 with a late stage post-cue onset. The results suggested that when language selection occurred after lemma activation, the switch costs mainly occurred at the lemma selection stage. In the cue-stimulus sequence, the analysis that was time-locked to cues did not reveal significant main effects of switching, whereas the analysis that was time-locked to digits yielded a switch cost, again indicating that switch costs mainly occurred at the lemma selection stage rather than at the language task schema competition stage. Overall, our results indicated that when bilinguals spoke digits aloud in the language switching task, switch costs mainly occurred at the lemma selection stage.

  18. Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

    PubMed Central

    Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

    2016-01-01

    Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation-related

  19. Effects of Cuts in Medicaid on Dental-Related Visits and Costs at a Safety-Net Hospital

    PubMed Central

    Neely, Martha; Rich, Sharron; Gutierrez, Lillelenny Santana; Mehra, Pushkar

    2014-01-01

    We used data from Boston Medical Center, Massachusetts, to determine whether dental-related emergency department (ED) visits and costs increased when Medicaid coverage for adult dental care was reduced in July 2010. In this retrospective study of existing data, we examined the safety-net hospital’s dental-related ED visits and costs for 3 years before and 2 years after Massachusetts Health Care Reform. Dental-related ED visits increased 2% the first and 14% the second year after Medicaid cuts. Percentage increases were highest among older adults, minorities, and persons receiving charity care, Medicaid, and Medicare. PMID:24825223

  20. Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973–2008

    PubMed Central

    2012-01-01

    Background Gender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours. Methods 22 OECD countries were followed 1973–2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units. Results Both the earner-carer cluster (ns after adjustment for GDP) and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality. Conclusion Results for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach – cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made. PMID:23145477

  1. Economics, health-related quality of life, and cost-effectiveness methods for the TACTICS (Treat Angina With Aggrastat [tirofiban

    PubMed

    Weintraub, W S; Culler, S D; Kosinski, A; Becker, E R; Mahoney, E; Burnette, J; Spertus, J A; Feeny, D; Cohen, D J; Krumholz, H; Ellis, S G; Demopoulos, L; Robertson, D; Boccuzzi, S J; Barr, E; Cannon, C P

    1999-02-01

    Concern over escalating health care costs has led to increasing focus on economics and assessment of outcome measures for expensive forms of therapy. This is being investigated in the Treat Angina With Aggrastat [tirofiban] and Determine Cost of Therapy with Invasive or Conservative Strategy (TACTICS)-TIMI 18 trial, a randomized trial comparing outcome of patients with unstable angina or non-Q-wave myocardial infarction treated with tirofiban and then randomized to an invasive versus a conservative strategy. Hospital and professional costs initially and over 6 months, including outpatient costs, will be assessed. Hospital costs will be determined for patients in the United States from the UB92 formulation of the hospital bill, with costs derived from charges using departmental cost to charge ratios. Professional costs will be determined by accounting for professional services and then converted to resource units using the Resource Based Relative Value Scale and then to costs using the Medicare conversion factor. Follow-up resource consumption, including medications, testing and office visits, will be carefully measured with a Patient Economic Form, and converted to costs from the Medicare fee schedule. Health-related quality of life will be assessed with a specific instrument, the Seattle Angina Questionnaire, and a general instrument, the Health Utilities Index at baseline, 1, and 6 months. The Health Utilities Index will also be used to construct a utility. By knowing utility and survival, quality-adjusted life years will be determined. These measures will permit the performance of a cost-effectiveness analysis, with the cost-effectiveness of the invasive strategy defined and the difference in cost between the invasive and conservative strategies divided by the difference in quality-adjusted life years. The economic and health-related quality of life aspects of TACTICS-TIMI 18 are an integral part of the study design and will provide a comprehensive understanding

  2. PROJECT WORK PLAN FOR REVISED AIR QUALITY CRITERIA FOR OZONE AND RELATED PHOTOCHEMICAL OXIDANTS (EXTERNAL REVIEW DRAFT)

    EPA Science Inventory

    The U.S. Environmental Protection Agency (EPA) promulgates the National Ambient Air Quality Standards (NAAQS) on the basis of scientific information contained in criteria documents. The previous ozone (O3 ) criteria document, Air Quality Criteria for Ozone and Related Photochemi...

  3. A Framework for Categorizing the Relative Vulnerability of Threatened and Endangered Species to Climate Change (External Review Draft)

    EPA Science Inventory

    NCEA/ORD has developed an evaluative framework that may be used to categorize the relative vulnerability of species to climate change. This framework is intended to provide information to ecosystem and resource managers to support their decision making about management actions th...

  4. 32 CFR 37.535 - How do I value cost sharing related to real property or equipment?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 1 2014-07-01 2014-07-01 false How do I value cost sharing related to real property or equipment? 37.535 Section 37.535 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Pre-Award Business Evaluation Cost Sharing § 37.535 How do I...

  5. Low cost sensors for PM and related air pollutants in the US and India

    EPA Science Inventory

    Emerging air quality sensors have a variety of possible applications. If accurate and reliable, they have a number of benefits over conventional monitors. They are low-cost, lightweight, and have low power consumption. Because of their low cost, a dense array of sensors instal...

  6. 77 FR 17360 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-26

    ... Federal Register on February 28, 2012, at 77 FR 11178. The original comment period was scheduled to end on... Cooperative Agreements; Cost Principles And Administrative Requirements (Including Single Audit Act) AGENCY... Grants and Cooperative Agreements; cost principles and administrative requirements (including...

  7. COSTS AND ISSUES RELATED TO REMEDIATION OF PETROLEUM-CONTAMINATED SITES (NEW ORLEANS, LA)

    EPA Science Inventory

    The remediation costs required at sites contaminated with petroleum-derived compounds remains a relevant issue because of the large number of existing underground storage tanks the United States and the presence of benzene, MTBE, and TBA in some drinking water supplies. Cost inf...

  8. COSTS AND ISSUES RELATED TO REMEDIATION OF PETROLEUM-CONTAMINATED SITES

    EPA Science Inventory

    The remediation costs required at sites contaminated with petroleum-derived compounds remains a relevant issue because of the large number of existing underground storage tanks the United States and the presence of benzene, MTBE, and TBA in some drinking water supplies. Cost inf...

  9. A Method for Record-Keeping and Analysis of Equipment and Related Costs by Educational Program.

    ERIC Educational Resources Information Center

    Thomas, Ruth G.

    A system employing a micro-level approach to the ongoing recording of educational equipment costs by educational program was developed. The system was designed to depreciate equipment and to allow determination of annual costs by educational program; consumption; maintenance and repair; interest on the capital investment; and insurance for…

  10. The Relative Effectiveness of Signaling Systems: Relying on External Items Reduces Signaling Accuracy while Leks Increase Accuracy

    PubMed Central

    Leighton, Gavin M.

    2014-01-01

    Multiple evolutionary phenomena require individual animals to assess conspecifics based on behaviors, morphology, or both. Both behavior and morphology can provide information about individuals and are often used as signals to convey information about quality, motivation, or energetic output. In certain cases, conspecific receivers of this information must rank these signaling individuals based on specific traits. The efficacy of information transfer associated within a signal is likely related to the type of trait used to signal, though few studies have investigated the relative effectiveness of contrasting signaling systems. I present a set of models that represent a large portion of signaling systems and compare them in terms of the ability of receivers to rank signalers accurately. Receivers more accurately assess signalers if the signalers use traits that do not require non-food resources; similarly, receivers more accurately ranked signalers if all the signalers could be observed simultaneously, similar to leks. Surprisingly, I also found that receivers are only slightly better at ranking signaler effort if the effort results in a cumulative structure. This series of findings suggests that receivers may attend to specific traits because the traits provide more information relative to others; and similarly, these results may explain the preponderance of morphological and behavioral display signals. PMID:24626221

  11. Relative amplitudes of external satellites of superfine-structure multiplets in the saturated absorption spectrum of SiF4

    NASA Astrophysics Data System (ADS)

    Krylov, I. R.; Akulinin, D. A.; Chubykin, A. D.

    2015-08-01

    Variation of amplitudes of Doppler-free saturated absorption resonances as a result of changes in the gas pressure and power of light waves is studied theoretically and experimentally. The results of the investigation are used for the interpretation of weak satellites of superfine-structure multiplets in the spectrum related to tunnel transitions between energy states of a molecule corresponding to its rotation about equivalent symmetry axes. Relative amplitudes of satellites of the AFE and FEF multiplets of the superfine structure of the SiF4 molecule in the frequency tuning interval of a CO2 laser operating at the P(38) line of the 9.7-µm band are studied experimentally. It is confirmed that the variation of relative amplitudes of the satellites is caused mainly by the fact that the magnitudes of the self-induced transparency of the medium that are created by each light wave for itself are different for the main resonances of the multiplet and for their satellites. The discrepancy between the experimental and theoretical dependences of the relative amplitudes of the satellites upon variation of the gas pressure and power of light waves is analyzed. Based on the discovered discrepancy, it is suggested that molecular collisions with Bennett dip or peak transfer contribute to the formation of satellites of the FEF multiplet. Multiphoton processes participate in the formation of one of the multiplets of the FEF multiplet. It is suggested that the power of the light field partially lifts the ban on transitions participating in the formation of satellites of both studied multiplets. Processing of the experimental curves by the leastsquares method revealed spectrally unresolved satellites within the FEF multiplet, which represent crossover resonances between allowed and forbidden transitions. For these satellites, no additional dependence of the amplitude on the laser power or gas pressure was found. The dependence of the amplitude of these satellites is completely

  12. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

    PubMed Central

    2012-01-01

    Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS). Methods Population attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010). Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs) due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions. PMID:22713624

  13. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE... conditions in the area; (B) The type, expected life, condition, and value of the facilities or...

  14. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE... conditions in the area; (B) The type, expected life, condition, and value of the facilities or...

  15. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE... conditions in the area; (B) The type, expected life, condition, and value of the facilities or...

  16. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE... conditions in the area; (B) The type, expected life, condition, and value of the facilities or...

  17. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE... conditions in the area; (B) The type, expected life, condition, and value of the facilities or...

  18. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... memberships in civic and community organizations. (8) Costs associated with the donation of excess food to nonprofit organizations in accordance with the Federal Food Donation Act of 2008 (Pub. L. 110-247)(see...

  19. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... memberships in civic and community organizations. (8) Costs associated with the donation of excess food to nonprofit organizations in accordance with the Federal Food Donation Act of 2008 (42 U.S.C. 1792,...

  20. 48 CFR 31.205-47 - Costs related to legal and other proceedings.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... proceeding could have led to any of the outcomes listed in subparagraphs (b) (1) through (3) of this... that which led to a different proceeding whose costs are unallowable by reason of subparagraphs (b)...

  1. Cost of presumptive source term Remedial Actions Laboratory for energy-related health research, University of California, Davis

    SciTech Connect

    Last, G.V.; Bagaasen, L.M.; Josephson, G.B.; Lanigan, D.C.; Liikala, T.L.; Newcomer, D.R.; Pearson, A.W.; Teel, S.S.

    1995-12-01

    A Remedial Investigation/Feasibility Study (RI/FS) is in progress at the Laboratory for Energy Related Health Research (LEHR) at the University of California, Davis. The purpose of the RI/FS is to gather sufficient information to support an informed risk management decision regarding the most appropriate remedial actions for impacted areas of the facility. In an effort to expedite remediation of the LEHR facility, the remedial project managers requested a more detailed evaluation of a selected set of remedial actions. In particular, they requested information on both characterization and remedial action costs. The US Department of Energy -- Oakland Office requested the assistance of the Pacific Northwest National Laboratory to prepare order-of-magnitude cost estimates for presumptive remedial actions being considered for the five source term operable units. The cost estimates presented in this report include characterization costs, capital costs, and annual operation and maintenance (O&M) costs. These cost estimates are intended to aid planning and direction of future environmental remediation efforts.

  2. Oxygen cost of dynamic or isometric exercise relative to recruited muscle mass

    PubMed Central

    Elder, Christopher P; Mahoney, Edward T; Black, Christopher D; Slade, Jill M; Dudley, Gary A

    2006-01-01

    Background Oxygen cost of different muscle actions may be influenced by different recruitment and rate coding strategies. The purpose of this study was to account for these strategies by comparing the oxygen cost of dynamic and isometric muscle actions relative to the muscle mass recruited via surface electrical stimulation of the knee extensors. Methods Comparisons of whole body pulmonary Δ V˙ MathType@MTEF@5@5@+=feaafiart1ev1aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacH8akY=wiFfYdH8Gipec8Eeeu0xXdbba9frFj0=OqFfea0dXdd9vqai=hGuQ8kuc9pgc9s8qqaq=dirpe0xb9q8qiLsFr0=vr0=vr0dc8meaabaqaciaacaGaaeqabaqabeGadaaakeaacuWGwbGvgaGaaaaa@2DEA@O2 were made in seven young healthy adults (1 female) during 3 minutes of dynamic or isometric knee extensions, both induced by surface electrical stimulation. Recruited mass was quantified in T2 weighted spin echo magnetic resonance images. Results The Δ V˙ MathType@MTEF@5@5@+=feaafiart1ev1aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacH8akY=wiFfYdH8Gipec8Eeeu0xXdbba9frFj0=OqFfea0dXdd9vqai=hGuQ8kuc9pgc9s8qqaq=dirpe0xb9q8qiLsFr0=vr0=vr0dc8meaabaqaciaacaGaaeqabaqabeGadaaakeaacuWGwbGvgaGaaaaa@2DEA@O2 for dynamic muscle actions, 242 ± 128 ml • min-1 (mean ± SD) was greater (p = 0.003) than that for isometric actions, 143 ± 99 ml • min-1. Recruited muscle mass was also greater (p = 0.004) for dynamic exercise, 0.716 ± 282 versus 0.483 ± 0.139 kg. The rate of oxygen consumption per unit of recruited muscle (V˙O2RM MathType@MTEF@5@5@+=feaafiart1ev1aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacH8akY=wiFfYdH8Gipec8Eeeu0xXdbba9frFj0=OqFfea0dXdd9vqai=hGuQ8kuc9pgc9s8qqaq=dirpe0xb9q8qiLsFr0=vr0=vr0dc8meaabaqaciaacaGaaeqabaqabeGadaaakeaacuqGwbGvgaGaaiabb+eapnaaBaaaleaacqaIYaGmdaahaaadbeqaaiabbkfasjabb2eanbaaaSqabaaaaa@32B0@) was similar in dynamic and isometric exercise (346 ± 162 versus 307 ± 198 ml • kg-1 • min-1; p = 0.352), but the V˙O2RM MathType@MTEF@5

  3. Relative contribution of set cathode potential and external mass transport on TCE dechlorination in a continuous-flow bioelectrochemical reactor.

    PubMed

    Verdini, Roberta; Aulenta, Federico; de Tora, Francesca; Lai, Agnese; Majone, Mauro

    2015-10-01

    Microbial bioelectrochemical systems, which use solid-state cathodes to drive the reductive degradation of contaminants such as the chlorinated hydrocarbons, are recently attracting considerable attention for bioremediation applications. So far, most of the published research has focused on analyzing the influence of key (bio)electrochemical factors influencing contaminant degradation, such as the cathode potential, whereas only few studies have examined the potential impact of mass transport phenomena on process performance. Here we analyzed the performance of a flow-through bioelectrochemical reactor, continuously fed with a synthetic groundwater containing trichloroethene at three different linear fluid velocities (from 0.3 m d(-1) to 1.7 m d(-1)) and three different set cathode potentials (from -250 mV to -450 mV vs. the standard hydrogen electrode). The obtained results demonstrated that, in the range of fluid velocities which are characteristics for natural groundwater systems, mass transport phenomena may strongly influence the rate and extent of reductive dechlorination. Nonetheless, the relative importance of mass transport largely depends on the applied cathode potential which, in turn, controls the intrinsic kinetics of biological reactions and the underlying electron transfer mechanisms. PMID:25950501

  4. Altered diurnal pattern of steroid hormones in relation to various behaviors, external factors and pathologies: A review.

    PubMed

    Collomp, K; Baillot, A; Forget, H; Coquerel, A; Rieth, N; Vibarel-Rebot, N

    2016-10-01

    The adrenal and gonadal stress steroids [i.e., cortisol, testosterone and dehydroepiandrosterone (DHEA)] have gathered considerable attention in the last few decades due to their very broad physiological and psychological actions. Their diurnal patterns have become a particular focus following new data implicating altered diurnal hormone patterns in various endocrine, behavioral and cardiovascular risk profiles. In this review of the current literature, we present a brief overview of the altered diurnal patterns of these hormones that may occur in relation to chronic stress, nutritional behaviors, physical exercise, drugs and sleep deprivation/shift. We also present data on the altered diurnal hormone patterns implicated in cardiometabolic and psychiatric/neurologic diseases, cancer and other complex pathologies. We consider the occasionally discrepant results of the studies, and summarize the current knowledge in this new field of interest, underlining the potential effects on both biological and psychological functioning, and assess the implications of these effects. Last, we conclude with some practical considerations and perspectives. PMID:27235338

  5. Relative Cost and Performance Comparison of GEO Space Situational Awareness Architectures

    NASA Astrophysics Data System (ADS)

    Morris, K.; Rice, C.; Little, E.

    2014-09-01

    With declining government budgets, new architecture approaches are being studied to determine the most cost effective GEO Space Situational Awareness architectures. Looking at four different architecture concepts utilizing CubeSats, Microsats, Hosted Payload Sensors, and larger satellites, highlights the benefits and regrets of each class of spacecraft that helps support upgrades to the current space surveillance network. CubeSats have been shown in previous studies to provide GEO SSA mission value while maintaining affordability. However, there are limitations such as mission assurance that will increase the costs over time. Microsats provide higher quality SSA with less restrictions, but the rideshare options to GEO become fewer. Hosted Payload sensors on future GEO spacecraft can provide affordable access to space but are constrained by the host orbit. Larger satellites can provide exquisite SSA information but are more expensive individually and require dedicated launches. To credibly compare costs, the analysis is based on launch, spacecraft, ground and operations, spacecraft replenishment based on expected mission life, and integration costs over the life of the architecture. Performance is based on observations of all GEO objects with evaluation on percentage of time with access to each object, and the revisit times to each object. The results show the CubeSat architecture can provide good performance for access and percentages with a low initial investment but require increased costs over time to cover the lower mission assurance. Hosted payloads suffer performance due to limited GEO locations but at an affordable cost. Microsats provide a balance between performance and cost but have lower revisit rates due to fewer spacecraft in orbit. The larger satellites provide high performance but require higher costs mostly due to the dedicated launches. All of these architectures have benefits and regrets that help to highlight where future investments are needed

  6. Health-related quality of life as a predictor of pediatric healthcare costs: A two-year prospective cohort analysis

    PubMed Central

    Seid, Michael; Varni, James W; Segall, Darron; Kurtin, Paul S

    2004-01-01

    Background The objective of this study was to test the primary hypothesis that parent proxy-report of pediatric health-related quality of life (HRQL) would prospectively predict pediatric healthcare costs over a two-year period. The exploratory hypothesis tested anticipated that a relatively small group of children would account for a disproportionately large percent of healthcare costs. Methods 317 children (157 girls) ages 2 to 18 years, members of a managed care health plan with prospective payment participated in a two-year prospective longitudinal study. At Time 1, parents reported child HRQL using the Pediatric Quality of Life Inventory™ (PedsQL™ 4.0) Generic Core Scales, and chronic health condition status. Costs, based on health plan utilization claims and encounters, were derived for 6, 12, and 24 months. Results In multiple linear regression equations, Time 1 parent proxy-reported HRQL prospectively accounted for significant variance in healthcare costs at 6, 12, and 24 months. Adjusted regression models that included both HRQL scores and chronic health condition status accounted for 10.1%, 14.4%, and 21.2% of the variance in healthcare costs at 6, 12, and 24 months. Parent proxy-reported HRQL and chronic health condition status together defined a 'high risk' group, constituting 8.7% of the sample and accounting for 37.4%, 59.2%, and 62% of healthcare costs at 6, 12, and 24 months. The high risk group's per member per month healthcare costs were, on average, 12 times that of other enrollees' at 24 months. Conclusions While these findings should be further tested in a larger sample, our data suggest that parent proxy-reported HRQL can be used to prospectively predict healthcare costs. When combined with chronic health condition status, parent proxy-reported HRQL can identify an at risk group of children as candidates for proactive care coordination. PMID:15361252

  7. A retrospective analysis of treatment-related hospitalization costs of pediatric, adolescent, and young adult acute lymphoblastic leukemia.

    PubMed

    Kaul, Sapna; Korgenski, Ernest Kent; Ying, Jian; Ng, Christi F; Smits-Seemann, Rochelle R; Nelson, Richard E; Andrews, Seth; Raetz, Elizabeth; Fluchel, Mark; Lemons, Richard; Kirchhoff, Anne C

    2016-02-01

    This retrospective study examined the longitudinal hospital outcomes (costs adjusted for inflation, hospital days, and admissions) associated with the treatment of pediatric, adolescent, and young adult acute lymphoblastic leukemia (ALL). Patients between one and 26 years of age with newly diagnosed ALL, who were treated at Primary Children's Hospital (PCH) in Salt Lake City, Utah were included. Treatment and hospitalization data were retrieved from system-wide cancer registry and enterprise data warehouse. PCH is a member of the Children's Oncology Group (COG) and patients were treated on, or according to, active COG protocols. Treatment-related hospital costs of ALL were examined by computing the average annual growth rates (AAGR). Longitudinal regressions identified patient characteristics associated with costs. A total of 505 patients (46.9% female) were included. The majority of patients had B-cell lineage ALL, 6.7% had T-ALL, and the median age at diagnosis was 4 years. Per-patient, first-year ALL hospitalization costs at PCH rose from $24,197 in 1998 to $37,924 in 2012. The AAGRs were 6.1, 13.0, and 7.6% for total, pharmacy, and room and care costs, respectively. Average days (AAGR = 5.2%) and admissions (AAGR = 3.8%) also demonstrated an increasing trend. High-risk patients had 47% higher costs per 6-month period in the first 5 years from diagnosis than standard-risk patients (P < 0.001). Similarly, relapsed ALL and stem cell transplantations were associated with significantly higher costs than nonrelapsed and no transplantations, respectively (P < 0.001). Increasing treatment-related costs of ALL demonstrate an area for further investigation. Value-based interventions such as identifying low-risk fever and neutropenia patients and managing them in outpatient settings should be evaluated for reducing the hospital burden of ALL. PMID:26714675

  8. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs.

    PubMed

    Tanner, J; Khan, D; Aplin, C; Ball, J; Thomas, M; Bankart, J

    2009-07-01

    A growing number of surveillance studies have highlighted concerns with relying only on data from inpatients. Without post-discharge surveillance (PDS) data, the rate and burden of surgical site infections (SSIs) are underestimated. PDS data for colorectal surgery in the UK remains to be published. This is an important specialty to study since it is considered to have the highest SSI rate and is among the most expensive to treat. This study of colorectal SSI used a 30 day surveillance programme with telephone interviews and home visits. Each additional healthcare resource used by patients with SSI was documented and costed. Of the 105 patients who met the inclusion criteria and completed the 30 day follow-up, 29 (27%) developed SSI, of which 12 were diagnosed after discharge. The mean number of days to presentation of SSI was 13. Multivariable logistic analysis identified body mass index as the only significant risk factor. The additional cost of treating each infected patient was pound sterling 10,523, although 15% of these additional costs were met by primary care. The 5 month surveillance programme cost pound sterling 5,200 to run. An analysis of the surveillance nurse's workload showed that the nurse could be replaced by a healthcare assistant. PDS to detect SSI after colorectal surgery is necessary to provide complete data with accurate additional costs. PMID:19446918

  9. External phenome analysis enables a rational federated query strategy to detect changing rates of treatment-related complications associated with multiple myeloma.

    PubMed

    Warner, Jeremy L; Alterovitz, Gil; Bodio, Kelly; Joyce, Robin M

    2013-01-01

    Electronic health records (EHRs) are increasingly useful for health services research. For relatively uncommon conditions, such as multiple myeloma (MM) and its treatment-related complications, a combination of multiple EHR sources is essential for such research. The Shared Health Research Information Network (SHRINE) enables queries for aggregate results across participating institutions. Development of a rational search strategy in SHRINE may be augmented through analysis of pre-existing databases. We developed a SHRINE query for likely non-infectious treatment-related complications of MM, based upon an analysis of the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC II) database. Using this query strategy, we found that the rate of likely treatment-related complications significantly increased from 2001 to 2007, by an average of 6% a year (p=0.01), across the participating SHRINE institutions. This finding is in keeping with increasingly aggressive strategies in the treatment of MM. This proof of concept demonstrates that a staged approach to federated queries, using external EHR data, can yield potentially clinically meaningful results. PMID:23515788

  10. External phenome analysis enables a rational federated query strategy to detect changing rates of treatment-related complications associated with multiple myeloma

    PubMed Central

    Warner, Jeremy L; Alterovitz, Gil; Bodio, Kelly; Joyce, Robin M

    2013-01-01

    Electronic health records (EHRs) are increasingly useful for health services research. For relatively uncommon conditions, such as multiple myeloma (MM) and its treatment-related complications, a combination of multiple EHR sources is essential for such research. The Shared Health Research Information Network (SHRINE) enables queries for aggregate results across participating institutions. Development of a rational search strategy in SHRINE may be augmented through analysis of pre-existing databases. We developed a SHRINE query for likely non-infectious treatment-related complications of MM, based upon an analysis of the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC II) database. Using this query strategy, we found that the rate of likely treatment-related complications significantly increased from 2001 to 2007, by an average of 6% a year (p=0.01), across the participating SHRINE institutions. This finding is in keeping with increasingly aggressive strategies in the treatment of MM. This proof of concept demonstrates that a staged approach to federated queries, using external EHR data, can yield potentially clinically meaningful results. PMID:23515788

  11. Estimation of the full marginal costs of port related truck traffic.

    PubMed

    Berechman, Joseph

    2009-11-01

    NY region is expected to grow by additional 1 million people by 2020, which translates into roughly 70 million more tons of goods to be delivered annually. Due to lack of rail capacity, mainly trucks will haul this volume of freight, challenging an already much constrained highway network. What are the total costs associated with this additional traffic, in particular, congestion, safety and emission? Since a major source of this expected flow is the Port of New York-New Jersey, this paper focuses on the estimation of the full marginal costs of truck traffic resulting from the further expansion of the port's activities. PMID:19796817

  12. Challenges and costs related to recruitment of female adolescents for clinical research.

    PubMed

    Logsdon, M Cynthia; Gohmann, Stephan

    2008-10-01

    Addressing health issues in adolescents is a national priority. However, recruitment of adolescents into research studies can be challenging and costly. The purpose of this article was to compare procedures, costs, and challenges in recruiting female adolescents from two hospitals and two high schools in an urban area of the southern United States. Three studies will be described. The findings indicate that the choice of recruitment procedures and sites has major implications for study budget in terms of personnel time as well as for the timeline of the study. PMID:18804013

  13. Recovery of costs related to patent rights waived to contractors or inventors

    SciTech Connect

    Not Available

    1987-12-01

    Our review showed that the Department had not recovered all patent application and prosecution costs for waivers granted to M and O contractors and employee-inventors. The operations offices and M and O contractors used different and inconsistent methods of computing these costs. The precise amount of the under-recovery could not be accurately determined. However, we estimated the under-recovery on 34 patents waived at the Lawrence Livermore and Los Alamos during FY 1984 through 1986 was about $187,000.

  14. Natural gas and CO2 price variation: impact on the relative cost-efficiency of LNG and pipelines

    PubMed Central

    Ulvestad, Marte; Overland, Indra

    2012-01-01

    This article develops a formal model for comparing the cost structure of the two main transport options for natural gas: liquefied natural gas (LNG) and pipelines. In particular, it evaluates how variations in the prices of natural gas and greenhouse gas emissions affect the relative cost-efficiency of these two options. Natural gas is often promoted as the most environmentally friendly of all fossil fuels, and LNG as a modern and efficient way of transporting it. Some research has been carried out into the local environmental impact of LNG facilities, but almost none into aspects related to climate change. This paper concludes that at current price levels for natural gas and CO2 emissions the distance from field to consumer and the volume of natural gas transported are the main determinants of transport costs. The pricing of natural gas and greenhouse emissions influence the relative cost-efficiency of LNG and pipeline transport, but only to a limited degree at current price levels. Because more energy is required for the LNG process (especially for fuelling the liquefaction process) than for pipelines at distances below 9100 km, LNG is more exposed to variability in the price of natural gas and greenhouse gas emissions up to this distance. If the prices of natural gas and/or greenhouse gas emission rise dramatically in the future, this will affect the choice between pipelines and LNG. Such a price increase will be favourable for pipelines relative to LNG. PMID:24683269

  15. 40 CFR 35.3520 - Systems, projects, and project-related costs eligible for assistance from the Fund.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Systems, projects, and project-related costs eligible for assistance from the Fund. 35.3520 Section 35.3520 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Drinking Water State Revolving Funds § 35.3520...

  16. 40 CFR 35.3520 - Systems, projects, and project-related costs eligible for assistance from the Fund.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Systems, projects, and project-related costs eligible for assistance from the Fund. 35.3520 Section 35.3520 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Drinking Water State Revolving Funds § 35.3520...

  17. 26 CFR 1.1059A-1 - Limitation on taxpayer's basis or inventory cost in property imported from related persons.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 11 2012-04-01 2012-04-01 false Limitation on taxpayer's basis or inventory cost in property imported from related persons. 1.1059A-1 Section 1.1059A-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Special Rules § 1.1059A-1 Limitation...

  18. 32 CFR 37.535 - How do I value cost sharing related to real property or equipment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false How do I value cost sharing related to real property or equipment? 37.535 Section 37.535 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Pre-Award...

  19. Externalities and the Coase Theorem: A Diagrammatic Presentation

    ERIC Educational Resources Information Center

    Halteman, James

    2005-01-01

    In intermediate microeconomic textbooks the reciprocal nature of externalities is presented using numerical examples of costs and benefits. This treatment of the Coase theorem obscures the fact that externality costs and benefits are best understood as being on a continuum where costs vary with the degree of intensity of the externality. When…

  20. Stocking of hatchery-reared striped bass in the Patuxent River, Maryland: survival, relative abundance, and cost-effectiveness

    USGS Publications Warehouse

    Dorazio, R.M.; Florence, B.M.; Wooley, C.M.

    1991-01-01

    Hatchery-reared fingerlings of striped bass Morone saxatilis were tagged, stocked, and recovered in the Patuxent River, Maryland, to estimate their survival and abundance relative to wild young of the year and to compare the costs and benefits of stocking phase-I (35–50 mm, total length) and phase-II (150–200 mm) fish. About 100,000 phase-I fingerlings were tagged and released each year during midsummer 1988 and 1989. Both tagged and untagged (wild) young of the year were recovered by alongshore seining in the river through 80 d poststocking. Mortality rates of wild and hatchery-reared young of the year were not significantly different-about 3%/d. Wild young of the year were more abundant in 1989 than in 1988. In 1988, phase-I fingerlings composed 56% of all young-of-the-year striped bass in the river. In 1989 wild young-of-the-year striped bass outnumbered hatchery-reared fingerlings by about 11 to 1. Whether phase-I or phase-II stocking was more cost-effective depended on the relative magnitudes of fingerling survival and on hatchery production costs. The range of phase-II survival (5–50%) observed among different hatcheries and years of production was too broad to support generalizations about cost-effectiveness, given the fivefold difference in the unit costs of phase-I and phase-II production.

  1. Impact of mobility impairment on indirect costs and health-related quality of life in multiple sclerosis.

    PubMed

    Coleman, Craig I; Sidovar, Matthew F; Roberts, Matthew S; Kohn, Christine

    2013-01-01

    This study was conducted to estimate the indirect costs and health-related quality of life (HRQoL) (utilities) of multiple sclerosis (MS) patients in the United States (US), and to determine the impact of worsening mobility on these parameters. In collaboration with the North American Research Committee on Multiple Sclerosis (NARCOMS) registry we conducted a cross-sectional study of participants who completed the biannual update and supplemental spring 2010 survey. Demographic, employment status, income, mobility impairment, and health utility data were collected from a sample of registry participants who met the study criteria and agreed to participate in the supplemental Mobility Study. Mean annual indirect costs per participant in 2011US$ and mean utilities for the population and for cohorts reporting different levels of mobility impairment were estimated. Analyses included 3,484 to 3,611 participants, based on survey completeness. Thirty-seven percent of registrants were not working or attending school and 46.7% of these reported retiring early. Indirect costs per participant per year, not including informal caregiver cost, were estimated at $30,601±31,184. The largest relative increase in indirect costs occurred at earlier mobility impairment stages, regardless of the measure used. Participants' mean utility score (0.73±0.18) was lower than that of a similarly aged sample from the general US population (0.87). As with indirect costs, larger decrements in utility were seen at earlier mobility impairment stages. These results suggest that mobility impairment may contribute to increases in indirect costs and declines in HRQoL in MS patients. PMID:23355896

  2. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... scarce items for contract performance; or (ii) Disposing of scrap or surplus materials acquired for contract performance; (2) Costs of activities to promote sales of products normally sold to the U.S... sale of products or services and to accomplish the activities referred to in paragraph (d) of...

  3. 48 CFR 931.205-47 - Costs related to legal and other proceedings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... contractor and any administrative procedure initiated by an employee under 29 CFR part 24, 48 CFR subpart 3.9, 10 CFR part 708 or 42 U.S.C. 7239. Retaliatory act means a discharge, demotion, reduction in pay... ENERGY GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With...

  4. Inactive Lifestyles and Obesity in Chilean Youth: Individual Costs in Health-Related Choices

    ERIC Educational Resources Information Center

    Correa-Burrows, Paulina; Burrows, Raquel A.

    2014-01-01

    Objective: A recent economic approach suggests that people do not account for the long-term implications of unhealthy behaviours, preventing them from performing a fully rational trade-off between current benefits and future costs, leading to negative health outcomes. We examined whether the current allocation of time to physical activity among…

  5. 48 CFR 31.205-47 - Costs related to legal and other proceedings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... legal services, whether performed by in-house or private counsel; the costs of the services of... connection with— (1) Defense against Federal Government claims or appeals or the prosecution of claims or... prosecution of lawsuits or appeals between contractors arising from either (i) an agreement or...

  6. Community College Finance: A Cost Analysis of Community College Expenditures Related to Maintenance and Operations

    ERIC Educational Resources Information Center

    Collins, Michael T.

    2011-01-01

    The purpose of this study is to develop a costing model for maintenance and operations expenditures among 16 single-campus California community college districts and assess the impact of a variety of variables including size of student enrollment, physical plant age, acreage, gross square footage, and general obligation facility bonds on district…

  7. Fall-Related Hospitalization and Facility Costs among Residents of Institutions Providing Long-Term Care

    ERIC Educational Resources Information Center

    Carroll, Norman V.; Delafuente, Jeffrey C.; Cox, Fred M.; Narayanan, Siva

    2008-01-01

    Purpose: The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). Design and Methods: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers.…

  8. 48 CFR 931.205-47 - Costs related to legal and other proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... contractor and any administrative procedure initiated by an employee under 29 CFR part 24, 48 CFR subpart 3.9, 10 CFR part 708 or 42 U.S.C. 7239. Retaliatory act means a discharge, demotion, reduction in pay... costs on a provisional basis, in appropriate cases; (ii) Must consult with the Office of General...

  9. Multi-method Assessment of Psychopathy in Relation to Factors of Internalizing and Externalizing from the Personality Assessment Inventory: The Impact of Method Variance and Suppressor Effects

    PubMed Central

    Blonigen, Daniel M.; Patrick, Christopher J.; Douglas, Kevin S.; Poythress, Norman G.; Skeem, Jennifer L.; Lilienfeld, Scott O.; Edens, John F.; Krueger, Robert F.

    2010-01-01

    Research to date has revealed divergent relations across factors of psychopathy measures with criteria of internalizing (INT; anxiety, depression) and externalizing (EXT; antisocial behavior, substance use). However, failure to account for method variance and suppressor effects has obscured the consistency of these findings across distinct measures of psychopathy. Using a large correctional sample, the current study employed a multi-method approach to psychopathy assessment (self-report, interview/file review) to explore convergent and discriminant relations between factors of psychopathy measures and latent criteria of INT and EXT derived from the Personality Assessment Inventory (PAI; L. Morey, 2007). Consistent with prediction, scores on the affective-interpersonal factor of psychopathy were negatively associated with INT and negligibly related to EXT, whereas scores on the social deviance factor exhibited positive associations (moderate and large, respectively) with both INT and EXT. Notably, associations were highly comparable across the psychopathy measures when accounting for method variance (in the case of EXT) and when assessing for suppressor effects (in the case of INT). Findings are discussed in terms of implications for clinical assessment and evaluation of the validity of interpretations drawn from scores on psychopathy measures. PMID:20230156

  10. Public Relations: The Cost-Effective Way to Build Your Business.

    ERIC Educational Resources Information Center

    Ochman, B. L.

    1989-01-01

    Differences between advertising and public relations are described, and basic elements of public relations are outlined: community relations, special events, and publicity. Examples of successful community relations and special events conducted by corporations are noted. Techniques for acquiring publicity are described using the acronym NEWS (new,…

  11. Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

    SciTech Connect

    Morton, Gerard C.; Loblaw, D. Andrew; Chung, Hans; Tsang, Gail; Sankreacha, Raxa; Deabreu, Andrea; Zhang Liying; Mamedov, Alexandre; Cheung, Patrick; Batchelar, Deidre; Danjoux, Cyril; Szumacher, Ewa

    2011-08-01

    Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose

  12. Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

    SciTech Connect

    Ferrer, Montserrat Suarez, Jose Francisco; Guedea, Ferran; Fernandez, Pablo; Macias, Victor; Marino, Alfonso; Hervas, Asuncion; Herruzo, Ismael; Ortiz, Maria Jose; Villavicencio, Humberto; Craven-Bratle, Jordi; Garin, Olatz; Aguilo, Ferran

    2008-10-01

    Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel

  13. The relative cost of bent-hip bent-knee walking is reduced in water.

    PubMed

    Kuliukas, Algis V; Milne, Nick; Fournier, Paul

    2009-01-01

    The debate about how early hominids walked may be characterised as two competing hypotheses: They moved with a fully upright (FU) gait, like modern humans, or with a bent-hip, bent-knee (BK) gait, like apes. Both have assumed that this bipedalism was almost exclusively on land, in trees or a combination of the two. Recent findings favoured the FU hypothesis by showing that the BK gait is 50-60% more energetically costly than a FU human gait on land. We confirm these findings but show that in water this cost differential is markedly reduced, especially in deeper water, at slower speeds and with greater knee flexion. These data suggest that the controversy about australopithecine locomotion may be eased if it is assumed that wading was a component of their locomotor repertoire and supports the idea that shallow water might have been an environment favourable to the evolution of early forms of "non-optimal" hominid bipedalism. PMID:19853850

  14. Roots and Benefits of Costly Giving: Young Children's Altruism is Related to Having Less Family Wealth and More Autonomic Flexibility

    PubMed Central

    Miller, Jonas G.; Kahle, Sarah; Hastings, Paul D.

    2015-01-01

    Altruism, although costly, may promote well-being for those who give. Costly giving by adults has received considerable attention, but less is known about the possible benefits, as well as biological and environmental correlates, of altruism in early childhood. In the current study, we present evidence that children who forgo self-gain to help others show greater vagal flexibility and higher subsequent vagal tone than those who do not, and children from less wealthy families behave more altruistically than those from wealthier families. These results suggest that altruism should be viewed through a biopsychosocial lens; that privileged contexts have an early-emerging influence on children's willingness to make personal sacrifices for others; and that altruism and healthy vagal functioning may share reciprocal relations in childhood. When children help others at a cost to themselves, they could be playing an active role in promoting their own well-being as well as the well-being of others. PMID:26015412

  15. Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases

    PubMed Central

    Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

    2016-01-01

    Context In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. Methods and Findings We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15–75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. Conclusion The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings. PMID:26909802

  16. Alternating between pro- and antisaccades: switch-costs manifest via decoupling the spatial relations between stimulus and response.

    PubMed

    Heath, Matthew; Gillen, Caitlin; Samani, Ashna

    2016-03-01

    Antisaccades are a nonstandard task requiring a response mirror-symmetrical to the location of a target. The completion of an antisaccade has been shown to delay the reaction time (RT) of a subsequent prosaccade, whereas the converse switch elicits a null RT cost (i.e., the unidirectional prosaccade switch-cost). The present study sought to determine whether the prosaccade switch-cost arises from low-level interference specific to the sensory features of a target (i.e., modality-dependent) or manifests via the high-level demands of dissociating the spatial relations between stimulus and response (i.e., modality-independent). Participants alternated between pro- and antisaccades wherein the target associated with the response alternated between visual and auditory modalities. Thus, the present design involved task-switch (i.e., switching from a pro- to antisaccade and vice versa) and modality-switch (i.e., switching from a visual to auditory target and vice versa) trials as well as their task- and modality-repetition counterparts. RTs were longer for modality-switch than modality-repetition trials. Notably, however, modality-switch trials did not nullify or lessen the unidirectional prosaccade switch-cost; that is, the magnitude of the RT cost for task-switch prosaccades was equivalent across modality-switch and modality-repetition trials. Thus, competitive interference within a sensory modality does not contribute to the unidirectional prosaccade switch-cost. Instead, the modality-independent findings evince that dissociating the spatial relations between stimulus and response instantiates a high-level and inertially persistent nonstandard task-set that impedes the planning of a subsequent prosaccade. PMID:26661337

  17. Cost of care and social consequences of very low birth weight infants without premature- related morbidities in Italy.

    PubMed

    Cavallo, Maria Caterina; Gugiatti, Attilio; Fattore, Giovanni; Gerzeli, Simone; Barbieri, Dario; Zanini, Rinaldo

    2015-01-01

    Aim of this study was to estimate the cost that is borne by the Italian National Health Service, families, and social security due to very low birth weight infants (VLBWIs) without prematurity-related morbidities up to the age of 18 months. We followed up on 150 VLBWIs and 145 comparable full-term infants (FTIs) who were born in one of 25 different neonatal intensive care units upon discharge from the hospital and at six and 18 months of age. The average length of the primary hospitalisation of the VLBWIs was 59.7 days (SD 21.6 days), with a total cost of €20,502 (SD €8409), compared with three days (SD 0.4 days) with a total cost of €907 (SD €304) for the FTIs. The total societal cost of the VLBWIs for the first 18 months of life was €58,098 (SD €21,625), while the corresponding figure for FTIs was €24,209 (SD €15,557). Among VLBWIs, both low birth weight and gestational age were correlated with the length of hospitalisation after birth (r(2) = 0.61 and r(2) = 0.57, respectively; p values < 0.0005). Our findings highlight that the existing DRGs and tariffs inadequately reflect the actual costs for Italian National Health Service. PMID:26286526

  18. Reduced oxygen cost of running is related to alignment of the resultant GRF and leg axis vector: A pilot study.

    PubMed

    Moore, I S; Jones, A M; Dixon, S J

    2016-07-01

    This pilot study investigated whether a 10-week running program (10wkRP), which reduced the oxygen cost of running, affected resultant ground reaction force (GRF), leg axis alignment, joint moment characteristics, and gear ratios. Ten novice, female runners completed a 10wkRP. Running kinematics and kinetics, in addition to oxygen consumption ( V ˙ O 2 ) during steady-state running, were recorded pre- and post-10wkRP. V ˙ O 2 decreased (8%) from pre-10wkRP to post-10wkRP. There was a better alignment of the resultant GRF and leg axis at peak propulsion post-10wkRP compared with pre-10wkRP (10.8 ± 4.9 vs 1.6 ± 1.2°), as the resultant GRF vector was applied 7 ± 0.6° (P = 0.008) more horizontally. There were shorter external ankle moment arms (24%) and smaller knee extensor moments (23%) at peak braking post-10wkRP. The change in V ˙ O 2 was associated with the change in alignment of the resultant GRF and leg axis (rs  = 0.88, P = 0.003). As runners became more economical, they exhibited a more aligned resultant GRF vector and leg axis at peak propulsion. This appears to be a self-optimization strategy that may improve performance. Additionally, changes to external ankle moment arms indicated beneficial low gear ratios were achieved at the time of peak braking force. PMID:26148145

  19. Relative contribution of maize and external manure amendment to soil carbon sequestration in a long-term intensive maize cropping system

    PubMed Central

    Zhang, Wenju; Liu, Kailou; Wang, Jinzhou; Shao, Xingfang; Xu, Minggang; Li, Jianwei; Wang, Xiujun; Murphy, Daniel V.

    2015-01-01

    We aimed to quantify the relative contributions of plant residue and organic manure to soil carbon sequestration. Using a 27-year-long inorganic fertilizer and manure amendment experiment in a maize (Zea mays L.) double-cropping system, we quantified changes in harvestable maize biomass and soil organic carbon stocks (0–20 cm depth) between 1986-2012. By employing natural 13C tracing techniques, we derived the proportional contributions of below-ground crop biomass return (maize-derived carbon) and external manure amendment (manure-derived carbon) to the total soil organic carbon stock. The average retention of maize-derived carbon plus manure-derived carbon during the early period of the trial (up to 11 years) was relatively high (10%) compared to the later period (22 to 27 years, 5.1–6.3%). About 11% of maize-derived carbon was converted to soil organic carbon, which was double the retention of manure-derived carbon (4.4–5.1%). This result emphasized that organic amendments were necessary to a win-win strategy for both SOC sequestration and maize production. PMID:26039186

  20. Investigating the chemical profile of regenerated scorpion (Parabuthus transvaalicus) venom in relation to metabolic cost and toxicity.

    PubMed

    Nisani, Zia; Boskovic, Danilo S; Dunbar, Stephen G; Kelln, Wayne; Hayes, William K

    2012-09-01

    We investigated the biochemical profile of regenerated venom of the scorpion Parabuthus transvaalicus in relation to its metabolic cost and toxicity. Using a closed-system respirometer, we compared oxygen consumption between milked and unmilked scorpions to determine the metabolic costs associated with the first 192 h of subsequent venom synthesis. Milked scorpions had a substantially (21%) higher mean metabolic rate than unmilked scorpions, with the largest increases in oxygen consumption occurring at approximately 120 h, 162 h, and 186 h post-milking. Lethality tests in crickets indicated that toxicity of the regenerated venom returned to normal levels within 4 d after milking. However, the chemical profile of the regenerated venom, as evaluated by FPLC and MALDI-TOF mass spectrometry, suggested that regeneration of different venom components was asynchronous. Some peptides regenerated quickly, particularly those associated with the scorpion's "prevenom," whereas others required much or all of this time period for regeneration. This asynchrony could explain the different spikes detected in oxygen consumption of milked scorpions as various peptides and other venom components were resynthesized. These observations confirm the relatively high metabolic cost of venom regeneration and suggest that greater venom complexity can be associated with higher costs of venom production. PMID:22564718

  1. The Reciprocal Internal/External Frame of Reference Model: An Integration of Models of Relations between Academic Achievement and Self-Concept

    ERIC Educational Resources Information Center

    Moller, Jens; Retelsdorf, Jan; Koller, Olaf; Marsh, Herb W.

    2011-01-01

    The reciprocal internal/external frame of reference model (RI/EM) combines the internal/external frame of reference model and the reciprocal effects model. The RI/EM predicts positive effects of mathematics and verbal achievement and academic self-concepts (ASC) on subsequent mathematics and verbal achievements and ASCs within domains and negative…

  2. External Beam Therapy (EBT)

    MedlinePlus

    ... Physician Resources Professions Site Index A-Z External Beam Therapy (EBT) External beam therapy (EBT) is a ... follow-up should I expect? What is external beam therapy and how is it used? External beam ...

  3. Costs associated with functional gastrointestinal disorders and related signs and symptoms in infants: a systematic review protocol

    PubMed Central

    Glanville, Julie; Ludwig, Thomas; Lifschitz, Carlos; Mahon, James; Miqdady, Mohamad; Saps, Miguel; Hock Quak, Seng; Lenoir-Wijnkoop, Irene; Wood, Hannah; Szajewska, Hania

    2016-01-01

    Introduction Functional gastrointestinal disorders (FGIDs) and FGID-related signs and symptoms have a fundamental impact on the psychosocial, physical and mental well-being of infants and their parents alike. Recent reviews and studies have indicated that FGIDs and related signs and symptoms may also have a substantial impact on the budgets of third-party payers and/or parents. The objective of this systematic review is to investigate these costs. Methods and analysis The population of interest is healthy term infants (under 12 months of age) with colic, regurgitation and/or functional constipation. Outcomes of interest will include the frequency and volume of reported treatments, the cost to third-party payers and/or parents for prescribed or over the counter treatments, visits to health professionals and changes in infant formula purchases, and the loss of income through time taken off work and out of pocket costs. Relevant studies will be identified by searching databases from 2005 onwards (including MEDLINE, EMBASE, PsycINFO, NEXIS, DARE, Health Technology Assessment database, National Health Service Economic Evaluation Database and others), conferences from the previous 3 years and scanning reference lists of eligible studies. Study selection, data extraction and quality assessment will be conducted by two independent reviewers and disagreements resolved in discussion with a third reviewer. Quality assessment will involve study design-specific checklists. Relevant studies will be summarised narratively and presented in tables. An overview of treatments and costs will be provided, with any geographical or other differences highlighted. An assessment of how the totals for cost differ across countries and elements that contribute to the differences will be generated. Ethics and dissemination This is a systematic review of published studies that will be submitted for publication to a peer-reviewed journal. Ethical committee approval is not required. Trial

  4. Relative effects of submersion and increased pressure on respiratory mechanics, work, and energy cost of breathing.

    PubMed

    Held, Heather E; Pendergast, David R

    2013-03-01

    Submersion and increased pressure (depth) characterize the diving environment and may independently increase demand on the respiratory system. To quantify changes in respiratory mechanics, this study employed a unique protocol and techniques to measure, in a hyperbaric chamber, inspiratory and expiratory alveolar pressures (interrupter technique), inspiratory and expiratory resistance in the airways (RawI and RawE, esophageal balloon technique), nitric oxide elimination (thought to correlate with Raw), inspiratory and expiratory mechanical power of breathing, and the total energy cost of ventilation. Eight healthy adult men underwent experiments at 1, 2.7, and 4.6 atmospheres absolute (ATA) in dry and fully submersed conditions. Subjects rested, cycled on an ergometer at 100 W, and rested while voluntarily matching their ventilation to their own exercise hyperpnea (isocapnic simulated exercise ventilation). During isocapnic simulated exercise ventilation, increased O2 uptake (above rest values) resulted from increased expired ventilation. RawI decreased with submersion (mean 43% during rest and 20% during exercise) but increased from 1 to 4.6 ATA (19% during rest and 75% during exercise), as did RawE (53% decrease with submersion during rest and 10% during exercise; 9% increase from 1 to 4.6 ATA during rest and 66% during exercise). Nitric oxide elimination did not correlate with Raw. Depth increased inspiratory mechanical power of breathing during rest (40%) and exercise (20%). Expiratory mechanical power of breathing was largely unchanged. These results suggest that the diving environment affects ventilatory mechanics primarily by increasing Raw, secondary to increased gas density. This necessitates increased alveolar pressure and increases the work and energy cost of breathing as the diver descends. These findings can inform physician assessment of diver fitness and the pulmonary risks of hyperbaric O2 therapy. PMID:23305982

  5. Social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain

    PubMed Central

    2012-01-01

    Background Cost-of-illness analysis is the main method of providing an overall vision of the economic impact of a disease. Such studies have been used to set priorities for healthcare policies and inform resource allocation. The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) in the first, second and third years after surviving a stroke in the Canary Islands, Spain. Methods Cross-sectional, retrospective study of 448 patients with stroke based on ICD 9 discharge codes, who received outpatient care at five hospitals. The study was approved by the Research Ethics Committee of Nuestra Señora de la Candelaria University Hospital. Data on demographic characteristics, health resource utilization, informal care, labor productivity losses and HRQOL were collected from the hospital admissions databases and questionnaires completed by stroke patients or their caregivers. Labor productivity losses were calculated from physical units and converted into monetary units with a human capital-based method. HRQOL was measured with the EuroQol EQ-5D questionnaire. Healthcare costs, productivity losses and informal care costs were analyzed with log-normal, probit and ordered probit multivariate models. Results The average cost for each stroke survivor was €17 618 in the first, €14 453 in the second and €12 924 in the third year after the stroke; the reference year for unit prices was 2004. The largest expenditures in the first year were informal care and hospitalizations; in the second and third years the main costs were for informal care, productivity losses and medication. Mean EQ-5D index scores for stroke survivors were 0.50 for the first, 0.47 for the second and 0.46 for the third year, and mean EQ-5D visual analog scale scores were 56, 52 and 55, respectively. Conclusions The main strengths of this study lie in our bottom-up-approach to costing, and in the evaluation of stroke survivors from a broad perspective (societal

  6. The Indirect Effect of Age Group on Switch Costs via Gray Matter Volume and Task-Related Brain Activity.

    PubMed

    Steffener, Jason; Gazes, Yunglin; Habeck, Christian; Stern, Yaakov

    2016-01-01

    Healthy aging simultaneously affects brain structure, brain function, and cognition. These effects are often investigated in isolation ignoring any relationships between them. It is plausible that age related declines in cognitive performance are the result of age-related structural and functional changes. This straightforward idea is tested in within a conceptual research model of cognitive aging. The current study tested whether age-related declines in task-performance were explained by age-related differences in brain structure and brain function using a task-switching paradigm in 175 participants. Sixty-three young and 112 old participants underwent MRI scanning of brain structure and brain activation. The experimental task was an executive context dual task with switch costs in response time as the behavioral measure. A serial mediation model was applied voxel-wise throughout the brain testing all pathways between age group, gray matter volume, brain activation and increased switch costs, worsening performance. There were widespread age group differences in gray matter volume and brain activation. Switch costs also significantly differed by age group. There were brain regions demonstrating significant indirect effects of age group on switch costs via the pathway through gray matter volume and brain activation. These were in the bilateral precuneus, bilateral parietal cortex, the left precentral gyrus, cerebellum, fusiform, and occipital cortices. There were also significant indirect effects via the brain activation pathway after controlling for gray matter volume. These effects were in the cerebellum, occipital cortex, left precentral gyrus, bilateral supramarginal, bilateral parietal, precuneus, middle cingulate extending to medial superior frontal gyri and the left middle frontal gyri. There were no significant effects through the gray matter volume alone pathway. These results demonstrate that a large proportion of the age group effect on switch costs can

  7. The Indirect Effect of Age Group on Switch Costs via Gray Matter Volume and Task-Related Brain Activity

    PubMed Central

    Steffener, Jason; Gazes, Yunglin; Habeck, Christian; Stern, Yaakov

    2016-01-01

    Healthy aging simultaneously affects brain structure, brain function, and cognition. These effects are often investigated in isolation ignoring any relationships between them. It is plausible that age related declines in cognitive performance are the result of age-related structural and functional changes. This straightforward idea is tested in within a conceptual research model of cognitive aging. The current study tested whether age-related declines in task-performance were explained by age-related differences in brain structure and brain function using a task-switching paradigm in 175 participants. Sixty-three young and 112 old participants underwent MRI scanning of brain structure and brain activation. The experimental task was an executive context dual task with switch costs in response time as the behavioral measure. A serial mediation model was applied voxel-wise throughout the brain testing all pathways between age group, gray matter volume, brain activation and increased switch costs, worsening performance. There were widespread age group differences in gray matter volume and brain activation. Switch costs also significantly differed by age group. There were brain regions demonstrating significant indirect effects of age group on switch costs via the pathway through gray matter volume and brain activation. These were in the bilateral precuneus, bilateral parietal cortex, the left precentral gyrus, cerebellum, fusiform, and occipital cortices. There were also significant indirect effects via the brain activation pathway after controlling for gray matter volume. These effects were in the cerebellum, occipital cortex, left precentral gyrus, bilateral supramarginal, bilateral parietal, precuneus, middle cingulate extending to medial superior frontal gyri and the left middle frontal gyri. There were no significant effects through the gray matter volume alone pathway. These results demonstrate that a large proportion of the age group effect on switch costs can

  8. Singing-related neural activity distinguishes two putative pallidal cell types in the songbird basal ganglia: comparison to the primate internal and external pallidal segments

    PubMed Central

    Goldberg, Jesse H.; Adler, Avital; Bergman, Hagai; Fee, Michale S.

    2010-01-01

    The songbird area X is a basal ganglia homologue that contains two pallidal cell types—local neurons that project within the basal ganglia and output neurons that project to the thalamus. Based on these projections, it has been proposed that these classes are structurally homologous to the primate external (GPe) and internal (GPi) pallidal segments. To test the hypothesis that the two area X pallidal types are functionally homologous to GPe and GPi neurons, we recorded from neurons in area X of singing juvenile male zebra finches, and directly compare their firing patterns to neurons recorded in the primate pallidus. In area X, we find two cell classes that exhibited high firing (HF) rates (>60Hz) characteristic of pallidal neurons. HF-1 neurons, like most GPe neurons we examined, exhibited large firing rate modulations, including bursts and long pauses. In contrast, HF-2 neurons, like GPi neurons, discharged continuously without bursts or long pauses. To test if HF-2 neurons were the output neurons that project to the thalamus, we next recorded directly from pallidal axon terminals in thalamic nucleus DLM, and found that all terminals exhibited singing-related firing patterns indistinguishable from HF-2 neurons. Our data show that singing-related neural activity distinguishes two putative pallidal cell types in area X: thalamus-projecting neurons that exhibit activity similar to the primate GPi, and non-thalamus-projecting neurons that exhibit activity similar to the primate GPe. These results suggest that song learning in birds and motor learning in mammals employ conserved basal ganglia signaling strategies. PMID:20484651

  9. Cost-Effectiveness Evaluation of Quadrivalent Human Papilloma Virus Vaccine for HPV-Related Disease in Iran

    PubMed Central

    Khatibi, Mohsen; Rasekh, Hamid Reza; Shahverdi, Zohreh; jamshidi, Hamid Reza

    2014-01-01

    Human Papilloma Virus (HPV) vaccine has been added recently to the Iran Drug List. So, decision makers need information beyond that available from RCTs to recommend funding for this vaccination program to add it to the National Immunization program in Iran. Modeling and economic studies have addressed some of those information needs in foreign countries. In order to determine the long term benefit of this vaccine and impact of vaccine program on the future rate of cervical cancer in Iran, we described a model, based on the available economic and health effects of human papilloma virus (HPV), to estimate the cost-effectiveness of HPV vaccination of 15-year-old girls in Iran. Our objective is to estimate the cost-effectiveness of HPV vaccination in Iran against cervical cancer based on available data; incremental cost-effectiveness ratio (ICER) calculations were based on a model comparing a cohort of 15-year-old girls with and without vaccination. We developed a static model based on available data in Iran on the epidemiology of HPV related health outcome. The model compared the cohort of all 15-year old girls alive in the year 2013 with and without vaccination. The cost per QALY, which was found based on our assumption for the vaccination of 15-years old girl to current situation was 439,000,000 Iranian Rial rate (IRR). By considering the key parameters in our sensitivity analysis, value varied from 251,000,000 IRR to 842,000,000 IRR. In conclusion, quadrivalent HPV vaccine (Gardasil) is not cost-effective in Iran based on the base-case parameters value. PMID:24711850

  10. Impact of External Beam Adjuvant Radiotherapy on Health-Related Quality of Life for Long-Term Survivors of Endometrial Adenocarcinoma: A Population-Based Study

    SciTech Connect

    Poll-Franse, Lonneke V. van de; Essink-Bot, Marie-Louise; Vingerhoets, Ad J.J.M.; Lybeert, Marnix L.M.; Berg, Hetty A. van den; Coebergh, Jan Willem W.

    2007-09-01

    Purpose: To compare the health-related quality of life (HRQOL) among 5-10-year survivors of Stage I-II endometrial (adeno-)carcinoma (EC) treated with surgery alone or surgery with external beam adjuvant radiotherapy (EBRT) and an age-matched norm population. Methods and Materials: A population-based, cross-sectional survey was conducted by the Eindhoven Cancer Registry. All patients were included who had been diagnosed with EC between 1994 and 1998 (n = 462). Information from the questionnaires returned was linked to data from the Eindhoven Cancer Registry on patient, tumor, and treatment characteristics. Results: Responses were received from 75% of the patients. The analyses were restricted to women with Stage I-II disease at diagnosis, treated with either surgery alone or surgery with adjuvant EBRT, and without recurrent disease or new primary malignancies (n = 264). The patients who had received adjuvant EBRT (n = 80) had had a significantly higher tumor stage and grade at diagnosis (p < 0.0001) and a longer mean time since diagnosis (p = 0.04). Age, number of comorbid diseases, current marital status, nulliparity, education, and occupation were similar for both treatment groups. On multivariate analyses, adjuvant EBRT was independently and negatively associated with the vitality and physical and social well-being scale scores. The HRQOL scores of both treatment groups, however, were similar to those of an age-matched norm population. Conclusion: In general, the HRQOL of EC survivors is good. EC survivors treated with surgery alone had a better HRQOL than women treated with surgery and adjuvant EBRT, although for both groups, the HRQOL was in the range of the norm population.

  11. Reproductive patterns result from age-related sensitivity to resources and reproductive costs in a mammalian carnivore.

    PubMed

    Rauset, Geir Rune; Low, Matthew; Persson, Jens

    2015-12-01

    Although the effects of individual age, resource availability, and reproductive costs have been extensively studied to understand the causes of variation in reproductive output, there are almost no studies showing how these factors interact in explaining this variation. To examine this interaction, we used longitudinal demographic data from an 18-year study of 53 breeding female wolverines (Gulo gulo), and corresponding environmental data from their individual home ranges. Females showed a typical age-related pattern in reproductive output, with an initial increase followed by a senescent decline in later years. This pattern was largely driven by four processes: (1) physiological/behavioral maturation between ages two and three; (2) age-related differences in the costs of reproduction resulting in an initial increase, and then a declining probability of breeding two years in a row as individuals aged; (3) resource availability (reindeer [Rangifer tarandus] carcass abundance; mostly Eurasian lynx [Lynx lynx] kills) in the months preceding parturition, which influenced the probability of having cubs, but only for individuals that had successfully bred in the previous year; and (4) resource availability also influenced the cost of reproduction in an age-dependent manner, as prime age females that had bred in the previous year were more responsive to resource availability than those at other ages. This study demonstrates that by examining how drivers of reproductive variation interact, we can get a much clearer understanding of the mechanisms responsible for age-related patterns of reproduction. This has implications not only for general ecological theory, but will also allow better predictions of population resnonses to environmental changes or management based on a population's age-structure. PMID:26909422

  12. Increased strength and decreased flexibility are related to reduced oxygen cost of walking

    PubMed Central

    McCarthy, John P.; Bryan, David R.; Zuckerman, Paul A.; Bamman, Marcas M.; Byrne, Nuala M.

    2009-01-01

    Purpose was determine effects resistance training/weight loss induced changes in muscular strength and flexibility have on net walking oxygen uptake (netVO2). Sixty-seven premenopausal women lost 12 kg. Before weight loss subjects were assigned to diet (WL) or diet/3 days per week resistance training (WLRT). Resting energy expenditure, oxygen uptake while walking at 4.84 km h−1 on the flat and up 2.5% grade, isometric knee extension strength, and flexibility of the knee extensors and plantar flexors were measured. Strength increased in WLRT (+36 N) but not in WL (−24 N). NetVO2 decreased significantly while flat walking (7.3%) and 2.5% grade walking (5.7%) in WLRT, but not in WL. Delta strength was negatively while delta knee extensor and plantar flexor flexibility were positively related to delta netVO2. Decreases in walking and grade netVO2 were independently and positively related to increased knee extension strength and decreased knee extensor and plantar flexor flexibility. PMID:18758805

  13. Bevacizumab (AVASTIN) and age-related macular degeneration. Lower cost does not justify taking risks.

    PubMed

    2015-09-01

    Intravitreal injection of ranibizumab, a VEGF inhibitor, is an option for patients with neovascular age-related macular degeneration (AMD). Because of its lower price, bevacizumab, a VEGF inhibitor closely related to ranibizumab and marketed for the treatment of various malignancies, is sometimes used off label for intravitreal injection in AMD. In 2011, the harm-benefit balance of bevacizumab in patients with AMD was uncertain. New data are available in 2015. In six randomised trials including a total of about 3200 patients, funded independently of the pharmaceutical industry, bevacizumab (1.25 mg per dose) was about as effective as ranibizumab (0.5 mg per injection): visual acuity stabilised or improved in 90% to 95% of patients after one to two years of treatment. During these trials, bevacizumab did not reduce the number of injections needed, as compared with ranibizumab. These trials confirmed the known adverse effect profile of bevacizumab, which is similar to that of ranibizumab and includes serious ocular as well as extraocular adverse effects, in particular cardiac disorders. Serious extraocular adverse events, especially gastrointestinal disorders, were more frequent with bevacizumab than with ranibizumab at one year (18% versus 14%). In early 2015, there are no bevacizumab products suitable for intravitreal injection. In 2011, cases of sight-threatening infectious endophthalmitis were reported in the United States, following contamination during syringe preparation for intravitreal administration. In practice, when treatment with a VEGF inhibitor is considered for AMD, it is more prudent to choose ranibizumab, despite its currently unacceptable price. PMID:26417625

  14. Predation-Related Costs and Benefits of Conspecific Attraction in Songbirds—An Agent-Based Approach

    PubMed Central

    Szymkowiak, Jakub; Kuczyński, Lechosław

    2015-01-01

    Songbirds that follow a conspecific attraction strategy in the habitat selection process prefer to settle in habitat patches already occupied by other individuals. This largely affects the patterns of their spatio-temporal distribution and leads to clustered breeding. Although making informed settlement decisions is expected to be beneficial for individuals, such territory clusters may potentially provide additional fitness benefits (e.g., through the dilution effect) or costs (e.g., possibly facilitating nest localization if predators respond functionally to prey distribution). Thus, we hypothesized that the fitness consequences of following a conspecific attraction strategy may largely depend on the composition of the predator community. We developed an agent-based model in which we simulated the settling behavior of birds that use a conspecific attraction strategy and breed in a multi-predator landscape with predators that exhibited different foraging strategies. Moreover, we investigated whether Bayesian updating of prior settlement decisions according to the perceived predation risk may improve the fitness of birds that rely on conspecific cues. Our results provide evidence that the fitness consequences of conspecific attraction are predation-related. We found that in landscapes dominated by predators able to respond functionally to prey distribution, clustered breeding led to fitness costs. However, this cost could be reduced if birds performed Bayesian updating of prior settlement decisions and perceived nesting with too many neighbors as a threat. Our results did not support the hypothesis that in landscapes dominated by incidental predators, clustered breeding as a byproduct of conspecific attraction provides fitness benefits through the dilution effect. We suggest that this may be due to the spatial scale of songbirds’ aggregative behavior. In general, we provide evidence that when considering the fitness consequences of conspecific attraction for

  15. Six climate change-related events in the United States accounted for about $14 billion in lost lives and health costs.

    PubMed

    Knowlton, Kim; Rotkin-Ellman, Miriam; Geballe, Linda; Max, Wendy; Solomon, Gina M

    2011-11-01

    The future health costs associated with predicted climate change-related events such as hurricanes, heat waves, and floods are projected to be enormous. This article estimates the health costs associated with six climate change-related events that struck the United States between 2000 and 2009. The six case studies came from categories of climate change-related events projected to worsen with continued global warming-ozone pollution, heat waves, hurricanes, infectious disease outbreaks, river flooding, and wildfires. We estimate that the health costs exceeded $14 billion, with 95 percent due to the value of lives lost prematurely. Actual health care costs were an estimated $740 million. This reflects more than 760,000 encounters with the health care system. Our analysis provides scientists and policy makers with a methodology to use in estimating future health costs related to climate change and highlights the growing need for public health preparedness. PMID:22068410

  16. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    PubMed

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010. PMID:27413666

  17. Cost of Preventing, Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination

    PubMed Central

    Östensson, Ellinor; Fröberg, Maria; Leval, Amy; Hellström, Ann-Cathrin; Bäcklund, Magnus; Zethraeus, Niklas; Andersson, Sonia

    2015-01-01

    Objective Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented. Methods and Materials Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts. Results From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million. Conclusion Prevention, management, and treatment costs

  18. How are parent-child conflict and childhood externalizing symptoms related over time? Results from a genetically informative cross-lagged study.

    PubMed

    Burt, S Alexandra; McGue, Matt; Krueger, Robert F; Iacono, William G

    2005-01-01

    The present study attempted to determine the direction and etiology of the robust relationship between childhood externalizing (EXT) symptoms and parent-child conflict using a genetically informative longitudinal model and data from the ongoing Minnesota Twin Family Study. Participants consisted of 1,506 same-sex twins assessed at ages 11 and 14, and their parents. The relationship between EXT and parent-child conflict from ages 11 to 14 was examined within a biometrical cross-lagged design. The results revealed three primary findings: first, the stability of conflict and externalizing over time is largely, although not solely, a result of genetic factors. Second, there appears to be a bidirectional relationship between conflict and EXT over time, such that both conflict and EXT at 11 independently predict the other 3 years later. Finally, the results are consistent with the notion that parent-child conflict partially results from parental responses to their child's heritable externalizing behavior, while simultaneously contributing to child externalizing via environmental mechanisms. These results suggest a "downward spiral" of interplay between parent-child conflict and EXT, and offer confirmation of a (partially) environmentally mediated effect of parenting on child behavior. PMID:15971764

  19. Cooperative transients in inter-atomic correlation in the presence of an externally applied coherent field - Relation to intrinsic mirrorless optical bistability

    NASA Astrophysics Data System (ADS)

    Bowden, C. M.; Sung, C. C.

    1982-08-01

    The model presented earlier (Bowden and Sung, 1979), which predicts the circumstances under which intrinsic mirrorless optical bistability (OB) can occur due to atomic pair correlation in a small volume, is outlined and the results presented. These results, which predict a first-order phase transition in steady state for an externally driven collection of a large number of atoms far removed from thermodynamic equilibrium, form the motivation for a detailed microscopic examination of the dynamical behavior of atomic pair correlation in the presence of externally applied coherent radiation. A model is presented and results are discussed for the transient dynamic evolution of two two-level atoms separated from each other by a distance r in the presence of an externally applied coherent radiation field. The results predict collective radiation reaction, frequency shifts, relaxation in terms of the atomic separation r (assumed much larger than single atom dimensions), the externally applied field intensity and spacial uniformity of the field with respect to the inter-atomic volume.

  20. Measuring Use and Cost of Health Sector and Related Care in a Population of Girls and Young Women with Rett Syndrome

    ERIC Educational Resources Information Center

    Hendrie, Delia; Bebbington, Ami; Bower, Carol; Leonard, Helen

    2011-01-01

    This study measured use and cost of health sector and related services in Rett syndrome and effects of socio-demographic, clinical severity and genetic factors on costs. The study population consisted of individuals with Rett syndrome registered with the Australian Rett Syndrome Database in 2004. Descriptive analysis was used to examine patterns…

  1. 49 CFR 195.108 - External pressure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false External pressure. 195.108 Section 195.108 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PIPELINE Design Requirements § 195.108 External pressure. Any external pressure that will be exerted on...

  2. 49 CFR 195.108 - External pressure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false External pressure. 195.108 Section 195.108 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PIPELINE Design Requirements § 195.108 External pressure. Any external pressure that will be exerted on...

  3. 49 CFR 195.108 - External pressure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false External pressure. 195.108 Section 195.108 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PIPELINE Design Requirements § 195.108 External pressure. Any external pressure that will be exerted on...

  4. 49 CFR 195.108 - External pressure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false External pressure. 195.108 Section 195.108 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PIPELINE Design Requirements § 195.108 External pressure. Any external pressure that will be exerted on...

  5. 49 CFR 195.108 - External pressure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false External pressure. 195.108 Section 195.108 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PIPELINE Design Requirements § 195.108 External pressure. Any external pressure that will be exerted on...

  6. Donor impurity states and related terahertz range nonlinear optical response in GaN cylindrical quantum wires: Effects of external electric and magnetic fields

    SciTech Connect

    Correa, J. D.; Mora-Ramos, M. E.; Duque, C. A.

    2014-06-07

    We report a study on the optical absorption coefficient associated to hydrogenic impurity interstate transitions in zinc-blende GaN quantum wires of cylindrical shape taking into account the effects of externally applied static electric and magnetic fields. The electron states emerge within the effective mass approximation, via the exact diagonalization of the donor-impurity Hamiltonian with parabolic confinement and external field effects. The nonlinear optical absorption is calculated using a recently derived expression for the dielectric susceptibility, obtained via a nonperturbative solution of the density-matrix Bloch equation. Our results show that this treatment eliminates not only the intensity-dependent bleaching effect but also the change in sign of the nonlinear contribution due to the combined effect of asymmetric impurity location and the applied electric field.

  7. Donor impurity states and related terahertz range nonlinear optical response in GaN cylindrical quantum wires: Effects of external electric and magnetic fields

    NASA Astrophysics Data System (ADS)

    Correa, J. D.; Mora-Ramos, M. E.; Duque, C. A.

    2014-06-01

    We report a study on the optical absorption coefficient associated to hydrogenic impurity interstate transitions in zinc-blende GaN quantum wires of cylindrical shape taking into account the effects of externally applied static electric and magnetic fields. The electron states emerge within the effective mass approximation, via the exact diagonalization of the donor-impurity Hamiltonian with parabolic confinement and external field effects. The nonlinear optical absorption is calculated using a recently derived expression for the dielectric susceptibility, obtained via a nonperturbative solution of the density-matrix Bloch equation. Our results show that this treatment eliminates not only the intensity-dependent bleaching effect but also the change in sign of the nonlinear contribution due to the combined effect of asymmetric impurity location and the applied electric field.

  8. External referencing and pharmaceutical price negotiation.

    PubMed

    Garcia Mariñoso, Begoña; Jelovac, Izabela; Olivella, Pau

    2011-06-01

    External referencing (ER) imposes a price cap for pharmaceuticals, based on prices of identical or comparable products in foreign countries. Suppose a foreign country (F) negotiates prices with a pharmaceutical firm, whereas a home country (H) can either negotiate prices independently or implement ER, based on the foreign price. We show that country H prefers ER if copayments in H are relatively high. This preference is reinforced when H's population is small. Irrespective of relative country sizes, ER by country H harms country F. Our model is inspired by the wide European experience with this cost-containment policy. Namely, in Europe, drug authorization and price negotiations are carried out by separate agencies. We confirm our main results in two extensions. The first one allows for therapeutic competition between drugs. In the second one, drug authorization and price negotiation take place in a single agency. PMID:20577969

  9. Statistical Estimation of Dose-response Functions of Respiratory Diseases and Societal Costs of Haze-related Air Pollution in Brunei Darussalam

    NASA Astrophysics Data System (ADS)

    Anaman, K. A.; Ibrahim, N.

    - The effects on human health resulting from the January to April 1998 haze-related air pollution episode in Brunei Darussalam were analysed for five groups of diseases of the respiratory system. The analysis concentrated on the statistical estimation of dose-response functions which related the number of cases of respiratory diseases to the level of quality of ambient environment as measured by the pollutants standards index (PSI) and other environmental variables. The total number of cases of the five groups of diseases was shown to be significantly related to PSI and temperature. Societal costs were also estimated. The results showed that societal costs were significantly related to PSI, temperature and relative humidity. Societal costs increased with higher PSI and relative humidity but decreased with increasing temperature.

  10. The impact of relative energy prices on industrial energy consumption in China: a consideration of inflation costs.

    PubMed

    He, Lingyun; Ding, Zhihua; Yin, Fang; Wu, Meng

    2016-01-01

    Significant effort has been exerted on the study of economic variables such as absolute energy prices to understand energy consumption and economic growth. However, this approach ignores general inflation effects, whereby the prices of baskets of goods may rise or fall at different rates from those of energy prices. Thus, it may be the relative energy price, not the absolute energy price, that has most important effects on energy consumption. To test this hypothesis, we introduce a new explanatory variable, the domestic relative energy price, which we define as "the ratio of domestic energy prices to the general price level of an economy," and we test the explanatory power of this new variable. Thus, this paper explores the relationship between relative energy prices and energy consumption in China from the perspective of inflation costs over the period from 1988 to 2012. The direct, regulatory and time-varying effects are captured using methods such as ridge regression and the state-space model. The direct impacts of relative energy prices on total energy consumption and intensity are -0.337 and -0.250, respectively; the effects of comprehensive regulation on energy consumption through the economic structure and the energy structure are -0.144 and -0.148, respectively; and the depressing and upward effects of rising and falling energy prices on energy consumption are 0.3520 and 0.3564, respectively. When economic growth and the energy price level were stable, inflation persisted; thus, rising energy prices benefitted both the economy and the environment. Our analysis is important for policy makers to establish effective energy-pricing policies that ensure both energy conservation and the stability of the pricing system. PMID:27398277

  11. Does increasing community and liquor licensees' awareness, police activity, and feedback reduce alcohol-related violent crime? A benefit-cost analysis.

    PubMed

    Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M; Petrie, Dennis J

    2013-11-01

    Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees' awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions. PMID:24169411

  12. Does Increasing Community and Liquor Licensees’ Awareness, Police Activity, and Feedback Reduce Alcohol-Related Violent Crime? A Benefit-Cost Analysis

    PubMed Central

    Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M.; Petrie, Dennis J.

    2013-01-01

    Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions. PMID:24169411

  13. Cost-effectiveness of employing a total parenteral nutrition surveillance nurse for the prevention of catheter-related bloodstream infections.

    PubMed

    Fraher, M H; Collins, C J; Bourke, J; Phelan, D; Lynch, M

    2009-10-01

    The cost of catheter-related bloodstream infection (CRBSI) is substantial in terms of morbidity, mortality and financial resources. Total parenteral nutrition (TPN) is a recognised risk factor for CRBSI. In 1997, an intravenous nutrition nurse was promoted to TPN surveillance clinical nurse manager (CNM) and quarterly infection audit meetings were introduced to monitor trends in CRBSI. Data were prospectively collected over a 15-year period using specific TPN records in a 535-bed tertiary acute university hospital. A total of 20 439 CVC-days and 307 CRBSIs were recorded. Mean number of infections before, and after, the introduction of a dedicated TPN surveillance CNM were compared. Mean CRBSI per 1000 catheter-days+/-SD was 20.5+/-6.34 prior to 1997 and 14.64+/-7.81 after 1997, representing a mean reduction of 5.84 CRBSIs per 1000 catheter-days (95% CI: -4.92 to 16.60; P=0.05). Mean number of CRBSIs per year+/-SD was 28.3+/-4.93 prior to 1997 and 18.5+/-7.37 after 1997, representing a mean decrease of 9.8 infections per year (95% CI: 0.01 to 19.66; P<0.05). The savings made by preventing 9.8 infections per year were calculated from data on bed-days obtained from the hospital finance office. The cost in hospital days saved per annum was euro135,000. Introduction of a TPN surveillance CNM saved the hospital at least euro78,300 per annum and led to a significant decrease in CRBSIs in TPN patients. PMID:19709776

  14. Estimating the costs of rearing young dairy cattle in the Netherlands using a simulation model that accounts for uncertainty related to diseases.

    PubMed

    Mohd Nor, N; Steeneveld, W; Mourits, M C M; Hogeveen, H

    2012-10-01

    The costs of rearing young dairy cattle are a part of the cost of the price of milk, as rearing produces the future dairy cows. As most dairy farmers are not aware of the rearing costs, the rearing of dairy replacements often does not get the attention it deserves. Calculating the distribution of the rearing costs throughout the rearing process is difficult as the costs are correlated with biological processes, such as variation in growth rate and disease uncertainty. In this study, a calf level simulation model was built to estimate the rearing costs and their distribution from 2 weeks of age until first calving in the Netherlands. The uncertainties related to calf diseases (calf scours and bovine respiratory disease) were included, in which both the probabilities of disease and the effects of diseases (growth reduction) differ at different ages. In addition, growth was modeled stochastically and in a detailed manner using a two-phase growth function. The total cost of rearing young dairy cattle was estimated as €1567 per successfully reared heifer and varied between €1423 and €1715. Reducing the age of first calving by 1 month reduced the total cost between 2.6% and 5.7%. The difference in the average cost of rearing between heifers that calved at 24 months and those calving at 30 months was €400 per heifer reared. Average rearing costs were especially influenced by labor efficiency and cost of feed. The rearing costs of a heifer that experienced disease at least once (20% of the simulated heifers) were on average €95 higher than those of healthy heifers. Hence, for an individual diseased heifer, disease costs can be rather high, while the relative contribution to the average rearing cost for a standard Dutch dairy farm is low (approx. 3%). Overall, the model developed proved to be a useful tool to investigate the total cost of rearing young dairy cattle, providing insights to dairy farmers with respect to the cost-efficiency of their own rearing

  15. The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

    PubMed

    Mabry, C D

    2001-03-01

    Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement. PMID:11239383

  16. Automated External Defibrillator

    MedlinePlus

    ... from the NHLBI on Twitter. What Is an Automated External Defibrillator? An automated external defibrillator (AED) is a portable device that ... Institutes of Health Department of Health and Human Services USA.gov

  17. Assessment of external combustion, Brayton-cycle engine potential in total and integrated energy systems

    SciTech Connect

    Marciniak, T.J.; Bratis, J.C.; Davis, A.; Jain, M.L.; Ashe, T.L.; Six, L.D.; Trimble, S.W.

    1980-03-01

    The history, advantages, disadvantages, and performance and cost characteristics of the external-combustion, Brayton engine are discussed. Included are studies of external combustion, Brayton engines in Integrated Energy Systems, and comparisons with current technologies, such as diesels and gas turbines, as well as with other advanced prime-mover technologies, such as large Stirling engines and adiabatic turbocompound diesel engines. Lastly, a development program, one that would lead to a commercializable external combustion, Brayton engine using an atmospheric fluidized bed combustor is described. The fluidized bed offers a method for burning coal in an environmentally acceptable manner at a fairly reasonable cost so that the external combustion Brayton concept can be used in the residential/commercial sector. Based on this study, it appears that the external combustion, Brayton engine, using a fluidized-bed combustion system, offers a technologically sound alternative for developing an economically viable, environmentally acceptable method for using non-scarce fuels. Although the efficiency of the engine is not as high as that projected for large diesel and Stirling engines, the capital cost advantages, fuel flexibility, relatively low developmental costs, and high chance of success make it an attractive alternative.

  18. Persistent food insecurity is associated with higher levels of cost-related medication nonadherence in low-income older adults.

    PubMed

    Sattler, Elisabeth Lilian Pia; Lee, Jung Sun

    2013-01-01

    The purpose of this study was to examine relationships between changes in food insecurity (FI) and cost-related medication nonadherence (CRN) among Older Americans Act Nutrition Program participants and wait-listed individuals in Georgia. This study used data collected from 3 waves of self-administered mail surveys conducted 4 months apart in 2008 and 2009 (n = 664, mean age 74.6 ± 8.9 years, 71.5% female, 31.0% African American). FI was assessed by using a validated 6-item U.S. Household Food Security Survey Module. Practice of 5 CRN behaviors was evaluated. Changes in FI and CRN were determined based on ≥ 2 repeated measures. Participants with persistent FI and CRN were more likely to be younger, low-income, and in poorer health. After controlling for potential confounders, persistently food insecure individuals and those who became food insecure showed 8.2 (95% CI: 5.4-12.5) times and 5.3 (95% CI: 3.2-8.8) times increased odds of reporting higher levels of CRN than persistently food secure individuals. PMID:23451845

  19. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010

    PubMed Central

    Rehm, Colin D.; Monsivais, Pablo; Drewnowski, Adam

    2016-01-01

    Background Food prices may be one reason for the growing socioeconomic disparities in diet quality. Objective To evaluate the association between diet costs and the Healthy Eating Index-2010 (HEI-2010). Methods Cross-sectional study based on 11,181 adults from the 2007-2010 National Health and Nutrition Examination Survey, analyzed in spring 2014. Diet cost was estimated by linking dietary data with a national food price database. The HEI-2010, a measure of adherence to the Dietary Guidelines, was the outcome. The population ratio method was used to estimate the average HEI-2010 scores by quintile of energy-adjusted diet cost. Additional analyses evaluated the association between cost and HEI-2010 components. Results There was a strong positive association between lower energy-adjusted diet costs and lower HEI-2010 scores. The association was stronger among women (p-interaction=0.003). Lower diet costs were associated with lower consumption of vegetables, fruit, whole grains, and seafood, and higher consumption of refined grains and solid fat, alcohol and added sugars. Conclusions Lower energy-adjusted diet costs were associated with lower-quality diets. Future efforts to improve the nutritional status of the US public should take food prices and diet costs into account. PMID:25625693

  20. Relative Cost-Effectiveness of Treatments for Adolescent Depression: 36-Week Results from the TADS Randomized Trial

    ERIC Educational Resources Information Center

    Domino, Marisa Elena; Foster, E. Michael; Vitiello, Benedetto; Kratochvil, Christopher J.; Burns, Barbara J.; Silva, Susan G.; Reinecke, Mark A.; March, John S.

    2009-01-01

    Randomized controlled trials that involve 327 participants aged 12 to 18 who were diagnosed with major depression were given either fluoxetine alone, cognitive-behavioral therapy, or a combination of both. Cost-effectiveness acceptability curves suggest that combination treatment is highly likely to be the most cost-effective treatment than…

  1. External artery heat pipe

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor); Ernst, Donald M. (Inventor); Shaubach, Robert M. (Inventor)

    1989-01-01

    An improved heat pipe with an external artery. The longitudinal slot in the heat pipe wall which interconnects the heat pipe vapor space with the external artery is completely filled with sintered wick material and the wall of the external artery is also covered with sintered wick material. This added wick structure assures that the external artery will continue to feed liquid to the heat pipe evaporator even if a vapor bubble forms within and would otherwise block the liquid transport function of the external artery.

  2. Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies

    PubMed Central

    2014-01-01

    Background This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various ‘levels’ across the system. Methods/Design The method we propose is use of Bayesian ideas as a philosophical guide. Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit – the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can “re-calibrate” their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses. Discussion The

  3. Cost-effectiveness of anti-oxidant vitamins plus zinc treatment to prevent the progression of intermediate age-related macular degeneration. A Singapore perspective

    PubMed Central

    Saxena, Nakul; George, Pradeep Paul; Heng, Bee Hoon; Lim, Tock Han; Yong, Shao Onn

    2015-01-01

    Purpose: To determine if providing high dose anti-oxidant vitamins and zinc treatment age-related eye disease study (AREDS formulation) to patients with intermediate age-related macular degeneration (AMD) aged 40–79 years from Singapore is cost-effective in preventing progression to wet AMD. Methods: A hypothetical cohort of category 3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly) for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen). Costs were estimated for the above scenarios from the providers’ perspective, and cost-effectiveness was measured by cost per disability-adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs were discounted at an annual rate of 3%. Results: Over 5400 patients could be prevented from progressing to wet AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was cost-effective compared to placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more cost-effective compared to AREDS formulation followed by bevacizumab. Conclusion: Prophylactic treatment with AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore. PMID:26265643

  4. Hanford External Dosimetry Program

    SciTech Connect

    Fix, J.J.

    1990-10-01

    This document describes the Hanford External Dosimetry Program as it is administered by Pacific Northwest Laboratory (PNL) in support of the US Department of Energy (DOE) and its Hanford contractors. Program services include administrating the Hanford personnel dosimeter processing program and ensuring that the related dosimeter data accurately reflect occupational dose received by Hanford personnel or visitors. Specific chapters of this report deal with the following subjects: personnel dosimetry organizations at Hanford and the associated DOE and contractor exposure guidelines; types, characteristics, and procurement of personnel dosimeters used at Hanford; personnel dosimeter identification, acceptance testing, accountability, and exchange; dosimeter processing and data recording practices; standard sources, calibration factors, and calibration processes (including algorithms) used for calibrating Hanford personnel dosimeters; system operating parameters required for assurance of dosimeter processing quality control; special dose evaluation methods applied for individuals under abnormal circumstances (i.e., lost results, etc.); and methods for evaluating personnel doses from nuclear accidents. 1 ref., 14 figs., 5 tabs.

  5. External Measures of Cognition

    PubMed Central

    Cairό, Osvaldo

    2011-01-01

    The human brain is undoubtedly the most impressive, complex, and intricate organ that has evolved over time. It is also probably the least understood, and for that reason, the one that is currently attracting the most attention. In fact, the number of comparative analyses that focus on the evolution of brain size in Homo sapiens and other species has increased dramatically in recent years. In neuroscience, no other issue has generated so much interest and been the topic of so many heated debates as the difference in brain size between socially defined population groups, both its connotations and implications. For over a century, external measures of cognition have been related to intelligence. However, it is still unclear whether these measures actually correspond to cognitive abilities. In summary, this paper must be reviewed with this premise in mind. PMID:22065955

  6. Accounting for Heterogeneity in Relative Treatment Effects for Use in Cost-Effectiveness Models and Value-of-Information Analyses.

    PubMed

    Welton, Nicky J; Soares, Marta O; Palmer, Stephen; Ades, Anthony E; Harrison, David; Shankar-Hari, Manu; Rowan, Kathy M

    2015-07-01

    Cost-effectiveness analysis (CEA) models are routinely used to inform health care policy. Key model inputs include relative effectiveness of competing treatments, typically informed by meta-analysis. Heterogeneity is ubiquitous in meta-analysis, and random effects models are usually used when there is variability in effects across studies. In the absence of observed treatment effect modifiers, various summaries from the random effects distribution (random effects mean, predictive distribution, random effects distribution, or study-specific estimate [shrunken or independent of other studies]) can be used depending on the relationship between the setting for the decision (population characteristics, treatment definitions, and other contextual factors) and the included studies. If covariates have been measured that could potentially explain the heterogeneity, then these can be included in a meta-regression model. We describe how covariates can be included in a network meta-analysis model and how the output from such an analysis can be used in a CEA model. We outline a model selection procedure to help choose between competing models and stress the importance of clinical input. We illustrate the approach with a health technology assessment of intravenous immunoglobulin for the management of adult patients with severe sepsis in an intensive care setting, which exemplifies how risk of bias information can be incorporated into CEA models. We show that the results of the CEA and value-of-information analyses are sensitive to the model and highlight the importance of sensitivity analyses when conducting CEA in the presence of heterogeneity. The methods presented extend naturally to heterogeneity in other model inputs, such as baseline risk. PMID:25712447

  7. ASSESSMENTOF BETA PARTICLE FLUX FROM SURFACE CONTAMINATION AS A RELATIVE INDICATOR FOR RADIONUCLIDE DISTRIBUTION ON EXTERNAL SURFACES OF A MULTI-STORY BUILDING IN PRIPYAT

    SciTech Connect

    Farfan, E.

    2009-11-17

    How would we recover if a Radiological Dispersion Device (e.g., dirty bomb) or Improvised Nuclear Device were to detonate in a large city? In order to assess the feasibility of remediation following such an event, several issues would have to be considered, including the levels and characteristics of the radioactive contamination, the availability of the required resources to accomplish decontamination, and the planned future use of the city's structures and buildings. Presently little is known about the distribution, redistribution, and migration of radionuclides in an urban environment. However, Pripyat, a city substantially contaminated by the Chernobyl Nuclear Power Plant accident, may provide some answers. The main objective of this study was to determine the radionuclide distribution on a Pripyat multi-story building, which had not been previously decontaminated and therefore could reflect the initial fallout and its further natural redistribution on external surfaces. The 7-story building selected was surveyed from the ground floor to the roof on horizontal and vertical surfaces along seven ground-to-roof transections. Some of the results from this study indicate that the upper floors of the building had higher contamination levels than the lower floors. The authors consequently recommend that existing decontamination procedures for tall structures be re-examined and modified accordingly.

  8. Assessment of beta particle flux from surface contamination as a relative indicator for radionuclide distribution on external surfaces of a multistory building in Pripyat.

    PubMed

    Farfán, Eduardo B; Gaschak, Sergii P; Maksymenko, Andriy M; Jannik, G Tim; Marra, James C; Bondarkov, Mikhail D; Donnelly, Elizabeth H

    2011-02-01

    Several issues should be considered when assessing the feasibility of remediation following the detonation of a radiological dispersion device (e.g., dirty bomb) or improvised nuclear device in a large city. These issues include the levels and characteristics of the radioactive contamination, the availability of resources required for decontamination, and the planned future use of the city's structures and buildings. Presently, little is known about the distribution, redistribution, and migration of radionuclides in an urban environment. However, Pripyat, a city substantially contaminated by the Chernobyl Nuclear Power Plant accident in April 1986, may provide some answers. The main objective of this study was to determine the radionuclide distribution on a Pripyat multistory building that had not been decontaminated and, therefore, could reflect the initial fallout and its further natural redistribution on external surfaces over 23 y. The seven-story building selected was surveyed from the ground floor to the roof on horizontal and vertical surfaces along seven ground-to-roof transections. Some results from this study indicate that the upper floors of the building had higher contamination levels than the lower floors. Consequently, the authors recommend that thorough decontamination should be considered for all the floors of tall buildings (not just lower floors). PMID:21399438

  9. The efficiency of life insurance and family Takaful in Malaysia: Relative efficiency using the stochastic cost frontier analysis

    NASA Astrophysics Data System (ADS)

    Baharin, Roziana; Isa, Zaidi

    2013-04-01

    This paper focuses on the Stochastic cost Frontier Analysis (SFA) approach, in an attempt to measure the relationship between efficiency and organizational structure for Takaful and insurance operators in Malaysia's dual financial system. This study applied a flexible cost functional form i.e., Fourier Flexible Functional Form, for a sample consisting of 19 firms, chosen between 2002 and 2010, by employing the Battese and Coelli invariant efficiency model. The findings show that on average, there is a significant difference in cost efficiency between the Takaful industry and the insurance industry. It was found that Takaful has lower cost efficiency than conventional insurance, which shows that the organization form has an influence on efficiency. Overall, it was observed that the level of efficiency scores for both life insurance and family Takaful do not vary across time.

  10. Cost-effectiveness of primary care referral to a commercial provider for weight loss treatment, relative to standard care–a modelled lifetime analysis

    PubMed Central

    Fuller, Nicholas R; Carter, Hannah; Schofield, Deborah; Hauner, Hans; Jebb, Susan A; Colagiuri, Stephen; Caterson, Ian D

    2015-01-01

    Background Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings. Objective To evaluate the long-term cost-effectiveness of a commercial weight loss programme (Weight Watchers) (CP) compared with standard care (SC), as defined by national guidelines. Methods A Markov model was developed to calculate the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality adjusted life year (QALY) over the lifetime. The probabilities and quality-of-life utilities of outcomes were extrapolated from trial data using estimates from the published literature. A health sector perspective was adopted. Results Over a patient’s lifetime, the CP resulted in an incremental cost saving of AUD 70 per patient, and an incremental 0.03 QALYs gained per patient. As such, the CP was found to be the dominant treatment, being more effective and less costly than SC (95% confidence interval: dominant to 6 225 per QALY). Despite the CP delaying the onset of diabetes by approximately 10 months, there was no significant difference in the incidence of type 2 diabetes, with the CP achieving less than 0.1% fewer cases than SC over the lifetime. Conclusion The modelled results suggest that referral to community based interventions may provide a highly cost-effective approach for those at high risk of weight-related co-morbidities. PMID:24301133

  11. THE COST OF POSITIONAL NEGOTIATIONS VERSUS COLLABORATIVE OR RELATIONAL NEGOTIATIONS FOR NEGOTIATING COMPLIANCE MILESTONES AT HANFORD WA

    SciTech Connect

    HOPKINS, A.M.

    2004-02-26

    The Hanford site is subject to the Hanford Federal Facility Agreement and Consent Order (HFFACO), an order on consent signed by the DOE, the U. S. Environmental Protection Agency, (EPA) and the Washington Department of Ecology (WDOE). Under the HFFCCO, negotiations for transition milestones begin within six months after the issuance of a shutdown order. In the case of the PFP, the Nuclear Materials disposition and stabilization activities, a DOE responsibility, were necessary as precursor activities to Transition. This situation precipitated a crisis in the negotiations between the agencies, and formal negotiations initiated in 1997 ended in failure. The negotiations reached impasse on several key regulatory and operational issues. The 1997 negotiation was characterized by a strongly positional style. DOE and the regulatory personnel took hard lines early in the negotiations and were unable to move to resolution of key issues after a year and a half. This resulted in unhappy stakeholders, poor publicity, and work delays as well as wounded relationships between DOE and the regulatory community. The PFP is a former plutonium metal production facility. The operating mission of the PFP ended with a DOE Headquarters shutdown letter in October of 1996. Generally, the receipt of a shutdown letter initiates the start of Transition (as the first step of Decommissioning) of a facility. In the 2000-2001 PFP negotiations, a completely different approach was suggested and eventually initiated: Collaborative or Relational Negotiations. The relational negotiation style resulted in agreement between the agencies on all key issues within 6 months of initiation. All parties were very pleased with the results and all parties were relieved that protracted negotiations sessions were not needed with the new style of working together collaboratively to serve each other's interests without compromising each party's needs. The characteristics of collaborative negotiations included building

  12. Costs of a Public Health Model to Increase Receipt of Hepatitis-Related Services for Persons with Mental Illness

    PubMed Central

    Slade, Eric P.; Rosenberg, Stanley D.; Dixon, Lisa B.; Goldberg, Richard W.; Wolford, George; Himelhoch, Seth; Tapscott, Stephanie

    2013-01-01

    Objective The objective was to contextualize the costs associated with implementation of a specialized HIV/hepatitis preventive services model designed to reach persons with serious mental illness and co-occurring disorders, an underserved population. Methods Between 2006 and 2008, a random sample of 236 non-elderly, predominantly African American, male participants with serious mental illness and a co-occurring substance use disorder were recruited at four community mental health outpatient programs in a large metropolitan area. All participants had been diagnosed with a psychotic or major depressive disorder. Participants were randomized within site to receive either the experimental intervention Screen, Test, Immunize, Reduce risk, and Refer (STIRR) or enhanced treatment as usual, which consisted of education and referral to medical testing. We estimated STIRR’s standardized costs, the costs of STIRR per person who received hepatitis testing, HIV testing, and/or hepatitis A/B vaccination during the 6-months post-randomization. Results The average cost of delivering the STIRR intervention was $423 (SD±$90) per participant (in 2008 dollars) and the average cost of delivering the eTAU intervention was $24 (SD±$22) per participant (test of difference t=52.9, P<.001). The standardized costs per person who received hepatitis C testing, hepatitis B testing, HIV testing, and hepatitis A/B vaccination were $706 (SD±$165), $776 (SD±$181), $3,630 (SD±$846), and $561 (SD±131). Conclusions The STIRR model’s standardized costs suggest that hepatitis and HIV prevention services delivered in outpatient mental health settings to persons with serious mental illness can be at least as cost-effective as similar interventions designed for other at-risk populations. PMID:23475451

  13. Technical review of externalities issues. Final report

    SciTech Connect

    Niemeyer, V.

    1994-12-01

    Externalities has become the catchword for a major experiment in electric utility regulation. Together with increased competition as a means for economic regulation, this experiment represents a potential revolution in how electric utilities are regulated. It is very important for utilities and policy makers to understand the technical issues and arguments driving the externality experiment. This Technical Review presents four papers covering topics in economics that may play important roles in this revolution. The four papers are: Economic Issues in the Application of Externalities to Electricity Resource Selection; Climate Change, the Marginal Cost of Carbon Dioxide Emissions and the Implications for Carbon Dioxide Emissions Adders; Positive Externalities and Benefits from Electricity; and Socioeconomic Effects of Externality Adders for Electric Utility Emissions.

  14. Parkinson Symptoms and Health Related Quality of Life as Predictors of Costs: A Longitudinal Observational Study with Linear Mixed Model Analysis

    PubMed Central

    Martinez-Martín, Pablo; Rodriguez-Blazquez, Carmen; Paz, Silvia; Forjaz, Maria João; Frades-Payo, Belén; Cubo, Esther; de Pedro-Cuesta, Jesús; Lizán, Luis

    2015-01-01

    Objective To estimate the magnitude in which Parkinson’s disease (PD) symptoms and health- related quality of life (HRQoL) determined PD costs over a 4-year period. Materials and Methods Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL. Results One-hundred and seventy four patients were included. Mean (SD) age: 63 (11) years, mean (SD) disease duration: 8 (6) years. Ninety-three percent were HY I, II or III (mild or moderate disease). Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD) PD total costs augmented 92.5%, from €2,082.17 (€2,889.86) in year 1 to €4,008.6 (€7,757.35) in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased €75.72 (p = 0.0174); for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented €49.21 (p = 0.0094) and €44.81 (p = 0.0404), respectively; and for each extra point on the pain scale, indirect costs increased €16.31 (p = 0.0228). Conclusions PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses. PMID:26698860

  15. Multisystemic Therapy for Externalizing Youth.

    PubMed

    Zajac, Kristyn; Randall, Jeff; Swenson, Cynthia Cupit

    2015-07-01

    Externalizing problems are multidetermined and related to individual, family, peer, school, and community risk factors. Multisystemic therapy (MST) was originally developed to address these risk factors among youth with serious conduct problems who are at-risk for out-of-home placement. Several decades of research have established MST as an evidence-based intervention for adolescents with serious clinical problems, including serious offending, delinquency, substance abuse, and parental physical abuse and neglect. This article presents an overview of the clinical procedures and evidence base of MST for externalizing problems as well as 2 adaptations: MST for Substance Abuse and MST for Child Abuse and Neglect. PMID:26092742

  16. Restricted access molecularly imprinted polymers obtained by bovine serum albumin and/or hydrophilic monomers' external layers: a comparison related to physical and chemical properties.

    PubMed

    Santos, Mariane Gonçalves; Moraes, Gabriel de Oliveira Isac; Nakamura, Maurício Gustavo; dos Santos-Neto, Álvaro José; Figueiredo, Eduardo Costa

    2015-11-21

    Molecularly imprinting polymers (MIPs) can be modified with external layers in order to obtain restricted access molecularly imprinted polymers (RAMIPs) able to exclude macromolecules and retain low weight compounds. These modifications have been frequently achieved using hydrophilic monomers, chemically bound on the MIP surface. Recently, our group proposed a new biocompatible RAMIP based on the formation of a bovine serum albumin coating on the surface of MIP particles. This material has been used to extract drugs directly from untreated human plasma samples, but its physicochemical evaluation has not been carried out yet, mainly in comparison with RAMIPs obtained by hydrophilic monomers. Thus, we proposed in this paper a comparative study involving the surface composition, microscopic aspect, selectivity, binding kinetics, adsorption and macromolecule elimination ability of these different materials. We concluded that the synthesis procedure influences the size and shape of particles and that hydrophilic co-monomer addition as well as coating with BSA do not alter the chemical recognition ability of the material. The difference between imprinted and non-imprinted polymers' adsorption was evident (suggesting that imprinted polymers have a better capacity to bind the template than the non-imprinted ones). The Langmuir model presents the best fit to describe the materials' adsorption profile. The polymer covered with hydrophilic monomers presented the best adsorption for the template in an aqueous medium, probably due to a hydrophilic layer on its surface. We also concluded that an association of the hydrophilic monomers with the bovine serum albumin coating is important to obtain materials with higher capacity of macromolecule exclusion. PMID:26460233

  17. Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries

    PubMed Central

    Boehler, Christian E. H.; Lord, Joanne

    2016-01-01

    Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single

  18. External radiation surveillance

    SciTech Connect

    Antonio, E.J.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report describes how external radiation was measured, how surveys were performed, and the results of these measurements and surveys. External radiation exposure rates were measured at locations on and off the Hanford Site using thermoluminescent dosimeters (TLD). External radiation and contamination surveys were also performed with portable radiation survey instruments at locations on and around the Hanford Site.

  19. Non-Traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Nakao, Sy; Scott, JoAnna M.; Masterson, Erin E.; Chi, Donald L.

    2015-01-01

    We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million…

  20. When is Genomic Testing Cost-Effective? Testing for Lynch Syndrome in Patients with Newly-Diagnosed Colorectal Cancer and Their Relatives

    PubMed Central

    Grosse, Scott D.

    2015-01-01

    Varying estimates of the cost-effectiveness of genomic testing applications can reflect differences in study questions, settings, methods and assumptions. This review compares recently published cost-effectiveness analyses of testing strategies for Lynch Syndrome (LS) in tumors from patients newly diagnosed with colorectal cancer (CRC) for either all adult patients or patients up to age 70 along with cascade testing of relatives of probands. Seven studies published from 2010 through 2015 were identified and summarized. Five studies analyzed the universal offer of testing to adult patients with CRC and two others analyzed testing patients up to age 70; all except one reported incremental cost-effectiveness ratios (ICERs) < $ 100,000 per life-year or quality-adjusted life-year gained. Three studies found lower ICERs for selective testing strategies using family history-based predictive models compared with universal testing. However, those calculations were based on estimates of sensitivity of predictive models derived from research studies, and it is unclear how sensitive such models are in routine clinical practice. Key model parameters that are influential in ICER estimates included 1) the number of first-degree relatives tested per proband identified with LS and 2) the cost of gene sequencing. Others include the frequency of intensive colonoscopic surveillance, the cost of colonoscopy, and the inclusion of extracolonic surveillance and prevention options. PMID:26473097

  1. Results of calculations of external gamma radiation exposure rates from local fallout and the related radionuclide compositions of two hypothetical 1-MT nuclear bursts. Final report

    SciTech Connect

    Hicks, H.

    1984-12-01

    This report presents data on calculated gamma radiation exposure rates and local surface deposition of related radionuclides resulting from two hypothetical 1-Mt nuclear bursts. Calculations are made of the debris from two types of bombs: one containing /sup 235/U as a fissionable material (designated oralloy), the other containing /sup 238/U (designated tuballoy). 4 references.

  2. Absolute Copy Number and Relative Change in Determinations of Human Immunodeficiency Virus Type 1 RNA in Plasma: Effect of an External Standard on Kit Comparisons

    PubMed Central

    Brambilla, Donald; Leung, Sheila; Lew, Judy; Todd, John; Herman, Steven; Cronin, Mike; Shapiro, David E.; Bremer, James; Hanson, Celine; Hillyer, George V.; McSherry, George D.; Sperling, Rhoda S.; Coombs, Robert W.; Reichelderfer, Patricia S.

    1998-01-01

    Use of a common set of human immunodeficiency virus type 1 (HIV-1) RNA standards eliminated differences among absolute HIV-1 RNA copy number estimates made with three commercially available assays. The relative changes in the viral RNA levels determined by the commercial assays were similar and were unaffected by the use of a common set of standards. PMID:9431977

  3. Health-related cost-to-benefit measurement. A difficult sell in a "show me the money" era.

    PubMed

    Morton, Max; Gilfillan-Morton, Lynn

    2003-01-01

    "Cost to benefit" is both a generic term and a specific technique used to describe and guide budgetary and investment scenarios. The methodology is based on computer mathematical models to prospectively define the short- and long-term financial gain or burden that may be produced by investing today's dollars in tomorrow's programs, technology or facilities. PMID:12886651

  4. Cost related sensitivity analysis for optimal operation of a grid-parallel PEM fuel cell power plant

    NASA Astrophysics Data System (ADS)

    El-Sharkh, M. Y.; Tanrioven, M.; Rahman, A.; Alam, M. S.

    Fuel cell power plants (FCPP) as a combined source of heat, power and hydrogen (CHP&H) can be considered as a potential option to supply both thermal and electrical loads. Hydrogen produced from the FCPP can be stored for future use of the FCPP or can be sold for profit. In such a system, tariff rates for purchasing or selling electricity, the fuel cost for the FCPP/thermal load, and hydrogen selling price are the main factors that affect the operational strategy. This paper presents a hybrid evolutionary programming and Hill-Climbing based approach to evaluate the impact of change of the above mentioned cost parameters on the optimal operational strategy of the FCPP. The optimal operational strategy of the FCPP for different tariffs is achieved through the estimation of the following: hourly generated power, the amount of thermal power recovered, power trade with the local grid, and the quantity of hydrogen that can be produced. Results show the importance of optimizing system cost parameters in order to minimize overall operating cost.

  5. On the externalization of auditory images

    NASA Technical Reports Server (NTRS)

    Durlach, N. I.; Rigopulos, A.; Pang, X. D.; Woods, W. S.; Kulkarni, A.; Colburn, H. S.; Wenzel, E. M.

    1992-01-01

    An acoustic image is said to be 'externalized' if the sound source appears to the listener to lie outside the head. The purpose of the note is to put the phenomenon of externalization of auditory images in proper perspective. It points out that the listener's pinnae (the so-called 'pinna factor') is only one of many factors that determine the extent to which a sound image is externalized and that the relative importance of these factors is not yet clear. The note begins with some general comments on externalization. It then considers the effect of reverberation. It examines head movements, visual effects, and other factors. It concludes with remarks on externalization's relation to head-related transfer functions (HRTFs), the pinna factor, and improved experimental instrumentation.

  6. The External Degree Project.

    ERIC Educational Resources Information Center

    Syracuse Univ., NY. School of Management.

    An external degree is one granted on the basis of academic work undertaken through independent and flexible study and pursued in whole or in part outside of the framework of existing college and university courses. A person's qualifications for an external degree are measured not by a list of accumulated formal courses taken and passed, but by an…

  7. Forms of Spanking and Children's Externalizing Behaviors

    ERIC Educational Resources Information Center

    Lansford, Jennifer E.; Wager, Laura B.; Bates, John E.; Pettit, Gregory S.; Dodge, Kenneth A.

    2012-01-01

    Research suggests that corporal punishment is related to higher levels of child externalizing behavior, but there has been controversy regarding whether infrequent, mild spanking predicts child externalizing or whether more severe and frequent forms of corporal punishment account for the link. Mothers rated the frequency with which they spanked…

  8. The Feto-Maternal Health Cost of Intimate Partner Violence Among Delivery-Related Discharges in the United States, 2002-2009.

    PubMed

    Mogos, Mulubrhan F; Araya, Winta N; Masho, Saba W; Salemi, Jason L; Shieh, Carol; Salihu, Hamisu M

    2016-02-01

    Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost. PMID:25392375

  9. Metabolic costs of avian flight in relation to flight velocity: a study in Rose Coloured Starlings (Sturnus roseus, Linnaeus).

    PubMed

    Engel, Sophia; Biebach, Herbert; Visser, G Henk

    2006-06-01

    The metabolic costs of flight at a natural range of speeds were investigated in Rose Coloured Starlings (Sturnus roseus, Linnaeus) using doubly labelled water. Eight birds flew repeatedly and unrestrained for bouts of 6 h at speeds from 9 to 14 m s(-1) in a low-turbulence wind tunnel, corresponding to travel distances between 200 and 300 km, respectively. This represents the widest speed range where we could obtain voluntarily sustained flights. From a subset of these flights, data on the wing beat frequency (WBF) and intermittent flight behaviour were obtained. Over the range of speeds that were tested, flight costs did not change with velocity and were on an average 8.17+/-0.64 W or 114 W kg(-1). Body mass was the only parameter with a significant (positive) effect on flight costs, which can be described as EE(f)=0.741 M(0.554). WBF changed slightly with speed, but correlated better with body mass. Birds showed both types of intermittent flight, undulating and bounding, but their frequencies did not systematically change with flight speed. PMID:16425018

  10. The Clinical Effectiveness and Cost-Effectiveness of Screening for Age-Related Macular Degeneration in Japan: A Markov Modeling Study

    PubMed Central

    Tamura, Hiroshi; Goto, Rei; Akune, Yoko; Hiratsuka, Yoshimune; Hiragi, Shusuke; Yamada, Masakazu

    2015-01-01

    Objective To investigate the cost-effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan. Methods The clinical effectiveness and cost-effectiveness of screening and subsequent intervention for AMD were assessed using a Markov model. The Markov model simulation began at the age of 40 years and concluded at the age of 90 years. The first-eye and second-eye combined model assumed an annual state-transition probability, development of prodromal symptoms, choroidal neovascularization (CNV), and reduction in visual acuity. Anti–vascular-endothelial-growth-factor (anti-VEGF) intravitreal injection therapy and photodynamic therapy (PDT) were performed to treat CNV. Intake of supplements was recommended to patients who had prodromal symptoms and unilateral AMD. Data on prevalence, morbidity, transition probability, utility value of each AMD patient, and treatment costs were obtained from published clinical reports. Results In the base-case analysis, screening for AMD every 5 years, beginning at the age of 50 years, showed a decrease of 41% in the total number of blind patients. The screening program reduced the incidence of blindness more than did the additional intake of supplements. However, the incremental cost-effectiveness ratio (ICER) of screening versus no screening was 27,486,352 Japanese yen (JPY), or 259,942 US dollars (USD) per quality-adjusted life year (QALY). In the sensitivity analysis, prodromal symptom-related factors for AMD had great impacts on the cost-effectiveness of screening. The lowest ICER obtained from the best scenario was 4,913,717 JPY (46,470 USD) per QALY, which was approximately equal to the willingness to pay in Japan. Conclusions Ophthalmologic screening for AMD in adults is highly effective in reducing the number of patients with blindness but not cost-effective as demonstrated by a Markov model based on clinical data from Japan. PMID:26214804

  11. Proceedings: National conference on environmental externalities

    SciTech Connect

    Not Available

    1990-12-31

    This report is the proceedings of the National Conference on Environmental Externalities. A environmental externality is the environmental impact of a process or a plant that society must endure. It is a social cost and is paid, but not by the company who produced it or the company`s customers who endure it. The main purpose of this report is to gather the many designs and ideas of how and why to internalize the externalities into the pricing systems of the public utility commissions, especially that of the electric utilities. Economic and sociological aspects of the internalization of these externalities are given in these proceedings. Individual papers are processed separately for databases. (MB)

  12. Forms of Spanking and Children's Externalizing Behaviors.

    PubMed

    Lansford, Jennifer E; Wager, Laura B; Bates, John E; Pettit, Gregory S; Dodge, Kenneth A

    2012-04-01

    Research suggests that corporal punishment is related to higher levels of child externalizing behavior, but there has been controversy regarding whether infrequent, mild spanking predicts child externalizing or whether more severe and frequent forms of corporal punishment account for the link. Mothers rated the frequency with which they spanked and whether they spanked with a hand or object when their child was 6, 7, and 8 years old. Mothers and teachers rated children's externalizing behaviors at each age. Analyses of covariance revealed higher levels of mother-reported externalizing behavior for children who experienced harsh spanking. Structural equation models for children who experienced no spanking or mild spanking only revealed that spanking was related to concurrent and prior, but not subsequent, externalizing. Mild spanking in one year was a risk factor for harsh spanking in the next year. Findings are discussed in the context of efforts to promote children's rights to protection. PMID:22544988

  13. Relation between the Greenberger-Horne-Zeilinger-entanglement cost of preparing a multipartite pure state and its quantum discord

    NASA Astrophysics Data System (ADS)

    Yang, Seungho; Jeong, Hyunseok

    2015-08-01

    We investigate how much amount of Greenberger-Horne-Zeilinger (GHZ) entanglement is required in order to prepare a given multipartite state by local operations and classical communication (LOCC). We present a LOCC procedure that asymptotically converts GHZ states into an arbitrary multipartite pure state, whose conversion rate is given by the multipartite discord of the state. This reveals that the GHZ-entanglement cost of preparing a pure state is not higher than the multipartite discord of the state. It also provides an operational interpretation of multipartite discord for pure states, namely, the consumption rate of GHZ entanglement in the devised procedure.

  14. Siting a municipal solid waste disposal facility, part II: the effects of external criteria on the final decision.

    PubMed

    Korucu, M Kemal; Karademir, Aykan

    2014-02-01

    The procedure of a multi-criteria decision analysis supported by the geographic information systems was applied to the site selection process of a planning municipal solid waste management practice based on twelve different scenarios. The scenarios included two different decision tree modes and two different weighting models for three different area requirements. The suitability rankings of the suitable sites obtained from the application of the decision procedure for the scenarios were assessed by a factorial experimental design concerning the effect of some external criteria on the final decision of the site selection process. The external criteria used in the factorial experimental design were defined as "Risk perception and approval of stakeholders" and "Visibility". The effects of the presence of these criteria in the decision trees were evaluated in detail. For a quantitative expression of the differentiations observed in the suitability rankings, the ranking data were subjected to ANOVA test after a normalization process. Then the results of these tests were evaluated by Tukey test to measure the effects of external criteria on the final decision. The results of Tukey tests indicated that the involvement of the external criteria into the decision trees produced statistically meaningful differentiations in the suitability rankings. Since the external criteria could cause considerable external costs during the operation of the disposal facilities, the presence of these criteria in the decision tree in addition to the other criteria related to environmental and legislative requisites could prevent subsequent external costs in the first place. PMID:24654382

  15. Evaluating External Communication.

    ERIC Educational Resources Information Center

    DeSantis, James R.

    1978-01-01

    Effective external communication by higher education institutions is described as an ongoing program, based on objective research, continuous informal feedback, and informed anticipation of changes in the environment that will force changes in the institution. (JMF)

  16. Future of External Reporting

    ERIC Educational Resources Information Center

    Powers, Kristina

    2015-01-01

    This chapter builds on prior chapters and focuses on higher education trends on the horizon and the resulting impact on external reporting for institutional researchers. Three practical recommendations and examples for institutional researchers are also presented.

  17. Relative cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in Poland

    PubMed Central

    Guest, Julian F; Weidlich, Diana; Kaczmarski, Maciej; Jarocka-Cyrta, Elzbieta; Kobelska-Dubiel, Natalia; Krauze, Agnieszka; Sakowska-Maliszewska, Iwona; Zawadzka-Krajewska, Anna

    2016-01-01

    Objective To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) as an initial treatment for cow’s milk allergy compared with eHCF alone and amino acid formulas (AAF) in Poland from the perspective of the Polish National Health Fund (Narodowy Fundusz Zdrowia [NFZ]) and parents. Methods Decision modeling was used to estimate the probability of cow’s milk allergic infants developing tolerance to cow’s milk by 18 months. The model also estimated the cost to the NFZ and parents (Polish Zloty [PLN] at 2013–2014 prices) for managing infants over 18 months after starting one of the formulas as well as the relative cost-effectiveness of each of the formulas. Results The probability of developing tolerance to cow’s milk by 18 months was higher among infants who were fed eHCF + LGG (0.82) compared with those fed eHCF alone (0.53) or an AAF (0.22). An infant who is initially managed with eHCF + LGG is expected to consume fewer health care resources than infants managed with the other formulas. Hence, the estimated total health care cost incurred by the NFZ for initially feeding infants with eHCF + LGG (PLN 5,693) was less than that of feeding infants with eHCF alone (PLN 7,749) or an AAF (PLN 24,333). However, the total cost incurred by parents for initially feeding infants with an AAF (PLN 815) was marginally less than that of feeding with eHCF + LGG (PLN 993), which was less than that of feeding with eHCF alone (PLN 1,226). Conclusion Using eHCF + LGG instead of eHCF alone or an AAF for first-line management of newly diagnosed infants with cow’s milk allergy affords a cost-effective use of NFZ-funded resources, since it improves outcome for less cost. Whether eHCF + LGG would be viewed as being cost-effective by parents is dependent on their willingness to pay an additional cost for additional tolerance acquisition to cow’s milk. PMID:27418845

  18. Master external pressure charts

    SciTech Connect

    Michalopoulos, E.

    1996-12-01

    This paper presents a method to develop master external pressure charts from which individual external pressure charts for each material specification may be derived. The master external charts can represent a grouping of materials with similar chemical composition, similar stress-strain curves but produced to different strength levels. External pressure charts are used by various Sections of the ASME Boiler and Pressure Vessel and Piping Codes to design various components such as cylinders, sphered, formed heads, tubes, piping, rings and other components, subjected to external pressure or axial compression loads. These charts are pseudo stress-strain curves for groups of materials with similar stress-strain shapes. The traditional approach was originally developed in the 1940`s and is a graphical approach where slopes to the strain curves are drawn graphically from which pseudo-strain levels are calculated. The new method presented in this paper develops mathematical relationships for the material stress-strain curves and the external pressure charts. The method has the ability to calculate stress-strain curves from existing external pressure charts. The relationships are a function of temperature, the modulus of elasticity, yield strength, and two empirical material constants. In this approach, conservative assumptions used to assign materials to lower bound external pressure charts can be removed. This increases the buckling strength capability of many materials in the Code, providing economic benefits while maintaining the margin of safety specified by the Code criteria. The method can also reduce the number of material charts needed in the Code and provides for the capability to extend the existing pressure charts to higher design temperatures. The new method is shown to contain a number of improvements over the traditional approach and is presently under consideration by appropriate ASME Code committees.

  19. Helminth Interaction with the Host Immune System: Short-Term Benefits and Costs in Relation to the Infectious Environment.

    PubMed

    Guivier, Emmanuel; Bellenger, Jérome; Sorci, Gabriele; Faivre, Bruno

    2016-08-01

    Chronic infections imply that the parasite and the host immune system closely interact for a long time without a fatal outcome. Environmental changes encountered by hosts and parasites, such as coinfections, can deeply affect the stability of this apparent equilibrium. Our study aimed to determine the effect of the infectious environment on the costs and benefits of chronic infection with the gut nematode Heligmosomoides polygyrus in mice. Heligmosomoides polygyrus is known for its capacity to actively interfere with the host immune response by secreting molecules that can dampen immunity. We simulated bacterial coinfection of H. polygyrus-infected CBA-strain mice during the chronic phase of the infection by injecting them with Escherichia coli lipopolysaccharide. We found that infection by H. polygyrus induced only weak costs for the host (in terms of reproductive investment) and was characterized by the upregulation of both Th1 (interferon-γ) and anti-inflammatory (transforming growth factor-β) cytokines, which is favorable to parasite persistence. However, when co-occurring with the simulated bacterial infection, H. polygyrus infection was associated with a pronounced shift toward a pro-inflammatory status, which was deleterious to both the parasite and the host. Our study highlights the dynamic equilibrium reached during chronic infection, where a rapid environmental change, such as a concomitant bacterial infection, can deeply affect the outcome of the host-parasite interaction. PMID:27420789

  20. A safe, efficient and cost effective process for removing petroleum hydrocarbons from a highly heterogeneous and relatively inaccessible shoreline.

    PubMed

    Guerin, Turlough F

    2015-10-01

    A rocky, intractable and highly heterogeneous, intertidal zone, was contaminated from a diesel fuel spill that occurred during refuelling of a grader used in road construction, on an operational mine's shiploading facility. A practical, cost-effective, and safer (to personnel by avoiding drilling and earthworks), and non-invasive sampling and remediation strategy was designed and implemented since the location and nature of the impacted geology (rock fill) and sediment, precluded conventional ex-situ and any in-situ treatment where drilling would be required. Enhanced biostimulation with surfactant, available N & P (which were highly constrained), and increased aeration, increased the degradation rate from no discernable change for 2 years post-spill, to 170 mg/kg/day; the maximum degradation rate after intervention. While natural attenuation was ineffective in this application, the low-cost, biostimulation intervention proved successful, allowing the site owner to meet their regulatory obligations. Petroleum hydrocarbons (aliphatic fraction) decreased from ∼20,000 mg/kg to <200 mg/kg at the completion of 180 weeks of treatment. PMID:26241934

  1. Externally modulated theranostic nanoparticles

    PubMed Central

    Urban, Cordula; Urban, Alexander S.; Charron, Heather; Joshi, Amit

    2013-01-01

    Externally modulated nanoparticles comprise a rapidly advancing class of cancer nanotherapeutics, which combine the favorable tumor accumulation of nanoparticles, with external spatio-temporal control on therapy delivery via optical, magnetic, or ultrasound modalities. The local control on therapy enables higher tumor treatment efficacy, while simultaneously reducing off-target effects. The nanoparticle interactions with external fields have an additional advantage of frequently generating an imaging signal, and thus such agents provide theranostic (both diagnostic and therapeutic) capabilities. In this review, we classify the emerging externally modulated theranostic nanoparticles according to the mode of external control and describe the physiochemical mechanisms underlying the external control of therapy, and illustrate the major embodiments of nanoparticles in each class with proven biological efficacy: (I) electromagnetic radiation in visible and near-infrared range is being exploited for gold based and carbon nanostructures with tunable surface plasmon resonance (SPR) for imaging and photothermal therapy (PTT) of cancer, photochemistry based manipulations are employed for light sensitive liposomes and porphyrin based nanoparticles; (II) Magnetic field based manipulations are being developed for iron-oxide based nanostructures for magnetic resonance imaging (MRI) and magnetothermal therapy; (III) ultrasound based methods are primarily being employed to increase delivery of conventional drugs and nanotherapeutics to tumor sites. PMID:24834381

  2. Relative cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in Spain

    PubMed Central

    Guest, Julian F; Weidlich, Diana; Mascuñan Díaz, J Ignacio; Díaz, Juan J; Ojeda, Pedro Manuel; Ferrer-González, J Pablo; Gil, David; Onrubia, Isabel; Rincón Victor, Pedro

    2015-01-01

    Objective To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) as a first-line management for cow’s milk allergy compared with eHCF alone, and amino acid formulae in Spain, from the perspective of the Spanish National Health Service (SNS). Methods Decision modeling was used to estimate the probability of immunoglobulin E (IgE)-mediated and non–IgE-mediated allergic infants developing tolerance to cow’s milk by 18 months. The models also estimated the SNS cost (at 2012/2013 prices) of managing infants over 18 months after starting a formula as well as the relative cost-effectiveness of each of the formulae. Results The probability of developing tolerance to cow’s milk by 18 months was higher among infants with either IgE-mediated or non–IgE-mediated allergy who were fed eHCF + LGG compared with those fed one of the other formulae. The total health care cost of initially feeding infants with eHCF + LGG was less than that of feeding infants with one of the other formulae. Hence, eHCF + LGG affords the greatest value for money to the SNS for managing both IgE-mediated and non–IgE-mediated cow’s milk allergy. Conclusion Using eHCF + LGG instead of eHCF alone or amino acid formulae for first-line management of newly-diagnosed infants with cow’s milk allergy affords a cost-effective use of publicly funded resources because it improves outcome for less cost. A randomized controlled study showing faster tolerance development in children receiving a probiotic-containing formula is required before this conclusion can be confirmed. PMID:26648744

  3. The Role of Advocacy Organizations in Reducing Negative Externalities.

    PubMed

    Biglan, Anthony

    2009-07-01

    An externality is a cost that a corporation's actions impose on society. For example, a power plant may emit mercury, but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the unsustainability of manufacturing processes, and marketing of products contributing to environmental damage, and economic policies that maintain high levels of poverty due to effective lobbying by the business community. This paper examines the problem of externalities in terms of metacontingencies. Externalities continue precisely because there is no cost to the organizations for practices that impose these costs on third parties. The paper describes the cultural practices needed to influence governments are motivated to make corporations bear the true costs of their practices-costs that are currently imposed on others. PMID:20011073

  4. The Role of Advocacy Organizations in Reducing Negative Externalities

    PubMed Central

    Biglan, Anthony

    2009-01-01

    An externality is a cost that a corporation’s actions impose on society. For example, a power plant may emit mercury, but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the unsustainability of manufacturing processes, and marketing of products contributing to environmental damage, and economic policies that maintain high levels of poverty due to effective lobbying by the business community. This paper examines the problem of externalities in terms of metacontingencies. Externalities continue precisely because there is no cost to the organizations for practices that impose these costs on third parties. The paper describes the cultural practices needed to influence governments are motivated to make corporations bear the true costs of their practices—costs that are currently imposed on others. PMID:20011073

  5. A system dynamic modeling approach for evaluating municipal solid waste generation, landfill capacity and related cost management issues.

    PubMed

    Kollikkathara, Naushad; Feng, Huan; Yu, Danlin

    2010-11-01

    As planning for sustainable municipal solid waste management has to address several inter-connected issues such as landfill capacity, environmental impacts and financial expenditure, it becomes increasingly necessary to understand the dynamic nature of their interactions. A system dynamics approach designed here attempts to address some of these issues by fitting a model framework for Newark urban region in the US, and running a forecast simulation. The dynamic system developed in this study incorporates the complexity of the waste generation and management process to some extent which is achieved through a combination of simpler sub-processes that are linked together to form a whole. The impact of decision options on the generation of waste in the city, on the remaining landfill capacity of the state, and on the economic cost or benefit actualized by different waste processing options are explored through this approach, providing valuable insights into the urban waste-management process. PMID:20547450

  6. A system dynamic modeling approach for evaluating municipal solid waste generation, landfill capacity and related cost management issues

    SciTech Connect

    Kollikkathara, Naushad; Feng Huan; Yu Danlin

    2010-11-15

    As planning for sustainable municipal solid waste management has to address several inter-connected issues such as landfill capacity, environmental impacts and financial expenditure, it becomes increasingly necessary to understand the dynamic nature of their interactions. A system dynamics approach designed here attempts to address some of these issues by fitting a model framework for Newark urban region in the US, and running a forecast simulation. The dynamic system developed in this study incorporates the complexity of the waste generation and management process to some extent which is achieved through a combination of simpler sub-processes that are linked together to form a whole. The impact of decision options on the generation of waste in the city, on the remaining landfill capacity of the state, and on the economic cost or benefit actualized by different waste processing options are explored through this approach, providing valuable insights into the urban waste-management process.

  7. Implications of environmental externalities assessments for solar thermal powerplants

    NASA Astrophysics Data System (ADS)

    Lee, A. D.; Baechler, M. C.

    1991-03-01

    Externalities are those impacts of one activity on other activities that are not priced in the marketplace. An externality is said to exist when two conditions hold: (1) the utility or operations of one economic agent, A, include nonmonetary variables whose values are chosen by another economic agent, B, without regard to the effects on A, and (2) B does not pay A compensation equal to the incremental costs inflicted on A. Electricity generation involves a wide range of potential and actual environmental impacts. Legislative, permitting, and regulatory requirements directly or indirectly control certain environmental impacts, implicitly causing them to become internalized in the cost of electricity generation. Electricity generation, however, often produces residual environmental impacts that meet the definition of an externality. Mechanisms have been developed by several states to include the costs associated with externalities in the cost-effectiveness analyses of new powerplants. This paper examines these costs for solar thermal plants and applies two states' scoring methodologies to estimate how including externalities would affect the levelized costs of power from a solar plant in the Pacific Northwest. It concludes that including externalities in the economics can reduce the difference between the levelized cost of a coal and solar plant by between 0.74 and 2.42 cents/kWh.

  8. Are floods in part a form of land use externality?

    NASA Astrophysics Data System (ADS)

    Dorner, W.; Porter, M.; Metzka, R.

    2008-05-01

    Peak and volume of river flows are functions of the catchment surface characteristics. This means that any impacts to the run-off regime (for example surface sealing and river training) could affect people and land users in the lower system. The costs of flood defence or compensation of damages are usually not included in the economic calculation of the upstream land owner or land user. In economic terms these effects are referred to as unidirectional externalities. This paper presents a methodology to identify externalities related to land use and run-off and describes the relevant cause-effect relations and how they can be modelled. The Herzogbach is a small tributary of the Danube River in Lower Bavaria. It is located in a rural area, dominated by intensive farming practices. A combination of hydrological and hydraulic modelling provided the core of the project methodology to allow the interpretation of economic data. Comparisons of damage estimates resulting from different hydrological scenarios based on different land uses, and flood mitigation costs were used to show the economic significance of human impacts.

  9. AB037. Drug-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy ​​purchases​

    PubMed Central

    Carney, A. Simon; Price, David B.; Smith, Pete; Harvey, Richard; Bosnic-Anticevich, Sinthia; Christian, Louise; Skinner, Derek; Carter, Victoria; Durieux, Alice M. S.

    2016-01-01

    Background Intranasal corticosteroids (INS) are a first-line therapy for rhinitis according to all international clinical guidelines for rhinitis. Although many added treatments are not recommended, the use of multiple therapies to control symptoms is frequent, as patients often continue to experience debilitating symptoms while on medication. Previous estimates of multiple therapy prescriptions may have been too conservative, as most rhinitis therapies are also available over-the-counter (OTC). This may affect the cost burden of rhinitis treatment. To investigate the extent of multiple therapy use to treat rhinitis in Australia, using doctor prescriptions and OTC medication; and to assess the additional cost incurred by multiple therapy use. Methods This was a historical cohort study of pharmacy-related claims from NostraData, Australia. We examined all rhinitis therapy purchases (antihistamines, INS, combination treatments of both such as Dymista, non-steroidal nasal sprays, leukotriene receptor antagonists (LTRA), eye drops for allergic conjunctivitis, oral steroids and systemic steroids) from 909 pharmacies, including OTC and prescription drugs. We used therapies purchased at the same transaction to assess the proportion of multiple therapy purchases and their cost. Results A total of 4,247,193 pharmacy transactions including rhinitis therapies were analysed; 4% of transactions included multiple rhinitis therapy classes. The average transaction cost was 12.82 EUR for single therapy purchases and 26.72 EUR for multiple therapy purchases. 15% of single therapy purchases were INS, for an average cost of 20.68 EUR. The most frequent additions to INS therapy were antihistamine (74%) and non-steroidal nasal spray (10%). About 94% of antihistamine and 97% of non-steroidal nasal spray purchased as add-on therapy to INS were bought over-the-counter. The average cost of INS & antihistamine and INS & non-steroidal nasal spray transactions was 30.65 and 26.57 EUR

  10. Reduction of Medical Cost through Pharmaceutical Inquiries by Community Pharmacists and Relation with Iyaku Bungyo Rates: A Nationwide Survey on Prescription Inquiries.

    PubMed

    Shikamura, Yoshiaki; Mano, Yasunari; Komoda, Masayo; Negishi, Kenichi; Sato, Tsugumichi; Miyazaki, Satoru

    2016-01-01

    This nationwide survey aimed to evaluate reduction of drug and medical costs due to prevention of serious adverse drug reactions through pharmaceutical inquires by community pharmacist, and investigate relation with iyaku bungyo (separation of dispensing from medical practice) rates. Using the national list of pharmacies, 10% of pharmacies were randomly selected by prefecture and asked to participate in an Internet-based survey. The survey period was 7 days, from July 21 to July 27, 2015. Of the 5575 pharmacies queried, 818 responded to the survey (response rate: 14.7%). The proportion of inquiries to total prescriptions was 2.6%. Among these, the proportion of prescriptions changed in response to inquiry was 74.9%. An estimated 103 million yen was saved by reducing drug costs, and 133 million yen was saved by reducing medical costs due to prevention of serious adverse drug reactions. Comparison of prescription change rates between pharmacies with high and low iyaku bungyo rates indicated that the proportion of prescriptions changed was significantly higher in pharmacies with high iyaku bungyo rates than in those with low iyaku bungyo rates (78.2% vs. 69.9%, p<0.01). The findings suggest that inquiries about prescriptions are useful in ensuring the safety of pharmacotherapy and reducing the cost of healthcare. They also suggest that iyaku bungyo promotes prescription changes through inquiries, leading to proper use of pharmaceutical products. PMID:27592829

  11. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis.

    PubMed Central

    O'Connor, Joanne; McCaughan, Dorothy; McDaid, Catriona; Booth, Alison; Fayter, Debra; Rodriguez-Lopez, Roccio; Bowers, Roy; Dyson, Lisa; Iglesias, Cynthia P; Lalor, Simon; O'Connor, Rory J; Phillips, Margaret; Ramdharry, Gita

    2016-01-01

    BACKGROUND Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). OBJECTIVES To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs. METHODS Qualitative study of views of orthoses users - a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review - 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis - a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis. RESULTS Qualitative study - a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients' prime desired outcome was a reduction in pain, falls or trips, with improved

  12. Multisystemic Therapy for Externalizing Youth

    PubMed Central

    Zajac, Kristyn; Randall, Jeff; Swenson, Cynthia Cupit

    2015-01-01

    Synopsis Externalizing problems are multi-determined and related to individual, family, peer, school, and community risk factors. Multisystemic therapy (MST) was originally developed to address these risk factors among youth with serious conduct problems who were at-risk for out-of-home placement. Several decades of research has established MST as an evidence-based intervention for adolescents with serious clinical problems, including serious offending, delinquency, substance abuse, and parental physical abuse and neglect. Further, research points to the importance of maintaining high treatment fidelity through systematic quality assurance procedures to replicate positive clinical outcomes. This paper presents an overview of the clinical procedures and evidence base of MST for externalizing problems as well as two adaptations: MST for Substance Abuse and MST for Child Abuse and Neglect. PMID:26092742

  13. Lifetime risk and cost of clinical mastitis in dairy cows in relation to heifer rearing conditions in southwest Sweden.

    PubMed

    Hultgren, J; Svensson, C

    2009-07-01

    Relationships between heifer rearing conditions and the risk of veterinary-reported clinical mastitis (VRCM) during productive life were studied by generalized linear mixed modeling at the lactation level. Data consisted of 5,693 lactations in 2,126 Swedish Reds, Swedish Holsteins, or dairy cows of other or mixed breeds, representing all female animals born in 110 herds in southwest Sweden in 1998. During a lactation, a cow was defined as affected by VRCM if one or more cases were reported by a veterinarian, starting from 7 d precalving. The applied model of VRCM included effects of breed, parity, diarrhea between 3 and 7 mo of age, increase in body weight from weaning to first breeding, increase in daily concentrate ration before first calving, herd-level median age at first calving, cow housing, and random effects of cow and herd. The VRCM incidence was 14% in a given lactation, or 0.11 cases/cow annually; 31% of the cows had VRCM at least once during their productive life. Ninety percent of the variation in mastitis risk was due to factors at the lactation level such as parity, milk yield, cow diseases, and other disturbances, instead of cow or herd factors. Severe diarrhea between 3 and 7 mo of age was associated with 2.8-fold higher odds of VRCM compared with mild diarrhea during the same period, whereas the VRCM odds of calves with mild diarrhea were half that without diarrhea. The odds of VRCM had a predicted maximum at an estimated prepubertal growth rate of 859 g/d and increased with 10% for every 1-kg increase in concentrate ration during the last 2 mo before first calving. Costs of VRCM were estimated based on assumptions regarding veterinary service, extra labor, culling and herd replacement, discarded milk, and production loss depending on parity and lactation stage when VRCM was diagnosed. The total mean costs of VRCM were estimated to be $735 per lactation with a diagnosis of CM, $103 per lactation across all cows, or $95 per cow annually during

  14. Negotiators who give too much: unmitigated communion, relational anxieties, and economic costs in distributive and integrative bargaining.

    PubMed

    Amanatullah, Emily T; Morris, Michael W; Curhan, Jared R

    2008-09-01

    A series of studies found that the personality dimension of unmitigated communion (H. L. Fritz & V. S. Helgeson, 1998) leads negotiators to make concessions to avoid straining relationships. Results indicate that even within the population of successful business executives, this dimension of relational anxiety can be identified distinctly from more general relational orientations, such as agreeableness, and that it distinctly predicts accommodating tendencies in everyday conflicts. In economic games, unmitigated communion predicts giving in contexts in which the relational norm of reciprocity applies, but not in contexts tapping instrumental or altruistic motives for cooperation. In distributive negotiations, the effect of unmitigated communion in lowering a negotiator's outcome is mediated by prenegotiation anxieties about relational strain and plans to make large concessions if needed to avoid impasse (lower reservation points). In integrative negotiations, high unmitigated communion on both sides of the negotiation dyad results in relational accommodation, evidenced by decreased success in maximizing economic joint gain but increased subjective satisfaction with the relationship. PMID:18729705

  15. Health insurance and the obesity externality.

    PubMed

    Bhattacharya, Jay; Sood, Neeraj

    2007-01-01

    If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool. To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes--(1) underwriting on weight is allowed and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in bodyweight, and reduced social welfare. Using data on medical expenditures and bodyweight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate. PMID:19548556

  16. What Does it Really Cost? Allocating Indirect Costs.

    ERIC Educational Resources Information Center

    Snyder, Herbert; Davenport, Elisabeth

    1997-01-01

    Better managerial control in terms of decision making and understanding the costs of a system/service result from allocating indirect costs. Allocation requires a three-step process: selecting cost objectives, pooling related overhead costs, and selecting costs bases to connect the objectives to the pooled costs. Argues that activity-based costing…

  17. Post-settlement migratory behaviour and growth-related costs in two diadromous fish species, Galaxias maculatus and Galaxias brevipinnis.

    PubMed

    Jung, C A; Barbee, N C; Swearer, S E

    2009-08-01

    The physiological challenges incurred during the transition from sea to fresh water and the constraints they place on the rate at which the common galaxiid Galaxias maculatus and the climbing galaxiid Galaxias brevipinnis can migrate from marine to freshwater habitats were examined. The duration of the marine to freshwater transition, the relationship between post-settlement age (PSA) and standard length (L(S)) as a proxy for energetic costs incurred during settlement and the potential effects of estuary geomorphology on migratory behaviour was investigated. Rate of upstream migration after settlement was not uniform. Upstream migration rate was slowest directly after settlement and increased with increasing PSA and distance from the river mouth, indicating a delay in upstream migration by newly recruited galaxiids. L(s) did not increase with age, at least within the first 21 days post settlement. These patterns were consistent for both species, in spite of differences in their life histories, across the recruitment season, despite seasonal variation in recruit size, and among estuaries with different properties. The results suggest that the timing and speed of migratory behaviour primarily reflect physiological constraints. Given the duration of residency of these species in estuaries, this study indicates that estuaries are critical transitional habitats for diadromous fishes during their migration from marine to freshwater habitats. PMID:20738553

  18. Computer Vision Tools for Low-Cost and Noninvasive Measurement of Autism-Related Behaviors in Infants

    PubMed Central

    Vallin Spina, Thiago; Papanikolopoulos, Nikolaos; Egger, Helen

    2014-01-01

    The early detection of developmental disorders is key to child outcome, allowing interventions to be initiated which promote development and improve prognosis. Research on autism spectrum disorder (ASD) suggests that behavioral signs can be observed late in the first year of life. Many of these studies involve extensive frame-by-frame video observation and analysis of a child's natural behavior. Although nonintrusive, these methods are extremely time-intensive and require a high level of observer training; thus, they are burdensome for clinical and large population research purposes. This work is a first milestone in a long-term project on non-invasive early observation of children in order to aid in risk detection and research of neurodevelopmental disorders. We focus on providing low-cost computer vision tools to measure and identify ASD behavioral signs based on components of the Autism Observation Scale for Infants (AOSI). In particular, we develop algorithms to measure responses to general ASD risk assessment tasks and activities outlined by the AOSI which assess visual attention by tracking facial features. We show results, including comparisons with expert and nonexpert clinicians, which demonstrate that the proposed computer vision tools can capture critical behavioral observations and potentially augment the clinician's behavioral observations obtained from real in-clinic assessments. PMID:25045536

  19. Design and Fabrication of Low-Cost 1536-Chamber Microfluidic Microarrays for Mood-Disorders-Related Serological Studies

    PubMed Central

    Zhao, Xinyan; Dong, Tao

    2013-01-01

    Mood disorders are common mental diseases, but physiological diagnostic methods are still lacking. Since much evidence has implied a relationship between mood disorders and the protein composition of blood sera, it is conceivable to develop a serological criterion for assisting diagnosis of mood disorders, based on a correlative database with enough capacity and high quality. In this pilot study, a low-cost microfluidic microarray device for quantifying at most 384 serological biomarkers at the same time was designed for the data acquisition of the serological study. The 1,536-chamber microfluidic device was modeled on a 1,536-well microtiter plate in order to employ a common microplate reader as the detection module for measuring the chemiluminescent immunoassay tests on the chips. The microfluidic microarrays were rapidly fabricated on polymethylmethacrylate slides using carbon dioxide laser ablation, followed by effective surface treatment processing. Sixteen types of different capture antibodies were immobilized on the chips to test the corresponding hormones and cytokines. The preliminary tests indicated that the signal-to-noise ratio and the limit of detection of microfluidic microarrays have reached the level of standard ELISA tests, whereas the operation time of microfluidic microarrays was sharply reduced. PMID:24169541

  20. Both costs and benefits of sex correlate with relative frequency of asexual reproduction in cyclically parthenogenic Daphnia pulicaria populations.

    PubMed

    Allen, Desiree E; Lynch, Michael

    2008-07-01

    Sexual reproduction is generally believed to yield beneficial effects via the expansion of expressed genetic variation, which increases the efficiency of selection and the adaptive potential of a population. However, when nonadditive gene action is involved, sex can actually impede the adaptive progress of a population. If selection promotes coupling disequilibria between genes of similar effect, recombination and segregation can result in a decrease in expressed genetic variance in the offspring population. In addition, when nonadditive gene action underlies a quantitative trait, sex can produce a change in trait means in a direction opposite to that favored by selection. In this study we measured the change in genotypic trait means and genetic variances across a sexual generation in four populations of the cyclical parthenogen Daphnia pulicaria, which vary predictably in their incidence of sexual reproduction. We show that both the costs and benefits of sex, as measured by changes in means and variances in life-history traits, increase substantially with decreasing frequency of sex. PMID:18562659

  1. Metasurface external cavity laser

    SciTech Connect

    Xu, Luyao Curwen, Christopher A.; Williams, Benjamin S.; Hon, Philip W. C.; Itoh, Tatsuo; Chen, Qi-Sheng

    2015-11-30

    A vertical-external-cavity surface-emitting-laser is demonstrated in the terahertz range, which is based upon an amplifying metasurface reflector composed of a sub-wavelength array of antenna-coupled quantum-cascade sub-cavities. Lasing is possible when the metasurface reflector is placed into a low-loss external cavity such that the external cavity—not the sub-cavities—determines the beam properties. A near-Gaussian beam of 4.3° × 5.1° divergence is observed and an output power level >5 mW is achieved. The polarized response of the metasurface allows the use of a wire-grid polarizer as an output coupler that is continuously tunable.

  2. Metasurface external cavity laser

    NASA Astrophysics Data System (ADS)

    Xu, Luyao; Curwen, Christopher A.; Hon, Philip W. C.; Chen, Qi-Sheng; Itoh, Tatsuo; Williams, Benjamin S.

    2015-11-01

    A vertical-external-cavity surface-emitting-laser is demonstrated in the terahertz range, which is based upon an amplifying metasurface reflector composed of a sub-wavelength array of antenna-coupled quantum-cascade sub-cavities. Lasing is possible when the metasurface reflector is placed into a low-loss external cavity such that the external cavity—not the sub-cavities—determines the beam properties. A near-Gaussian beam of 4.3° × 5.1° divergence is observed and an output power level >5 mW is achieved. The polarized response of the metasurface allows the use of a wire-grid polarizer as an output coupler that is continuously tunable.

  3. Relative cost-effectiveness of an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in Italy

    PubMed Central

    Guest, Julian F; Panca, Monica; Ovcinnikova, Olga; Nocerino, Rita

    2015-01-01

    Objective To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) containing the probiotic Lactobacillus rhamnosus GG, (eHCF + LGG; Nutramigen LGG) as first-line management for cow’s milk allergy (CMA) compared with eHCF alone, soy-based formulae (SBF), hydrolyzed rice formulae (HRF), and amino acid formulae (AAF) in Italy, from the perspective of the Italian National Health Service (INHS) and parents. Methods Decision modeling was used to estimate the probability of infants developing tolerance to cow’s milk by 18 months, based on an observational study dataset. The model also estimated the cost (at 2012/2013 prices) of health care resource use funded by the INHS and formulae paid for by parents over 18 months after starting a formula, as well as the relative cost-effectiveness of each of the formulae. Results The probability of developing tolerance to cow’s milk by 18 months was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were fed eHCF + LGG compared to those fed one of the other formulae. The total health care cost of initially feeding infants with eHCF + LGG was less than that of feeding infants with one of the other formulae. Hence, eHCF + LGG affords the greatest value for money to both the INHS and parents of infants with either IgE-mediated or non-IgE-mediated CMA. Conclusion Using eHCF + LGG instead of eHCF, SBF, HRF, or an AAF for first-line management of newly diagnosed infants with CMA in Italy affords a cost-effective use of publicly funded resources, and is cost-effective from the parents’ perspective, since it improves outcome for less cost. A randomized controlled study showing faster tolerance development in children receiving a probiotic-containing formula is required before this conclusion can be confirmed. PMID:26089692

  4. 32 CFR 536.80 - Payment of costs, settlements, and judgments related to certain medical malpractice claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... wrongful actions or omissions occurred during the performance of medical, dental, or related health care functions (including clinical studies and investigations) while the medical or health care employee was acting within the scope of employment. (2) Such personnel furnish prompt notification and delivery of...

  5. 32 CFR 536.80 - Payment of costs, settlements, and judgments related to certain medical malpractice claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... wrongful actions or omissions occurred during the performance of medical, dental, or related health care functions (including clinical studies and investigations) while the medical or health care employee was acting within the scope of employment. (2) Such personnel furnish prompt notification and delivery of...

  6. Teradata University Network: A No Cost Web-Portal for Teaching Database, Data Warehousing, and Data-Related Subjects

    ERIC Educational Resources Information Center

    Jukic, Nenad; Gray, Paul

    2008-01-01

    This paper describes the value that information systems faculty and students in classes dealing with database management, data warehousing, decision support systems, and related topics, could derive from the use of the Teradata University Network (TUN), a free comprehensive web-portal. A detailed overview of TUN functionalities and content is…

  7. Estimating Airline Operating Costs

    NASA Technical Reports Server (NTRS)

    Maddalon, D. V.

    1978-01-01

    The factors affecting commercial aircraft operating and delay costs were used to develop an airline operating cost model which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model permits estimates of aircraft related costs, i.e., aircraft service, landing fees, flight attendants, and control fees. A method for estimating the costs of certain types of airline delay is also described.

  8. On the Cost of Big Events: Are Weather-Related Disasters as Bad as Economic Recessions for Health Disparities Related to Drug Use?

    PubMed

    Caiaffa, Waleska Teixeira; Andrade, Roseli Gomes

    2015-01-01

    This commentary reviews two manuscripts about big event empirical data exploring concepts and pathways of drug use and health-related events. Using basic concepts and tools, it proposes a focused framework in order to help comprehension of the multifactorial and multilevel components between macrosocial determinants of health, contextual pathways of drug use and drug-use harm and individual levels in the episode of a big event occurrence. The text also discusses implications of preexisting conditions that may be contributing factors for socially and economically segregated subsets of the population, groups possibly "at risk of risks," meaning unequally exposed to risks that generate exposure to other risks, amplifying preexistent inequities. PMID:26158750

  9. Costs and benefits of children's physical and relational aggression trajectories on peer rejection, acceptance, and friendships: Variations by aggression subtypes, gender, and age.

    PubMed

    Ettekal, Idean; Ladd, Gary W

    2015-12-01

    This study examined the associations between children's co-occurring relational and physical aggression trajectories and their peer relations (i.e., peer rejection, peer acceptance, and reciprocated friendships) from late childhood (Grade 4; Mage = 10.0) to early adolescence (Grade 8; Mage = 13.9). Using a sample of 477 children (240 girls), the findings indicated there were multiple heterogeneous subgroups of children who followed distinct co-occurring aggression trajectories. For each of these subgroups, multiple indices of their relational development were assessed and findings revealed notable group differences. These results have implications about the potential costs and benefits of aggression, and how its associations with children's peer relationships may vary as a function of aggression subtype, developmental timing, and gender. PMID:26414097

  10. Discrete Wavelength-Locked External Cavity Laser

    NASA Technical Reports Server (NTRS)

    Pilgrim, Jeffrey S.; Silver, Joel A.

    2004-01-01

    A prototype improved external cavity laser (ECL) was demonstrated in the second phase of a continuing effort to develop wavelength-agile lasers for fiber-optic communications and trace-gas-sensing applications. This laser is designed to offer next-generation performance for incorporation into fiber-optic networks. By eliminating several optical components and simplifying others used in prior designs, the design of this laser reduces costs, making lasers of this type very competitive in a price-sensitive market. Diode lasers have become enabling devices for fiber optic networks because of their cost, compactness, and spectral properties. ECLs built around diode laser gain elements further enhance capabilities by virtue of their excellent spectral properties with significantly increased (relative to prior lasers) wavelength tuning ranges. It is essential to exploit the increased spectral coverage of ECLs while simultaneously insuring that they operate only at precisely defined communication channels (wavelengths). Heretofore, this requirement has typically been satisfied through incorporation of add-in optical components that lock the ECL output wavelengths to these specific channels. Such add-in components contribute substantially to the costs of ECL lasers to be used as sources for optical communication networks. Furthermore, the optical alignment of these components, needed to attain the required wavelength precision, is a non-trivial task and can contribute substantially to production costs. The design of the present improved ECL differs significantly from the designs of prior ECLs. The present design relies on inherent features of components already included within an ECL, with slight modifications so that these components perform their normal functions while simultaneously effecting locking to the required discrete wavelengths. Hence, add-in optical components and the associated cost of alignment can be eliminated. The figure shows the locking feedback signal

  11. Literature: External Forms.

    ERIC Educational Resources Information Center

    Regional Curriculum Project, Atlanta, GA.

    This curriculum guide, developed as part of a total English curriculum for pre-kindergarten through grade 10, suggests that students can best understand literature by understanding its recurring external forms or genres, and includes (1) an overview describing the four literary genres of drama, narrative poetry, narrative fiction, and lyric poetry…

  12. External Environmental Forecast.

    ERIC Educational Resources Information Center

    Lapin, Joel D.

    Representing current viewpoints of academics, futures experts, and social observers, this external environmental forecast presents projections and information of particular relevance to the future of Catonsville Community College. The following topics are examined: (1) population changes and implications for higher education; (2) state and local…

  13. External Otitis (Swimmer's Ear)

    MedlinePlus

    ... drops, keeping water out of the ear, and pain relievers are the most common forms of treatment. External otitis may involve the entire canal, as ... does not allow fungus to grow as well. Treatment of boils depends on ... relievers, such as oxycodone with acetaminophen , can be given ...

  14. [Agricultural activity and environmental externality: an analysis of the use of pesticides in the Brazilian savannah].

    PubMed

    Soares, Wagner Lopes; Porto, Marcelo Firpo

    2007-01-01

    This paper discusses the negative externalities associated with the intensive use of pesticides in the Brazilian savannah. These externalities are mainly related to impacts on the environment and on human health (rural workers and families, consumers), the costs of which end up being socialized. The externality considered in the present paper is of soil and water contamination by pesticides. The data source is the questionnaire of the Basic Municipal Information Research applied in 2003. Maps are used in order to associate contaminated areas with agricultural activity. Some risk factors associated with soil and water contamination by pesticides such as seasonal crop area, air pollution by burning and weed proliferation, were obtained through a logistic regression. The study concludes that the results can be helpful to formulate policies and aid in the design of regulating instruments and the definition of priority areas where preventive actions should be implemented. PMID:17680064

  15. Autism and Externalizing Behaviors: Buffering Effects of Parental Emotion Coaching

    ERIC Educational Resources Information Center

    Wilson, Beverly J.; Berg, Jessica L.; Zurawski, Megan E.; King, Kathleen A.

    2013-01-01

    The purpose of this study was to examine the relation between parental emotion coaching and externalizing behaviors in children with autism spectrum disorders (ASD). Children with ASD often exhibit externalizing behaviors, particularly emotionally driven externalizing behaviors, at a higher rate than their typically developing peers. An…

  16. Estimating airline operating costs

    NASA Technical Reports Server (NTRS)

    Maddalon, D. V.

    1978-01-01

    A review was made of the factors affecting commercial aircraft operating and delay costs. From this work, an airline operating cost model was developed which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model, similar in some respects to the standard Air Transport Association of America (ATA) Direct Operating Cost Model, permits estimates of aircraft-related costs not now included in the standard ATA model (e.g., aircraft service, landing fees, flight attendants, and control fees). A study of the cost of aircraft delay was also made and a method for estimating the cost of certain types of airline delay is described.

  17. Trends in Hospital Cost and Revenue, 1994–2005: How Are They Related to HMO Penetration, Concentration, and For-Profit Ownership?

    PubMed Central

    Shen, Yu-Chu; Wu, Vivian Y; Melnick, Glenn

    2010-01-01

    Objective Analyze trends in hospital cost and revenue, as well as price and quantity (1994–2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Data Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. Study Design A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. Principal Findings A 10 percentage point increase in HMO enrollment is associated with 4.1–4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1–2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19–27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization. Conclusions The historical difference of lower spending in high HMO penetration markets compared with low HMO markets narrowed after 2000 and the relative concentration between HMO and hospital markets can substantially influence hospital spending. Additional research is needed to understand how different aspects of these two markets have changed and interacted and how they are causally linked to spending trends. PMID:19840134

  18. Cost-effectiveness of postural exercise therapy versus physiotherapy in computer screen-workers with early non-specific work-related upper limb disorders (WRULD); a randomized controlled trial

    PubMed Central

    2009-01-01

    Background Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders (WRULD). Aims To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints, both from health care and societal perspective. Methods Prospective randomized trial including cost-effectiveness analysis; one year follow-up. Participants: Eighty-eight screen-workers with early non-specific WRULD; six drop-outs. Interventions: A ten week postural exercise program versus regular physiotherapy. Outcome measures: Effectiveness measures: Pain: visual analogous scale (VAS), self-perceived WRULD (yes/no). Functional outcome: Disabilities of Arm, Shoulder and Hand- Dutch Language Version (DASH-DLV). Quality of life outcome: EQ-5D. Economic measures: health care costs including patient and family costs and productivity costs resulting in societal costs. Cost-effectiveness measures: health care costs and societal costs related to the effectiveness measures. Outcome measures were assessed at baseline; three, six and twelve months after baseline. Results At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs. No significant differences between the groups concerning effectiveness at one year follow-up were found. Effectiveness scores slightly improved over time. After one year 55% of participants were free of complaints. After one year the postural exercise group had higher mean total health care costs, but lower productivity costs compared to the physiotherapy group. Mean societal costs after one year (therefore) were in favor of postural exercise therapy [- €622; 95% CI -2087; +590)]. After one year, only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy; however the probability of acceptable cost-effectiveness did not exceed

  19. [External ear melanoma].

    PubMed

    Amando García, L; Suárez Nieto, C; Madrigal Rubiales, B; García García, J

    2003-02-01

    Cutaneous melanomas are the tumours that have increased more their incidence in the last fifty years. Melanomas arising from the external auditory canal are extraordinariously unfrequent. These tumours show an aggressive and silent behaviour, and due to this the diagnosis is frequently made in an advanced stage. A male with a malignant melanoma arising from his left external auditory canal was attended in our department, suspecting an epidermoid carcinoma. The clinical findings and the extension of the lesion required a lateral temporal bone resection, parotidectomy and neck dissection to achieve a total resection. We present a review of the literature about this entity and an analysis of the incidence, significance of the lymph node metastases and value of the elective neck dissection. PMID:12802982

  20. Externally triggered microcapsules

    NASA Technical Reports Server (NTRS)

    Morrison, Dennis R. (Inventor); Mosier, Benjamin (Inventor)

    2011-01-01

    Disclosed are microcapsules comprising a polymer shell enclosing one or more immiscible liquid phases in which a drug or drug precursor are contained in a liquid phase. The microparticles also contain magnetic particles that can be heated by application of an external magnetic field and thus heated to a predetermined Curie temperature. Heating of the particles melts the polymer shell and releases the drug without causing heating of surrounding tissues.

  1. The Role of Advocacy Organizations in Reducing Negative Externalities

    ERIC Educational Resources Information Center

    Biglan, Anthony

    2009-01-01

    An externality is a cost that a corporation's actions impose on society. For example, a power plant may emit mercury but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the…

  2. Relative Biologic Effects of Low-Dose-Rate {alpha}-Emitting {sup 227}Th-Rituximab and {beta}-Emitting {sup 90}Y-Tiuexetan-Ibritumomab Versus External Beam X-Radiation

    SciTech Connect

    Dahle, Jostein Bruland, Oyvind S.; Larsen, Roy H.

    2008-09-01

    Purpose: To determine the relative biologic effects (RBE) of {alpha}-particle radiation from {sup 227}Th-rituximab and of {beta}-radiation from {sup 90}Y-tiuexetan-ibritumomab (Zevalin) compared with external beam X-radiation in the Raji lymphoma xenograft model. Methods and Materials: Radioimmunoconjugates were administered intravenously in nude mice with Raji lymphoma xenografts at different levels of activity. Absorbed dose to tumor was estimated by separate biodistribution experiments for {sup 227}Th-rituximab and Zevalin. Tumor growth was measured two to three times per week after injection or X-radiation. Treatment-induced increase in growth delay to reach tumor volumes of 500 and 1,000 mm{sup 3}, respectively, was used as an end point. Results: The absorbed radiation dose-rate in tumor was slightly more than 0.1 Gy/d for the first week following injection of {sup 227}Th-rituximab, and thereafter gradually decreased to 0.03 Gy/d at 21 days after injection. For treatment with Zevalin the maximum dose-rate in tumor was achieved already 6 h after injection (0.2 Gy/d), and thereafter decreased to 0.01 Gy/d after 7 days. The relative biologic effect was between 2.5 and 7.2 for {sup 227}Th-rituximab and between 1 and 1.3 for Zevalin. Conclusions: Both at low doses and low-dose-rates, the {sup 227}Th-rituximab treatment was more effective per absorbed radiation dose unit than the two other treatments. The considerable effect at low doses suggests that the best way to administer low-dose-rates, {alpha}-emitting radioimmunoconjugates is via multiple injections.

  3. Cost savings from nuclear regulatory reform: An econometric model

    SciTech Connect

    Canterbery, E.R. |; Johnson, B.; Reading, D.

    1996-01-01

    The nuclear-generated power touted in the 1950s as someday being {open_quotes}too cheap to meter{close_quotes} got dismissed in the 1980s as incapable of being both safe and cost effective. Today, less than 20 percent of American`s electricity is nuclear-generated, no new plants are planned or on order, and some of the earliest units are scheduled for decommissioning within the next decade. Even so, interest in nuclear power has been revived by increasing energy demands, concerns about global warming, and the uncertainty surrounding oil resources in the Persian Gulf. As a long-term alternative to fossil fuels, atomic energy offers the important advantages of clean air and domestic availability of fuel. But these advantages will count for little unless and until the costs of nuclear power can be seen as reasonable. The authors premise is that the relevant costs are those of providing safe and environmentally clean electric energy. To the extent that increased costs have resulted from increasingly stringent regulations, they reflect the internalization of external costs. Indeed, the external costs of nuclear power (particularly safety and environmental protection) have been internalized to a greater degree than with most alternative fuel sources used by electric utilities. Nuclear construction costs are properly compared with those of alternative sources only after the latter are adjusted for environmental damage and endangerment, including, as examples, the costs of oil spills, of building double-hulled tankers, and of building off-shore offloading facilities. A shift to nuclear sources could reduce these costs whereas it would increase disposal costs for radioactive materials. The authors contend that a better understanding of nuclear plant construction costs is pivotal to a balanced evaluation of the merits of uranium relative to other fuel choices. 12 refs., 2 figs., 5 tabs.

  4. DIRBE External Calibrator (DEC)

    NASA Technical Reports Server (NTRS)

    Wyatt, Clair L.; Thurgood, V. Alan; Allred, Glenn D.

    1987-01-01

    Under NASA Contract No. NAS5-28185, the Center for Space Engineering at Utah State University has produced a calibration instrument for the Diffuse Infrared Background Experiment (DIRBE). DIRBE is one of the instruments aboard the Cosmic Background Experiment Observatory (COBE). The calibration instrument is referred to as the DEC (Dirbe External Calibrator). DEC produces a steerable, infrared beam of controlled spectral content and intensity and with selectable point source or diffuse source characteristics, that can be directed into the DIRBE to map fields and determine response characteristics. This report discusses the design of the DEC instrument, its operation and characteristics, and provides an analysis of the systems capabilities and performance.

  5. External split field generator

    SciTech Connect

    Thundat, Thomas George; Van Neste, Charles W.; Vass, Arpad Alexander

    2012-02-21

    A generator includes a coil disposed about a core. A first stationary magnetic field source may be disposed on a first end portion of the core and a second stationary magnetic field source may be disposed on a second end portion of core. The first and second stationary magnetic field sources apply a stationary magnetic field to the coil. An external magnetic field source may be disposed outside the coil to apply a moving magnetic field to the coil. Electrical energy is generated in response to an interaction between the coil, the moving magnetic field, and the stationary magnetic field.

  6. Progressive External Ophthalmoplegia.

    PubMed

    McClelland, Collin; Manousakis, Georgios; Lee, Michael S

    2016-06-01

    Progressive external ophthalmoplegia (PEO), marked by progressive bilateral ptosis and diffuse reduction in ocular motility, represents a finding of mitochondrial myopathy rather than a true diagnosis. PEO often occurs with other systemic features of mitochondrial dysfunction that can cause significant morbidity and mortality. Accurate and early recognition of PEO is paramount for the optimal care of these patients. We present an evidence-based review of the presenting neuro-ophthalmic features, differential diagnosis, diagnostic tools, systemic implications, and treatment options for isolated PEO and other PEO-associated mitochondrial syndromes. PMID:27072953

  7. Externalities and electric power: an integrated assessment approach

    SciTech Connect

    Lee, R.

    1995-12-31

    This paper describes an integrated assessment approach for considering the options that electric utilities have to meet the anticipated demand for their power. The objective that this paper considers is one of meeting the demand for power, with an acceptable degree of reliability, at minimum cost. The total cost is the sum of the private cost of producing the electric power plus the external costs that result from its production. These external costs, or externalities, are effects on the well-being of third parties that producers and consumers of electric power do not take into account in their decisions. The external costs include many different types of effects such as illness, ecosystem damage, and road damage. The solution to the problem of minimizing total cost is addressed in two steps. The first step uses damage function methods to establish a common metric for the weights of the different objectives (i.e., external costs). The damage function analysis also reduces the dimensionality of the analysis in the second step, and identifies criteria to include in that analysis. The second step uses multi-criteria decision methods. This analysis includes the most important externalities that the damage function analysis identifies and, in addition, potentially important factors that can not be quantified reliably using damage function methods. An example of the latter are the damages from global climate change. The two-step method that this paper describes addresses many of the limitations of the damage function method and multi-criteria methods, that arise when they are used separately. This linked method can be used by electric utilities for their integrated resource planning. It can also be adapted to other applications.

  8. Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study

    PubMed Central

    2011-01-01

    Background A new lower-cost rapid-throughput human papillomavirus (HPV) test (careHPV, Qiagen, Gaithersburg, USA) has been shown to have high sensitivity for the detection of high grade cervical intraepithelial neoplasia. Methods We assessed the outcomes and cost-effectiveness of careHPV screening in rural China, compared to visual inspection with acetic acid, when used alone (VIA) or in combination with Lugol's iodine (VIA/VILI). Using data on sexual behaviour, test accuracy, diagnostic practices and costs from studies performed in rural China, we estimated the cost-effectiveness ratio (CER) and associated lifetime outcomes for once-lifetime and twice-lifetime screening strategies, and for routine screening at 5-yearly, 10-yearly and IARC-recommended intervals. The optimal age range for once-lifetime screening was also assessed. Results For all strategies, the relative ordering of test technologies in reducing cervical cancer incidence and mortality was VIA (least effective); VIA/VILI; careHPV@1.0 pg/ml and careHPV@0.5 pg/ml (most effective). For once-lifetime strategies, maximum effectiveness was achieved if screening occurred between 35-50 years. Assuming a participation rate of ~70%, once-lifetime screening at age 35 years would reduce cancer mortality by 8% (for VIA) to 12% (for careHPV@0.5) over the long term, with a CER of US$557 (for VIA) to $959 (for careHPV@1.0) per life year saved (LYS) compared to no intervention; referenced to a 2008 GDP per capita in Shanxi Province of $2,975. Correspondingly, regular screening with an age-standardised participation rate of 62% (which has been shown to be achievable in this setting) would reduce cervical cancer mortality by 19-28% (for 10-yearly screening) to 43-54% (using IARC-recommended intervals), with corresponding CERs ranging from $665 (for 10-yearly VIA) to $2,269 (for IARC-recommended intervals using careHPV@1.0) per LYS. Conclusions This modelled analysis suggests that primary careHPV screening compares

  9. Blood Lifestyle: Externalizing the Cost of Human Life

    ERIC Educational Resources Information Center

    Model, David

    2012-01-01

    To build postsecondary institutions that educate responsible citizens as well as competent employees and consumers, it is important that people must teach and learn themselves about the context--domestic and global--in which work is to be done, and the purposes which economic and technological development serve. One aspect of that context is the…

  10. Prospective multi-center study for quantification of chemotherapies and CTX-related direct medication costs avoided by use of biomarkers uPA and PAI-1 in primary breast cancer.

    PubMed

    Jacobs, Volker R; Augustin, Doris; Wischnik, Arthur; Kiechle, Marion; Höss, Cornelia; Steinkohl, Oliver; Rack, Brigitte; Kapitza, Thomas; Krase, Peter

    2013-08-01

    Biomarkers uPA/PAI-1 as recommended by ASCO and AGO are used in primary breast cancer to avoid unnecessary CTX in medium risk-recurrence patients. This study verified how many CTX cycles and CTX-related direct medication costs can be avoided by uPA/PAI-1 testing. A prospective, non-interventional, multi-center study was performed among six Certified Breast Centers to analyze application of uPA/PAI-1 and consecutive decision-making. CTX avoided were identified and direct costs for CTX, CTX-related concomitant medication and febrile neutropenia (FN) prophylaxis with G-CSF calculated. In n = 93 breast cancers n = 35 CTX (37.6%) with 210 CTX cycles were avoided according to uPA/PAI-1 test result. uPA/PAI-1 testing saved direct medication costs for CTX of 177,453 €, CTX-related concomitant medication of 27,482 € and FN prophylaxis of 20,599 €, overall 225,534 €. At test costs at 287.50 € uPA/PAI-1 testing resulted in additional costs of 26,737.50 €. uPA/PAI-1 has proven to be cost-effective at a return-on-investment ratio of 8.4:1. Indirect cost savings further increase this ROI. These results support decision-making for cost-effective diagnostics and therapy in breast cancer. PMID:23643802

  11. Educational Costs.

    ERIC Educational Resources Information Center

    Arnold, Robert

    Problems in educational cost accounting and a new cost accounting approach are described in this paper. The limitations of the individualized cost (student units) approach and the comparative cost approach (in the form of fund-function-object) are illustrated. A new strategy, an activity-based system of accounting, is advocated. Borrowed from…

  12. Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia – a pilot evaluation

    PubMed Central

    Lenoir-Wijnkoop, Irene; van der Beek, Eline M.; Garssen, Johan; Nuijten, Mark J. C.; Uauy, Ricardo D.

    2015-01-01

    Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life. Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences. Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the

  13. [External ophthalmomyiasis: case reports].

    PubMed

    Yar, Kemal; Özcan, Altan Atakan; Koltaş, İ Soner

    2011-01-01

    We report two cases with external ophthalmomyiasis due to infestation with the larvae of Oestrus ovis. During an ophthalmologic examination, motile larvae were seen on the conjunctiva, which were removed and sent to the Department of Parasitology for identification. Microscopic examination of the specimens revealed that both patients were infested with the first stage larvae of O. ovis. The patients were treated with topical antibiotics and steroids and recovered without any complications. O. ovis larvae are the most common cause of ophthalmomyiasis worldwide. They are usually seen in underdeveloped, agricultural areas with high numbers of livestock, especially during Spring and Summer. These kind of infestations should be kept in mind in cases of conjunctivitis in the warm months of the year. PMID:22198925

  14. An external drag measuring element

    NASA Astrophysics Data System (ADS)

    Ringel, Mordechai; Levin, Daniel; Seginer, Arnan

    The accurate measurement of the axial-force component acting on small wind-tunnel models has traditionally made use of integral string balances, which eliminated many accuracy problems, such as friction and hysteresis, but also introduced interactions between the various force and moment sensing elements due to nonlinear elastic phenomena. The reduction of these interactions usually calls for complicated designs, expensive manufacturing, hard-to-handle calibration processes, and cumbersome data reduction programs. An approach is presented that is based on an external axial-force-measuring element and avoids the ill-conditioned design problems of integral balances. Other difficulties that are encountered, such as friction, misalignment, and relative motion between metric elements are considered, and their solution is examined. Calibration and test results show that the new approach duplicates and surpasses the results of much more complicated and expensive integral balances.

  15. Managing Information On Costs

    NASA Technical Reports Server (NTRS)

    Taulbee, Zoe A.

    1990-01-01

    Cost Management Model, CMM, software tool for planning, tracking, and reporting costs and information related to costs. Capable of estimating costs, comparing estimated to actual costs, performing "what-if" analyses on estimates of costs, and providing mechanism to maintain data on costs in format oriented to management. Number of supportive cost methods built in: escalation rates, production-learning curves, activity/event schedules, unit production schedules, set of spread distributions, tables of rates and factors defined by user, and full arithmetic capability. Import/export capability possible with 20/20 Spreadsheet available on Data General equipment. Program requires AOS/VS operating system available on Data General MV series computers. Written mainly in FORTRAN 77 but uses SGU (Screen Generation Utility).

  16. Functional Coherence of Insula Networks is Associated with Externalizing Behavior

    PubMed Central

    Abram, Samantha V.; Wisner, Krista M.; Grazioplene, Rachael G.; Krueger, Robert F.; MacDonald, Angus W.; DeYoung, Colin G.

    2015-01-01

    The externalizing spectrum encompasses a range of maladaptive behaviors, including substance use problems, impulsivity, and aggression. While previous literature has linked externalizing behaviors with prefrontal and amygdala abnormalities, recent studies suggest insula functionality is implicated. The present study investigated the relation between insula functional coherence and externalizing in a large community sample (N=244). Participants underwent a resting functional magnetic resonance imaging scan. Three non-artifactual intrinsic connectivity networks (ICNs) substantially involving the insula were identified after completing independent components analysis. Three externalizing domains—general disinhibition, substance abuse, and callous aggression—were measured with the Externalizing Spectrum Inventory. Regression models tested whether within-network coherence for the three insula ICNs was related to each externalizing domain. Posterior insula coherence was positively associated with general disinhibition and substance abuse. Anterior insula/ventral striatum/anterior cingulate network coherence was negatively associated with general disinhibition. Insula coherence did not relate to the callous aggression domain. Follow-up analyses indicated specificity for insula ICNs in their relation to general disinhibition and substance abuse as compared to other frontal and limbic ICNs. This study found insula network coherence was significantly associated with externalizing behaviors in community participants. Frontal and limbic ICNs containing less insular cortex were not related to externalizing. Thus, the neural synchrony of insula networks may be central for understanding externalizing psychopathology. PMID:26301974

  17. Assessment of population exposure to PM10 for respiratory disease in Lanzhou (China) and its health-related economic costs based on GIS

    PubMed Central

    2013-01-01

    Background Evaluation of the adverse health effects of PM10 pollution (particulate matter less than 10 microns in diameter) is very important for protecting human health and establishing pollution control policy. Population exposure estimation is the first step in formulating exposure data for quantitative assessment of harmful PM10 pollution. Methods In this paper, we estimate PM10 concentration using a spatial interpolation method on a grid with a spatial resolution 0.01° × 0.01°. PM10 concentration data from monitoring stations are spatially interpolated, based on accurate population data in 2000 using a geographic information system. Then, an interpolated population layer is overlaid with an interpolated PM10 concentration layer, and population exposure levels are calculated. Combined with the exposure-response function between PM10 and health endpoints, economic costs of the adverse health effects of PM10 pollution are analyzed. Results The results indicate that the population in Lanzhou urban areas is distributed in a narrow and long belt, and there are relatively large population spatial gradients in the XiGu, ChengGuan and QiLiHe districts. We select threshold concentration C0 at: 0 μg m-3 (no harmful health effects), 20 μg m-3 (recommended by the World Health Organization), and 50 μg m-3 (national first class standard in China) to calculate excess morbidity cases. For these three scenarios, proportions of the economic cost of PM10 pollution-related adverse health effects relative to GDP are 0.206%, 0.194% and 0.175%, respectively. The impact of meteorological factors on PM10 concentrations in 2000 is also analyzed. Sandstorm weather in spring, inversion layers in winter, and precipitation in summer are important factors associated with change in PM10 concentration. Conclusions The population distribution by exposure level shows that the majority of people live in polluted areas. With the improvement of evaluation criteria, economic damage of

  18. [External cephalic version using tocalytica (author's transl)].

    PubMed

    Meyenburg, M; Busch, W

    1976-12-01

    1. This report relates our experiences with 63 external versions of random breech or transverse presentations in cranial presentation between the 35th and 40th week of pregnancy p.m. using tocolytica. Only 22 of the 63 versions were successful when only tocolytica were administered. In 17 cases from a total of 34 the external version was successful under subsequent general anasthesia. 2. Of these 39, in whose case an external version of the foetus was successful, there were only two caesarian deliveries. The number of caesarian sections in the case of breech presentation on the other hand totalled, in the year the present investigation was carried out, 62%. By external version the number of caesarian sections performed on those women whose external version was successful was indirectly reduced twelve-fold. 3. It was not possible to turn 24 of the total of 63 foetuses - either by tocolytica or under general anaesthesia. The following factors - partly in combination - were responsible for this: 10 tendencies to contraction; 9 cases of a relatively narrow amniotic cavity: 3 cases of adiposity of the abdominal wall; 3 dorso-anterior or -posterior presentations; one case of "extended legs"; one relatively broad amniotic cavity. 4. An external version can cause damage to the placenta: a) in the case of 6 out of 22 women under obervation foetomaternal transfusion was detected. b) In once case materno-foetel transfusion with polyglobulism of the new-born was suspected. c) In one case a premature partial abruption of the placenta had to be assumed. The danger of damage to the placenta is especially great when the placenta is located next to the anterior wall of the uterus. 5. In 40% of the cases a brief deceleration of the foetal heart-frequency occurred immediately after the external version. Two cases were observed in which the foetal heart-frequency remained low over a period of several minutes. 6. In 5 out of the total of 63 cases a caesarian section was performed after

  19. Using DRGs and standard costs to control nursing labor costs.

    PubMed

    Meeting, D T; Saunders, G; Curcio, R F

    1988-09-01

    Nursing care is a very significant part of a healthcare organization's costs. However, until recently, methods of controlling nursing costs were largely ineffective. With the implementation of the prospective payment system and the use of diagnosis related groups, budgeting and controlling nursing costs are now possible with the use of standard costing. In this article, methods and procedures are discussed and explained for controlling inpatient nursing costs with the use of DRGs and standard costs. PMID:10312677

  20. Heterogeneity in the Energy Cost of Posture Maintenance during Standing Relative to Sitting: Phenotyping According to Magnitude and Time-Course

    PubMed Central

    Miles-Chan, Jennifer L.; Sarafian, Delphine; Montani, Jean-Pierre; Schutz, Yves; Dulloo, Abdul

    2013-01-01

    Background Reducing sitting-time may decrease risk of disease and increase life-span. In the search for approaches to reduce sitting-time, research often compares sitting to standing and ambulation, but the energetic cost of standing alone versus sitting is equivocal, with large variation in reported mean values (0% to >20% increase in energy expenditure (EE) during standing). Objective To determine the magnitude and time-course of changes in EE and respiratory quotient (RQ) during steady-state standing versus sitting. Design Min-by-min monitoring using a posture-adapted ventilated-hood indirect calorimetry system was conducted in 22 young adults with normal BMI during 10 min of steady-state standing versus sitting comfortably. Results This study reveals three distinct phenotypes based on the magnitude and time-course of the EE response to steady-state standing. One-third of participants (8/22) showed little or no change in EE during standing relative to sitting (ΔEE <5%; below first quartile). Of the 14 responders (ΔEE 7–21%), 4 showed sustained, elevated EE during standing, while 10 decreased their EE to baseline sitting values during the second half of the standing period. These EE phenotypes were systematically mirrored by alterations in RQ (a proxy of substrate oxidation), with ΔEE inversely correlated with ΔRQ (r = 0.6–0.8, p<0.01). Conclusion This study reveals different phenotypes pertaining to both energy cost and fuel utilization during standing, raising questions regarding standing as a strategy to increase EE and thermogenesis for weight control, and opening new avenues of research towards understanding the metabolic and psychomotor basis of variability in the energetics of standing and posture maintenance. PMID:23741514

  1. External audio for IBM-compatible computers

    NASA Technical Reports Server (NTRS)

    Washburn, David A.

    1992-01-01

    Numerous applications benefit from the presentation of computer-generated auditory stimuli at points discontiguous with the computer itself. Modification of an IBM-compatible computer for use of an external speaker is relatively easy but not intuitive. This modification is briefly described.

  2. Life cycle costing of waste management systems: Overview, calculation principles and case studies

    SciTech Connect

    Martinez-Sanchez, Veronica; Kromann, Mikkel A.

    2015-02-15

    Highlights: • We propose a comprehensive model for cost assessment of waste management systems. • The model includes three types of LCC: Conventional, Environmental and Societal LCCs. • The applicability of the proposed model is tested with two case studies. - Abstract: This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, and each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental

  3. Estimating Externalities of Natural Gas Fuel Cycles, Report 4

    SciTech Connect

    Barnthouse, L.W.; Cada, G.F.; Cheng, M.-D.; Easterly, C.E.; Kroodsma, R.L.; Lee, R.; Shriner, D.S.; Tolbert, V.R.; Turner, R.S.

    1998-01-01

    This report describes methods for estimating the external costs (and possibly benefits) to human health and the environment that result from natural gas fuel cycles. Although the concept of externalities is far from simple or precise, it generally refers to effects on individuals' well being, that result from a production or market activity in which the individuals do not participate, or are not fully compensated. In the past two years, the methodological approach that this report describes has quickly become a worldwide standard for estimating externalities of fuel cycles. The approach is generally applicable to any fuel cycle in which a resource, such as coal, hydro, or biomass, is used to generate electric power. This particular report focuses on the production activities, pollution, and impacts when natural gas is used to generate electric power. In the 1990s, natural gas technologies have become, in many countries, the least expensive to build and operate. The scope of this report is on how to estimate the value of externalities--where value is defined as individuals' willingness to pay for beneficial effects, or to avoid undesirable ones. This report is about the methodologies to estimate these externalities, not about how to internalize them through regulations or other public policies. Notwithstanding this limit in scope, consideration of externalities can not be done without considering regulatory, insurance, and other considerations because these institutional factors affect whether costs (and benefits) are in fact external, or whether they are already somehow internalized within the electric power market. Although this report considers such factors to some extent, much analysis yet remains to assess the extent to which estimated costs are indeed external. This report is one of a series of reports on estimating the externalities of fuel cycles. The other reports are on the coal, oil, biomass, hydro, and nuclear fuel cycles, and on general methodology.

  4. Relating Child Care during Infancy to Externalizing and Internalizing Behaviors in Toddlerhood: How Specific Features of Child Care Quality Matter Depending on a Child's Gender and Temperament

    ERIC Educational Resources Information Center

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2014-01-01

    This study explored whether the relationships between specific features of child care quality and externalizing and internalizing behaviors in 24-month-old children are moderated by gender and temperament. Questionnaires were used to record children's gender and measure their temperament. Child care quality was observed with the…

  5. [Costs and benefits of quality management].

    PubMed

    Schroeder-Printzen, I

    2014-01-01

    The establishment of quality management (QM) has been mandatory for health care providers of the national health insurance since 2004; however, certification is so far only compulsory for rehabilitation clinics. The costs have so far only been quantified in a few medical studies, while they are widely known in business administration with a basic distinction made between planning, steering, auditing, and declaration costs. Another business economics approach differentiates between prevention, appraisal, and non-conformance costs. The benefits of QM relates to customers, employees, external service providers, and health insurance providers. Also important in our consideration of the patient as a customer is that they should not be considered a customer in the usual business sense because the patient is in an emergency situation and can not freely decide. Improvements in treatment quality and in reducing the rate of adverse events make up the largest portion of the benefits of QM. Furthermore, QM can have a positive influence on motivation and employee recruitment. In addition, the cost savings that result despite costs for QM must not be forgotten. PMID:24452399

  6. Potential orbital use of the Space Shuttle External Tanks

    NASA Technical Reports Server (NTRS)

    Nein, Max E.; Fikes, John C.

    1990-01-01

    The Space Shuttle was designed so that major components would be reusable; however, it has been shown that it would not be cost-effective to reuse the external tanks in the same manner as the solid rocket boosters. Studies have been conducted to investigate using the external tanks on orbit. Utilizing an external tank on-orbit appears simple enough, since the tank obtains 98 percent of orbital velocity during the Space Shuttle's ascent phase. However, there are many requirements, issues, and difficulties that users must be aware of and satisfy. Studies for converting an external tank into a gamma-ray imaging telescope (GRIT), conducted at NASA Marshall, have identified many of these specific issues. Results of the GRIT studies and other considerations for the potential conversion of external tanks into useful space resources are summarized.

  7. National Mass Drug Administration Costs for Lymphatic Filariasis Elimination

    PubMed Central

    Goldman, Ann S.; Guisinger, Victoria H.; Aikins, Moses; Amarillo, Maria Lourdes E.; Belizario, Vicente Y.; Garshong, Bertha; Gyapong, John; Kabali, Conrad; Kamal, Hussein A.; Kanjilal, Sanjat; Kyelem, Dominique; Lizardo, Jefrey; Malecela, Mwele; Mubyazi, Godfrey; Nitièma, P. Abdoulaye; Ramzy, Reda M. R.; Streit, Thomas G.; Wallace, Aaron; Brady, Molly A.; Rheingans, Richard; Ottesen, Eric A.; Haddix, Anne C.

    2007-01-01

    Background Because lymphatic filariasis (LF) elimination efforts are hampered by a dearth of economic information about the cost of mass drug administration (MDA) programs (using either albendazole with diethylcarbamazine [DEC] or albendazole with ivermectin), a multicenter study was undertaken to determine the costs of MDA programs to interrupt transmission of infection with LF. Such results are particularly important because LF programs have the necessary diagnostic and treatment tools to eliminate the disease as a public health problem globally, and already by 2006, the Global Programme to Eliminate LF had initiated treatment programs covering over 400 million of the 1.3 billion people at risk. Methodology/Principal Findings To obtain annual costs to carry out the MDA strategy, researchers from seven countries developed and followed a common cost analysis protocol designed to estimate 1) the total annual cost of the LF program, 2) the average cost per person treated, and 3) the relative contributions of the endemic countries and the external partners. Costs per person treated ranged from $0.06 to $2.23. Principal reasons for the variation were 1) the age (newness) of the MDA program, 2) the use of volunteers, and 3) the size of the population treated. Substantial contributions by governments were documented – generally 60%–90% of program operation costs, excluding costs of donated medications. Conclusions/Significance MDA for LF elimination is comparatively inexpensive in relation to most other public health programs. Governments and communities make the predominant financial contributions to actual MDA implementation, not counting the cost of the drugs themselves. The results highlight the impact of the use of volunteers on program costs and provide specific cost data for 7 different countries that can be used as a basis both for modifying current programs and for developing new ones. PMID:17989784

  8. DYADIC PARENTING AND CHILDREN'S EXTERNALIZING SYMPTOMS.

    PubMed

    Meteyer, Karen B; Perry-Jenkins, Maureen

    2009-07-01

    We explore dyadic parenting styles and their association with first-grade children's externalizing behavior symptoms in a sample of 85 working-class, dual-earner families. Cluster analysis is used to create a typology of parenting types, reflecting the parental warmth, overreactivity, and laxness of both mothers and fathers in two-parent families. Three distinct groups emerged: Supportive Parents, Mixed-Support Parents and Unsupportive Parents. Results indicate that dyadic parenting styles were related to teacher-reported externalizing symptoms for boys but not for girls. PMID:20221305

  9. Data of high performance precast external walls for warm climate.

    PubMed

    Baglivo, Cristina; Maria Congedo, Paolo

    2015-09-01

    The data given in the following paper are related to input and output information of the paper entitled Design method of high performance precast external walls for warm climate by multi-objective optimization analysis by Baglivo et al. [1]. Previous studies demonstrate that the superficial mass and the internal areal heat capacity are necessary to reach the best performances for the envelope of the Zero Energy Buildings located in a warm climate [2-4]. The results show that it is possible to achieve high performance precast walls also with light and ultra-thin solutions. A multi-criteria optimization has been performed in terms of steady and dynamic thermal behavior, eco sustainability score and costs. The modeFRONTIER optimization tool, with the use of computational procedures developed in Matlab, has been used to assess the thermal dynamics of building components. A large set of the best configurations of precast external walls for warm climate with their physical and thermal properties have been reported in the data article. PMID:26306317

  10. An implementation on the social cost of hospital acquired infections.

    PubMed

    Kurutkan, Mehmet Nurullah; Kara, Oğuz; Eraslan, İsmail Hakki

    2015-01-01

    Hospital Acquired Infections (HAIs) are defined as infections developing in relation to health services at inpatient treatment facilities in general. Although health services improve, HAIs continue to be seen both in underdeveloped and developed countries. HAIs result in a range of negative externalities. Negative externalities include factors such as an increase in morbidity and mortality, extension of the hospitalization duration, impaired quality of life, loss of working power and performance. HAIs pose a big burden regarding population and community health care. This study aims to calculate the financial burden of HAIs by evaluating it within the scope of negative externality. The communal costs of HAIs patients were calculated by using a genuine approach with reference to samples obtained from the Duzce University Research and Application Hospital. This approach includes 4 stages and the results of each stage is sorted according to the data of 2013 as follows: (i) HAIs expenditure undertaken by the Social Security Institution is 5,832,167 TL, (ii) the monetary value of the work power loss of the HAIs patients who are at a working age is 126,154 TL, (iii) the relative cost of HAIs patients compared to a group of normal patients is 21,507 TL and (iv) HAIs patients' communal cost is 6,013,101 TL. Based on the received results, the annual communal cost of the estimated HAIs patients in Turkey is predicted to be 3,640,442,057 TL. In addition to these findings, HAIs patients experience 14 times longer in-patient stay at the hospitals as compared to normal patients, and their treatment expenditures are 23 times higher than the normal patients. In the conclusion part of the study, regarding the preventability (internalization) of HAIs, which was evaluated as part of negative externality, alternative applicable political suggestions are presented for the use of policymakers. PMID:26064367

  11. An implementation on the social cost of hospital acquired infections

    PubMed Central

    Kurutkan, Mehmet Nurullah; Kara, Oğuz; Eraslan, İsmail Hakki

    2015-01-01

    Hospital Acquired Infections (HAIs) are defined as infections developing in relation to health services at inpatient treatment facilities in general. Although health services improve, HAIs continue to be seen both in underdeveloped and developed countries. HAIs result in a range of negative externalities. Negative externalities include factors such as an increase in morbidity and mortality, extension of the hospitalization duration, impaired quality of life, loss of working power and performance. HAIs pose a big burden regarding population and community health care. This study aims to calculate the financial burden of HAIs by evaluating it within the scope of negative externality. The communal costs of HAIs patients were calculated by using a genuine approach with reference to samples obtained from the Duzce University Research and Application Hospital. This approach includes 4 stages and the results of each stage is sorted according to the data of 2013 as follows: (i) HAIs expenditure undertaken by the Social Security Institution is 5,832,167 TL, (ii) the monetary value of the work power loss of the HAIs patients who are at a working age is 126,154 TL, (iii) the relative cost of HAIs patients compared to a group of normal patients is 21,507 TL and (iv) HAIs patients’ communal cost is 6,013,101 TL. Based on the received results, the annual communal cost of the estimated HAIs patients in Turkey is predicted to be 3,640,442,057 TL. In addition to these findings, HAIs patients experience 14 times longer in-patient stay at the hospitals as compared to normal patients, and their treatment expenditures are 23 times higher than the normal patients. In the conclusion part of the study, regarding the preventability (internalization) of HAIs, which was evaluated as part of negative externality, alternative applicable political suggestions are presented for the use of policymakers. PMID:26064367

  12. The Regulation of a Spatially Heterogeneous Externality: Tradable Groundwater Permits to Protect Streams

    NASA Astrophysics Data System (ADS)

    Kuwayama, Y.; Brozovic, N.

    2012-12-01

    Groundwater pumping from aquifers can reduce the flow of surface water in nearby streams through a process known as stream depletion. In the United States, recent awareness of this externality has led to intra- and inter-state conflict and rapidly-changing water management policies and institutions. A factor that complicates the design of groundwater management policies to protect streams is the spatial heterogeneity of the stream depletion externality; the marginal damage of groundwater use on stream flows depends crucially on the location of pumping relative to streams. Under these circumstances, economic theory predicts that spatially differentiated policies can achieve an aggregate reduction in stream depletion cost effectively. However, whether spatially differentiated policies offer significant abatement cost savings and environmental improvements over simpler, alternative policies is an empirical question. In this paper, we analyze whether adopting a spatially differentiated groundwater permit system can lead to significant savings in compliance costs while meeting targets on stream protection. Using a population data set of active groundwater wells in the Nebraska portion of the Republican River Basin, we implement an optimization model of each well owner's crop choice, land use, and irrigation decisions to determine the distribution of regulatory costs. We model the externality of pumping on streams by employing an analytical solution from the hydrology literature that determines reductions in stream flow caused by groundwater pumping over space and time. The economic and hydrologic model components are then combined into one optimization framework, which allows us to measure farmer abatement costs and stream flow benefits under a constrained optimal market that features spatially differentiated, tradable groundwater permits. We compare this outcome to the efficiency of alternative second-best policies, including spatially uniform permit markets and

  13. Cost goals

    NASA Technical Reports Server (NTRS)

    Hoag, J.

    1981-01-01

    Cost goal activities for the point focusing parabolic dish program are reported. Cost goals involve three tasks: (1) determination of the value of the dish systems to potential users; (2) the cost targets of the dish system are set out; (3) the value side and cost side are integrated to provide information concerning the potential size of the market for parabolic dishes. The latter two activities are emphasized.

  14. Life cycle costing of waste management systems: overview, calculation principles and case studies.

    PubMed

    Martinez-Sanchez, Veronica; Kromann, Mikkel A; Astrup, Thomas Fruergaard

    2015-02-01

    This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, and each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental impacts and the coverage of shadow prices, and there was also significant confusion regarding terminology. The presented cost model was implemented in two case study scenarios assessing the costs involved in the source segregation of organic waste from 100,000 Danish households and

  15. Tracking Costs

    ERIC Educational Resources Information Center

    Erickson, Paul W.

    2010-01-01

    Even though there's been a slight reprieve in energy costs, the reality is that the cost of non-renewable energy is increasing, and state education budgets are shrinking. One way to keep energy and operations costs from overshadowing education budgets is to develop a 10-year energy audit plan to eliminate waste. First, facility managers should…

  16. 45 CFR 149.115 - Cost threshold and cost limit.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....115 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.115 Cost threshold and cost limit. The following cost threshold and cost limits apply individually, to each early retiree as...

  17. 45 CFR 149.115 - Cost threshold and cost limit.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....115 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.115 Cost threshold and cost limit. The following cost threshold and cost limits apply individually, to each early retiree as...

  18. 45 CFR 149.115 - Cost threshold and cost limit.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....115 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.115 Cost threshold and cost limit. The following cost threshold and cost limits apply individually, to each early retiree as...

  19. 45 CFR 149.115 - Cost threshold and cost limit.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....115 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.115 Cost threshold and cost limit. The following cost threshold and cost limits apply individually, to each early retiree as...

  20. 45 CFR 149.115 - Cost threshold and cost limit.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....115 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.115 Cost threshold and cost limit. The following cost threshold and cost limits apply individually, to each early retiree as...

  1. Agricultural losses related to frost events: use of the 850 hPa level temperature as an explanatory variable of the damage cost

    NASA Astrophysics Data System (ADS)

    Papagiannaki, K.; Lagouvardos, K.; Kotroni, V.; Papagiannakis, G.

    2014-09-01

    The objective of this study is the analysis of damaging frost events in agriculture, by examining the relationship between the daily minimum temperature in the lower atmosphere (at an isobaric level of 850 hPa) and crop production losses. Furthermore, the study suggests a methodological approach for estimating agriculture risk due to frost events, with the aim of estimating the short-term probability and magnitude of frost-related financial losses for different levels of 850 hPa temperature. Compared with near-surface temperature forecasts, temperature forecasts at the level of 850 hPa are less influenced by varying weather conditions or by local topographical features; thus, they constitute a more consistent indicator of the forthcoming weather conditions. The analysis of the daily monetary compensations for insured crop losses caused by weather events in Greece shows that, during the period 1999-2011, frost caused more damage to crop production than any other meteorological phenomenon. Two regions of different geographical latitudes are examined further, to account for the differences in the temperature ranges developed within their ecological environment. Using a series of linear and logistic regressions, we found that minimum temperature (at an 850 hPa level), grouped into three categories according to its magnitude, and seasonality, are significant variables when trying to explain crop damage costs, as well as to predict and quantify the likelihood and magnitude of damaging frost events.

  2. Agricultural losses related to frost events: use of the 850 hPa level temperature as an explanatory variable of the damage cost

    NASA Astrophysics Data System (ADS)

    Papagiannaki, K.; Lagouvardos, K.; Kotroni, V.; Papagiannakis, G.

    2014-01-01

    The objective of this study is to analyze frost damaging events in agriculture, by examining the relationship between the daily minimum temperature at the lower atmosphere (at the pressure level of 850 hPa) and crop production losses. Furthermore, the study suggests a methodological approach for estimating agriculture risk due to frost events, with the aim to estimate the short-term probability and magnitude of frost-related financial losses for different levels of 850 hPa temperature. Compared with near surface temperature forecasts, temperature forecast at the level of 850 hPa is less influenced by varying weather conditions, as well as by local topographical features, thus it constitutes a more consistent indicator of the forthcoming weather conditions. The analysis of the daily monetary compensations for insured crop losses caused by weather events in Greece, during the period 1999-2011, shows that frost is the major meteorological phenomenon with adverse effects on crop productivity in the largest part of the country. Two regions of different geographical latitude are further examined, to account for the differences in the temperature ranges developed within their ecological environment. Using a series of linear and logistic regressions, we found that minimum temperature (at 850 hPa level), grouped in three categories according to its magnitude, and seasonality are significant variables when trying to explain crop damage costs, as well as to predict and quantify the likelihood and magnitude of frost damaging events.

  3. Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia.

    PubMed

    Bengle, Rebecca; Sinnett, Stephanie; Johnson, Tommy; Johnson, Mary Ann; Brown, Arvine; Lee, Jung Sun

    2010-04-01

    Low-income older adults are at increased risk of cutting back on basic needs, including food and medication. This study examined the relationship between food insecurity and cost-related medication non-adherence (CRN) in low-income Georgian older adults. The study sample includes new Older Americans Act Nutrition Program participants and waitlisted people assessed by a self-administered mail survey (N = 1000, mean age 75.0 + so - 9.1 years, 68.4% women, 25.8% African American). About 49.7% of participants were food insecure, while 44.4% reported practicing CRN. Those who were food insecure and/or who practiced CRN were more likely to be African American, low-income, younger, less educated, and to report poorer self-reported health status. Food insecure participants were 2.9 (95% CI 2.2, 4.0) times more likely to practice CRN behaviors than their counterparts after controlling for potential confounders. Improving food security is important inorder to promote adherence to recommended prescription regimens. PMID:20473811

  4. Can chronic disease management programs for patients with type 2 diabetes reduce productivity-related indirect costs of the disease? Evidence from a randomized controlled trial.

    PubMed

    Adepoju, Omolola E; Bolin, Jane N; Ohsfeldt, Robert L; Phillips, Charles D; Zhao, Hongwei; Ory, Marcia G; Forjuoh, Samuel N

    2014-04-01

    The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; P<0.001) and persons with greater than high school education were associated with additional productivity losses (+$758/year; P<0.001). Persons with more than 1 comorbid condition were marginally associated with lower productivity losses (-$326/year; P=0.055). No evidence was found that the chronic disease management programs examined in this trial affect indirect productivity losses. PMID:24152055

  5. In-office distal Symes lesser toe amputation: a safe, reliable, and cost-effective treatment of diabetes-related tip of toe ulcers complicated by osteomyelitis.

    PubMed

    Boffeli, Troy J; Abben, Kyle W; Hyllengren, Shelby B

    2014-01-01

    Diabetes-related tip of lesser toe ulcers have typically been associated with both underlying hammertoe contracture and peripheral neuropathy. The combination of digital deformity and neuropathy commonly results in non-healing, deep sores that frequently become complicated by osteomyelitis. We report on a well-known, but poorly reported, technique for surgical management of non-healing tip of lesser toe ulcers. After approval by the institutional review board, a review was performed of consecutive patients who had undergone office-based distal Symes toe amputation for a non-healing tip of lesser toe ulcer from January 2007 to December 2012. A variety of clinical, laboratory, and radiographic data were collected. A total of 48 consecutive patients (48 toe ulcers) were identified for inclusion in the present study. All patients had ulcers at the time of surgery, and no patient developed repeat ulceration of the involved digit postoperatively. Of the 48 patients, 44 (92%) had hammertoe deformity preoperatively. Also, 30 patients (63%) had positive probe-to-bone results, and 29 (97%) of these patients had culture or histologic findings positive for osteomyelitis. Of the 48 patients (48 ulcers), 73% had positive bone cultures, 69% had positive pathologic findings demonstrating osteomyelitis, and 100% had clean margins. Methicillin-resistant Staphylococcus epidermidis was the most common pathogen isolated (13 of 48, 27%). No patient required additional amputation related to the operative digit. The mean follow-up period was 28.79 months. Our results have shown that in-office distal Symes lesser toe amputation is a safe, reliable, and likely cost-effective treatment of non-healing tip of lesser toe ulcers complicated by osteomyelitis. This office-based procedure allows bone biopsy diagnosis, removes the non-healing ulcer, confirms clear margins regarding the osteomyelitis, and addresses the underlying toe deformity to minimize the chances of repeat ulceration. PMID

  6. Leaf trait co-ordination in relation to construction cost, carbon gain and resource-use efficiency in exotic invasive and native woody vine species

    PubMed Central

    Osunkoya, Olusegun O.; Bayliss, Deanna; Panetta, F. Dane; Vivian-Smith, Gabrielle

    2010-01-01

    Background and Aims Success of invasive plant species is thought to be linked with their higher leaf carbon fixation strategy, enabling them to capture and utilize resources better than native species, and thus pre-empt and maintain space. However, these traits are not well-defined for invasive woody vines. Methods In a glass house setting, experiments were conducted to examine how leaf carbon gain strategies differ between non-indigenous invasive and native woody vines of south-eastern Australia, by investigating their biomass gain, leaf structural, nutrient and physiological traits under changing light and moisture regimes. Key Results Leaf construction cost (CC), calorific value and carbon : nitrogen (C : N) ratio were lower in the invasive group, while ash content, N, maximum photosynthesis, light-use efficiency, photosynthetic energy-use efficiency (PEUE) and specific leaf area (SLA) were higher in this group relative to the native group. Trait plasticity, relative growth rate (RGR), photosynthetic nitrogen-use efficiency and water-use efficiency did not differ significantly between the groups. However, across light resource, regression analyses indicated that at a common (same) leaf CC and PEUE, a higher biomass RGR resulted for the invasive group; also at a common SLA, a lower CC but higher N resulted for the invasive group. Overall, trait co-ordination (using pair-wise correlation analyses) was better in the invasive group. Ordination using 16 leaf traits indicated that the major axis of invasive-native dichotomy is primarily driven by SLA and CC (including its components and/or derivative of PEUE) and was significantly linked with RGR. Conclusions These results demonstrated that while not all measures of leaf resource traits may differ between the two groups, the higher level of trait correlation and higher revenue returned (RGR) per unit of major resource need (CC) and use (PEUE) in the invasive group is in line with their rapid spread where introduced

  7. Relativity

    NASA Astrophysics Data System (ADS)

    Stephani, Hans

    2004-02-01

    Preface; Notation; Part I. Special Relativity: 1. Introduction: inertial systems and Galilei invariance of classical mechanics; 2. Light propagation in moving coordinate systems and Lorentz transformations; 3. Our world as a Minkowski space; 4. Mechanics of special relativity; 5. Optics of plane waves; 6. Four-dimensional vectors and tensors; 7. Electrodynamics in vacuo; 8. Transformation properties of electromagnetic fields: examples; 9. Null vectors and the algebraic properties of electromagnetic field tensors; 10. Charged point particles and their field; 11. Pole-dipole particles and their field; 12. Electrodynamics in media; 13. Perfect fluids and other physical theories; Part II. Riemannian Geometry: 14. Introduction: the force-free motion of particles in Newtonian mechanics; 15. Why Riemannian geometry?; 16. Riemannian space; 17. Tensor algebra; 18. The covariant derivative and parallel transport; 19. The curvature tensor; 20. Differential operators, integrals and integral laws; 21. Fundamental laws of physics in Riemannian spaces; Part III. Foundations of Einstein's Theory of Gravitation: 22. The fundamental equations of Einstein's theory of gravitation; 23. The Schwarzschild solution; 24. Experiments to verify the Schwarzschild metric; 25. Gravitational lenses; 26. The interior Schwarzschild solution; Part IV. Linearized Theory of Gravitation, Far Fields and Gravitational Waves: 27. The linearized Einstein theory of gravity; 28. Far fields due to arbitrary matter distributions and balance equations for momentum and angular momentum; 29. Gravitational waves; 30. The Cauchy problem for the Einstein field equations; Part V. Invariant Characterization of Exact Solutions: 31. Preferred vector fields and their properties; 32. The Petrov classification; 33. Killing vectors and groups of motion; 34. A survey of some selected classes of exact solutions; Part VI. Gravitational Collapse and Black Holes: 35. The Schwarzschild singularity; 36. Gravitational collapse

  8. The Long-Term Effectiveness of Reading Recovery and the Cost-Efficiency of Reading Recovery Relative to the Learning Disabled Classification Rate

    ERIC Educational Resources Information Center

    Galluzzo, Charles A.

    2010-01-01

    There is a great deal of research supporting Reading Recovery as a successful reading intervention program that assists below level first graders readers in closing the gap in reading at the same level of their average peers. There is a lack of research that analyses the cost-effectiveness of the Reading Recovery program compared to the cost in…

  9. Is cost-related non-collection of prescriptions associated with a reduction in health? Findings from a large-scale longitudinal study of New Zealand adults

    PubMed Central

    Jatrana, Santosh; Richardson, Ken; Norris, Pauline; Crampton, Peter

    2015-01-01

    Objective To investigate whether cost-related non-collection of prescription medication is associated with a decline in health. Settings New Zealand Survey of Family, Income and Employment (SoFIE)-Health. Participants Data from 17 363 participants with at least two observations in three waves (2004–2005, 2006–2007, 2008–2009) of a panel study were analysed using fixed effects regression modelling. Primary outcome measures Self-rated health (SRH), physical health (PCS) and mental health scores (MCS) were the health measures used in this study. Results After adjusting for time-varying confounders, non-collection of prescription items was associated with a 0.11 (95% CI 0.07 to 0.15) unit worsening in SRH, a 1.00 (95% CI 0.61 to 1.40) unit decline in PCS and a 1.69 (95% CI 1.19 to 2.18) unit decline in MCS. The interaction of the main exposure with gender was significant for SRH and MCS. Non-collection of prescription items was associated with a decline in SRH of 0.18 (95% CI 0.11 to 0.25) units for males and 0.08 (95% CI 0.03 to 0.13) units for females, and a decrease in MCS of 2.55 (95% CI 1.67 to 3.42) and 1.29 (95% CI 0.70 to 1.89) units for males and females, respectively. The interaction of the main exposure with age was significant for SRH. For respondents aged 15–24 and 25–64 years, non-collection of prescription items was associated with a decline in SRH of 0.12 (95% CI 0.03 to 0.21) and 0.12 (95% CI 0.07 to 0.17) units, respectively, but for respondents aged 65 years and over, non-collection of prescription items had no significant effect on SRH. Conclusion Our results show that those who do not collect prescription medications because of cost have an increased risk of a subsequent decline in health. PMID:26553826

  10. Individual thyroid dose estimates for a case-control study of chernobyl-related thyroid cancer among children of Belarus--part II. Contributions from long-lived radionuclides and external radiation.

    PubMed

    Minenko, Victor F; Ulanovsky, Alexander V; Drozdovitch, Vladimir V; Shemiakina, Elena V; Gavrilin, Yuri I; Khrouch, Valeri T; Shinkarev, Sergei M; Voillequé, Paul G; Bouville, André; Anspaugh, Lynn R; Luckyanov, Nickolas

    2006-04-01

    Significant quantities of long-lived radionuclides were released to the environment during the Chernobyl nuclear power plant accident in 1986. These radionuclides contributed to radiation doses due to ingestion of contaminated foods and external exposure from the ground deposition that resulted. The contributions of these exposure pathways to thyroid doses received by subjects of an epidemiologic study of children from Belarus are evaluated and presented. The analysis shows that ingestion of the long-lived radionuclides, primarily radiocesium, typically contributed a small percentage of the total thyroid dose received by the study subjects. The median and mean fractional contributions were 0.76 and 0.95%, respectively. The contribution of external exposure to the thyroid dose was generally larger and more variable, with median and mean contributions of 1.2 and 1.8% of the total thyroid doses, respectively. For regions close to the reactor site, where radionuclide deposition was highest, the contributions of radiocesium ingestion and external exposure were generally lower than those of the short-lived radioiodine isotopes (132I and 133I) and their precursors (132Te). In other areas, the contributions of these two pathways were comparable to those of the short-lived radioiodines. For all subjects, intakes of 131I were the primary source of dose to the thyroid. PMID:16538137

  11. Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities

    PubMed Central

    Patel, Shraddha P; Pena, Margarita E; Babcock, Charlene Irvin

    2015-01-01

    Introduction: The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die. Objective: To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care. Materials and Methods: A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal. Results: The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD. Conclusion: Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available. PMID:26664158

  12. External Tank GH2 Vent Arm

    NASA Technical Reports Server (NTRS)

    Reichle, G. E.; Glassburn, C. W.

    1985-01-01

    Because the venting of free hydrogen gas to the atmosphere presents an extremely hazardous situation, it was necessary to devise a means for safe, controlled venting of the shuttle external tank gaseous hydrogen during and after liquid hydrogen tank loading. Several design concepts that were considered initially were discarded as unfeasible because of vehicle weight restrictions, high cost, and because the proposed structure was itself deemed a hazard due to the vehicle's nonvertical launch trajectory. These design concepts are discussed. A design employing a support structure/access arm attached to the fixed service structure was finally selected. The various design problems resolved included vent arm disconnect/drop interference, minimizing refurbishment due to launch damage, disconnect reliability, vehicle movement tracking, minimizing vent line pressure drop, and the presence of other vehicle services at the same centralized supply area. Six launches have proven the system to be reliable, efficient, and of nearly zero refurbishment cost.

  13. Prospective memory in an air traffic control simulation: External aids that signal when to act

    PubMed Central

    Loft, Shayne; Smith, Rebekah E.; Bhaskara, Adella

    2011-01-01

    At work and in our personal life we often need to remember to perform intended actions at some point in the future, referred to as Prospective Memory. Individuals sometimes forget to perform intentions in safety-critical work contexts. Holding intentions can also interfere with ongoing tasks. We applied theories and methods from the experimental literature to test the effectiveness of external aids in reducing prospective memory error and costs to ongoing tasks in an air traffic control simulation. Participants were trained to accept and hand-off aircraft, and to detect aircraft conflicts. For the prospective memory task participants were required to substitute alternative actions for routine actions when accepting target aircraft. Across two experiments, external display aids were provided that presented the details of target aircraft and associated intended actions. We predicted that aids would only be effective if they provided information that was diagnostic of target occurrence and in this study we examined the utility of aids that directly cued participants when to allocate attention to the prospective memory task. When aids were set to flash when the prospective memory target aircraft needed to be accepted, prospective memory error and costs to ongoing tasks of aircraft acceptance and conflict detection were reduced. In contrast, aids that did not alert participants specifically when the target aircraft were present provided no advantage compared to when no aids we used. These findings have practical implications for the potential relative utility of automated external aids for occupations where individuals monitor multi-item dynamic displays. PMID:21443381

  14. Unintended Consequences of Cost Recovery

    ERIC Educational Resources Information Center

    Piercey, David

    2010-01-01

    An Alberta school district that used a cost-recovery model to finance school services for 20 years is finding that the model produces unintended negative results. Some schools didn't spend this money on services but used it for other school operations. Some spent the money on external consultants. Professional relationships were damaged, and…

  15. Regulatory cost-risk study

    SciTech Connect

    Not Available

    1983-04-01

    This study is intended to provide some quantitative perspective by selecting certain examples of criteria for which estimates of risks and costs can be obtained, and the balance of the various risks, (i.e., internal versus external risks), can be put into perspective. 35 refs., 39 tabs. (JDB)

  16. Costs of groundwater contamination

    SciTech Connect

    O'Neil, W.B.; Raucher, R.S. )

    1990-01-01

    Two factors determine the cost of groundwater contamination: (1) the ways in which water was being used or was expected to be used in the future and (2) the physical characteristics of the setting that constrain the responses available to regain lost uses or to prevent related damages to human health and the environment. Most contamination incidents can be managed at a low enough cost that uses will not be foreclosed. It is important to take into account the following when considering costs: (1) natural cleansing through recharge and dilution can take many years; (2) it is difficult and costly to identify the exact area and expected path of a contamination plume; and (3) treatment or replacement of contaminated water often may represent the cost-effective strategy for managing the event. The costs of contamination include adverse health effects, containment and remediation, treatment and replacement costs. In comparing the costs and benefits of prevention programs with those of remediation, replacement or treatment, it is essential to adjust the cost/benefit numbers by the probability of their actual occurrence. Better forecasts of water demand are needed to predict more accurately the scarcity of new supply and the associated cost of replacement. This research should include estimates of the price elasticity of water demand and the possible effect on demand of more rational cost-based pricing structures. Research and development of techniques for in situ remediation should be encouraged.

  17. Cost characteristics of hospitals.

    PubMed

    Smet, Mike

    2002-09-01

    Modern hospitals are complex multi-product organisations. The analysis of a hospital's production and/or cost structure should therefore use the appropriate techniques. Flexible functional forms based on the neo-classical theory of the firm seem to be most suitable. Using neo-classical cost functions implicitly assumes minimisation of (variable) costs given that input prices and outputs are exogenous. Local and global properties of flexible functional forms and short-run versus long-run equilibrium are further issues that require thorough investigation. In order to put the results based on econometric estimations of cost functions in the right perspective, it is important to keep these considerations in mind when using flexible functional forms. The more recent studies seem to agree that hospitals generally do not operate in their long-run equilibrium (they tend to over-invest in capital (capacity and equipment)) and that it is therefore appropriate to estimate a short-run variable cost function. However, few studies explicitly take into account the implicit assumptions and restrictions embedded in the models they use. An alternative method to explain differences in costs uses management accounting techniques to identify the cost drivers of overhead costs. Related issues such as cost-shifting and cost-adjusting behaviour of hospitals and the influence of market structure on competition, prices and costs are also discussed shortly. PMID:12220092

  18. External Examining: Fit for Purpose?

    ERIC Educational Resources Information Center

    Bloxham, Sue; Price, Margaret

    2015-01-01

    In a context of international concern about academic standards, the practice of external examining is widely admired for its role in defending standards. Yet a contradiction exists between this faith in examining and continuing concerns about standards. This article argues that external examining rests on assumptions about standards which are…

  19. Choosing a Truly External Evaluator

    ERIC Educational Resources Information Center

    Ray, Marilyn

    2006-01-01

    This scenario discusses a situation in which a proposal has been published by a consortium of foundations for an "external" evaluator to evaluate a replication at two new sites of a program they have been funding for many years. A proposal is received from Dr. Porto-Novo, who has been the external evaluator of the initial program for about 10…

  20. Preparation of highly anisotropic cobalt ferrite/silica microellipsoids using an external magnetic field.

    PubMed

    Abramson, Sébastien; Dupuis, Vincent; Neveu, Sophie; Beaunier, Patricia; Montero, David

    2014-08-01

    Magnetic cobalt ferrite/silica microparticles having both an original morphology and an anisotropic nanostructure are synthesized through the use of an external magnetic field and nanoparticles characterized by a high magnetic anisotropy. The association of these two factors implies that the ESE (emulsion and solvent evaporation) sol-gel method employed here allows the preparation of silica microellipsoids containing magnetic nanoparticles aggregated in large chains. It is clearly shown that without this combination, microspheres characterized by an isotropic distribution of the magnetic nanoparticles are obtained. While the chaining of the cobalt ferrite nanoparticles inside the silica matrix is related to the increase of their magnetic dipolar interactions, the ellipsoidal shape of the microparticles may be explained by the elongation of the sol droplets in the direction of the external magnetic field during the synthesis. Because of their highly anisotropic structure, these microparticles exhibit permanent magnetic moments, which are responsible, at a larger scale, for the existence of strong magnetic dipolar interactions. Therefore, when they are dispersed in water, the microellipsoids self-assemble into large and irregular chains. These interactions can be reinforced by the use of external magnetic field, allowing the preparation of very large permanent chains. This research illustrates how nanostructured particles exhibiting complex architectures can be elaborated through simple, fast, and low-cost methods, such as the use of external fields in combination with soft chemistry. PMID:25029515