47 CFR 51.609 - Determination of avoided retail costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Determination of avoided retail costs. 51.609... (CONTINUED) INTERCONNECTION Resale § 51.609 Determination of avoided retail costs. (a) Except as provided in § 51.611, the amount of avoided retail costs shall be determined on the basis of a cost study that...

47 CFR 51.609 - Determination of avoided retail costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Determination of avoided retail costs. 51.609... (CONTINUED) INTERCONNECTION Resale § 51.609 Determination of avoided retail costs. (a) Except as provided in § 51.611, the amount of avoided retail costs shall be determined on the basis of a cost study that...

47 CFR 51.609 - Determination of avoided retail costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Determination of avoided retail costs. 51.609... (CONTINUED) INTERCONNECTION Resale § 51.609 Determination of avoided retail costs. (a) Except as provided in § 51.611, the amount of avoided retail costs shall be determined on the basis of a cost study that...

47 CFR 51.609 - Determination of avoided retail costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Determination of avoided retail costs. 51.609... (CONTINUED) INTERCONNECTION Resale § 51.609 Determination of avoided retail costs. (a) Except as provided in § 51.611, the amount of avoided retail costs shall be determined on the basis of a cost study that...

47 CFR 51.609 - Determination of avoided retail costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Determination of avoided retail costs. 51.609... (CONTINUED) INTERCONNECTION Resale § 51.609 Determination of avoided retail costs. (a) Except as provided in § 51.611, the amount of avoided retail costs shall be determined on the basis of a cost study that...

Procalcitonin Biomarker Algorithm Reduces Antibiotic Prescriptions, Duration of Therapy, and Costs in Chronic Obstructive Pulmonary Disease: A Comparison in the Netherlands, Germany, and the United Kingdom.

PubMed

van der Maas, Marloes E; Mantjes, Gertjan; Steuten, Lotte M G

2017-04-01

Antibiotics are often recommended as treatment for patients with chronic obstructive pulmonary disease (COPD) exacerbations. However, not all COPD exacerbations are caused by bacterial infections and there is consequently considerable misuse and overuse of antibiotics among patients with COPD. This poses a severe burden on healthcare resources such as increased risk of developing antibiotic resistance. The biomarker procalcitonin (PCT) displays specificity to distinguish bacterial inflammations from nonbacterial inflammations and may therefore help to rationalize antibiotic prescriptions. We report in this study, a three-country comparison of the health and economic consequences of a PCT biomarker-guided prescription and clinical decision-making strategy compared to current practice in hospitalized patients with COPD exacerbations. A decision tree was developed, comparing the expected costs and effects of the PCT algorithm to current practice in the Netherlands, Germany, and the United Kingdom. The time horizon of the model captured the length of hospital stay and a societal perspective was also adopted. The primary health outcome was the duration of antibiotic therapy. The incremental cost-effectiveness ratio was defined as the incremental costs per antibiotic day avoided. The incremental cost savings per day on antibiotic therapy avoided were (in Euros) €90 in the Netherlands, €125 in Germany, and €52 in the United Kingdom. Probabilistic sensitivity analyses showed that in the majority of simulations, the PCT biomarker strategy was superior to current practice (the Netherlands: 58%, Germany: 58%, and the United Kingdom: 57%). In conclusion, the PCT biomarker algorithm to optimize antibiotic prescriptions in COPD is likely to be cost-effective compared to current practice. Both the percentage of patients who start with antibiotic treatment as well as the duration of antibiotic therapy are reduced with the PCT decision algorithm, leading to a decrease in total costs per patient. Economic analysis based on real-life data is recommended for further research. Biomarker-driven prescription algorithms are important instruments for personalized medicine in COPD. This also attests to the emerging convergence of biomarker innovations and the broader field of Health Technology Assessment (HTA).

Higher threat avoidance costs reduce avoidance behaviour which in turn promotes fear extinction in humans.

PubMed

Rattel, Julina A; Miedl, Stephan F; Blechert, Jens; Wilhelm, Frank H

2017-09-01

Theoretical models specifying the underlying mechanisms of the development and maintenance of anxiety and related disorders state that fear responses acquired through classical Pavlovian conditioning are maintained by repeated avoidance behaviour; thus, it is assumed that avoidance prevents fear extinction. The present study investigated behavioural avoidance decisions as a function of avoidance costs in a naturalistic fear conditioning paradigm. Ecologically valid avoidance costs - manipulated between participant groups - were represented via time-delays during a detour in a gamified computer task. After differential acquisitions of shock-expectancy to a predictive conditioned stimulus (CS+), participants underwent extinction where they could either take a risky shortcut, while anticipating shock signaled by the CS+, or choose a costly avoidance option (lengthy detour); thus, they were faced with an approach-avoidance conflict. Groups with higher avoidance costs (longer detours) showed lower proportions of avoiders. Avoiders gave heightened shock-expectancy ratings post-extinction, demonstrating 'protecting from extinction', i.e. failure to extinguish. Moreover, there was an indirect effect of avoidance costs on protection from extinction through avoidance behaviour. No moderating role of trait-anxiety was found. Theoretical implications of avoidance behaviour are discussed, considering the involvement of instrumental learning in the maintenance of fear responses. Copyright © 2016 Elsevier Ltd. All rights reserved.

Economic benefits of sponsored clinical trials on pharmaceutical expenditures at a medical center in Taiwan.

PubMed

Shen, Li-Jiuan; Chou, Hua; Huang, Chih-Fen; Chou, Guann-Miaw; Chan, Wing Kai; Wu, Fe-Lin Lin

2011-07-01

Concerns exist regarding the additional cost of patient care when patients are enrolled in clinical trials at hospitals. To assess the avoidance of drug costs by conducting sponsored clinical trials, a retrospective analysis evaluating drug cost avoidance in all sponsored clinical trials was conducted in 2008 at the most prominent medical center in Taiwan. The National Health Insurance (NHI) reimbursement prices of either the investigated drugs or the standardized drug therapy for each specific disease were used to calculate the cost avoidance. Drug cost avoidance from sponsored clinical trials per year, per trial, per patient, in different therapeutic areas, and in different phases was analyzed. Three quarters of the cost avoidance in drug expenditures from 194 sponsored clinical trials were estimated. All cost values are in US Dollars. Around $11.2 million was avoided at the center in 2008. The average value of cost avoidance was $58,000/trial-year or $3,900/participant-year. The early-phase trials and phase III trials accounted for 25% and 56% of all trials, respectively, while they constituted 32% and 49% of the total costs avoided, respectively. The most frequently conducted and highest cost-avoiding trials were those for antineoplastic agents, especially targeted therapy which accounted for 85% of the total cost avoidance of anti-cancer trials. This study demonstrates the profoundly positive economic impact on the healthcare system in Taiwan by sponsored clinical trials. To understand the trend of economic benefits of the trials on pharmaceutical expenditure, it would be important to analyze the cost avoidance of trials regularly in an institution. Copyright © 2011 Elsevier Inc. All rights reserved.

Underground storage systems for high-pressure air and gases

NASA Technical Reports Server (NTRS)

Beam, B. H.; Giovannetti, A.

1975-01-01

This paper is a discussion of the safety and cost of underground high-pressure air and gas storage systems based on recent experience with a high-pressure air system installed at Moffett Field, California. The system described used threaded and coupled oil well casings installed vertically to a depth of 1200 ft. Maximum pressure was 3000 psi and capacity was 500,000 lb of air. A failure mode analysis is presented, and it is shown that underground storage offers advantages in avoiding catastrophic consequences from pressure vessel failure. Certain problems such as corrosion, fatigue, and electrolysis are discussed in terms of the economic life of such vessels. A cost analysis shows that where favorable drilling conditions exist, the cost of underground high-pressure storage is approximately one-quarter that of equivalent aboveground storage.

Win some, lose some: parental hypertension and heart rate change in an incentive versus response cost paradigm.

PubMed

Hastrup, J L; Johnson, C A; Hotchkiss, A P; Kraemer, D L

1986-11-01

Fowles (1983), citing evidence from separate studies, suggests that both incentive and response cost paradigms increase heart rate and should be subsumed under Gray's (1975) 'appetitive motivational system'. Shock avoidance and loss of reward (response cost) contingencies, while aversive, appear to evoke this motivational system; consequently both should elicit heart rate increases independent of anxiety. The present investigation compared magnitude of heart rate changes observed under conditions of winning and losing money. Results showed: no differences between incentive and response cost conditions; no effect of state anxiety on heart rate in these conditions, despite an elevation of state anxiety on the task day relative to a subsequent relaxation day assessment; and some evidence for the presence under both such appetitive conditions of cardiovascular hyperresponsivity among offspring of hypertensive parents. The results suggest a need for systematic parametric studies of experimental conditions.

Survival and quality of life in burns.

PubMed

Königová, R

2010-07-01

Advances in medical technology and practices have been associated with increasing medical specialization, but they have developed at a price. This price has included not only enormous financial costs, but the additional cost of dehumanized patient care, diminished confidence in the medical staff and, consequently, human suffering. Burn injuries are catastrophic in scope and require specialized, intensive and prolonged treatment from which ensure ethical and psychological problems often complicated by many individual factors. Some of them arising from the Code of Patients Rights not only in the Czech Republic and contribute to DNR decisions (do-not-resuscitate). Not only "Quantity" of life but also "Quality" of life should be considered, particularly in burns. Critical factor is age. In old patients more sophisticated medical knowledge and practice may actually contribute to suffering. At any age scarring represents a special type of disfigurement. The "burn image" is more likely to evoke public avoidance than sympathy. The non handicapped by their negative attitudes help create and perpetuate the handicap and the consequent burden of suffering in burn patients.

Cost-consequence analysis of different active flowable hemostatic matrices in cardiac surgical procedures.

PubMed

Makhija, D; Rock, M; Xiong, Y; Epstein, J D; Arnold, M R; Lattouf, O M; Calcaterra, D

2017-06-01

A recent retrospective comparative effectiveness study found that use of the FLOSEAL Hemostatic Matrix in cardiac surgery was associated with significantly lower risks of complications, blood transfusions, surgical revisions, and shorter length of surgery than use of SURGIFLO Hemostatic Matrix. These outcome improvements in cardiac surgery procedures may translate to economic savings for hospitals and payers. The objective of this study was to estimate the cost-consequence of two flowable hemostatic matrices (FLOSEAL or SURGIFLO) in cardiac surgeries for US hospitals. A cost-consequence model was constructed using clinical outcomes from a previously published retrospective comparative effectiveness study of FLOSEAL vs SURGIFLO in adult cardiac surgeries. The model accounted for the reported differences between these products in length of surgery, rates of major and minor complications, surgical revisions, and blood product transfusions. Costs were derived from Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) 2012 database and converted to 2015 US dollars. Savings were modeled for a hospital performing 245 cardiac surgeries annually, as identified as the average for hospitals in the NIS dataset. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to test model robustness. The results suggest that if FLOSEAL is utilized in a hospital that performs 245 mixed cardiac surgery procedures annually, 11 major complications, 31 minor complications, nine surgical revisions, 79 blood product transfusions, and 260.3 h of cumulative operating time could be avoided. These improved outcomes correspond to a net annualized saving of $1,532,896. Cost savings remained consistent between $1.3m and $1.8m and between $911k and $2.4m, even after accounting for the uncertainty around clinical and cost inputs, in a one-way and probabilistic sensitivity analysis, respectively. Outcome differences associated with FLOSEAL vs SURGIFLO that were previously reported in a comparative effectiveness study may result in substantial cost savings for US hospitals.

Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

PubMed

Hoque, Mohammad Enamul; Dasgupta, Sushil Kanta; Naznin, Eva; Al Mamun, Abdullah

2015-10-01

This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication. © 2015 John Wiley & Sons Ltd.

Using Risk Assessment Methodologies to Meet Management Objectives

NASA Technical Reports Server (NTRS)

DeMott, D. L.

2015-01-01

Corporate and program objectives focus on desired performance and results. ?Management decisions that affect how to meet these objectives now involve a complex mix of: technology, safety issues, operations, process considerations, employee considerations, regulatory requirements, financial concerns and legal issues. ?Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures. Using a risk assessment methodology is only a starting point. ?A risk assessment program provides management with important input in the decision making process. ?A pro-active organization looks to the future to avoid problems, a reactive organization can be blindsided by risks that could have been avoided. ?You get out what you put in, how useful your program is will be up to the individual organization.

Evolution of precopulatory and post-copulatory strategies of inbreeding avoidance and associated polyandry.

PubMed

Duthie, A B; Bocedi, G; Germain, R R; Reid, J M

2018-01-01

Inbreeding depression is widely hypothesized to drive adaptive evolution of precopulatory and post-copulatory mechanisms of inbreeding avoidance, which in turn are hypothesized to affect evolution of polyandry (i.e. female multiple mating). However, surprisingly little theory or modelling critically examines selection for precopulatory or post-copulatory inbreeding avoidance, or both strategies, given evolutionary constraints and direct costs, or examines how evolution of inbreeding avoidance strategies might feed back to affect evolution of polyandry. Selection for post-copulatory inbreeding avoidance, but not for precopulatory inbreeding avoidance, requires polyandry, whereas interactions between precopulatory and post-copulatory inbreeding avoidance might cause functional redundancy (i.e. 'degeneracy') potentially generating complex evolutionary dynamics among inbreeding strategies and polyandry. We used individual-based modelling to quantify evolution of interacting precopulatory and post-copulatory inbreeding avoidance and associated polyandry given strong inbreeding depression and different evolutionary constraints and direct costs. We found that evolution of post-copulatory inbreeding avoidance increased selection for initially rare polyandry and that evolution of a costly inbreeding avoidance strategy became negligible over time given a lower-cost alternative strategy. Further, fixed precopulatory inbreeding avoidance often completely precluded evolution of polyandry and hence post-copulatory inbreeding avoidance, but fixed post-copulatory inbreeding avoidance did not preclude evolution of precopulatory inbreeding avoidance. Evolution of inbreeding avoidance phenotypes and associated polyandry is therefore affected by evolutionary feedbacks and degeneracy. All else being equal, evolution of precopulatory inbreeding avoidance and resulting low polyandry is more likely when post-copulatory inbreeding avoidance is precluded or costly, and evolution of post-copulatory inbreeding avoidance greatly facilitates evolution of costly polyandry. © The Authors. Journal of Evolutionary Biology published by John Wiley & Sons Ltd on behalf of European Society for Evolutionary Biology.

A national hypertension treatment program in Germany and its estimated impact on costs, life expectancy, and cost-effectiveness.

PubMed

Gandjour, Afschin; Stock, Stephanie

2007-10-01

Almost 15 million Germans may suffer from untreated hypertension. The purpose of this paper is to estimate the cost-effectiveness of a national hypertension treatment program compared to no program. A Markov decision model from the perspective of the statutory health insurance (SHI) was built. All data were taken from secondary sources. The target population consists of hypertensive male and female patients at high or low risk for cardiovascular events at different age groups (40-49, 50-59, and 60-69 years). The analysis shows fairly moderate cost-effectiveness ratios even for low-risk groups (less than 12,000 euros per life year gained). In women at high risk antihypertensive treatment even leads to savings. This suggests that a national hypertension treatment program provides good value for money. Given the considerable costs of the program itself, any savings from avoiding long-term consequences of hypertension are likely to be offset, however.

Communication Avoiding and Overlapping for Numerical Linear Algebra

DTIC Science & Technology

2012-05-08

future exascale systems, communication cost must be avoided or overlapped. Communication-avoiding 2.5D algorithms improve scalability by reducing...linear algebra problems to future exascale systems, communication cost must be avoided or overlapped. Communication-avoiding 2.5D algorithms improve...will continue to grow relative to the cost of computation. With exascale computing as the long-term goal, the community needs to develop techniques

Methodology for Determining the Avoidable and Fully Allocated Costs of Amtrak Routes : Volume II, Appendix A

DOT National Transportation Integrated Search

2009-08-01

The Federal Railroad Administration tasked the Volpe Center with developing a methodology for determining the avoidable and fully allocated costs of Amtrak routes. Avoidable costs are costs that would not be incurred if an Amtrak route were discontin...

Methodology for Determining the Avoidable and Fully Allocated Costs of Amtrak Routes : Volume III, Appendix B-H

DOT National Transportation Integrated Search

2009-08-01

The Federal Railroad Administration tasked the Volpe Center with developing a methodology for determining the avoidable and fully allocated costs of Amtrak routes. Avoidable costs are costs that would not be incurred if an Amtrak route were discontin...

Methodology for determining the avoidable and fully allocated costs of Amtrak routes, volume 1 : main report

DOT National Transportation Integrated Search

2009-08-01

The Federal Railroad Administration tasked the Volpe Center with developing a methodology for determining the avoidable and fully allocated costs of Amtrak routes. Avoidable costs are costs that would not be incurred if an Amtrak route were discontin...

The Prophylactic Extraction of Third Molars: A Public Health Hazard

PubMed Central

Friedman, Jay W.

2007-01-01

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion. In addition, more than 11 million patient days of “standard discomfort or disability”—pain, swelling, bruising, and malaise—result postoperatively, and more than 11000 people suffer permanent paresthesia—numbness of the lip, tongue, and cheek—as a consequence of nerve injury during the surgery. At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability. Avoidance of prophylactic extraction of third molars can prevent this public health hazard. PMID:17666691

Febuxostat in the management of gout: a cost-effectiveness analysis.

PubMed

Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki

2016-01-01

To determine the cost-effectiveness of febuxostat vs allopurinol for the management of gout. A stochastic microsimulation cost-effectiveness model with a US private-payer perspective and 5-year time horizon was developed. Model flow based on guideline and real-world treatment paradigms incorporated gout flare, serum uric acid (sUA) testing, treatment titration, discontinuation, and adverse events, chronic kidney disease (CKD) incidence and progression, and type 2 diabetes mellitus (T2DM) incidence. Outcomes were estimated for the general gout population and for gout patients with CKD stages 3/4. Modeled treatment interventions were daily oral febuxostat 40-80 mg and allopurinol 100-300 mg. Baseline patient characteristics were taken from epidemiologic studies, efficacy data from randomized controlled trials, adverse event rates from package inserts, and costs from the literature, government sources, and expert opinion. Eight clinically-relevant incremental cost-effectiveness ratios were estimated: per patient reaching target sUA, per flare avoided, per CKD incidence, progression, stages 3/4 progression, and stage 5 progression avoided, per incident T2DM avoided, and per death avoided. Five-year incremental cost-effectiveness ratios for the general gout population were $5377 per patient reaching target sUA, $1773 per flare avoided, $221,795 per incident CKD avoided, $29,063 per CKD progression avoided, $36,018 per progression to CKD 3/4 avoided, $71,426 per progression to CKD 5 avoided, $214,277 per incident T2DM avoided, and $217,971 per death avoided. In patients with CKD 3/4, febuxostat dominated allopurinol for all cost-effectiveness outcome measures. Febuxostat may be a cost-effective alternative to allopurinol, especially for patients with CKD stages 3 or 4.

Solar Avoided Cost Solution SunShot 6 Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tucker, John; Danziger, Eric

2014-01-29

The core objectives of this project were two separate but integrated products, collectively providing game-changing Avoided Cost capabilities. The first was a kit of avoided cost tools and data that any solar provider can use a-lacarte or as a whole. It’s open and easily accessible nature allows the rapid and accurate calculation of avoided cost in whatever context and software that make sense (“Typical and Avoided Cost Tools”). This kit includes a dataset of typical energy rates, costs and usage that can be used for solar prospecting, lead generation and any situation where data about an opportunity is missing ormore » imperfect. The second is a web application and related APIs specifically built for solar providers to radically streamline their lead-to-sale process (“Solar Provider Module”). The typical and Avoided Cost tools are built directly into this, and allow for solar providers to track their opportunities, collaborate with their installers and financiers, and close more sales faster.« less

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

PubMed

Buerhaus, Peter I

2009-01-01

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

Incorporation of Tropical Cyclone Avoidance Into Automated Ship Scheduling

DTIC Science & Technology

2014-06-01

damage and even sink ships. Avoiding TCs adds to fuel costs and causes delays. In the private sector, commercial shipping uses automated routing...improvements in forecasting have enabled ships to avoid TC-impacted areas altogether. Avoiding TCs does not come without a cost . Delaying departure or...steaming around a TC results in more fuel being burned at a high cost , plus the cost due to the delay in arrival at the destination, and the associated

Reproducibility Issues: Avoiding Pitfalls in Animal Inflammation Models.

PubMed

Laman, Jon D; Kooistra, Susanne M; Clausen, Björn E

2017-01-01

In light of an enhanced awareness of ethical questions and ever increasing costs when working with animals in biomedical research, there is a dedicated and sometimes fierce debate concerning the (lack of) reproducibility of animal models and their relevance for human inflammatory diseases. Despite evident advancements in searching for alternatives, that is, replacing, reducing, and refining animal experiments-the three R's of Russel and Burch (1959)-understanding the complex interactions of the cells of the immune system, the nervous system and the affected tissue/organ during inflammation critically relies on in vivo models. Consequently, scientific advancement and ultimately novel therapeutic interventions depend on improving the reproducibility of animal inflammation models. As a prelude to the remaining hands-on protocols described in this volume, here, we summarize potential pitfalls of preclinical animal research and provide resources and background reading on how to avoid them.

Gaps in clinical prevention and treatment for alcohol use disorders: costs, consequences, and strategies.

PubMed

Willenbring, Mark L

2013-01-01

Heavy drinking causes significant morbidity, premature mortality, and other social and economic burdens on society, prompting numerous prevention and treatment efforts to avoid or ameliorate the prevalence of heavy drinking and its consequences. However, the impact on public health of current selective (i.e., clinical) prevention and treatment strategies is unclear. Screening and brief counseling for at-risk drinkers in ambulatory primary care has the strongest evidence for efficacy, and some evidence indicates this approach is cost-effective and reduces excess morbidity and dysfunction. Widespread implementation of screening and brief counseling of nondependent heavy drinkers outside of the medical context has the potential to have a large public health impact. For people with functional dependence, no appropriate treatment and prevention approaches currently exist, although such strategies might be able to prevent or reduce the morbidity and other harmful consequences associated with the condition before its eventual natural resolution. For people with alcohol use disorders, particularly severe and recurrent dependence, treatment studies have shown improvement in the short term. However, there is no compelling evidence that treatment of alcohol use disorders has resulted in reductions in overall disease burden. More research is needed on ways to address functional alcohol dependence as well as severe and recurrent alcohol dependence.

Economic consequences of the vaccination against hepatitis A in the Bulgarian healthcare setting.

PubMed

Dimitrova, Maria; Petrova, Guenka; Tachkov, Konstantin; Bozhkova, Maria Krasteva; Kamusheva, Maria; Mitov, Konstantin

2014-03-04

The purpose of the present analysis is to calculate and compare the costs and results of the implication of the inactivated vaccine against hepatitis A virus (HAV) in the Bulgarian healthcare setting in the period of 2002-2012. A combined pharmacoeconomic and epidemiological study was performed on the basis of the prevalence of hepatitis A infection in this 10-year period. The investments in the vaccination were considered as costs and the avoided costs in the case of vaccination of all one-year old children in the population - as benefits. The results show that the vaccination of one-year-old children would be cost effective to the healthcare system in the years with an epidemiologic outbreak, as in these years the total cost of treatment of patients with hepatitis A infection exceeds the cost for vaccination of the whole one-year-old cohort. The critical threshold is 4600 infected patients per year that equalize the benefits to costs. The inclusion of HAV vaccine in the National Immunization Calendar would be cost effective for the healthcare system when the vaccination is performed in certain risk groups and could help to decrease the circulation of the virus in the general population.

Faith community nursing demonstrates good stewardship of community benefit dollars through cost savings and cost avoidance.

PubMed

Brown, Ameldia R; Coppola, Patricia; Giacona, Marian; Petriches, Anne; Stockwell, Mary Ann

2009-01-01

Health systems seeking responsible stewardship of community benefit dollars supporting Faith Community Nursing Networks require demonstration of positive measurable health outcomes. Faith Community Nurses (FCNs) answer the call for measurable outcomes by documenting cost savings and cost avoidances to families, communities, and health systems associated with their interventions. Using a spreadsheet tool based on Medicare reimbursements and diagnostic-related groupings, 3 networks of FCNs have together shown more than 600 000 (for calendar year 2008) healthcare dollars saved by avoidance of unnecessary acute care visits and extended care placements. The cost-benefit ratio of support dollars to cost savings and cost avoidance demonstrates that support of FCNs is good stewardship of community benefit dollars.

Fast Context Switching in Real-Time Propositional Reasoning

NASA Technical Reports Server (NTRS)

Nayak, P. Pandurang; Williams, Brian C.

1997-01-01

The trend to increasingly capable and affordable control processors has generated an explosion of embedded real-time gadgets that serve almost every function imaginable. The daunting task of programming these gadgets is greatly alleviated with real-time deductive engines that perform all execution and monitoring functions from a single core model, Fast response times are achieved using an incremental propositional deductive database (an LTMS). Ideally the cost of an LTMS's incremental update should be linear in the number of labels that change between successive contexts. Unfortunately an LTMS can expend a significant percentage of its time working on labels that remain constant between contexts. This is caused by the LTMS's conservative approach: a context switch first removes all consequences of deleted clauses, whether or not those consequences hold in the new context. This paper presents a more aggressive incremental TMS, called the ITMS, that avoids processing a significant number of these consequences that are unchanged. Our empirical evaluation for spacecraft control shows that the overhead of processing unchanged consequences can be reduced by a factor of seven.

The 24-hour society between myth and reality.

PubMed

Costa, G

2001-12-01

The 24-hour society appears to be an ineluctable process towards a social organisation where time constraints are no more "restricting" the human life. But, what kind of 24-hour society do we need? At what costs? Are they acceptable/sustainable? Shift work, night work, irregular and flexible working hours, together with new technologies, are the milestone of this epochal passage, of which shift workers are builders and victims at the same time. The borders between working and social times are no more fixed and rigidly determined: not only the link between work place and working hours is broken, but also the value of working time changes according to the different economic/productive/social effects it can make. What are the advantages and disadvantages for the individual, the companies, and the society? What is the cost/benefit ratio in terms of physical health; psychological well-being, family and social life? The research on irregular working hours and health shows us what can be the negative consequences of non-human-centered working times organisations. Coping properly with this process means avoiding a passive acceptance of it with consequent maladjustments at both individual and social level, but adopting effective preventive and compensative strategies aimed at building a more sustainable society, at acceptable costs and with the highest possible benefits.

Natural wind variability triggered drop in German redispatch volume and costs from 2015 to 2016.

PubMed

Wohland, Jan; Reyers, Mark; Märker, Carolin; Witthaut, Dirk

2018-01-01

Avoiding dangerous climate change necessitates the decarbonization of electricity systems within the next few decades. In Germany, this decarbonization is based on an increased exploitation of variable renewable electricity sources such as wind and solar power. While system security has remained constantly high, the integration of renewables causes additional costs. In 2015, the costs of grid management saw an all time high of about € 1 billion. Despite the addition of renewable capacity, these costs dropped substantially in 2016. We thus investigate the effect of natural climate variability on grid management costs in this study. We show that the decline is triggered by natural wind variability focusing on redispatch as a main cost driver. In particular, we find that 2016 was a weak year in terms of wind generation averages and the occurrence of westerly circulation weather types. Moreover, we show that a simple model based on the wind generation time series is skillful in detecting redispatch events on timescales of weeks and beyond. As a consequence, alterations in annual redispatch costs in the order of hundreds of millions of euros need to be understood and communicated as a normal feature of the current system due to natural wind variability.

Acceptance threshold theory can explain occurrence of homosexual behaviour.

PubMed

Engel, Katharina C; Männer, Lisa; Ayasse, Manfred; Steiger, Sandra

2015-01-01

Same-sex sexual behaviour (SSB) has been documented in a wide range of animals, but its evolutionary causes are not well understood. Here, we investigated SSB in the light of Reeve's acceptance threshold theory. When recognition is not error-proof, the acceptance threshold used by males to recognize potential mating partners should be flexibly adjusted to maximize the fitness pay-off between the costs of erroneously accepting males and the benefits of accepting females. By manipulating male burying beetles' search time for females and their reproductive potential, we influenced their perceived costs of making an acceptance or rejection error. As predicted, when the costs of rejecting females increased, males exhibited more permissive discrimination decisions and showed high levels of SSB; when the costs of accepting males increased, males were more restrictive and showed low levels of SSB. Our results support the idea that in animal species, in which the recognition cues of females and males overlap to a certain degree, SSB is a consequence of an adaptive discrimination strategy to avoid the costs of making rejection errors. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

[From the nursing home to hospital and back again… A mixed methods study on hospital transfers from nursing homes].

PubMed

Kada, Olivia; Brunner, Eva; Likar, Rudolf; Pinter, Georg; Leutgeb, Ines; Francisci, Nina; Pfeiffer, Bettina; Janig, Herbert

2011-01-01

Hospital transfers from nursing homes are frequent, costly, often preventable, and can have negative effects on the residents' health. The present study investigated the current situation in Carinthia (Austria) regarding the characteristics of relocated nursing home residents, the proportion of avoidable transfers, the consequences of relocation from the physicians' and nurses' perspectives and ways for improving nursing home care. Retrospectively, the documentations of a regional hospital (N=4149), a rescue service (N=10754), and a social insurance agency (N=7051) were analysed; qualitative interviews with physicians (N=25) and nursing administrators (N=16) were conducted. A considerable proportion of these transports seemed to be avoidable: for example, about 40% of the ambulatory treatments in the emergency department of the investigated hospital were inappropriate. Options for improving the current situation will be discussed. Copyright © 2011. Published by Elsevier GmbH.

Environment, physical activity, and neurogenesis: implications for prevention and treatment of Alzhemier's disease.

PubMed

Briones, Teresita L

2006-02-01

Age is the biggest risk factor for the development of neurodegenerative diseases. Consequently, as the population ages it becomes more critical to find ways to avoid the debilitating cost of neurodegenerative diseases such as Alzheimer's. Some of the non-invasive strategies that can potentially slow down the mental decline associated with aging are exercise and use of multi-sensory environmental stimulation. The beneficial effects of both exercise and multi-sensory environmental stimulation have been well-documented, thus it is possible that these strategies can either provide neuroprotection or increase resistance to the development of age-related cognitive problems.

Why reduce health inequalities?

PubMed

Woodward, A; Kawachi, I

2000-12-01

It is well known that social, cultural and economic factors cause substantial inequalities in health. Should we strive to achieve a more even share of good health, beyond improving the average health status of the population? We examine four arguments for the reduction of health inequalities.1 Inequalities are unfair. Inequalities in health are undesirable to the extent that they are unfair, or unjust. Distinguishing between health inequalities and health inequities can be contentious. Our view is that inequalities become "unfair" when poor health is itself the consequence of an unjust distribution of the underlying social determinants of health (for example, unequal opportunities in education or employment).2 Inequalities affect everyone. Conditions that lead to marked health disparities are detrimental to all members of society. Some types of health inequalities have obvious spillover effects on the rest of society, for example, the spread of infectious diseases, the consequences of alcohol and drug misuse, or the occurrence of violence and crime.3 Inequalities are avoidable. Disparities in health are avoidable to the extent that they stem from identifiable policy options exercised by governments, such as tax policy, regulation of business and labour, welfare benefits and health care funding. It follows that health inequalities are, in principle, amenable to policy interventions. A government that cares about improving the health of the population ought therefore to incorporate considerations of the health impact of alternative options in its policy setting process.3 Interventions to reduce health inequalities are cost effective. Public health programmes that reduce health inequalities can also be cost effective. The case can be made to give priority to such programmes (for example, improving access to cervical cancer screening in low income women) on efficiency grounds. On the other hand, few programmes designed to reduce health inequalities have been formally evaluated using cost effectiveness analysis. We conclude that fairness is likely to be the most influential argument in favour of acting to reduce disparities in health, but the concept of equity is contested and susceptible to different interpretations. There is persuasive evidence for some outcomes that reducing inequalities will diminish "spill over" effects on the health of society at large. In principle, you would expect that differences in health status that are not biologically determined are avoidable. However, the mechanisms giving rise to inequalities are still imperfectly understood, and evidence remains to be gathered on the effectiveness of interventions to reduce such inequalities.

Cost-effectiveness of natalizumab vs fingolimod for the treatment of relapsing-remitting multiple sclerosis: analyses in Sweden.

PubMed

O'Day, Ken; Meyer, Kellie; Stafkey-Mailey, Dana; Watson, Crystal

2015-04-01

To assess the cost-effectiveness of natalizumab vs fingolimod over 2 years in relapsing-remitting multiple sclerosis (RRMS) patients and patients with rapidly evolving severe disease in Sweden. A decision analytic model was developed to estimate the incremental cost per relapse avoided of natalizumab and fingolimod from the perspective of the Swedish healthcare system. Modeled 2-year costs in Swedish kronor of treating RRMS patients included drug acquisition costs, administration and monitoring costs, and costs of treating MS relapses. Effectiveness was measured in terms of MS relapses avoided using data from the AFFIRM and FREEDOMS trials for all patients with RRMS and from post-hoc sub-group analyses for patients with rapidly evolving severe disease. Probabilistic sensitivity analyses were conducted to assess uncertainty. The analysis showed that, in all patients with MS, treatment with fingolimod costs less (440,463 Kr vs 444,324 Kr), but treatment with natalizumab results in more relapses avoided (0.74 vs 0.59), resulting in an incremental cost-effectiveness ratio (ICER) of 25,448 Kr per relapse avoided. In patients with rapidly evolving severe disease, natalizumab dominated fingolimod. Results of the sensitivity analysis demonstrate the robustness of the model results. At a willingness-to-pay (WTP) threshold of 500,000 Kr per relapse avoided, natalizumab is cost-effective in >80% of simulations in both patient populations. Limitations include absence of data from direct head-to-head studies comparing natalizumab and fingolimod, use of relapse rate reduction rather than sustained disability progression as the primary model outcome, assumption of 100% adherence to MS treatment, and exclusion of adverse event costs in the model. Natalizumab remains a cost-effective treatment option for patients with MS in Sweden. In the RRMS patient population, the incremental cost per relapse avoided is well below a 500,000 Kr WTP threshold per relapse avoided. In the rapidly evolving severe disease patient population, natalizumab dominates fingolimod.

Maladaptive behavioral consequences of conditioned fear-generalization: a pronounced, yet sparsely studied, feature of anxiety pathology.

PubMed

van Meurs, Brian; Wiggert, Nicole; Wicker, Isaac; Lissek, Shmuel

2014-06-01

Fear-conditioning experiments in the anxiety disorders focus almost exclusively on passive-emotional, Pavlovian conditioning, rather than active-behavioral, instrumental conditioning. Paradigms eliciting both types of conditioning are needed to study maladaptive, instrumental behaviors resulting from Pavlovian abnormalities found in clinical anxiety. One such Pavlovian abnormality is generalization of fear from a conditioned danger-cue (CS+) to resembling stimuli. Though lab-based findings repeatedly link overgeneralized Pavlovian-fear to clinical anxiety, no study assesses the degree to which Pavlovian overgeneralization corresponds with maladaptive, overgeneralized instrumental-avoidance. The current effort fills this gap by validating a novel fear-potentiated startle paradigm including Pavlovian and instrumental components. The paradigm is embedded in a computer game during which shapes appear on the screen. One shape paired with electric-shock serves as CS+, and other resembling shapes, presented in the absence of shock, serve as generalization stimuli (GSs). During the game, participants choose whether to behaviorally avoid shock at the cost of poorer performance. Avoidance during CS+ is considered adaptive because shock is a real possibility. By contrast, avoidance during GSs is considered maladaptive because shock is not a realistic prospect and thus unnecessarily compromises performance. Results indicate significant Pavlovian-instrumental relations, with greater generalization of Pavlovian fear associated with overgeneralization of maladaptive instrumental-avoidance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs.

PubMed

Fidler, Carrie; Elmelund Christensen, Torsten; Gillard, Samantha

2011-01-01

The clinical goal in the treatment of diabetes is to achieve good glycemic control. Tight glycemic control achieved with intensive glucose lowering treatment reduces the risk of long-term micro- and macro-vascular complications of diabetes, resulting in an improvement in quality-of-life for the patient and decreased healthcare costs. The positive impact of good glycemic control is, however, counterbalanced by the negative impact of an increased incidence of hypoglycemia. A search of PubMed was conducted to identify published literature on the impact of hypoglycemia, both on patient quality-of-life and associated costs to the healthcare system and society. In people with type 1 or type 2 diabetes, hypoglycemia is associated with a reduction in quality-of-life, increased fear and anxiety, reduced productivity, and increased healthcare costs. Fear of hypoglycemia may promote compensatory behaviors in order to avoid hypoglycemia, such as decreased insulin doses, resulting in poor glycemic control and an increased risk of serious health consequences. Every non-severe event may be associated with a utility loss in the range of 0.0033-0.0052 over 1 year, further contributing to the negative impact. This review is intended to provide an overview of hypoglycemia in diabetes and its impact on patients and society, and consequently it is not a comprehensive evaluation of all studies reporting hypoglycemic episodes. To provide the best possible care for patients and a cost-effective treatment strategy for healthcare decision-makers, a treatment that provides good glycemic control with a limited risk of hypoglycemia would be a welcome addition to diabetes management options.

The social benefits of private infectious disease-risk mitigation.

PubMed

Morin, Benjamin R; Perrings, Charles; Kinzig, Ann; Levin, Simon

2015-11-01

Does society benefit from private measures to mitigate infectious disease risks? Since mitigation reduces both peak prevalence and the number of people who fall ill, the answer might appear to be yes. But mitigation also prolongs epidemics and therefore the time susceptible people engage in activities to avoid infection. These avoidance activities come at a cost-in lost production or consumption, for example. Whether private mitigation yields net social benefits depends on the social weight given to the costs of illness and illness avoidance, now and into the future. We show that, for a large class of infectious diseases, private risk mitigation is socially beneficial. However, in cases where society discounts the future at either very low or very high rates relative to private individuals, or where it places a low weight on the private cost of illness, the social cost of illness under proportionate mixing (doing nothing) may be lower than the social cost of illness under preferential mixing (avoiding infectious individuals). That is, under some circumstances, society would prefer shorter, more intense epidemics without avoidance costs over longer, less intense epidemics with avoidance costs. A sobering (although not surprising) implication of this is that poorer societies should be expected to promote less private disease-risk mitigation than richer societies.

Individual and Sex Differences in the Consequences of Victimization: Moderation by Approach and Avoidance Motivation

PubMed Central

Llewellyn, Nicole; Rudolph, Karen D.

2015-01-01

Peer victimization is a known risk factor for various forms of maladjustment; however, the specific type of maladjustment may depend on individual differences in youth. This 2-wave longitudinal study examined the hypothesis that social approach–avoidance motivation, together with sex, would moderate the contribution of 3rd-grade victimization to 4th-grade maladjustment. Children (N = 574, M age = 8.94, SD = 0.37) reported on their victimization exposure, social approach–avoidance motivation, and depressive symptoms. Teachers reported on students’ victimization exposure and aggressive behavior. Victimization predicted aggressive behavior only in boys with moderate to high approach motivation; victimization predicted depressive symptoms only in girls with moderate to high avoidance motivation. This research elucidates the diverse consequences associated with peer victimization and informs efforts to address these consequences in a targeted manner. PMID:25019947

Individual and sex differences in the consequences of victimization: Moderation by approach and avoidance motivation.

PubMed

Llewellyn, Nicole; Rudolph, Karen D

2014-09-01

Peer victimization is a known risk factor for various forms of maladjustment; however, the specific type of maladjustment may depend on individual differences in youth. This 2-wave longitudinal study examined the hypothesis that social approach-avoidance motivation, together with sex, would moderate the contribution of 3rd-grade victimization to 4th-grade maladjustment. Children (N = 574, M age = 8.94, SD = 0.37) reported on their victimization exposure, social approach-avoidance motivation, and depressive symptoms. Teachers reported on students' victimization exposure and aggressive behavior. Victimization predicted aggressive behavior only in boys with moderate to high approach motivation; victimization predicted depressive symptoms only in girls with moderate to high avoidance motivation. This research elucidates the diverse consequences associated with peer victimization and informs efforts to address these consequences in a targeted manner.

Economic consequences of the vaccination against hepatitis A in the Bulgarian healthcare setting

PubMed Central

Dimitrova, Maria; Petrova, Guenka; Tachkov, Konstantin; Bozhkova, Maria Krasteva; Kamusheva, Maria; Mitov, Konstantin

2014-01-01

The purpose of the present analysis is to calculate and compare the costs and results of the implication of the inactivated vaccine against hepatitis A virus (HAV) in the Bulgarian healthcare setting in the period of 2002–2012. A combined pharmacoeconomic and epidemiological study was performed on the basis of the prevalence of hepatitis A infection in this 10-year period. The investments in the vaccination were considered as costs and the avoided costs in the case of vaccination of all one-year old children in the population – as benefits. The results show that the vaccination of one-year-old children would be cost effective to the healthcare system in the years with an epidemiologic outbreak, as in these years the total cost of treatment of patients with hepatitis A infection exceeds the cost for vaccination of the whole one-year-old cohort. The critical threshold is 4600 infected patients per year that equalize the benefits to costs. The inclusion of HAV vaccine in the National Immunization Calendar would be cost effective for the healthcare system when the vaccination is performed in certain risk groups and could help to decrease the circulation of the virus in the general population. PMID:26019522

Identifying Variations in Baseline Behavior of Killer Whales (Orcinus orca) to Contextualize Their Responses to Anthropogenic Noise.

PubMed

Samarra, Filipa I P; Miller, Patrick J O

2016-01-01

Determining the baseline behavior of a whale requires understanding natural variations occurring due to environmental context, such as changes in prey behavior. Killer whales feeding on herring consistently encircle herring schools; however, depth of feeding differs from near the surface in winter to deeper than 10 m in spring and summer. These variations in feeding depth are probably due to the depth of the prey and the balance between the costs and benefits of bringing schools of herring to the surface. Such variation in baseline behavior may incur different energetic costs and consequently change the motivation of whales to avoid a feeding area. Here, we discuss these variations in feeding behavior in the context of exposure to noise and interpret observed responses to simulated navy sonar signals.

Depleted uranium hexafluoride: The source material for advanced shielding systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Quapp, W.J.; Lessing, P.A.; Cooley, C.R.

1997-02-01

The U.S. Department of Energy (DOE) has a management challenge and financial liability problem in the form of 50,000 cylinders containing 555,000 metric tons of depleted uranium hexafluoride (UF{sub 6}) that are stored at the gaseous diffusion plants. DOE is evaluating several options for the disposition of this UF{sub 6}, including continued storage, disposal, and recycle into a product. Based on studies conducted to date, the most feasible recycle option for the depleted uranium is shielding in low-level waste, spent nuclear fuel, or vitrified high-level waste containers. Estimates for the cost of disposal, using existing technologies, range between $3.8 andmore » $11.3 billion depending on factors such as the disposal site and the applicability of the Resource Conservation and Recovery Act (RCRA). Advanced technologies can reduce these costs, but UF{sub 6} disposal still represents large future costs. This paper describes an application for depleted uranium in which depleted uranium hexafluoride is converted into an oxide and then into a heavy aggregate. The heavy uranium aggregate is combined with conventional concrete materials to form an ultra high density concrete, DUCRETE, weighing more than 400 lb/ft{sup 3}. DUCRETE can be used as shielding in spent nuclear fuel/high-level waste casks at a cost comparable to the lower of the disposal cost estimates. Consequently, the case can be made that DUCRETE shielded casks are an alternative to disposal. In this case, a beneficial long term solution is attained for much less than the combined cost of independently providing shielded casks and disposing of the depleted uranium. Furthermore, if disposal is avoided, the political problems associated with selection of a disposal location are also avoided. Other studies have also shown cost benefits for low level waste shielded disposal containers.« less

The Six Cs of Managing Federal Projects: How to Avoid Cost Disallowances.

ERIC Educational Resources Information Center

Goeres, Ernest R.; Mancini, Cesidio G.

1995-01-01

To avoid embarrassment and financial cost of incurring cost disallowances on federally-sponsored projects, college and university administrators must pay particular attention to these management areas: compensation (release time, overload, and others); costs (allowable, attributable, transfers, and others); consulting; certification of time and…

Land-use change and costs to rural households: a case study in groundwater nitrate contamination

NASA Astrophysics Data System (ADS)

Keeler, Bonnie L.; Polasky, Stephen

2014-07-01

Loss of grassland from conversion to agriculture threatens water quality and other valuable ecosystem services. Here we estimate how land-use change affects the probability of groundwater contamination by nitrate in private drinking water wells. We find that conversion of grassland to agriculture from 2007 to 2012 in Southeastern Minnesota is expected to increase the future number of wells exceeding 10 ppm nitrate-nitrogen by 45% (from 888 to 1292 wells). We link outputs of the groundwater well contamination model to cost estimates for well remediation, well replacement, and avoidance behaviors to estimate the potential economic value lost due to nitrate contamination from observed land-use change. We estimate 0.7-12 million in costs (present values over a 20 year horizon) to address the increased risk of nitrate contamination of private wells. Our study demonstrates how biophysical models and economic valuation can be integrated to estimate the welfare consequences of land-use change.

Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage

PubMed Central

Montz, Ellen; Layton, Tim; Busch, Alisa B.; Ellis, Randall P.; Rose, Sherri; McGuire, Thomas G.

2016-01-01

Under the Affordable Care Act, the risk-adjustment program is designed to compensate health plans for enrolling people with poorer health status so that plans compete on cost and quality rather than the avoidance of high-cost individuals. This study examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. Through a simulation of the program on a population constructed to reflect Marketplace enrollees, we analyzed the cost consequences for plans enrolling people with mental health and substance use disorders. Our assessment points to systematic underpayment to plans for people with these diagnoses. We document how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders. Adding mental health and substance use diagnoses used in Medicare Part D risk adjustment is one potential policy step toward addressing this problem in the Marketplaces. PMID:27269018

Multi-Destination and Multi-Purpose Trip Effects in the Analysis of the Demand for Trips to a Remote Recreational Site

NASA Astrophysics Data System (ADS)

Martínez-Espiñeira, Roberto; Amoako-Tuffour, Joe

2009-06-01

One of the basic assumptions of the travel cost method for recreational demand analysis is that the travel cost is always incurred for a single purpose recreational trip. Several studies have skirted around the issue with simplifying assumptions and dropping observations considered as nonconventional holiday-makers or as nontraditional visitors from the sample. The effect of such simplifications on the benefit estimates remains conjectural. Given the remoteness of notable recreational parks, multi-destination or multi-purpose trips are not uncommon. This article examines the consequences of allocating travel costs to a recreational site when some trips were taken for purposes other than recreation and/or included visits to other recreational sites. Using a multi-purpose weighting approach on data from Gros Morne National Park, Canada, we conclude that a proper correction for multi-destination or multi-purpose trip is more of what is needed to avoid potential biases in the estimated effects of the price (travel-cost) variable and of the income variable in the trip generation equation.

From avoidance to approach: The influence of threat-of-shock on reward-based decision making.

PubMed

Bublatzky, Florian; Alpers, Georg W; Pittig, Andre

2017-09-01

Potential threat can prime defensive responding and avoidance behavior, which may result in the loss of rewards. When aversive consequences do not occur, avoidance should, thus, be quickly overcome in healthy individuals. This study examined the impact of threat anticipation on reward-based decisions. Sixty-five participants completed a decision-making task in which they had to choose between high- and low-reward options. To model an approach-avoidance conflict, the high-reward option was contingent with a threat-of-shock cue; the low-reward option was contingent with a safety cue. In control trials, decisions were made without threat/safety instructions. Overall, behavioral data documented a typical preference for the profitable option. Importantly, under threat-of-shock, participants initially avoided the profitable option (i.e., safe, but less profitable choices). However, when they experienced that shocks did actually not occur, participants overcame initial avoidance in favor of larger gains. Furthermore, autonomic arousal (skin conductance and heart rate responses) was elevated during threat cues compared to safety and non-threatening control cues. Taken together, threat-of-shock was associated with behavioral consequences: initially, participants avoided threat-related options but made more profitable decisions as they experienced no aversive consequences. Although socially acquired threat contingencies are typically stable, incentives for approach can help to overcome threat-related avoidance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Natural wind variability triggered drop in German redispatch volume and costs from 2015 to 2016

PubMed Central

Reyers, Mark; Märker, Carolin; Witthaut, Dirk

2018-01-01

Avoiding dangerous climate change necessitates the decarbonization of electricity systems within the next few decades. In Germany, this decarbonization is based on an increased exploitation of variable renewable electricity sources such as wind and solar power. While system security has remained constantly high, the integration of renewables causes additional costs. In 2015, the costs of grid management saw an all time high of about € 1 billion. Despite the addition of renewable capacity, these costs dropped substantially in 2016. We thus investigate the effect of natural climate variability on grid management costs in this study. We show that the decline is triggered by natural wind variability focusing on redispatch as a main cost driver. In particular, we find that 2016 was a weak year in terms of wind generation averages and the occurrence of westerly circulation weather types. Moreover, we show that a simple model based on the wind generation time series is skillful in detecting redispatch events on timescales of weeks and beyond. As a consequence, alterations in annual redispatch costs in the order of hundreds of millions of euros need to be understood and communicated as a normal feature of the current system due to natural wind variability. PMID:29329349

The social benefits of private infectious disease-risk mitigation

PubMed Central

Perrings, Charles; Kinzig, Ann; Levin, Simon

2015-01-01

Does society benefit from private measures to mitigate infectious disease risks? Since mitigation reduces both peak prevalence and the number of people who fall ill, the answer might appear to be yes. But mitigation also prolongs epidemics and therefore the time susceptible people engage in activities to avoid infection. These avoidance activities come at a cost—in lost production or consumption, for example. Whether private mitigation yields net social benefits depends on the social weight given to the costs of illness and illness avoidance, now and into the future. We show that, for a large class of infectious diseases, private risk mitigation is socially beneficial. However, in cases where society discounts the future at either very low or very high rates relative to private individuals, or where it places a low weight on the private cost of illness, the social cost of illness under proportionate mixing (doing nothing) may be lower than the social cost of illness under preferential mixing (avoiding infectious individuals). That is, under some circumstances, society would prefer shorter, more intense epidemics without avoidance costs over longer, less intense epidemics with avoidance costs. A sobering (although not surprising) implication of this is that poorer societies should be expected to promote less private disease-risk mitigation than richer societies. PMID:26858777

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

PubMed

Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Managing Canine Aggression in the Home.

PubMed

Pike, Amy

2018-05-01

Canine aggression occurring in the home can be a dangerous diagnosis with costly consequences to all members of the household. Management is a key modality in the treatment of canine aggression in the home. A thorough history will detail each trigger, target, and context and allow for the veterinary team to put together a comprehensive management plan. Management allows for the avoidance of future aggressive episodes and minimizes the risks associated with living with a patient with these diagnoses. Although risk cannot be mitigated 100%, thorough management can create a safe environment for the implementation of the behavior treatment plan. Copyright © 2017 Elsevier Inc. All rights reserved.

The Elimination of a Self-Injurious Avoidance Response through a Forced Running Consequence.

ERIC Educational Resources Information Center

Borreson, Paul M.

1980-01-01

The self-injurious avoidance responses of a 22-year-old severely mentally retarded male were eliminated through a forced running consequence. Side effects, such as reduced noise, increase in smiling, and faster progress toward instructional objectives, were also noted. The results were maintained over a period of two years. (Author/PHR)

Swainson's Thrushes do not show strong wind selectivity prior to crossing the Gulf of Mexico.

PubMed

Bolus, Rachel T; Diehl, Robert H; Moore, Frank R; Deppe, Jill L; Ward, Michael P; Smolinsky, Jaclyn; Zenzal, Theodore J

2017-10-27

During long-distance fall migrations, nocturnally migrating Swainson's Thrushes often stop on the northern Gulf of Mexico coast before flying across the Gulf. To minimize energetic costs, trans-Gulf migrants should stop over when they encounter crosswinds or headwinds, and depart with supportive tailwinds. However, time constrained migrants should be less selective, balancing costs of headwinds with benefits of continuing their migrations. To test the hypotheses that birds select supportive winds and that selectivity is mediated by seasonal time constraints, we examined whether local winds affected Swainson's Thrushes' arrival and departure at Ft. Morgan, Alabama, USA at annual, seasonal, and nightly time scales. Additionally, migrants could benefit from forecasting future wind conditions, crossing on nights when winds are consistently supportive across the Gulf, thereby avoiding the potentially lethal consequences of depleting their energetic reserves over water. To test whether birds forecast, we developed a movement model, calculated to what extent departure winds were predictive of future Gulf winds, and tested whether birds responded to predictability. Swainson's Thrushes were only slightly selective and did not appear to forecast. By following the simple rule of avoiding only the strongest headwinds at departure, Swainson's Thrushes could survive the 1500 km flight between Alabama and Veracruz, Mexico.

Evaluating the cost of one telehealth application connecting an acute and long-term care setting.

PubMed

Specht, J K; Wakefield, B; Flanagan, J

2001-01-01

This article describes a study of the costs of a pilot telemedicine chronic wound consultation clinic. Cost minimization analysis is the technique used to examine the costs of the clinic. The components of cost analysis include the fixed costs of personnel and equipment and the indirect costs of circuit and line charges. Cost avoidance is also examined. Cost avoidance evaluates what costs were avoided by the use of the telemedicine clinic. Additionally, the cost perspectives of the consulting agency, the referring agency, and the patient are examined. The average cost of a chronic wound consultation was $136.16 (acute care perspective). Costs of a traditional face-to-face consultation, if the residents were transported to the acute care facility would be $246.28. Fifteen telehealth consultations per month were used to determine per consultation costs for line charges and depreciation/maintenance costs. In this pilot study, a cost savings was realized and patients benefited. Increased volume will help to offset the cost of the equipment depreciation and maintenance and make telehealth chronic wound consultations more cost effective.

Reasoned Decision Making Without Math? Adaptability and Robustness in Response to Surprise.

PubMed

Smithson, Michael; Ben-Haim, Yakov

2015-10-01

Many real-world planning and decision problems are far too uncertain, too variable, and too complicated to support realistic mathematical models. Nonetheless, we explain the usefulness, in these situations, of qualitative insights from mathematical decision theory. We demonstrate the integration of info-gap robustness in decision problems in which surprise and ignorance are predominant and where personal and collective psychological factors are critical. We present practical guidelines for employing adaptable-choice strategies as a proxy for robustness against uncertainty. These guidelines include being prepared for more surprises than we intuitively expect, retaining sufficiently many options to avoid premature closure and conflicts among preferences, and prioritizing outcomes that are steerable, whose consequences are observable, and that do not entail sunk costs, resource depletion, or high transition costs. We illustrate these concepts and guidelines with the example of the medical management of the 2003 SARS outbreak in Vietnam. © 2015 Society for Risk Analysis.

Inadequate prescription-drug coverage for Medicare enrollees--a call to action.

PubMed

Soumerai, S B; Ross-Degnan, D

1999-03-04

In summary, most low-income elderly and disabled persons lack coverage for important medications, resulting in avoidable deterioration of health among those with chronic illnesses and use of expensive institutional services. Rapidly escalating drug costs, more restrictive drug-coverage policies, and a dramatic increase in the population of elderly and disabled persons will exacerbate these problems. With the current budget surplus, as well as bipartisan concern about health care needs and public concern about drug costs and coverage, it is time to act responsibly and aggressively. We recommend a national replication of the best features of state pharmacy-assistance programs in a federal-state insurance program for low-income Medicare enrollees, either alone or in combination with expanded Medicare coverage. Such a program will reduce the current inequitable situation in which the most vulnerable patients have the least access to medications, with serious medical and economic consequences.

Defining the road ahead: thinking strategically in the new era of health care reform.

PubMed

Pudlowski, Edward M

2011-01-01

Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis.

PubMed

Chiao, Evelyn; Meyer, Kellie

2009-06-01

Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA). To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS. A combined cost effectiveness and budget impact model was developed. Model inputs were drug acquisition costs (wholesale acquisition cost), costs of drug administration and monitoring, costs of treating relapses, anticipated reduction in relapse rates after 2 years of therapy, and estimated market utilization of natalizumab. Outcomes included total 2-year costs of therapy per patient, costs per relapse avoided for each treatment, and overall 2-year costs to the health plan and per member per month (PMPM) costs. Drug acquisition costs are in 2008 US dollars, and all other costs were inflated to 2008 US dollars when necessary. Univariate sensitivity analyses were performed to determine the model inputs with the greatest influence on the cost per relapse avoided for natalizumab. The overall 2-year cost of therapy per patient was $72,120 for natalizumab, $56,790 for intramuscular (IM) interferon beta-1a (IFNbeta-1a), $56,773 for IFNbeta-1b, $57,180 for GA, and $58,538 for subcutaneous (SC) IFNbeta-1a. The cost per relapse avoided was lowest for natalizumab at $56,594, followed by $87,791 for IFNbeta-1b, $93,306 for IM IFNbeta-1a, $96,178 for SC IFNbeta-1a, and $103,665 for GA. The incremental cost-effectiveness ratios of natalizumab relative to IM IFNbeta-1a, IFNbeta-1b, GA, and SC IFNbeta-1a were $23,029, $24,452, $20,671, and $20,403 per additional relapse avoided, respectively. An increase in natalizumab utilization to 9% resulted in an increase of approximately $61 760 in total 2-year costs to a hypothetical health plan of 1 million members, or a $0.003 PMPM incremental cost. Univariate sensitivity analyses indicated that the model inputs with the most influence on cost per relapse avoided for natalizumab were the weighted average number of relapses before treatment and the anticipated relative relapse rate reduction. Natalizumab was the most cost-effective therapy as measured by total cost per relapse avoided, not withstanding a higher drug acquisition cost versus other DMTs. Entry of natalizumab to the market is likely to result in a minimal increase in health-plan costs on a PMPM basis. Limitations of the study include the use of a surrogate measure, relapse avoided, as an outcome measure; also, adverse events were not included in the model.

Neural Mechanisms for Adaptive Learned Avoidance of Mental Effort.

PubMed

Mitsuto Nagase, Asako; Onoda, Keiichi; Clifford Foo, Jerome; Haji, Tomoki; Akaishi, Rei; Yamaguchi, Shuhei; Sakai, Katsuyuki; Morita, Kenji

2018-02-05

Humans tend to avoid mental effort. Previous studies have demonstrated this tendency using various demand-selection tasks; participants generally avoid options associated with higher cognitive demand. However, it remains unclear whether humans avoid mental effort adaptively in uncertain and non-stationary environments, and if so, what neural mechanisms underlie this learned avoidance and whether they remain the same irrespective of cognitive-demand types. We addressed these issues by developing novel demand-selection tasks where associations between choice options and cognitive-demand levels change over time, with two variations using mental arithmetic and spatial reasoning problems (29:4 and 18:2 males:females). Most participants showed avoidance, and their choices depended on the demand experienced on multiple preceding trials. We assumed that participants updated the expected cost of mental effort through experience, and fitted their choices by reinforcement learning models, comparing several possibilities. Model-based fMRI analyses revealed that activity in the dorsomedial and lateral frontal cortices was positively correlated with the trial-by-trial expected cost for the chosen option commonly across the different types of cognitive demand, and also revealed a trend of negative correlation in the ventromedial prefrontal cortex. We further identified correlates of cost-prediction-error at time of problem-presentation or answering the problem, the latter of which partially overlapped with or were proximal to the correlates of expected cost at time of choice-cue in the dorsomedial frontal cortex. These results suggest that humans adaptively learn to avoid mental effort, having neural mechanisms to represent expected cost and cost-prediction-error, and the same mechanisms operate for various types of cognitive demand. SIGNIFICANCE STATEMENT In daily life, humans encounter various cognitive demands, and tend to avoid high-demand options. However, it remains unclear whether humans avoid mental effort adaptively under dynamically changing environments, and if so, what are the underlying neural mechanisms and whether they operate irrespective of cognitive-demand types. To address these issues, we developed novel tasks, where participants could learn to avoid high-demand options under uncertain and non-stationary environments. Through model-based fMRI analyses, we found regions whose activity was correlated with the expected mental effort cost, or cost-prediction-error, regardless of demand-type, with overlap or adjacence in the dorsomedial frontal cortex. This finding contributes to clarifying the mechanisms for cognitive-demand avoidance, and provides empirical building blocks for the emerging computational theory of mental effort. Copyright © 2018 the authors.

Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting.

PubMed

Marina, Nuria; Bayón, Juan Carlos; López de Santa María, Elena; Gutiérrez, Asunción; Inchausti, Marta; Bustamante, Victor; Gáldiz, Juan B

2016-01-01

To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cost-outcome description of clinical pharmacist interventions in a university teaching hospital.

PubMed

Gallagher, James; Byrne, Stephen; Woods, Noel; Lynch, Deirdre; McCarthy, Suzanne

2014-04-17

Pharmacist interventions are one of the pivotal parts of a clinical pharmacy service within a hospital. This study estimates the cost avoidance generated by pharmacist interventions due to the prevention of adverse drug events (ADE). The types of interventions identified are also analysed. Interventions recorded by a team of hospital pharmacists over a one year time period were included in the study. Interventions were assigned a rating score, determined by the probability that an ADE would have occurred in the absence of an intervention. These scores were then used to calculate cost avoidance. Net cost benefit and cost benefit ratio were the primary outcomes. Categories of interventions were also analysed. A total cost avoidance of €708,221 was generated. Input costs were calculated at €81,942. This resulted in a net cost benefit of €626,279 and a cost benefit ratio of 8.64: 1. The most common type of intervention was the identification of medication omissions, followed by dosage adjustments and requests to review therapies. This study provides further evidence that pharmacist interventions provide substantial cost avoidance to the healthcare payer. There is a serious issue of patient's regular medication being omitted on transfer to an inpatient setting in Irish hospitals.

Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a 'tobacco-free' UK.

PubMed

Hunt, Daniel; Knuchel-Takano, André; Jaccard, Abbygail; Bhimjiyani, Arti; Retat, Lise; Selvarajah, Chit; Brown, Katrina; Webber, Laura L; Brown, Martin

2018-03-01

Smoking is still the most preventable cause of cancer, and a leading cause of premature mortality and health inequalities in the UK. This study modelled the health and economic impacts of achieving a 'tobacco-free' ambition (TFA) where, by 2035, less than 5% of the population smoke tobacco across all socioeconomic groups. A non-linear multivariate regression model was fitted to cross-sectional smoking data to create projections to 2035. These projections were used to predict the future incidence and costs of 17 smoking-related diseases using a microsimulation approach. The health and economic impacts of achieving a TFA were evaluated against a predicted baseline scenario, where current smoking trends continue. If trends continue, the prevalence of smoking in the UK was projected to be 10% by 2035-well above a TFA. If this ambition were achieved by 2035, it could mean 97 300 +/- 5 300 new cases of smoking-related diseases are avoided by 2035 (tobacco-related cancers: 35 900+/- 4 100; chronic obstructive pulmonary disease: 29 000 +/- 2 700; stroke: 24 900 +/- 2 700; coronary heart disease: 7600 +/- 2 700), including around 12 350 diseases avoided in 2035 alone. The consequence of this health improvement is predicted to avoid £67 +/- 8 million in direct National Health Service and social care costs, and £548 million in non-health costs, in 2035 alone. These findings strengthen the case to set bold targets on long-term declines in smoking prevalence to achieve a tobacco 'endgame'. Results demonstrate the health and economic benefits that meeting a TFA can achieve over just 20 years. Effective ambitions and policy interventions are needed to reduce the disease and economic burden of smoking. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The costs of avoiding environmental impacts from shale-gas surface infrastructure.

PubMed

Milt, Austin W; Gagnolet, Tamara D; Armsworth, Paul R

2016-12-01

Growing energy demand has increased the need to manage conflicts between energy production and the environment. As an example, shale-gas extraction requires substantial surface infrastructure, which fragments habitats, erodes soils, degrades freshwater systems, and displaces rare species. Strategic planning of shale-gas infrastructure can reduce trade-offs between economic and environmental objectives, but the specific nature of these trade-offs is not known. We estimated the cost of avoiding impacts from land-use change on forests, wetlands, rare species, and streams from shale-energy development within leaseholds. We created software for optimally siting shale-gas surface infrastructure to minimize its environmental impacts at reasonable construction cost. We visually assessed sites before infrastructure optimization to test whether such inspection could be used to predict whether impacts could be avoided at the site. On average, up to 38% of aggregate environmental impacts of infrastructure could be avoided for 20% greater development costs by spatially optimizing infrastructure. However, we found trade-offs between environmental impacts and costs among sites. In visual inspections, we often distinguished between sites that could be developed to avoid impacts at relatively low cost (29%) and those that could not (20%). Reductions in a metric of aggregate environmental impact could be largely attributed to potential displacement of rare species, sedimentation, and forest fragmentation. Planners and regulators can estimate and use heterogeneous trade-offs among development sites to create industry-wide improvements in environmental performance and do so at reasonable costs by, for example, leveraging low-cost avoidance of impacts at some sites to offset others. This could require substantial effort, but the results and software we provide can facilitate the process. © 2016 Society for Conservation Biology.

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

PubMed Central

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-01-01

Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

PURPA 210 avoided cost rates: Economic and implementation issues

DOE Office of Scientific and Technical Information (OSTI.GOV)

Devine, M.D.; Chartock, M.A.; Gunn, E.M.

The purpose of Section 210 of the Public Utilities Regulatory Policies Act (PURPA) was to promote the utilization of waste and renewable fuels and cogeneration processes for increasing electric power supplies. It represents a radical change in policy by allowing financially unregulated parties to generate power in ''qualifying facilities'' and by requiring utilities to purchase this power at the utilities' marginal (or ''avoided'') cost. PURPA 210 has clearly had a major impact as measured by the actual and proposed number of new qualifying facilities; however, implementation has been difficult due to the adversarial nature of the process for negotiating ormore » setting the avoided cost rates. This paper reviews the pertinent PURPA rules and regulations, analyzes the status of current avoided cost rates that have been established, and discusses implementation issues and options for resolving those issues.« less

Current and future avoidable cost of smoking--estimates for Sweden 2007.

PubMed

Bolin, Kristian; Borgman, Benny; Gip, Christina; Wilson, Koo

2011-11-01

To estimate current and future avoidable smoking-attributable costs in Sweden for the year 2007. Disease specific smoking-attributable proportions were calculated for Swedish smoking patterns and applied to estimate costs for smoking-related diseases based on data from public registers. Avoidable future effects of smoking were calculated employing a Markov simulation model. The estimated total cost in 2007 was USD 1.6 billion, or USD 181 per capita. Healthcare (direct) cost accounted for 30% of the total cost. The number of deaths was 97 per 100,000 inhabitants (79 in 2001); the number of years of potential life lost 1,227 per 100,000 inhabitants (1012 in 2001); and the number of years of potential productive life lost 226 (185 in 2001) per 100,000 inhabitants. Avoidable future lifetime costs, per 100,000 inhabitants, amounted to USD 19 million (healthcare), 14,000 years of potential life lost, corresponding to a present value of USD 158 million. Total avoidable cost of current smoking amounted to USD 16 billion. In spite of declining smoking-prevalence rates during the last 30 years, smoking-attributable deaths increased between 2001 and 2007. The number of life years lost per death decreased somewhat, indicating that the age distribution of those dying shifted further towards older age. Simulations indicate that smoking-cessation among young smokers yields considerable more benefits each year than smoking-cessation among older smokers. The health benefits that accrued in 2007, as a result of declining smoking prevalence since 1980, correspond to more than the total cost of smoking in that year. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016.

PubMed

Li, Rui; Simmons, Katharine B; Bertolli, Jeanne; Rivera-Garcia, Brenda; Cox, Shanna; Romero, Lisa; Koonin, Lisa M; Valencia-Prado, Miguel; Bracero, Nabal; Jamieson, Denise J; Barfield, Wanda; Moore, Cynthia A; Mai, Cara T; Korhonen, Lauren C; Frey, Meghan T; Perez-Padilla, Janice; Torres-Muñoz, Ricardo; Grosse, Scott D

2017-01-01

We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus-related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus-associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs.

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016

PubMed Central

Simmons, Katharine B.; Bertolli, Jeanne; Rivera-Garcia, Brenda; Cox, Shanna; Romero, Lisa; Koonin, Lisa M.; Valencia-Prado, Miguel; Bracero, Nabal; Jamieson, Denise J.; Barfield, Wanda; Moore, Cynthia A.; Mai, Cara T.; Korhonen, Lauren C.; Frey, Meghan T.; Perez-Padilla, Janice; Torres-Muñoz, Ricardo; Grosse, Scott D.

2017-01-01

We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus–related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus–associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs. PMID:27805547

Optimizing emissions targets for residential recycling programmes: Why 'more' is not necessarily better with respect to diversion.

PubMed

Lakhan, Calvin

2016-11-01

This study highlights the economic and environmental challenges of recycling in Ontario, specifically examining the effect of attempting to increase the emissions target for the province's household recycling programme. The findings from the cost model analysis found that Ontario's Blue Box programme reduces overall carbon emissions by approximately 1.8 million tonnes every year. This study also found that targeting specific materials for recovery could result in a scenario where the province could improve both overall diversion and emissions offsets while reducing material management costs. Under our modelled scenario, as the tonnes of greenhouse gases (GHGs) avoided increases, the system cost per tonne of GHG avoided initial declines. However, after avoiding 2.05 million tonnes of GHGs, the system cost/tonne GHG avoided increases. To achieve an emissions target in excess of 2.05 million tonnes, the province will have to start recycling higher cost non-core materials (composite materials, other plastics, etc.). © The Author(s) 2016.

Healthy and wellbeing activities' promotion using a Big Data approach.

PubMed

Gachet Páez, Diego; de Buenaga Rodríguez, Manuel; Puertas Sánz, Enrique; Villalba, María Teresa; Muñoz Gil, Rafael

2018-06-01

The aging population and economic crisis specially in developed countries have as a consequence the reduction in funds dedicated to health care; it is then desirable to optimize the costs of public and private healthcare systems, reducing the affluence of chronic and dependent people to care centers; promoting healthy lifestyle and activities can allow people to avoid chronic diseases as for example hypertension. In this article, we describe a system for promoting an active and healthy lifestyle for people and to recommend with guidelines and valuable information about their habits. The proposed system is being developed around the Big Data paradigm using bio-signal sensors and machine-learning algorithms for recommendations.

Weathering a Perfect Storm from Space

USGS Publications Warehouse

Love, Jeffrey J.

2016-01-01

Extreme space-weather events — intense solar and geomagnetic storms — have occurred in the past: most recently in 1859, 1921 and 1989. So scientists expect that, sooner or later, another extremely intense spaceweather event will strike Earth again. Such storms have the potential to cause widespread interference with and damage to technological systems. A National Academy of Sciences study projects that an extreme space-weather event could end up costing the American economy more than $1 trillion. The question now is whether or not we will take the actions needed to avoid such expensive consequences. Let’s assume that we do. Below is an imagined scenario of how, sometime in the future, an extreme space-weather event might play out.

[Age-adaptable to any age].

PubMed

Philippen, D P

1996-01-01

A definition separating the "elderly" from younger people should be avoided as well as any manifestation of any type of segregation. The environment must provide equal chances and opportunities for every person, regardless of age or abilities. Self-determined independence throughout life and the chance to remain in one's established home, community, and familiar environment require barrier-free design in all areas of the person's life-space. Dependencies and disabling factors can be diminished, and abilities can be restored by intensive rehabilitation and support of personal dignity, assisted by ambulant care and by products designed as barrier-free. They, lower the need for special aids and save costs. Such solutions are available. They must be applied with all consequences.

Impact of edge removal on the centrality betweenness of the best spreaders

NASA Astrophysics Data System (ADS)

Chung, N. N.; Chew, L. Y.; Zhou, J.; Lai, C. H.

2012-06-01

The control of epidemic spreading is essential to avoid potential fatal consequences and also, to lessen the unforeseen socio-economic impact. The need for effective control is exemplified during the severe acute respiratory syndrome (SARS) epidemy in 2003, which has inflicted nearly a thousand deaths as well as bankruptcies of airlines and related businesses. In this article, we examine the efficacy of control strategies on the propagation of infectious diseases based on removing connections within real-world airline networks with the associated economic and social costs taken into account through defining appropriate quantitative measures. We uncover the surprising results that removing less busy connections can be far more effective in hindering the spread of the disease than removing the more popular connections. Since disconnecting the less popular routes tends to incur less socio-economic cost, our finding suggests the possibility of trading minimal reduction in connectivity of an important hub with efficiencies in epidemic control. In particular, we demonstrate the performance of various local epidemic control strategies, and show how our approach can predict their cost effectiveness through the spreading control characteristics.

Implementation of a real option in a sustainable supply chain: an empirical study of alkaline battery recycling

NASA Astrophysics Data System (ADS)

Cucchiella, Federica; D'Adamo, Idiano; Gastaldi, Massimo; Lenny Koh, S. C.

2014-06-01

Green supply chain management (GSCM) has emerged as a key approach for enterprises seeking to become environmentally sustainable. This paper aims to evaluate and describe the advantages of a GSCM approach by analysing practices and performance consequences in the battery recycling sector. It seeks to integrate works in supply chain management (SCM), environmental management, performance management and real option (RO) theory into one framework. In particular, life cycle assessment (LCA) is applied to evaluate the environmental impact of a battery recycling plant project, and life cycle costing (LCC) is applied to evaluate its economic impact. Firms, also understanding the relevance of GSCM, have often avoided applying the green principles because of the elevated costs that such management involved. Such costs could also seem superior to the potential advantages since standard performance measurement systems are internally and business focused; for these reasons, we consider all the possible value deriving also by uncertainty associated to a green project using the RO theory. This work is one of the few and pioneering efforts to investigate GSCM practices in the battery recycling sector.

Cost as a barrier to accessing dental care: findings from a Canadian population-based study.

PubMed

Thompson, Brandy; Cooney, Peter; Lawrence, Herenia; Ravaghi, Vahid; Quiñonez, Carlos

2014-01-01

The aim of this study is to determine the demographic and socioeconomic characteristics of Canadians who report cost barriers to dental care. An analysis of data collected from the 2007/09 Canadian Health Measures Survey was undertaken from a sample of 5,586 Canadian participants aged 6-79. Cost barriers to dental care were operationalized through two questions: "In the past 12 months, have you avoided going to a dental professional because of the cost of dental care?" and "In the past 12 months, have you avoided having all the dental treatment that was recommended because of the cost?" Logistic regressions were conducted to identify relationships between covariates and positive responses to these questions. Approximately 17.3 percent of respondents had avoided a dental professional because of cost within the previous year, and 16.5 percent had declined recommended dental treatment because of cost. Adjusted estimates demonstrate that respondents with lower incomes and without dental insurance were over four times more likely to avoid a dental professional because of cost and approximately two and a half times more likely to decline recommended dental treatment because of cost. Nearly one out of five Canadians surveyed reported cost barriers to dental care. This study provides valuable baseline information for future studies to assess whether financial barriers to dental care are getting better or worse for Canadians. © 2014 American Association of Public Health Dentistry.

No evidence for female discrimination against male house mice carrying a selfish genetic element

PubMed Central

Lindholm, Anna K.

2016-01-01

Meiotic drivers distort transmission to the next generation in their favor, with detrimental effects on the fitness of their homologues and the rest of the genome. Male carriers of meiotic drivers commonly inflict costs on their mates through genetic incompatibility, reduced fecundity, or biased brood sex ratios. Given these costs, evidence for female discrimination against male carriers is surprisingly rare. One of few examples is the t haplotype in house mice, a meiotic driver that shows strong transmission distortion in males and is typically homozygote lethal. As a consequence, mating between 2 t heterozygous (+/t) mice leads to high embryo mortality. Previous experiments showing that +/t females avoid this incompatibility cost by preferring +/+ versus +/t males have inferred preference based on olfactory cues or brief social interactions. Evidence from mating contexts in laboratory settings and semi-natural populations has been inconclusive. Here, we investigated female choice from a large number of no-choice mating trials. We found no evidence for discrimination against +/t males based on mating, remating, and copulatory behavior. Further, we found no evidence for avoidance of incompatibility through selective interactions between gametes. The likelihood of mating showed significant effects of female weight and genotype, suggesting that our test paradigm enabled females to exhibit mate choice. We discuss the strengths and limitations of our approach. By explicitly considering selection at both the individual and gene level, we argue why precopulatory female discrimination by +/t females may be less evolutionarily stable than discrimination by all females based on postcopulatory mechanisms. PMID:29491955

Use of temperature-controlled laminar airflow in the management of atopic asthma: clinical evidence and experience.

PubMed

Warner, John O

2017-04-01

Avoidance of allergens in the treatment of asthma has hitherto not achieved significant benefit despite the strong evidence that allergy both increases severity and contributes to exacerbations of asthma. House dust mite, cat and dog allergens are the most common perennial allergic triggers and most avoidance strategies have focused on reducing exposures in bedrooms. Cochrane reviews have suggested that they neither significantly reduce allergen levels nor improve asthma. While the lack of efficacy may be assumed to be a consequence of exposures occurring outside the bedroom, prolonged sleep is associated with increased susceptibility to bronchospasm and airway inflammation. Thus, if efficient reductions in allergen exposure could be achieved during sleep, it might be expected that this would result in significant improvements in control of asthma. The temperature-controlled laminar airflow (TLA) is a system which can be employed over beds in a domestic environment and results in massive reductions in particulate exposure of recumbent subjects, including highly respirable allergens such as Fel. D1 from cats. Trials of TLA have demonstrated highly significant improvements in asthma quality of life and reductions on airway inflammation as monitored by exhaled nitric oxide levels. Furthermore, in patients with the worst disease, severe exacerbation frequency was significantly reduced. Based on UK health-service costs, the use of TLA falls well below the National Institute for Health and Care Excellence (NICE) threshold for the incremental cost effectiveness ratio (ICER) per quality adjusted life year (QALY). Indeed, for those with frequent exacerbations, it is cost saving and should be prescribed for such allergic asthmatic patients.

Use of temperature-controlled laminar airflow in the management of atopic asthma: clinical evidence and experience

PubMed Central

Warner, John O.

2017-01-01

Avoidance of allergens in the treatment of asthma has hitherto not achieved significant benefit despite the strong evidence that allergy both increases severity and contributes to exacerbations of asthma. House dust mite, cat and dog allergens are the most common perennial allergic triggers and most avoidance strategies have focused on reducing exposures in bedrooms. Cochrane reviews have suggested that they neither significantly reduce allergen levels nor improve asthma. While the lack of efficacy may be assumed to be a consequence of exposures occurring outside the bedroom, prolonged sleep is associated with increased susceptibility to bronchospasm and airway inflammation. Thus, if efficient reductions in allergen exposure could be achieved during sleep, it might be expected that this would result in significant improvements in control of asthma. The temperature-controlled laminar airflow (TLA) is a system which can be employed over beds in a domestic environment and results in massive reductions in particulate exposure of recumbent subjects, including highly respirable allergens such as Fel. D1 from cats. Trials of TLA have demonstrated highly significant improvements in asthma quality of life and reductions on airway inflammation as monitored by exhaled nitric oxide levels. Furthermore, in patients with the worst disease, severe exacerbation frequency was significantly reduced. Based on UK health-service costs, the use of TLA falls well below the National Institute for Health and Care Excellence (NICE) threshold for the incremental cost effectiveness ratio (ICER) per quality adjusted life year (QALY). Indeed, for those with frequent exacerbations, it is cost saving and should be prescribed for such allergic asthmatic patients. PMID:28391760

No evidence for female discrimination against male house mice carrying a selfish genetic element.

PubMed

Sutter, Andreas; Lindholm, Anna K

2016-12-01

Meiotic drivers distort transmission to the next generation in their favor, with detrimental effects on the fitness of their homologues and the rest of the genome. Male carriers of meiotic drivers commonly inflict costs on their mates through genetic incompatibility, reduced fecundity, or biased brood sex ratios. Given these costs, evidence for female discrimination against male carriers is surprisingly rare. One of few examples is the t haplotype in house mice, a meiotic driver that shows strong transmission distortion in males and is typically homozygote lethal. As a consequence, mating between 2 t heterozygous (+/ t ) mice leads to high embryo mortality. Previous experiments showing that +/ t females avoid this incompatibility cost by preferring +/+ versus +/ t males have inferred preference based on olfactory cues or brief social interactions. Evidence from mating contexts in laboratory settings and semi-natural populations has been inconclusive. Here, we investigated female choice from a large number of no-choice mating trials. We found no evidence for discrimination against +/ t males based on mating, remating, and copulatory behavior. Further, we found no evidence for avoidance of incompatibility through selective interactions between gametes. The likelihood of mating showed significant effects of female weight and genotype, suggesting that our test paradigm enabled females to exhibit mate choice. We discuss the strengths and limitations of our approach. By explicitly considering selection at both the individual and gene level, we argue why precopulatory female discrimination by +/ t females may be less evolutionarily stable than discrimination by all females based on postcopulatory mechanisms.

The social cost of coastal erosion. Using cultural theory to enrich the interpretation of stated preference data.

NASA Astrophysics Data System (ADS)

Kontogianni, A.; Tourkolias, C.; Vousdoukas, M.; Skourtos, M.

2012-04-01

Natural coastal processes are to a great extent modified by proximity to man-made structures. Engineered interventions, port facilities, housing and industrial infrastructure, all can increase the coastline fluctuations significantly relative to those along a long unobstructed coastline. As a consequence, coastlines are increasingly exposed to coastal erosion, a phenomenon defined as the encroachment of land by the sea after averaging over a period, which is sufficiently long to eliminate the impacts of weather, storm events and local sediment dynamics. In order to provide cost effective management of coastal erosion it is crucial to estimate both the benefits and costs associated with various management alternatives. The initiatives on Integrated Coastal Zone Manegment in Europe, but also the upcoming Marine Strategy Framwork Directive would benefit greatly from a proliferation of socioeconomic information to assist decision makers who must weigh the impacts of various types of coastal improvement and the cost of beach protection/restoration. In that spirit, the objective of the present research is to report the results of a survey undertaken in two resort beaches on the island of Lesvos (Greece), designed to estimate public preferences for avoiding coastal erosion. A mixed methodological approach is employed by combining an open-ended contingent valuation survey with cultural theory of risk perception. The empirical models to analyze individual choices of erosion control programs and the associated welfare measures are presented, followed by the discussion of model specification and estimation issues, and the results of the data analysis. Some concluding remarks are then presented. By choosing this approach we aim at improving our understanding of preference structure for avoiding public risk, accepted level of risk and perceptions thereof. The framework can also be used for assessing the social cost of extreme weather events such as storm surges in the coastal zone, to get an insight for insurance values.

Planning and Assessing Stability Operations: A Proposed Value Focus Thinking Approach

DTIC Science & Technology

2007-03-01

to avoid double -counting of possible consequences. 8... Taxes War Profiteering Arms Smuggling Grey Economy Avoidance of taxes Violation of regulations Smuggling Evasion of economic embargoes... Taxes War Profiteering Arms Smuggling Grey Economy Avoidance of taxes Violation of regulations Smuggling Evasion of economic embargoes

Optimal city size and population density for the 21st century.

PubMed

Speare A; White, M J

1990-10-01

The thesis that large scale urban areas result in greater efficiency, reduced costs, and a better quality of life is reexamined. The environmental and social costs are measured for different scales of settlement. The desirability and perceived problems of a particular place are examined in relation to size of place. The consequences of population decline are considered. New York city is described as providing both opportunities in employment, shopping, and cultural activities as well as a high cost of living, crime, and pollution. The historical development of large cities in the US is described. Immigration has contributed to a greater concentration of population than would have otherwise have occurred. The spatial proximity of goods and services argument (agglomeration economies) has changed with advancements in technology such as roads, trucking, and electronic communication. There is no optimal city size. The overall effect of agglomeration can be assessed by determining whether the markets for goods and labor are adequate to maximize well-being and balance the negative and positive aspects of urbanization. The environmental costs of cities increase with size when air quality, water quality, sewage treatment, and hazardous waste disposal is considered. Smaller scale and lower density cities have the advantages of a lower concentration of pollutants. Also, mobilization for program support is easier with homogenous population. Lower population growth in large cities would contribute to a higher quality of life, since large metropolitan areas have a concentration of immigrants, younger age distributions, and minority groups with higher than average birth rates. The negative consequences of decline can be avoided if reduction of population in large cities takes place gradually. For example, poorer quality housing can be removed for open space. Cities should, however, still attract all classes of people with opportunities equally available.

Avoidable costs of comprehensive case management.

PubMed

Issel, L M; Anderson, R A

1999-01-01

Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.

Barriers to implementation of workplace health interventions: an economic perspective.

PubMed

Cherniack, Martin; Lahiri, Supriya

2010-09-01

To identify insurance related, structural, and workplace cultural barriers to the implementation of effective preventive and upstream clinical interventions in the working age adult population. Analysis of avoided costs from perspective of health economics theory and from empiric observations from large studies; presentation of data from our own cost-plus model on integrating health promotion and ergonomics. We identify key avoided costs issues as a misalignment of interests between employers, insurers, service institutions, and government. Conceptual limitations of neoclassical economics are attributable to work culture and supply-driven nature of health care. Effective valuation of avoided costs is a necessary condition for redirecting allocations and incentives. Key content for valuation models is discussed.

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis.

PubMed

Legrand, Guillaume; Ruscio, Laura; Benhamou, Dan; Pelletier-Fleury, Nathalie

2015-07-01

Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA. Effectiveness data were defined from meta-analyses of randomized clinical trials. The clinical end points were avoidance of hospital mortality and avoidance of major complications. Hospital costs were estimated by the cost of corresponding diagnosis-related groups. Both goal-directed therapy strategies evaluated were more effective and less costly than CCA. Perioperative mortality and the rate of major complications were reduced by the use of ED and APPWA. Cost reduction was mainly due to the decrease in the rate of major complications. APPWA was dominant compared with ED in 71.6% and 27.6% and dominated in 23.8% and 20.8% of the cases when the end point considered was "major complications avoided" and "death avoided," respectively. Regarding cost per death avoided, APPWA was more likely to be cost-effective than ED in a wide range of willingness to pay. Cardiac output monitoring during high-risk abdominal surgery is cost-effective and is associated with a reduced rate of hospital mortality and major complications, whatever the device used. The two devices evaluated had negligible costs compared with the observed reduction in hospital costs. Our comparative studies suggest a larger effect with APPWA that needs to be confirmed by further studies. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Exploring or Avoiding Novel Food Resources? The Novelty Conflict in an Invasive Bird

PubMed Central

Sol, Daniel; Griffin, Andrea S.; Bartomeus, Ignasi; Boyce, Hayley

2011-01-01

For an animal invading a novel region, the ability to develop new behaviors should facilitate the use of novel food resources and hence increase its survival in the new environment. However, the need to explore new resources may entail costs such as exposing the animal to unfamiliar predators. These two opposing forces result in an exploration-avoidance conflict, which can be expected to interfere with the acquisition of new resources. However, its consequences should be less dramatic in highly urbanized environments where new food opportunities are common and predation risk is low. We tested this hypothesis experimentally by presenting three foraging tasks to introduced common mynas (Acridotheres tristis) from environments with low and high urbanization levels from Australia. Individuals from the highly urbanized environments, where mynas are both more opportunistic when foraging and less fearful to predators, resolved a technical task faster than those from less urbanized environments. These differences did not reflect innovative ‘personalities’ and were not confounded by sex, morphology or motivational state. Rather, the principal factors underlying differences in mynas' problem-solving ability were neophobic-neophilic responses, which varied across habitats. Thus, mynas seem to modulate their problem-solving ability according to the benefits and costs of innovating in their particular habitat, which may help us understand the great success of the species in highly urbanized environments. PMID:21611168

Skill learning and the evolution of social learning mechanisms.

PubMed

van der Post, Daniel J; Franz, Mathias; Laland, Kevin N

2016-08-24

Social learning is potentially advantageous, but evolutionary theory predicts that (i) its benefits may be self-limiting because social learning can lead to information parasitism, and (ii) these limitations can be mitigated via forms of selective copying. However, these findings arise from a functional approach in which learning mechanisms are not specified, and which assumes that social learning avoids the costs of asocial learning but does not produce information about the environment. Whether these findings generalize to all kinds of social learning remains to be established. Using a detailed multi-scale evolutionary model, we investigate the payoffs and information production processes of specific social learning mechanisms (including local enhancement, stimulus enhancement and observational learning) and their evolutionary consequences in the context of skill learning in foraging groups. We find that local enhancement does not benefit foraging success, but could evolve as a side-effect of grouping. In contrast, stimulus enhancement and observational learning can be beneficial across a wide range of environmental conditions because they generate opportunities for new learning outcomes. In contrast to much existing theory, we find that the functional outcomes of social learning are mechanism specific. Social learning nearly always produces information about the environment, and does not always avoid the costs of asocial learning or support information parasitism. Our study supports work emphasizing the value of incorporating mechanistic detail in functional analyses.

Cost analysis of youth violence prevention.

PubMed

Sharp, Adam L; Prosser, Lisa A; Walton, Maureen; Blow, Frederic C; Chermack, Stephen T; Zimmerman, Marc A; Cunningham, Rebecca

2014-03-01

Effective violence interventions are not widely implemented, and there is little information about the cost of violence interventions. Our goal is to report the cost of a brief intervention delivered in the emergency department that reduces violence among 14- to 18-year-olds. Primary outcomes were total costs of implementation and the cost per violent event or violence consequence averted. We used primary and secondary data sources to derive the costs to implement a brief motivational interviewing intervention and to identify the number of self-reported violent events (eg, severe peer aggression, peer victimization) or violence consequences averted. One-way and multi-way sensitivity analyses were performed. Total fixed and variable annual costs were estimated at $71,784. If implemented, 4208 violent events or consequences could be prevented, costing $17.06 per event or consequence averted. Multi-way sensitivity analysis accounting for variable intervention efficacy and different cost estimates resulted in a range of $3.63 to $54.96 per event or consequence averted. Our estimates show that the cost to prevent an episode of youth violence or its consequences is less than the cost of placing an intravenous line and should not present a significant barrier to implementation.

Joint care can outweigh costs of nonkin competition in communal breeders

PubMed Central

Fairfield, Eleanor A; Spurgin, Lewis G; Komdeur, Jan; Richardson, David S

2018-01-01

Abstract Competition between offspring can greatly influence offspring fitness and parental investment decisions, especially in communal breeders where unrelated competitors have less incentive to concede resources. Given the potential for escalated conflict, it remains unclear what mechanisms facilitate the evolution of communal breeding among unrelated females. Resolving this question requires simultaneous consideration of offspring in noncommunal and communal nurseries, but such comparisons are missing. In the Seychelles warbler Acrocephalus sechellensis, we compare nestling pairs from communal nests (2 mothers) and noncommunal nests (1 mother) with singleton nestlings. Our results indicate that increased provisioning rate can act as a mechanism to mitigate the costs of offspring rivalry among nonkin. Increased provisioning in communal broods, as a consequence of having 2 female parents, mitigates any elevated costs of offspring rivalry among nonkin: per-capita provisioning and survival was equal in communal broods and singletons, but lower in noncommunal broods. Individual offspring costs were also more divergent in noncommunal broods, likely because resource limitation exacerbates differences in competitive ability between nestlings. It is typically assumed that offspring rivalry among nonkin will be more costly because offspring are not driven by kin selection to concede resources to their competitors. Our findings are correlational and require further corroboration, but may help explain the evolutionary maintenance of communal breeding by providing a mechanism by which communal breeders can avoid these costs. PMID:29622934

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation.

PubMed

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-06-23

This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Champlain health region in Eastern Ontario, Canada. Primary care providers and specialists registered to use the eConsult service. Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Avoidable cost of alcohol abuse in Canada.

PubMed

Rehm, Jürgen; Patra, Jayadeep; Gnam, William H; Sarnocinska-Hart, Anna; Popova, Svetlana

2011-01-01

To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002. A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse. It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales. The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree. Copyright © 2010 S. Karger AG, Basel.

Air pollution, avoidance behaviour and children's respiratory health: evidence from England.

PubMed

Janke, Katharina

2014-12-01

Despite progress in air pollution control, concerns remain over the health impact of poor air quality. Governments increasingly issue air quality information to enable vulnerable groups to avoid exposure. Avoidance behaviour potentially biases estimates of the health effects of air pollutants. But avoidance behaviour imposes a cost on individuals and therefore may not be taken in all circumstances. This paper exploits panel data at the English local authority level to estimate the relationship between children's daily hospital emergency admissions for respiratory diseases and common air pollutants, while allowing for avoidance behaviour in response to air pollution warnings. A 1% increase in nitrogen dioxide or ozone concentrations increases hospital admissions by 0.1%. For the subset of asthma admissions - where avoidance is less costly - there is evidence of avoidance behaviour. Ignoring avoidance behaviour, however, does not result in statistically significant underestimation of the health effect of air pollution. Copyright © 2014 Elsevier B.V. All rights reserved.

The relationships of physician practice characteristics to quality of care and costs.

PubMed

Kralewski, John; Dowd, Bryan; Knutson, David; Tong, Junliang; Savage, Megan

2015-06-01

Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care. Practice characteristics from a 2009 national survey of 211 group practices were linked to Medicare claims data for beneficiaries attributed to the practices. Multivariate regression was used to examine the relationship between practice characteristics and claims-computable measures of screening and monitoring, avoidable utilization, risk-adjusted per-beneficiary per-year (PBPY) costs, and the practice's net revenue. Several characteristics of group practices are predictive of screening and monitoring measures. Those measures, in turn, are predictive of lower values of avoidable utilization measures that contribute to higher PBPY costs. The effects of group practice characteristics on avoidable utilization, cost, and practice net revenue appear to work primarily through improved screening and monitoring. Practice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization. However, these relationships are not the only pathways connecting practice characteristics to cost and those additional pathways contain substantial "noise" adding uncertainty to the estimated direct effects. Some of the attributes thought to be important characteristics of accountable care organizations and medical homes appear to be associated with lower quality and no improvement in cost. © Health Research and Educational Trust.

National economic impact of tirofiban for unstable angina and myocardial infarction without ST elevation; example from the United Kingdom.

PubMed

Bakhai, Ameet; Flather, Marcus D; Collinson, Julian R; Stevens, Warren; Normand, Charles; Alemao, Evo; Itzler, Robbin; Ben-Joseph, Rami

2003-10-01

Acute coronary syndromes without ST elevation are a major health and economic burden. Treatments such as glycoprotein IIb/IIIa antagonists like tirofiban reduce the risk of complications but the cost impact of these agents including cost offsets of avoiding complications are needed particularly in Europe. We used treatment patterns from the Prospective Registry of Acute Ischemic Syndromes in the UK, risk reductions derived from the PRISM-PLUS trial and cost estimates from the CHKS database to estimate the impact of tirofiban on PRAIS-UK patients with and without complications and subgroups at higher risk of complications. These subgroups (and proportions) were patients: (1) aged 60 or over with abnormal electrocardiograms (58%), (2) with ST depression or bundle branch block on admission (30%) and (3) with ST depression, bundle branch block or MI on admission (37%). Total cost of care in the UK at 6 months for the estimated 87339 acute coronary syndromes admissions annually was pound 213 million, which would increase by pound 33 million (15.7%) if tirofiban were given to all patients, avoiding 2422 complications at a mean cost per event avoided of pound 13388. Among the subgroups, the mean cost per event avoided ranges from pound 10856 for subgroup 1 to pound 5953 for subgroup 3. Treating the latter subgroup, would avoid 1977 events at a cost of pound 12 million (5.5%). The use of tirofiban in the UK to treat acute coronary syndromes patients without ST elevation provides an important therapeutic advantage at modest proportional increase in cost, particularly if targeted to higher risk subgroups as recommended in the European guidelines.

Cost avoidance associated with optimal stroke care in Canada.

PubMed

Krueger, Hans; Lindsay, Patrice; Cote, Robert; Kapral, Moira K; Kaczorowski, Janusz; Hill, Michael D

2012-08-01

Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008-2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided. Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs). The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.

The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia.

PubMed

Sowa, P Marcin; Keller, Elena; Stormon, Nicole; Lalloo, Ratilal; Ford, Pauline J

2018-05-22

Despite a clear causal link between frequent consumption of sugar-sweetened beverages (SSBs) and dental disease, little is known about the implications of a tax on SSBs in the context of oral health. The aim of our study was to estimate the impacts of a SSB tax on the Australian population in the context of oral health outcomes, dental care utilisation and associated costs. We designed a cohort model that accounted for the consequences of the tax through the mechanisms of consumer response to price increase, the effect on oral health due to change in sugar intake, and the implications for dental care use. Our results indicate that in the adult population an ad valorem tax of 20% would lead to a reduction in decayed, missing and filled teeth (DMFT) by 3.9 million units over 10 years, resulting in cost savings of A$666 million. Scenario analyses show that the outcomes are sensitive to the choice of the time horizon, tax rate, price elasticity of demand for SSBs, and the definition of target population. We found that the total and per-person consequences of SSB tax were considerable, both in terms of dental caries (tooth decay) averted and dental care avoided. These results have to be compounded with the implications of SSB tax for other aspects of health and health care, especially in the context of chronic diseases. On the other hand, the improved outcomes have to be weighted against a welfare loss associated with introducing a tax.

Health and cost consequences of early versus late invasive strategy after thrombolysis for acute myocardial infarction.

PubMed

Bøhmer, Ellen; Kristiansen, Ivar Sønbø; Arnesen, Harald; Halvorsen, Sigrun

2011-10-01

The NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction showed an improved clinical outcome with early transfer for percutaneous coronary intervention (PCI) compared to a more conservative approach after thrombolysis. The aim of this substudy was to compare the 12-month quality-adjusted life years (QALYs) and costs of these alternative strategies. Patients with ST-elevation myocardial infarction <6 h duration and >90 min expected delay to PCI, received full-dose tenecteplase and were randomized to either early or late invasive strategy (n = 266). Detailed quality of life and resource use data were registered prospectively for a period of 12 months. Health outcomes were measured as quality of life using a generic instrument (15D). Quality of life scores were translated into QALYs. Unit costs were based on hospital accounts, fee schedules, and market prices. After 12 months of follow-up, patients in the early invasive group had 0.008 (95% CI -0.027 to 0.043) more QALYs compared to the late invasive group. The mean total costs were €18,201 in the early versus €17,643 in the late invasive group, with a mean difference of €558 (95% CI -2258 to 3484). Cost/QALY was €69,750 while cost/avoided clinical endpoint was €5636. Early and late invasive strategies after thrombolysis resulted in similar quality of life and similar costs in ST-elevation myocardial infarction patients living far from a PCI centre (NCT00161005).

A new method for examining the cost savings of reducing COPD exacerbations.

PubMed

Mapel, Douglas W; Schum, Michael; Lydick, Eva; Marton, Jeno P

2010-01-01

Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs. To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population. Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol). Exacerbations were captured using International Classification of Diseases, Ninth Edition (ICD-9) and current procedural terminology (CPT) codes, then logistic regression models were created that described the risk of exacerbations for each comparator group and exacerbation type over a 6-month period. A Monte Carlo simulation was then applied 1000 times to provide the range of potential exacerbation reductions and cost consequences in response to a range of hypothetical examples of COPD controller medications. Exacerbation events for each group could be modelled such that the events predicted by the Monte Carlo estimates were very close to the actual prevalences. The estimated cost per exacerbation avoided depended on the incidence of exacerbation in the various subpopulations, the assumed relative risk reduction, the projected daily cost for new therapy, and the costs of exacerbation treatment. COPD exacerbation events can be accurately modelled from the healthcare utilization data of a defined cohort with sufficient accuracy for cost-effectiveness analysis. Treatments that reduce the risk or severity of exacerbations are likely to be cost effective among those patients who have frequent exacerbations and hospitalizations.

From Science to Finance-A Tool for Deriving Economic Implications from the Results of Dietary Supplement Clinical Studies.

PubMed

Shanahan, Christopher J; de Lorimier, Robert

2016-01-01

This article examines evidence showing that the use of key dietary supplements can reduce overall disease treatment-related hospital utilization costs associated with coronary heart disease (CHD) in the United States among those at a high risk of experiencing a costly, disease-related event. Results show that the potential avoided hospital utilization costs related to the use of omega-3 supplements at preventive intake levels among the target population can be as much as $2.06 billion on average per year from 2013 to 2020. The potential net savings in avoided CHD-related hospital utilization costs after accounting for the cost of omega-3 dietary supplements at preventive daily intake levels would be more than $3.88 billion in cumulative health care cost savings from 2013 to 2020. Furthermore, the use of folic acid, B6, and B12 among the target population at preventive intake levels could yield avoided CHD-related hospital utilization costs savings of an average savings of $1.52 billion per year from 2013 to 2020. The potential net savings in avoided CHD-related health care costs after accounting for the cost of folic acid, B6, and B12 utilization at preventive daily intake levels would be more than $5.23 billion in cumulative health care cost net savings during the same period. Thus, targeted dietary supplement regimens are recommended as a means to help control rising societal health care costs, and as a means for high-risk individuals to minimize the chance of having to deal with potentially costly events and to invest in increased quality of life.

Challenges for allergy diagnosis in regions with complex pollen exposures.

PubMed

Barber, Domingo; Díaz-Perales, Araceli; Villalba, Mayte; Chivato, Tomas

2015-02-01

Over the past few decades, significant scientific progress has influenced clinical allergy practice. The biological standardization of extracts was followed by the massive identification and characterization of new allergens and their progressive use as diagnostic tools including allergen micro arrays that facilitate the simultaneous testing of more than 100 allergen components. Specific diagnosis is the basis of allergy practice and is always aiming to select the best therapeutic or avoidance intervention. As a consequence, redundant or irrelevant information might be adding unnecessary cost and complexity to daily clinical practice. A rational use of the different diagnostic alternatives would allow a significant improvement in the diagnosis and treatment of allergic patients, especially for those residing in complex pollen exposure areas.

Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

PubMed

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

2016-11-01

Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Cardiovascular consequences of childhood obesity.

PubMed

McCrindle, Brian W

2015-02-01

Childhood and adolescent overweight and obesity is an important and increasingly prevalent public health problem in Canada and worldwide. High adiposity in youth is indicated in clinical practice by plotting body mass index on appropriate percentile charts normed for age and sex, although waist measures might be a further tool. High adiposity can lead to adiposopathy in youth, with associated increases in inflammation and oxidative stress, changes in adipokines, and endocrinopathy. This is manifest as cardiometabolic risk factors in similar patterns to those in noted in obese adults. Obesity and cardiometabolic risk factors have been shown to be associated with vascular changes indicative of early atherosclerosis, and ventricular hypertrophy, dilation, and dysfunction. These cardiovascular consequences are evident in youth, but childhood obesity is also predictive of similar consequences in adulthood. Childhood obesity and risk factors have been shown to track into adulthood and worsen in most individuals. The result is an exponential acceleration of atherosclerosis, which can be predicted to translate into an epidemic of premature cardiovascular disease and events. A change in paradigm is needed toward preventing and curing atherosclerosis and not just preventing cardiovascular disease. This would necessarily create an imperative for preventing and treating childhood obesity. Urgent attention, policy, and action are needed to avoid the enormous future social and health care costs associated with the cardiovascular consequences of obesity in youth. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Future of electronic health records: implications for decision support.

PubMed

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

Psychopathic individuals exhibit but do not avoid regret during counterfactual decision making.

PubMed

Baskin-Sommers, Arielle; Stuppy-Sullivan, Allison M; Buckholtz, Joshua W

2016-12-13

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost-benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior.

Finding a needle in the haystack: the costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia.

PubMed

Larson, Bruce A; Lembela-Bwalya, Deophine; Bonawitz, Rachael; Hammond, Emily E; Thea, Donald M; Herlihy, Julie

2014-01-01

In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study. During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60. Screening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.

When does female multiple mating evolve to adjust inbreeding? Effects of inbreeding depression, direct costs, mating constraints, and polyandry as a threshold trait

PubMed Central

Duthie, A. Bradley; Bocedi, Greta; Reid, Jane M.

2016-01-01

Polyandry is often hypothesized to evolve to allow females to adjust the degree to which they inbreed. Multiple factors might affect such evolution, including inbreeding depression, direct costs, constraints on male availability, and the nature of polyandry as a threshold trait. Complex models are required to evaluate when evolution of polyandry to adjust inbreeding is predicted to arise. We used a genetically explicit individual‐based model to track the joint evolution of inbreeding strategy and polyandry defined as a polygenic threshold trait. Evolution of polyandry to avoid inbreeding only occurred given strong inbreeding depression, low direct costs, and severe restrictions on initial versus additional male availability. Evolution of polyandry to prefer inbreeding only occurred given zero inbreeding depression and direct costs, and given similarly severe restrictions on male availability. However, due to its threshold nature, phenotypic polyandry was frequently expressed even when strongly selected against and hence maladaptive. Further, the degree to which females adjusted inbreeding through polyandry was typically very small, and often reflected constraints on male availability rather than adaptive reproductive strategy. Evolution of polyandry solely to adjust inbreeding might consequently be highly restricted in nature, and such evolution cannot necessarily be directly inferred from observed magnitudes of inbreeding adjustment. PMID:27464756

Designing PURPA (Public Utilities Regulatory Act) power purchase auctions: Theory and practice. [Cogenerated electricity purchasing model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rothkopf, M.H.; Kahn, E.P.; Teisberg, T.J.

The Public Utilities Regulatory Act (PURPA) requires there to be procedures for electric utilities to buy electric power from qualifying cogenerators and small power producers (QFs) at rates up to ''avoided cost.'' This has led to price-posting procedures at prices calculated as the utility's marginal cost. Unexpectedly large sales at these prices and slow adjustment to falling energy cost are partially responsible for payments to QFs in excess of the utility's true avoided cost. Using competitive bidding instead of posted prices has been proposed as a way to avoid this outcome. This report reviews bidding theory and explores four issuesmore » that arise in deisigning auction systems for the purchase of power from QFs under PURPA. 77 refs., 6 figs., 15 tabs.« less

Designing PURPA (Public Utilities Regulatory Policies Act) power purchase auctions: Theory and practice. [Buys from cogenerators and small power generators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The Public Utilities Regulatory Act (PURPA) requires there to be procedures for electric utilities to buy electric power from qualifying cogenerators and small power producers (QFs) at rates up to ''avoided cost''. This has led to price-posting procedures at prices calculated as the utility's marginal cost. Unexpectedly large sales at these prices and slow adjustment to falling energy cost are partially responsible for payments to QFs in excess of the utility's true avoided cost. Using competitive bidding instead of posted prices has been proposed as a way to avoid this outcome. This report reviews bidding theory and explores four issuesmore » that arise in designing auction systems for the purchase of power from QFs under PURPA.« less

Attentional Flexibility During Approach and Avoidance Motivational States: The Role of Context in Shifts of Attentional Breadth

PubMed Central

Calcott, Rebecca D.; Berkman, Elliot T.

2014-01-01

In the present studies, we aimed to understand how approach and avoidance states affect attentional flexibility by examining attentional shifts on a trial-by-trial basis. We also examined how a novel construct in this area, task context, might interact with motivation to influence attentional flexibility. Participants completed a modified composite letter task in which the ratio of global to local targets was varied by block, making different levels of attentional focus beneficial to performance on different blocks. Study 1 demonstrated that, in the absence of a motivation manipulation, switch costs were lowest on blocks with an even ratio of global and local trials and were higher on blocks with an uneven ratio. Other participants completed the task while viewing pictures (Studies 2 and 3) and assuming arm positions (Studies 2 and 4) to induce approach, avoidance, and neutral motivational states. Avoidance motivation reduced switch costs in evenly proportioned contexts, whereas approach motivation reduced switch costs in mostly global contexts. Additionally, approach motivation imparted a similar switch cost magnitude across different contexts, whereas avoidance and neutral states led to variable switch costs depending on the context. Subsequent analyses revealed that these effects were driven largely by faster switching to local targets on mostly global blocks in the approach condition. These findings suggest that avoidance facilitates attentional shifts when switches are frequent, whereas approach facilitates responding to rare or unexpected local stimuli. The main implication of these results is that motivation has different effects on attentional shifts depending on the context. PMID:24294866

The health, poverty, and financial consequences of a cigarette price increase among 500 million male smokers in 13 middle income countries: compartmental model study

PubMed Central

2018-01-01

Abstract Objective To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection. Design Compartmental model study. Setting 13 middle income countries, totalling two billion men. Participants 500 million male smokers. Main outcome measures Life years gained, averted treatment costs, number of men avoiding catastrophic healthcare expenditures and poverty, and additional tax revenue by income group. Results A 50% increase in cigarette prices would lead to about 450 million years of life gained across the 13 countries from smoking cessation, with half of these in China. Across all countries, men in the bottom income group (poorest 20% of the population) would gain 6.7 times more life years than men in the top income group (richest 20% of the population; 155 v 23 million). The average life years gained from cessation for each smoker in the bottom income group was 5.1 times that of the top group (1.46 v 0.23 years). Of the $157bn (£113bn; €127bn) in averted treatment costs, the bottom income group would avert 4.6 times more costs than the top income group ($46bn v $10bn). About 15.5 million men would avoid catastrophic health expenditures in a subset of seven countries without universal health coverage. As result, 8.8 million men, half of them in the bottom income group, would avoid falling below the World Bank definition of extreme poverty. These 8.8 million men constitute 2.4% of people living in extreme poverty in these countries. In contrast, the top income group would pay twice as much as the bottom income group of the $122bn additional tax collected. Overall, the bottom income group would get 31% of the life years saved and 29% each of the averted disease costs and averted catastrophic health expenditures, while paying only 10% of the additional taxes. Conclusions Higher prices of cigarettes provide more health and financial gains to the poorest 20% than to the richest 20% of the population. Higher excise taxes support the targets of the sustainable development goals on non-communicable diseases and poverty, and provides financial protection against illness. PMID:29643096

Cost-effectiveness of Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage Resulting from Uterine Atony in Women at high-risk for bleeding in Colombia.

PubMed

Gil-Rojas, Yaneth; Lasalvia, Pieralessandro; Hernández, Fabián; Castañeda-Cardona, Camilo; Rosselli, Diego

2018-05-01

 To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/cesarean section in women with risk factors for bleeding.  A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$).  In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental cost-effectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event.  In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

Structural Considerations of a 20MW Multi-Rotor Wind Energy System

NASA Astrophysics Data System (ADS)

Jamieson, P.; Branney, M.

2014-12-01

The drive to upscale offshore wind turbines relates especially to possiblereductions in O&M and electrical interconnection costs per MW of installed capacity.Even with best current technologies, designs with rated capacity above about 3 MW are less cost effective exfactory per rated MW(turbine system costs) than smaller machines.Very large offshore wind turbines are thereforejustifiedprimarily by overall offshore project economics. Furthermore, continuing progress in materials and structures has been essential to avoid severe penalties in the power/mass ratio of large multi-MW machines.The multi-rotor concept employs many small rotors to maximise energy capture area withminimum systemvolume. Previous work has indicated that this can enablea very large reduction in the total weight and cost of rotors and drive trains compared to an equivalent large single rotor system.Thus the multi rotor concept may enable rated capacities of 20 MW or more at a single maintenancesite. Establishing the cost benefit of a multi rotor system requires examination of solutions for the support structure and yawing, ensuring aerodynamic losses from rotor interaction are not significant and that overall logistics, with much increased part count (more reliable components) and less consequence of single failuresare favourable. This paper addresses the viability of a support structure in respect of structural concept and likely weight as one necessary step in exploring the potential of the multi rotor concept.

Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany.

PubMed

Ultsch, Bernhard; Weidemann, Felix; Reinhold, Thomas; Siedler, Anette; Krause, Gérard; Wichmann, Ole

2013-09-26

Herpes zoster (HZ) is a self-limiting painful skin rash affecting mostly individuals from 50 years of age. The main complication is postherpetic neuralgia (PHN), a long-lasting pain after rash has resolved. A HZ-vaccine has recently been licensed in Europe for individuals older than 50 years. To support an informed decision-making for a potential vaccination recommendation, we conducted a health economic evaluation to identify the most cost-effective vaccination strategy. We developed a static Markov-cohort model, which compared a vaccine-scenario with no vaccination. The cohort entering the model was 50 years of age, vaccinated at age 60, and stayed over life-time in the model. Transition probabilities were based on HZ/PHN-epidemiology and demographic data from Germany, as well as vaccine efficacy (VE) data from clinical trials. Costs for vaccination and HZ/PHN-treatment (in Euros; 2010), as well as outcomes were discounted equally with 3% p.a. We accounted results from both, payer and societal perspective. We calculated benefit-cost-ratio (BCR), number-needed-to-vaccinate (NNV), and incremental cost-effectiveness ratios (ICERs) for costs per HZ-case avoided, per PHN-case avoided, and per quality-adjusted life-year (QALY) gained. Different target age-groups were compared to identify the most cost-effective vaccination strategy. Base-case-analysis as well as structural, descriptive-, and probabilistic-sensitivity-analyses (DSA, PSA) were performed. When vaccinating 20% of a cohort of 1 million 50 year old individuals at the age of 60 years, approximately 20,000 HZ-cases will be avoided over life-time. The NNV to avoid one HZ (PHN)-case was 10 (144). However, with a BCR of 0.34 this vaccination-strategy did not save costs. The base-case-analysis yielded an ICER of 1,419 (20,809) Euros per avoided HZ (PHN)-case and 28,146 Euros per QALY gained. Vaccination at the age of 60 was identified in most (sensitivity) analyses to be the most cost-effective vaccination strategy. In DSA, vaccine price and VE were shown to be the most critical input-data. According to our evaluation, HZ-vaccination is expected to avoid HZ/PHN-cases and gain QALYs to higher costs. However, the vaccine price had the highest impact on the ICERs. Among different scenarios, targeting individuals aged 60 years seems to represent the most cost-effective vaccination-strategy.

Differential Cost Avoidance and Successful Criminal Careers: Random or Rational?

ERIC Educational Resources Information Center

Kazemian, Lila; Le Blanc, Marc

2007-01-01

Using a sample of adjudicated French Canadian males from the Montreal Two Samples Longitudinal Study, this article investigates individual and social characteristics associated with differential cost avoidance. The main objective of this study is to determine whether such traits are randomly distributed across differential degrees of cost…

Estimating the avoided fuel-reatment costs of wildfire

Treesearch

Geoffrey H. Donovan; Thomas C. Brown

2008-01-01

Although the importance of wildfire to fire-adapted ecosystems is widely recognized, wildfire management has historically placed less emphasis on the beneficial effects of wildfire. We estimate the avoided fuel treatment cost for 10 ponderosa pine (Pinus ponderosa) stands on the Umatilla National Forest in the Pacific Northwest. Results show that...

Patient blood management in elective total hip- and knee-replacement surgery (Part 1): a randomized controlled trial on erythropoietin and blood salvage as transfusion alternatives using a restrictive transfusion policy in erythropoietin-eligible patients.

PubMed

So-Osman, Cynthia; Nelissen, Rob G H H; Koopman-van Gemert, Ankie W M M; Kluyver, Ewoud; Pöll, Ruud G; Onstenk, Ron; Van Hilten, Joost A; Jansen-Werkhoven, Thekla M; van den Hout, Wilbert B; Brand, Ronald; Brand, Anneke

2014-04-01

Patient blood management combines the use of several transfusion alternatives. Integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices on allogeneic erythrocyte use was evaluated using a restrictive transfusion threshold. In a factorial design, adult elective hip- and knee-surgery patients with hemoglobin levels 10 to 13 g/dl (n = 683) were randomized for erythropoietin or not, and subsequently for autologous reinfusion by cell saver or postoperative drain reinfusion devices or for no blood salvage device. Primary outcomes were mean allogeneic intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness. With erythropoietin (n = 339), mean erythrocyte use was 0.50 units (U)/patient and transfusion rate 16% while without (n = 344), these were 0.71 U/patient and 26%, respectively. Consequently, erythropoietin resulted in a nonsignificant 29% mean erythrocyte reduction (ratio, 0.71; 95% CI, 0.42 to 1.13) and 50% reduction of transfused patients (odds ratio, 0.5; 95% CI, 0.35 to 0.75). Erythropoietin increased costs by €785 per patient (95% CI, 262 to 1,309), that is, €7,300 per avoided transfusion (95% CI, 1,900 to 24,000). With autologous reinfusion, mean erythrocyte use was 0.65 U/patient and transfusion rate was 19% with erythropoietin (n = 214) and 0.76 U/patient and 29% without (n = 206). Compared with controls, autologous blood reinfusion did not result in erythrocyte reduction and increased costs by €537 per patient (95% CI, 45 to 1,030). In hip- and knee-replacement patients (hemoglobin level, 10 to 13 g/dl), even with a restrictive transfusion trigger, erythropoietin significantly avoids transfusion, however, at unacceptably high costs. Autologous blood salvage devices were not effective.

The Contractual Liability of Student Organizations with Outside Groups.

ERIC Educational Resources Information Center

Likins, Jeanne M.

1978-01-01

Included is a consideration of contract and agency law, how these apply to student organizations, potential liability consequences, guidelines to avoid such consequences, and a summary of the current situation. (Author)

Initiatives and Challenges in Consequence Management after a WMD Attack

DTIC Science & Technology

2004-08-01

Challenges in Consequence Management people to seek shelter or other protection when possible, to avoid exposure to weapons of mass destruction effects . The...Potential Effects .........................................9 V. Methods for Managing the Consequences of WMD Use.................14 VI. Toward a...mass destruction (WMD). Consequence management1 is a process to mitigate the effects of the use of weapons of mass destruction, including

Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting.

PubMed

Ektare, V; Khachatryan, A; Xue, M; Dunne, M; Johnson, K; Stephens, J

2015-01-01

To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.

Preventing diabetes blindness: cost effectiveness of a screening programme using digital non-mydriatic fundus photography for diabetic retinopathy in a primary health care setting in South Africa.

PubMed

Khan, Taskeen; Bertram, Melanie Y; Jina, Ruxana; Mash, Bob; Levitt, Naomi; Hofman, Karen

2013-08-01

South Africa like many other developing countries is experiencing an epidemiologic transition with a marked increase in the non-communicable disease (NCD) burden. Diabetic retinopathy is the most common cause of incidental blindness in adults. A screening programme using a mobile fundal camera in a primary care setting has been shown to be effective in the country. Information on affordability and cost is essential for policymakers to consider its adoption. Economic evaluation is the comparative analysis of competing alternative interventions in terms of costs and consequences. A cost effectiveness analysis was done using actual costs from the primary care screening programme. A total of 14,541 patients were screened in three primary healthcare facilities in the Western Cape. Photographs were taken by a trained technician with supervision by an ophthalmic nurse. The photographs were then read by a medical officer with ophthalmic experience. A cost effective ratio of $1206 per blindness case averted was obtained. This included costs for screening and treating an individual. The cost just to screen a patient for retinopathy was $22. The costs of screening and treating all incident cases of blindness due to diabetes in South Africa would be 168,000,000 ZAR ($19,310,344) per annum. Non mydriatic digital fundoscopy is a cost effective measure in the screening and diagnosis of diabetic retinopathy in a primary care setting in South Africa. The major savings in the long term are a result of avoiding government disability grant for people who suffer loss of vision. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Economic Consequences Incurred by Living Kidney Donors: A Canadian Multi-Center Prospective Study

PubMed Central

Klarenbach, S; Gill, J S; Knoll, G; Caulfield, T; Boudville, N; Prasad, G V R; Karpinski, M; Storsley, L; Treleaven, D; Arnold, J; Cuerden, M; Jacobs, P; Garg, A X

2014-01-01

Some living kidney donors incur economic consequences as a result of donation; however, these costs are poorly quantified. We developed a framework to comprehensively assess economic consequences from the donor perspective including out-of-pocket cost, lost wages and home productivity loss. We prospectively enrolled 100 living kidney donors from seven Canadian centers between 2004 and 2008 and collected and valued economic consequences ($CAD 2008) at 3 months and 1 year after donation. Almost all (96%) donors experienced economic consequences, with 94% reporting travel costs and 47% reporting lost pay. The average and median costs of lost pay were $2144 (SD 4167) and $0 (25th–75th percentile 0, 2794), respectively. For other expenses (travel, accommodation, medication and medical), mean and median costs were $1780 (SD 2504) and $821 (25th–75th percentile 242, 2271), respectively. From the donor perspective, mean cost was $3268 (SD 4704); one-third of donors incurred cost >$3000, and 15% >$8000. The majority of donors (83%) reported inability to perform usual household activities for an average duration of 33 days; 8% reported out-of-pocket costs for assistance with these activities. The economic impact of living kidney donation for some individuals is large. We advocate for programs to reimburse living donors for their legitimate costs. In a prospective costing study, the authors find that economic consequences incurred by living kidney donors are frequent and nontrivial, and a notable proportion of donors experience significant costs. PMID:24597854

32 CFR Appendix to Part 162 - Reporting Procedures

Code of Federal Regulations, 2014 CFR

2014-07-01

... generated. e. Projected Life-Cycle Savings. For each PIF project provide the estimated amount of savings the project is projected to earn over the project's economic life. f. Projected Life-Cycle Cost Avoidance. For... Projected Life-Cycle Savings. e. Total Projected Life-Cycle Cost Avoidance. 3. CSI. Each DoD Component that...

Climate impacts on hydropower and consequences for global electricity supply investment needs

DOE PAGES

Turner, Sean W. D.; Hejazi, Mohamad; Kim, Son H.; ...

2017-11-15

Climate change is projected to increase hydropower generation in some parts of the world and decrease it in others. Here we explore the possible consequences of these impacts for the electricity supply sector at the global scale. Regional hydropower projections are developed by forcing a coupled global hydrological and dam model with downscaled, bias-corrected climate realizations. Consequent impacts on power sector composition and associated emissions and investment costs are explored using the Global Change Assessment Model (GCAM). We find that climate-driven changes in hydropower generation may shift power demands onto and away from carbon intensive technologies. This then causes significantlymore » altered power sector CO 2 emissions in several hydro-dependent regions, although the net global impact is modest. For drying regions, we estimate a global, cumulative investment need of approximately one trillion dollars (±$500 billion) this century to make up for deteriorated hydropower generation caused by climate change. Total investments avoided are of a similar magnitude across regions projected to experience increased precipitation. Investment risks and opportunities are concentrated in hydro-dependent countries for which significant climate change is expected. Various countries throughout the Balkans, Latin America and Southern Africa are most vulnerable, whilst Norway, Canada, and Bhutan emerge as clear beneficiaries.« less

Climate impacts on hydropower and consequences for global electricity supply investment needs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Turner, Sean W. D.; Hejazi, Mohamad; Kim, Son H.

Climate change is projected to increase hydropower generation in some parts of the world and decrease it in others. Here we explore the possible consequences of these impacts for the electricity supply sector at the global scale. Regional hydropower projections are developed by forcing a coupled global hydrological and dam model with downscaled, bias-corrected climate realizations. Consequent impacts on power sector composition and associated emissions and investment costs are explored using the Global Change Assessment Model (GCAM). We find that climate-driven changes in hydropower generation may shift power demands onto and away from carbon intensive technologies. This then causes significantlymore » altered power sector CO 2 emissions in several hydro-dependent regions, although the net global impact is modest. For drying regions, we estimate a global, cumulative investment need of approximately one trillion dollars (±$500 billion) this century to make up for deteriorated hydropower generation caused by climate change. Total investments avoided are of a similar magnitude across regions projected to experience increased precipitation. Investment risks and opportunities are concentrated in hydro-dependent countries for which significant climate change is expected. Various countries throughout the Balkans, Latin America and Southern Africa are most vulnerable, whilst Norway, Canada, and Bhutan emerge as clear beneficiaries.« less

Moving to stay in place: behavioral mechanisms for coexistence of African large carnivores.

PubMed

Vanak, Abi Tamim; Fortin, Daniel; Thaker, Maria; Ogden, Monika; Owen, Cailey; Greatwood, Sophie; Slotow, Rob

2013-11-01

Most ecosystems have multiple predator species that not only compete for shared prey, but also pose direct threats to each other. These intraguild interactions are key drivers of carnivore community structure, with ecosystem-wide cascading effects. Yet, behavioral mechanisms for coexistence of multiple carnivore species remain poorly understood. The challenges of studying large, free-ranging carnivores have resulted in mainly coarse-scale examination of behavioral strategies without information about all interacting competitors. We overcame some of these challenges by examining the concurrent fine-scale movement decisions of almost all individuals of four large mammalian carnivore species in a closed terrestrial system. We found that the intensity ofintraguild interactions did not follow a simple hierarchical allometric pattern, because spatial and behavioral tactics of subordinate species changed with threat and resource levels across seasons. Lions (Panthera leo) were generally unrestricted and anchored themselves in areas rich in not only their principal prey, but also, during periods of resource limitation (dry season), rich in the main prey for other carnivores. Because of this, the greatest cost (potential intraguild predation) for subordinate carnivores was spatially coupled with the highest potential benefit of resource acquisition (prey-rich areas), especially in the dry season. Leopard (P. pardus) and cheetah (Acinonyx jubatus) overlapped with the home range of lions but minimized their risk using fine-scaled avoidance behaviors and restricted resource acquisition tactics. The cost of intraguild competition was most apparent for cheetahs, especially during the wet season, as areas with energetically rewarding large prey (wildebeest) were avoided when they overlapped highly with the activity areas of lions. Contrary to expectation, the smallest species (African wild dog, Lycaon pictus) did not avoid only lions, but also used multiple tactics to minimize encountering all other competitors. Intraguild competition thus forced wild dogs into areas with the lowest resource availability year round. Coexistence of multiple carnivore species has typically been explained by dietary niche separation, but our multi-scaled movement results suggest that differences in resource acquisition may instead be a consequence of avoiding intraguild competition. We generate a more realistic representation of hierarchical behavioral interactions that may ultimately drive spatially explicit trophic structures of multi-predator communities.

[The role of infection prevention in the control of antimicrobial resistance : Any avoided infection contributes to the reduction of antibiotic use].

PubMed

Mielke, Martin

2018-05-01

Clinically relevant infections are the primary indication for the use of antimicrobial agents in human medicine. Consequently, the prevention of infections is the fundament of all measures to rationally reduce the use of antibiotics. A prevented infection must not be treated. For the prevention of several community-acquired infections, vaccines are available. In addition, several infections may be prevented on the basis of knowledge and responsible behavior. However, the prevention of nosocomial infections depends mainly on the responsibility of third parties in the context of medical procedures. Effective preventive measures are described in guidelines carefully prepared by the commission for hospital hygiene and infection prevention in Germany. The consequent implementation of these guidelines contributes to patient safety and the prevention of the spread of multidrug-resistant bacteria. Highly cost-effective measures are a high degree of compliance with the rules for hand hygiene, perioperative antiseptic measures, and guidelines for the use of perioperative antimicrobial prophylaxis. The documentation of decreasing or low rates of infections and antimicrobial resistance helps to verify the success of preventive measures.

Five-year cost-effectiveness of the Patient Empowerment Programme (PEP) for type 2 diabetes mellitus in primary care.

PubMed

Lian, Jinxiao; McGhee, Sarah M; So, Ching; Chau, June; Wong, Carlos K H; Wong, William C W; Lam, Cindy L K

2017-09-01

This study evaluated the short-term cost-effectiveness of the Patient Empowerment Programme (PEP) for diabetes mellitus (DM) in Hong Kong. Propensity score matching was used to select a matched group of PEP and non-PEP subjects. A societal perspective was adopted to estimate the cost of PEP. Outcome measures were the cumulative incidence of all-cause mortality and diabetic complication over a 5-year follow-up period and the number needed to treat (NNT) to avoid 1 event. The incremental cost-effectiveness ratio (ICER) of cost per event avoided was calculated using the PEP cost per subject multiplied by the NNT. The PEP cost per subject from the societal perspective was US$247. There was a significantly lower cumulative incidence of all-cause mortality (2.9% vs 4.6%, P < .001), any DM complication (9.5% vs 10.8%, P = .001) and CVD events (6.8% vs 7.6%, P = .018), in the PEP group. The costs per death from any cause, DM complication or case of CVD avoided were US$14 465, US$19 617 and US$30 796, respectively. The extra amount allocated to managing PEP was small and it appears cost-effective in the short-term as an addition to RAMP. © 2017 John Wiley & Sons Ltd.

Barriers to movement: Modelling energetic costs of avoiding marine wind farms amongst breeding seabirds.

PubMed

Masden, Elizabeth A; Haydon, Daniel T; Fox, Anthony D; Furness, Robert W

2010-07-01

Proposals for wind farms in areas of known importance for breeding seabirds highlight the need to understand the impacts of these structures. Using an energetic modelling approach, we examine the effects of wind farms as barriers to movement on seabirds of differing morphology. Additional costs, expressed in relation to typical daily energetic expenditures, were highest per unit flight for seabirds with high wing loadings, such as cormorants. Taking species-specific differences into account, costs were relatively higher in terns, due to the high daily frequency of foraging flights. For all species, costs of extra flight to avoid a wind farm appear much less than those imposed by low food abundance or adverse weather, although such costs will be additive to these. We conclude that adopting a species-specific approach is essential when assessing the impacts of wind farms on breeding seabird populations, to fully anticipate the effects of avoidance flights. Copyright 2010 Elsevier Ltd. All rights reserved.

Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients.

PubMed

Dal, Negro Roberto; Eandi, M; Pradelli, L; Iannazzo, S

2007-01-01

Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol! budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately Euro 7 billion, with a mean cost per patient per year of around Euro 2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was Euro 679.5 per avoided exacerbation and Euro 3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs.

Sovereign cat bonds and infrastructure project financing.

PubMed

Croson, David; Richter, Andreas

2003-06-01

We examine the opportunities for using catastrophe-linked securities (or equivalent forms of nondebt contingent capital) to reduce the total costs of funding infrastructure projects in emerging economies. Our objective is to elaborate on methods to reduce the necessity for unanticipated (emergency) project funding immediately after a natural disaster. We also place the existing explanations of sovereign-level contingent capital into a catastrophic risk management framework. In doing so, we address the following questions. (1) Why might catastrophe-linked securities be useful to a sovereign nation, over and above their usefulness for insurers and reinsurers? (2) Why are such financial instruments ideally suited for protecting infrastructure projects in emerging economies, under third-party sponsorship, from low-probability, high-consequence events that occur as a result of natural disasters? (3) How can the willingness to pay of a sovereign government in an emerging economy (or its external project sponsor), who values timely completion of infrastructure projects, for such instruments be calculated? To supplement our treatment of these questions, we use a multilayer spreadsheet-based model (in Microsoft Excel format) to calculate the overall cost reductions possible through the judicious use of catastrophe-based financial tools. We also report on numerical comparative statics on the value of contingent-capital financing to avoid project disruption based on varying costs of capital, probability and consequences of disasters, the feasibility of strategies for mid-stage project abandonment, and the timing of capital commitments to the infrastructure investment. We use these results to identify high-priority applications of catastrophe-linked securities so that maximal protection can be realized if the total number of catastrophe instruments is initially limited. The article concludes with potential extensions to our model and opportunities for future research.

Ready-to-use pre-filled syringes of atropine for anaesthesia care in French hospitals - a budget impact analysis.

PubMed

Benhamou, Dan; Piriou, Vincent; De Vaumas, Cyrille; Albaladejo, Pierre; Malinovsky, Jean-Marc; Doz, Marianne; Lafuma, Antoine; Bouaziz, Hervé

2017-04-01

Patient safety is improved by the use of labelled, ready-to-use, pre-filled syringes (PFS) when compared to conventional methods of syringe preparation (CMP) of the same product from an ampoule. However, the PFS presentation costs more than the CMP presentation. To estimate the budget impact for French hospitals of switching from atropine in ampoules to atropine PFS for anaesthesia care. A model was constructed to simulate the financial consequences of the use of atropine PFS in operating theatres, taking into account wastage and medication errors. The model tested different scenarios and a sensitivity analysis was performed. In a reference scenario, the systematic use of atropine PFS rather than atropine CMP yielded a net one-year budget saving of €5,255,304. Medication errors outweighed other cost factors relating to the use of atropine CMP (€9,425,448). Avoidance of wastage in the case of atropine CMP (prepared and unused) was a major source of savings (€1,167,323). Significant savings were made by means of other scenarios examined. The sensitivity analysis suggests that the results obtained are robust and stable for a range of parameter estimates and assumptions. The financial model was based on data obtained from the literature and expert opinions. The budget impact analysis shows that even though atropine PFS is more expensive than atropine CMP, its use would lead to significant cost savings. Savings would mainly be due to fewer medication errors and their associated consequences and the absence of wastage when atropine syringes are prepared in advance. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Anonymity and live-donor transplantation: an ELPAT view.

PubMed

Mamode, Nizam; Lennerling, Annette; Citterio, Franco; Massey, Emma; Van Assche, Kristof; Sterckx, Sigrid; Frunza, Mihaela; Jung, Harald; Pascalev, Assya; Zuidema, Willij; Johnson, Rachel; Loven, Charlotte; Weimar, Willem; Dor, Frank J M F; Dor, Frank

2013-02-27

Anonymity of donors or recipients in living-donor transplantation is a complex issue and practice varies widely. There are compelling arguments for maintaining anonymity of both parties before unspecified donor transplantation and specified indirect transplantation. After transplantation, there are still good reasons to avoid disclosure of identities. Although anonymity could be lifted if both parties explicitly request it, there are significant, potentially negative consequences of such an approach. Both donor and recipient should be counseled regarding these, and transplant teams should consider the considerable financial and psychosocial costs if problems are encountered as a result of contact. Given the recent rise in the number of unspecified living-donor transplants and through paired exchange schemes, it is vital that data are collected regarding the effects of maintaining or revoking anonymity after transplantation.

Evaluating investments in typhoid vaccines in two slums in Kolkata, India.

PubMed

Cook, Joseph; Sur, Dipika; Clemens, John; Whittington, Dale

2009-12-01

New-generation vaccines against typhoid fever have the potential to reduce the burden of disease in areas where the disease is endemic. The case for public expenditure on typhoid Vi polysaccharide vaccines for two low-income, high-incidence slums (Narkeldanga and Tiljala) in Kolkata, India, was examined. Three measures of the economic benefits of the vaccines were used: private and public cost-of-illness (COI) avoided; avoided COI plus mortality risk-reduction benefits; and willingness-to-pay (WTP) derived from stated preference (contingent valuation) studies conducted in Tiljala in 2004. Benefits and costs were examined from a social perspective. The study represents a unique opportunity to evaluate typhoid-vaccine programmes using a wealth of new site-specific epidemiological and economic data. Three typhoid-vaccination strategies (targeting only enrolled school children, targeting all children, and targeting adults and children) would most likely pass a social cost-benefit test, unless benefits are restricted to include only avoided COI. All three strategies would be considered 'very cost-effective' using the standard comparisons of cost per disability-adjusted life-year avoided with per-capita gross domestic product. However, at an average total cost per immunized person of approximately US$ 1.1, a typhoid-vaccination programme would absorb a sixth of existing public-sector spending on health (on a per-capita basis) in India. Because there appears to be significant private economic demand for typhoid vaccines, the Government could design a financially-sustainable programme with user-fees. The results show that a programme where adults pay a higher fee to subsidize vaccines for children (who have higher incidence) would avoid more cases than a uniform user-fee and still achieve revenue-neutrality.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sathaye, Jayant; Andrasko, Ken; Chan, Peter

Greenhouse gas emissions from the forestry sector are estimated to be 8.4 GtCO2-eq./year or about 17percent of the global emissions. We estimate that the cost forreducing deforestation is low in Africa and several times higher in Latin America and Southeast Asia. These cost estimates are sensitive to the uncertainties of how muchunsustainable high-revenue logging occurs, little understood transaction and program implementation costs, and barriers to implementation including governance issues. Due to lack of capacity in the affected countries, achieving reduction or avoidance of carbon emissions will require extensive REDD-plus programs. Preliminary REDD-plus Readiness cost estimates and program descriptions for Indonesia,more » Democratic Republic of the Congo, Ghana, Guyana and Mexico show that roughly one-third of potential REDD-plus mitigation benefits might come from avoided deforestation and the rest from avoided forest degradation and other REDD-plus activities.« less

Active Collision Avoidance for Planetary Landers

NASA Technical Reports Server (NTRS)

Rickman, Doug; Hannan, Mike; Srinivasan, Karthik

2015-01-01

The use of automotive radar systems are being evaluated for collision avoidance in planetary landers. Our focus is to develop a low-cost, light-weight collision avoidance system that overcomes the drawbacks identified with optical-based systems. We also seek to complement the Autonomous Landing and Hazard Avoidance Technology system by providing mission planners an alternative system that can be used on low-cost, small robotic missions and in close approach. Our approach takes advantage of how electromagnetic radiation interacts with solids. As the wavelength increases, the sensitivity of the radiation to isolated solids of a specific particle size decreases. Thus, rocket exhaust-blown dust particles, which have major significance in visible wavelengths, have much less significance at radar wavelengths.

Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany

PubMed Central

2013-01-01

Background Herpes zoster (HZ) is a self-limiting painful skin rash affecting mostly individuals from 50 years of age. The main complication is postherpetic neuralgia (PHN), a long-lasting pain after rash has resolved. A HZ-vaccine has recently been licensed in Europe for individuals older than 50 years. To support an informed decision-making for a potential vaccination recommendation, we conducted a health economic evaluation to identify the most cost-effective vaccination strategy. Methods We developed a static Markov-cohort model, which compared a vaccine-scenario with no vaccination. The cohort entering the model was 50 years of age, vaccinated at age 60, and stayed over life-time in the model. Transition probabilities were based on HZ/PHN-epidemiology and demographic data from Germany, as well as vaccine efficacy (VE) data from clinical trials. Costs for vaccination and HZ/PHN-treatment (in Euros; 2010), as well as outcomes were discounted equally with 3% p.a. We accounted results from both, payer and societal perspective. We calculated benefit-cost-ratio (BCR), number-needed-to-vaccinate (NNV), and incremental cost-effectiveness ratios (ICERs) for costs per HZ-case avoided, per PHN-case avoided, and per quality-adjusted life-year (QALY) gained. Different target age-groups were compared to identify the most cost-effective vaccination strategy. Base-case-analysis as well as structural, descriptive-, and probabilistic-sensitivity-analyses (DSA, PSA) were performed. Results When vaccinating 20% of a cohort of 1 million 50 year old individuals at the age of 60 years, approximately 20,000 HZ-cases will be avoided over life-time. The NNV to avoid one HZ (PHN)-case was 10 (144). However, with a BCR of 0.34 this vaccination-strategy did not save costs. The base-case-analysis yielded an ICER of 1,419 (20,809) Euros per avoided HZ (PHN)-case and 28,146 Euros per QALY gained. Vaccination at the age of 60 was identified in most (sensitivity) analyses to be the most cost-effective vaccination strategy. In DSA, vaccine price and VE were shown to be the most critical input-data. Conclusions According to our evaluation, HZ-vaccination is expected to avoid HZ/PHN-cases and gain QALYs to higher costs. However, the vaccine price had the highest impact on the ICERs. Among different scenarios, targeting individuals aged 60 years seems to represent the most cost-effective vaccination-strategy. PMID:24070414

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

PubMed Central

Akazawa, Manabu; Stearns, Sally C; Biddle, Andrea K

2008-01-01

Objective To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources Claims between 1997 and 2005 from a large managed care database. Study Design Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods COPD patients aged 40 or older with ≥15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients ≥50 years old, ICS was cost saving 57 percent of time. Conclusions ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates. PMID:18671750

Working memory, math performance, and math anxiety.

PubMed

Ashcraft, Mark H; Krause, Jeremy A

2007-04-01

The cognitive literature now shows how critically math performance depends on working memory, for any form of arithmetic and math that involves processes beyond simple memory retrieval. The psychometric literature is also very clear on the global consequences of mathematics anxiety. People who are highly math anxious avoid math: They avoid elective coursework in math, both in high school and college, they avoid college majors that emphasize math, and they avoid career paths that involve math. We go beyond these psychometric relationships to examine the cognitive consequences of math anxiety. We show how performance on a standardized math achievement test varies as a function of math anxiety, and that math anxiety compromises the functioning of working memory. High math anxiety works much like a dual task setting: Preoccupation with one's math fears and anxieties functions like a resource-demanding secondary task. We comment on developmental and educational factors related to math and working memory, and on factors that may contribute to the development of math anxiety.

Economic consequence of local control with radiotherapy: Cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lievens, Yolande; Kesteloot, Katrien; Bogaert, Walter van den

2005-11-15

Purpose: To investigate the financial implications of radiotherapy (RT) to the internal mammary and medial supraclavicular lymph node chain (IM-MS) in postoperative breast cancer. Methods and Materials: A cost-effectiveness and cost-utility analysis were performed, using Markov models, comparing the early and delayed costs and effects of IM-MS during a 20-year time span from a societal viewpoint. The outcome estimates were based on Level I evidence from postoperative RT literature and the cost estimates on the standard practice of the Leuven University Hospitals, with the RT costs derived from an activity-based costing program developed in the department. Results: On the basismore » of the assumptions of the model and seen during a 20-year time span, primary treatment including IM-MS RT results in a cost savings (approximately EURO 10,000) compared with a strategy without RT. Because IM-MS RT also results in better clinical effectiveness and greater quality of life, the treatment with IM-MS dominates the approach without IM-MS. Sensitivity analyses confirmed the robustness of these results in all tested circumstances. Although threshold values were found for the cost of IM-MS, the cost at relapse, and the quality of life after treatment, these were substantially different from the baseline estimates, indicating that it is very unlikely that omitting IM-MS would become superior. Conclusion: This ex-ante cost evaluation of IM-MS RT showed that the upfront costs of locoregional RT are easily compensated for by avoiding the costs of treating locoregional and distant relapse at a later stage. The cost-sparing effect of RT should, however, be evaluated for a sufficiently long time span and is most specifically found in tumors with a rather slow natural history and a multitude of available systemic treatments at relapse, such as breast cancer.« less

Modeling the fiscal costs and benefits of alternative treatment strategies in the United Kingdom for chronic hepatitis C.

PubMed

Connolly, Mark P; Kotsopoulos, Nikos; Ustianowski, Andrew

2018-01-01

Hepatitis C (HCV) infection causes substantial direct health costs, but also impacts broader societal and governmental costs, such as tax revenue and social protection benefits. This study investigated the broader fiscal costs and benefits of curative interventions for chronic Hepatitis C (CHC) that allow individuals to avoid long-term HCV attributed health conditions. A prospective cohort model, assessing the long-term fiscal consequences of policy decisions, was developed for HCV infected individuals, following the generational accounting analytic framework that combines age-specific lifetime gross taxes paid and governmental transfers received (i.e. healthcare and social support costs). The analysis assessed the burden of a theoretical cohort of untreated HCV infected patients with the alternative of treating these patients with a highly efficacious curative intervention (ledipasvir/sofosbuvir [LDV/SOF]). It also compared treating patients at all fibrosis stages (Stages F0-F4) compared to late treatment (Stage F4). Based on projected lifetime work activity and taxes paid, the treated cohort paid an additional £5,900 per patient compared to the untreated cohort. Lifetime government disability costs of £97,555 and £125,359 per patient for treated cohort vs no treatment cohort were estimated, respectively. Lifetime direct healthcare costs in the treated cohort were £32,235, compared to non-treated cohort of £26,424, with an incremental healthcare costs increase of £5,901 per patient. The benefit cost ratio (BCR) of total government benefits and savings relative to government treatment costs (including LDV/SOF) ranged from 1.8-5.6. Treating patients early resulted in 77% less disability costs, 43% lower healthcare costs, and 33% higher tax revenue. The ability to cure Hepatitis C offers considerable fiscal benefits beyond direct medical costs and savings attributed to reduced disability costs, public allowances, and improved tax revenue. Changes in parameters, such as productivity, wage growth, and tax rates, can influence the conclusions described here.

Cancer patients' trade-offs among efficacy, toxicity, and out-of-pocket cost in the curative and noncurative setting.

PubMed

Wong, Yu-Ning; Egleston, Brian L; Sachdeva, Kush; Eghan, Naa; Pirollo, Melanie; Stump, Tammy K; Beck, John Robert; Armstrong, Katrina; Schwartz, Jerome Sanford; Meropol, Neal J

2013-09-01

When making treatment decisions, cancer patients must make trade-offs among efficacy, toxicity, and cost. However, little is known about what patient characteristics may influence these trade-offs. A total of 400 cancer patients reviewed 2 of 3 stylized curative and noncurative scenarios that asked them to choose between 2 treatments of varying levels of efficacy, toxicity, and cost. Each scenario included 9 choice sets. Demographics, cost concerns, numeracy, and optimism were assessed. Within each scenario, we used latent class methods to distinguish groups with discrete preferences. We then used regressions with group membership probabilities as covariates to identify associations. The median age of the patients was 61 years (range, 27-90 y). Of the total number of patients included, 25% were enrolled at a community hospital, and 99% were insured. Three latent classes were identified that demonstrated (1) preference for survival, (2) aversion to high cost, and (3) aversion to toxicity. Across all scenarios, patients with higher income were more likely to be in the class that favored survival. Lower income patients were more likely to be in the class that was averse to high cost (P<0.05). Similar associations were found between education, employment status, numeracy, cost concerns, and latent class. Even in these stylized scenarios, socioeconomic status predicted the treatment choice. Higher income patients may be more likely to focus on survival, whereas those of lower socioeconomic status may be more likely to avoid expensive treatment, regardless of survival or toxicity. This raises the possibility that insurance plans with greater cost-sharing may have the unintended consequence of increasing disparities in cancer care.

The costs and benefits of positive illusions

PubMed Central

Makridakis, Spyros; Moleskis, Andreas

2015-01-01

Positive illusions are associated with unrealistic optimism about the future and an inflated assessment of one’s abilities. They are prevalent in normal life and are considered essential for maintaining a healthy mental state, although, there are disagreements to the extent to which people demonstrate these positive illusions and whether they are beneficial or not. But whatever the situation, it is hard to dismiss their existence and their positive and/or negative influence on human behavior and decision making in general. Prominent among illusions is that of control, that is “the tendency for people to overestimate their ability to control events.” This paper describes positive illusions, their potential benefits but also quantifies their costs in five specific fields (gambling, stock and other markets, new firms and startups, preventive medicine and wars). It is organized into three parts. First the psychological reasons giving rise to positive illusions are described and their likely harm and benefits stated. Second, their negative consequences are presented and their costs are quantified in five areas seriously affected with emphasis to those related to the illusion of control that seems to dominate those of unrealistic optimism. The costs involved are huge and serious efforts must be undertaken to understand their enormity and steps taken to avoid them in the future. Finally, there is a concluding section where the challenges related to positive illusions are noted and directions for future research are presented. PMID:26175698

Does Aerosol Geoengineering the Earth's Climate Pass a Cost-Benefit Test?

NASA Astrophysics Data System (ADS)

Keller, K.; Urban, N.; Tuana, N.

2007-12-01

Anthropogenic carbon dioxide (CO2) emissions are changing the Earth's climate with potentially dangerous consequences. Ratified international agreements call for a reduction of CO2 emissions to avoid dangerous anthropogenic interference with the climate system. Recent studies have, however, proposed an alternative strategy: to geoengineer Earth's climate by injecting aerosol precursors into the stratosphere. It is often claimed that aerosol geoengineering would provide net economic benefits because geoengineering requires far lower near-term investments compared to deep cuts in CO2 emissions. However, aerosol geoengineering projects can also cause nontrivial economic costs. This is because aerosol geoengineering hinges on successfully counterbalancing the forcing effects of CO2 emissions (which decay over centuries) with the forcing effects of aerosol emissions (which decay within years). A failure to maintain this delicate balance can lead to abrupt climatic changes, with potentially substantial economic damages. Deferring cuts in CO2 emissions in favor of aerosol geoengineering is hence a deeply uncertain gamble, as it requires so far unknown institutions to reliably control aerosol forcings over centuries. Here we use a simple economic model to evaluate potential costs and benefits of aerosol geoengineering for a wide range of the deeply uncertain parameters. We show that aerosol geoengineering projects may cause economic damages that can far exceed the benefits and may hence fail a cost-benefit test.

The costs and benefits of positive illusions.

PubMed

Makridakis, Spyros; Moleskis, Andreas

2015-01-01

Positive illusions are associated with unrealistic optimism about the future and an inflated assessment of one's abilities. They are prevalent in normal life and are considered essential for maintaining a healthy mental state, although, there are disagreements to the extent to which people demonstrate these positive illusions and whether they are beneficial or not. But whatever the situation, it is hard to dismiss their existence and their positive and/or negative influence on human behavior and decision making in general. Prominent among illusions is that of control, that is "the tendency for people to overestimate their ability to control events." This paper describes positive illusions, their potential benefits but also quantifies their costs in five specific fields (gambling, stock and other markets, new firms and startups, preventive medicine and wars). It is organized into three parts. First the psychological reasons giving rise to positive illusions are described and their likely harm and benefits stated. Second, their negative consequences are presented and their costs are quantified in five areas seriously affected with emphasis to those related to the illusion of control that seems to dominate those of unrealistic optimism. The costs involved are huge and serious efforts must be undertaken to understand their enormity and steps taken to avoid them in the future. Finally, there is a concluding section where the challenges related to positive illusions are noted and directions for future research are presented.

When does female multiple mating evolve to adjust inbreeding? Effects of inbreeding depression, direct costs, mating constraints, and polyandry as a threshold trait.

PubMed

Duthie, A Bradley; Bocedi, Greta; Reid, Jane M

2016-09-01

Polyandry is often hypothesized to evolve to allow females to adjust the degree to which they inbreed. Multiple factors might affect such evolution, including inbreeding depression, direct costs, constraints on male availability, and the nature of polyandry as a threshold trait. Complex models are required to evaluate when evolution of polyandry to adjust inbreeding is predicted to arise. We used a genetically explicit individual-based model to track the joint evolution of inbreeding strategy and polyandry defined as a polygenic threshold trait. Evolution of polyandry to avoid inbreeding only occurred given strong inbreeding depression, low direct costs, and severe restrictions on initial versus additional male availability. Evolution of polyandry to prefer inbreeding only occurred given zero inbreeding depression and direct costs, and given similarly severe restrictions on male availability. However, due to its threshold nature, phenotypic polyandry was frequently expressed even when strongly selected against and hence maladaptive. Further, the degree to which females adjusted inbreeding through polyandry was typically very small, and often reflected constraints on male availability rather than adaptive reproductive strategy. Evolution of polyandry solely to adjust inbreeding might consequently be highly restricted in nature, and such evolution cannot necessarily be directly inferred from observed magnitudes of inbreeding adjustment. © 2016 The Author(s). Evolution published by Wiley Periodicals, Inc. on behalf of The Society for the Study of Evolution.

AskIT Service Desk Support Value Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ashcraft, Phillip Lynn; Cummings, Susan M.; Fogle, Blythe G.

The value model discussed herein provides an accurate and simple calculation of the funding required to adequately staff the AskIT Service Desk (SD).  The model is incremental – only technical labor cost is considered.  All other costs, such as management, equipment, buildings, HVAC, and training are considered common elements of providing any labor related IT Service. Depending on the amount of productivity loss and the number of hours the defect was unresolved, the value of resolving work from the SD is unquestionably an economic winner; the average cost of $16 per SD resolution can commonly translate to cost avoidance exceeding well overmore » $100. Attempting to extract too much from the SD will likely create a significant downside. The analysis used to develop the value model indicates that the utilization of the SD is very high (approximately 90%).  As a benchmark, consider a comment from a manager at Vitalyst (a commercial IT service desk) that their utilization target is approximately 60%.  While high SD utilization is impressive, over the long term it is likely to cause unwanted consequences to staff such as higher turnover, illness, or burnout.  A better solution is to staff the SD so that analysts have time to improve skills through training, develop knowledge, improve processes, collaborate with peers, and improve customer relationship skills.« less

Patient inducement, provider priorities, and resource allocation in public mental health systems.

PubMed

Sinaiko, Anna D; McGuire, Thomas G

2006-12-01

Public mental health systems are increasingly facing demands from the criminal justice system and social services agencies to provide services and support in cases in which mental illness contributes to crime, homelessness, or poverty. In this article we analyze how policies from outside public mental health systems affect resource allocation within these systems, using examples from criminal justice. These policies use two types of mechanisms: inducing patients to consume treatment (by offering rewards or imposing penalties) and inducing clinicians to provide treatment (by creating priorities). We propose a classification of these social policies based on whether they affect demand through rewards or penalties or supply through priorities. We then relate the classification to data on patients treated in public systems to evaluate the current prevalence and potential for growth in these outside demands. These inducements impose a set of nonobvious costs on other patients who are not targeted by the policies. Furthermore, they create incentives for both patients and providers to modify their behavior in order to take advantage of rewards, avoid penalties, or better compete for resources with prioritized patients. We consider some policy implications for avoiding unintended consequences of these policies.

[Prevention of atopic eczema. Evidence based guidelines].

PubMed

Schäfer, T

2005-03-01

With an estimated prevalence of 12% for preschool children and 3% for adults, atopic eczema is a serious public health problem. This disease severely jeopardizes quality of life and is associated with considerable costs. Since there is still no causal therapy, primary and secondary prevention are especially important. Here the evidence basis for recommendations on prevention of atopic eczema is discussed on the basis of the first evidence-based consensus guideline (S3) on allergy prevention. This recommends that babies should be breastfed exclusively for at least 4 months and exposure to passive smoking be avoided even during pregnancy; restriction of the maternal diet during pregnancy has no influence, though during breastfeeding it can lower the incidence of eczema among babies at risk. Thereby this measure should be balanced with potential consequences of malnutrition. There seems to be a positive correlation between keeping small rodents (rabbits, guinea pigs), and possibly cats, and the occurrence of atopic eczema, while keeping dogs has no effect or even a protective effect. Avoidance of an unfavorable indoor climate is probably also helpful in preventing eczema. There is no evidence to support deviating from the current recommendations of the standing committee for vaccination.

Reason behind wet pack after steam sterilization and its consequences: An overview from Central Sterile Supply Department of a cancer center in eastern India.

PubMed

Basu, Debabrata

Wet pack after steam sterilization process that means there are surely obtain millions of microorganisms that can breed and multiply rapidly and objects are unsterile and can never be used for further procedure. There are many reasons behind the wet pack occurrences after autoclaving like poor quality of wrapping materials, faulty valves of rigid container, faulty loading and packaging technique, poor steam quality, sterilizer malfunction and may be design related problems in CSSD sterile storage area. Cause of wet pack after steam sterilization processes may occur severe problems because of wasted time and effort, increased work load, increased cost, potentially contaminated instruments, infection risk to the patient, poor patient outcomes and delayed or cancellation of procedures. But such wet pack scenario can be avoided by various methods by using good steam (water) quality, performing periodic maintenance of the Autoclaves, avoidance of sterilizer overloading, allowing adequate post sterilization time to cool down the materials to room temperature, using good quality wrapping materials, properly maintain temperature and humidity of sterile storage area etc. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

29 CFR 102.54 - Initiation of formal compliance proceedings; issuance of compliance specification and notice of...

Code of Federal Regulations, 2011 CFR

2011-07-01

... the purposes and policies of the Act or to avoid unnecessary costs or delay, the Regional Director may... policies of the Act or to avoid unnecessary costs or delay, the Regional Director may consolidate with a... formal proceeding, the Regional Director may issue and serve on all parties a compliance specification in...

29 CFR 102.54 - Initiation of formal compliance proceedings; issuance of compliance specification and notice of...

Code of Federal Regulations, 2010 CFR

2010-07-01

... the purposes and policies of the Act or to avoid unnecessary costs or delay, the Regional Director may... policies of the Act or to avoid unnecessary costs or delay, the Regional Director may consolidate with a... formal proceeding, the Regional Director may issue and serve on all parties a compliance specification in...

Tradespace and Affordability - Phase 1

DTIC Science & Technology

2013-07-09

assessment options Cost-effectiveness, risk reduction leverage/ROI, rework avoidance Tool, data, scenario availability Contract Number: H98230-08-D-0171...Prepare FED assessment plans and earned value milestones Try to relate earned value to risk -exposure avoided rather than budgeted cost F. Begin...evaluate and iterate plans and enablers I. Assess readiness for Commitment Review Shortfalls identified as risks and covered by risk mitigation

Benchmarking in pathology: development of an activity-based costing model.

PubMed

Burnett, Leslie; Wilson, Roger; Pfeffer, Sally; Lowry, John

2012-12-01

Benchmarking in Pathology (BiP) allows pathology laboratories to determine the unit cost of all laboratory tests and procedures, and also provides organisational productivity indices allowing comparisons of performance with other BiP participants. We describe 14 years of progressive enhancement to a BiP program, including the implementation of 'avoidable costs' as the accounting basis for allocation of costs rather than previous approaches using 'total costs'. A hierarchical tree-structured activity-based costing model distributes 'avoidable costs' attributable to the pathology activities component of a pathology laboratory operation. The hierarchical tree model permits costs to be allocated across multiple laboratory sites and organisational structures. This has enabled benchmarking on a number of levels, including test profiles and non-testing related workload activities. The development of methods for dealing with variable cost inputs, allocation of indirect costs using imputation techniques, panels of tests, and blood-bank record keeping, have been successfully integrated into the costing model. A variety of laboratory management reports are produced, including the 'cost per test' of each pathology 'test' output. Benchmarking comparisons may be undertaken at any and all of the 'cost per test' and 'cost per Benchmarking Complexity Unit' level, 'discipline/department' (sub-specialty) level, or overall laboratory/site and organisational levels. We have completed development of a national BiP program. An activity-based costing methodology based on avoidable costs overcomes many problems of previous benchmarking studies based on total costs. The use of benchmarking complexity adjustment permits correction for varying test-mix and diagnostic complexity between laboratories. Use of iterative communication strategies with program participants can overcome many obstacles and lead to innovations.

Avoiding Mathematics Trauma: Alternative Teaching Methods.

ERIC Educational Resources Information Center

Ufuktepe, Unal; Ozel, Claire Thomas

Children in primary education often encounter mathematics having picked up a general fear of mathematics from the society around them. This results in lack of confidence, avoidance of non-standard thought processes, weakness in problem solving strategies, and other negative consequences. This study offers an alternative approach: presenting…

Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome.

PubMed

Knauert, Melissa; Naik, Sreelatha; Gillespie, M Boyd; Kryger, Meir

2015-09-01

To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome. PubMed database for English-language studies with no start date restrictions and with an end date of September 2014. A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences. There were 106 studies that formed the basis of this analysis. Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death. These consequences result in significant economic burden. Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea. Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies. Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed.

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

39 CFR 3050.24 - Documentation supporting estimates of costs avoided by worksharing and other mail characteristics...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Computer Reader finalization costs, cost per image, and Remote Bar Code Sorter leakage; (8) Percentage of... processing units costs for Carrier Route, High Density, and Saturation mail; (j) Mail processing unit costs...

"Watch out!": Effects of instructed threat and avoidance on human free-operant approach-avoidance behavior.

PubMed

Schlund, Michael W; Treacher, Kay; Preston, Oli; Magee, Sandy K; Richman, David M; Brewer, Adam T; Cameron, Gemma; Dymond, Simon

2017-01-01

Approach-avoidance paradigms create a competition between appetitive and aversive contingencies and are widely used in nonhuman research on anxiety. Here, we examined how instructions about threat and avoidance impact control by competing contingencies over human approach-avoidance behavior. Additionally, Experiment 1 examined the effects of threat magnitude (money loss amount) and avoidance cost (fixed ratio requirements), whereas Experiment 2 examined the effects of threat information (available, unavailable and inaccurate) on approach-avoidance. During the task, approach responding was modeled by reinforcing responding with money on a FR schedule. By performing an observing response, participants produced an escalating "threat meter". Instructions stated that the threat meter levels displayed the current probability of losing money, when in fact loss only occurred when the level reached the maximum. Instructions also stated pressing an avoidance button lowered the threat level. Overall, instructions produced cycles of approach and avoidance responding with transitions from approach to avoidance when threat was high and transitions back to approach after avoidance reduced threat. Experiment 1 revealed increasing avoidance cost, but not threat magnitude, shifted approach-avoidance transitions to higher threat levels and increased anxiety ratings, but did not influence the frequency of approach-avoidance cycles. Experiment 2 revealed when threat level information was available or absent earnings were high, but earnings decreased when inaccurate threat information was incompatible with contingencies. Our findings build on prior nonhuman and human approach-avoidance research by highlighting how instructed threat and avoidance can impact human AA behavior and self-reported anxiety. © 2017 Society for the Experimental Analysis of Behavior.

A mechanism for social selection and successful altruism.

PubMed

Simon, H A

1990-12-21

Within the framework of neo-Darwinism, with its focus on fitness, it has been hard to account for altruism behavior that reduces the fitness of the altruist but increases average fitness in society. Many population biologists argue that, except for altruism to close relatives, human behavior that appears to be altruistic amounts to reciprocal altruism, behavior undertaken with an expectation of reciprocation, hence incurring no net cost to fitness. Herein is proposed a simple and robust mechanism, based on human docility and bounded rationality that can account for the evolutionary success of genuinely altruistic behavior. Because docility-receptivity to social influence-contributes greatly to fitness in the human species, it will be positively selected. As a consequence, society can impose a "tax" on the gross benefits gained by individuals from docility by inducing docile individuals to engage in altruistic behaviors. Limits on rationality in the face of environmental complexity prevent the individual from avoiding this "tax." An upper bound is imposed on altruism by the condition that there must remain a net fitness advantage for docile behavior after the cost to the individual of altruism has been deducted.

Polymer-composite materials for radiation protection.

PubMed

Nambiar, Shruti; Yeow, John T W

2012-11-01

Unwanted exposures to high-energy or ionizing radiation can be hazardous to health. Prolonged or accumulated radiation dosage from either particle-emissions such as alpha/beta, proton, electron, neutron emissions, or high-energy electromagnetic waves such as X-rays/γ rays, may result in carcinogenesis, cell mutations, organ failure, etc. To avoid occupational hazards from these kinds of exposures, researchers have traditionally used heavy metals or their composites to attenuate the radiation. However, protective gear made of heavy metals are not only cumbersome but also are capable of producing more penetrative secondary radiations which requires additional shielding, increasing the cost and the weight factor. Consequently, significant research efforts have been focused toward designing efficient, lightweight, cost-effective, and flexible shielding materials for protection against radiation encountered in various industries (aerospace, hospitals, and nuclear reactors). In this regard, polymer composites have become attractive candidates for developing materials that can be designed to effectively attenuate photon or particle radiation. In this paper, we review the state-of-the-art of polymer composites reinforced with micro/nanomaterials, for their use as radiation shields.

Reducing risk of pressure sores: effects of watch prompts and alarm avoidance on wheelchair push-ups.

PubMed Central

White, G W; Mathews, R M; Fawcett, S B

1989-01-01

People who use wheelchairs are at risk for developing pressure sores. Regular pressure relief, in the form of a wheelchair push-up, is one way to reduce the likelihood of pressure sores. We examined the effects of antecedent (i.e., instructions, audible prompts) and consequent (i.e., alarm avoidance) events on wheelchair push-ups, using a multiple baseline analysis with 2 participants with spina bifida. Results suggest that the combined procedure was more effective than either antecedent or consequent events alone, and there is some evidence suggesting maintenance of effects over time. PMID:2793635

Optimal consensus algorithm integrated with obstacle avoidance

NASA Astrophysics Data System (ADS)

Wang, Jianan; Xin, Ming

2013-01-01

This article proposes a new consensus algorithm for the networked single-integrator systems in an obstacle-laden environment. A novel optimal control approach is utilised to achieve not only multi-agent consensus but also obstacle avoidance capability with minimised control efforts. Three cost functional components are defined to fulfil the respective tasks. In particular, an innovative nonquadratic obstacle avoidance cost function is constructed from an inverse optimal control perspective. The other two components are designed to ensure consensus and constrain the control effort. The asymptotic stability and optimality are proven. In addition, the distributed and analytical optimal control law only requires local information based on the communication topology to guarantee the proposed behaviours, rather than all agents' information. The consensus and obstacle avoidance are validated through simulations.

Rape avoidance behavior among Slovak women.

PubMed

Prokop, Pavol

2013-05-28

Rape has been a recurrent adaptive problem for many species, including humans. Rape is costly to women in terms of disease transmission, partner abandonment, and unwanted pregnancy (among other costs). Therefore, behavioral strategies which allow women to avoid coercive men may have been favored by selection. In line with this evolutionary reasoning, the current research documented that physically stronger women and those in a committed romantic relationship reported more rape avoidance behavior. In addition, virgin women tended to perform more rape avoidance behavior compared with their non-virgin counterparts. Women with high conception risk perceived themselves as physically stronger, which may protect them against a potential rapist. Fear of unwanted pregnancy from rape decreased as age increased, reflecting higher fertility among younger participants. However, older women reported more rape avoidance behavior, which contradicts evolutionary predictions. The results provide some support for evolutionary hypotheses of rape avoidance behavior which suggest that woman's perception of rape is influenced by parental investment and perceived physical condition.

Coastal flood damage and adaptation costs under 21st century sea-level rise.

PubMed

Hinkel, Jochen; Lincke, Daniel; Vafeidis, Athanasios T; Perrette, Mahé; Nicholls, Robert James; Tol, Richard S J; Marzeion, Ben; Fettweis, Xavier; Ionescu, Cezar; Levermann, Anders

2014-03-04

Coastal flood damage and adaptation costs under 21st century sea-level rise are assessed on a global scale taking into account a wide range of uncertainties in continental topography data, population data, protection strategies, socioeconomic development and sea-level rise. Uncertainty in global mean and regional sea level was derived from four different climate models from the Coupled Model Intercomparison Project Phase 5, each combined with three land-ice scenarios based on the published range of contributions from ice sheets and glaciers. Without adaptation, 0.2-4.6% of global population is expected to be flooded annually in 2100 under 25-123 cm of global mean sea-level rise, with expected annual losses of 0.3-9.3% of global gross domestic product. Damages of this magnitude are very unlikely to be tolerated by society and adaptation will be widespread. The global costs of protecting the coast with dikes are significant with annual investment and maintenance costs of US$ 12-71 billion in 2100, but much smaller than the global cost of avoided damages even without accounting for indirect costs of damage to regional production supply. Flood damages by the end of this century are much more sensitive to the applied protection strategy than to variations in climate and socioeconomic scenarios as well as in physical data sources (topography and climate model). Our results emphasize the central role of long-term coastal adaptation strategies. These should also take into account that protecting large parts of the developed coast increases the risk of catastrophic consequences in the case of defense failure.

Medical cost and frequent mental distress among the non-elderly US adult population.

PubMed

Bruning, John; Arif, Ahmed A; Rohrer, James E

2014-03-01

Frequent mental distress (FMD) is an important measure of perceived poor mental health. With the rising cost of health care, it is not uncommon for working adults to delay seeking care. The objective of this study was to determine the relationship between avoidance of medical care due to cost and FMD among the non-elderly US population. We analyzed data from 282 044 non-elderly US population from a 2008 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression models were used to assess the association between avoidance of medical care due to cost and FMD adjusted for covariates. The overall prevalence of FMD in the non-elderly population was 11.1%; whereas it was 24.2% for those reporting avoiding medical care due to cost. Approximately 18% of the population had no health insurance coverage and the prevalence of FMD was significantly greater in this group. The odds of FMD were >2-fold elevated for respondents who were unable to see a doctor because of cost (adjusted odds ratio: 2.40, 99% confidence interval: 2.19, 2.63). These findings highlight the need for affordable medical care for reducing mental distress and improving population health.

Helping Teenage Girls Avoid the Female Athlete Triad.

ERIC Educational Resources Information Center

Ilardi, Deb

2002-01-01

Describes how school nurses can advocate for adolescent female students and help them avoid the female athlete triad that includes disordered eating, amenorrhea, and osteoporosis. The article focuses on consequences of the triad, how to uncover the symptoms, working to improve public support, and creating a successful program through partnership.…

When winning is everything.

PubMed

Malhotra, Deepak; Ku, Gillian; Murnighan, J Keith

2008-05-01

In the heat of competition, executives can easily become obsessed with beating their rivals. This adrenaline-fueled emotional state, which the authors call competitive arousal, often leads to bad decisions. Managers can minimize the potential for competitive arousal and the harm it can inflict by avoiding certain types of interaction and targeting the causes of a win-at-all-costs approach to decision making. Through an examination of companies such as Boston Scientific and Paramount, and through research on auctions, the authors identified three principal drivers of competitive arousal: intense rivalry, especially in the form of one-on-one competitions; time pressure, found in auctions and other bidding situations, for example; and being in the spotlight--that is, working in the presence of an audience. Individually, these factors can seriously impair managerial decision making; together, their consequences can be dire, as evidenced by many high-profile business disasters. It's not possible to avoid destructive competitions and bidding wars completely. But managers can help prevent competitive arousal by anticipating potentially harmful competitive dynamics and then restructuring the deal-making process. They can also stop irrational competitive behavior from escalating by addressing the causes of competitive arousal. When rivalry is intense, for instance, managers can limit the roles of those who feel it most. They can reduce time pressure by extending or eliminating arbitrary deadlines. And they can deflect the spotlight by spreading the responsibility for critical competitive decisions among team members. Decision makers will be most successful when they focus on winning contests in which they have a real advantage--and take a step back from those in which winning exacts too high a cost.

Estimating costs of quality improvement for outpatient healthcare organisations: a practical methodology.

PubMed

Brown, Sydney E S; Chin, Marshall H; Huang, Elbert S

2007-08-01

Outpatient healthcare organisations worldwide participate in quality improvement (QI) programmes. Despite the importance of understanding the financial impact of such programmes, there are no established standard methods for empirically assessing QI programme costs and their consequences for small outpatient healthcare organisations. The costs and cost consequences were evaluated for a diabetes QI programme implemented throughout the USA in federally qualified community health centres. For five case study centres, survey instruments and methods for data analysis were developed. Two types of cost/revenue were evaluated. Direct costs/revenues, such as personnel time, items purchased and grants received, were evaluated using self-administered surveys. Cost/revenue consequences, which were cost/revenue changes that may have occurred due to changes in patient utilisation or physician behaviour, were evaluated using electronic billing data. Other methods for evaluating cost/revenue consequences if electronic billing data are not available are also discussed. This paper describes a practical taxonomy and method for assessing the costs and revenues of QI programmes for outpatient organisations. Results of such analyses will be useful for healthcare organisations implementing QI programmes and also for policy makers designing incentives for QI participation.

Ensuring food security with lower environmental costs under intensive agricultural land use patterns: A case study from China.

PubMed

Qi, Xiaoxing; Wang, Raymond Yu; Li, Jianchun; Zhang, Tao; Liu, Liming; He, Yanling

2018-05-01

Rapid population growth and environmental deterioration make ensuring food security with lower environmental costs fundamental to realizing sustainable development in China and other developing countries. The conceptual framework used in this paper integrates the major consequences of intensive agricultural land use and the diverse objectives of policymakers and farmers. It also offers an operational approach, based on farmers' diverse performance in grain production and farmland productivity, to assess food production and environmental impacts under foci-differentiated scenarios. Using data from farmer household surveys, soil surveys, land use images, and statistical yearbooks, this approach was tested using a regional case in China. The results indicate that, among all farmer types, the medium-scale farmers had a better comprehensive performance for grain production for yield, fertilizer and pesticide inputs, labor productivity, and sustainability. Therefore, grain yields can be increased and environmental costs reduced simultaneously through the use of policy instruments that encourage the transformation of trapped farmers into medium-scale farmers and balancing the proportion of single and double cropped rice. In addition, and in order to reduce grain losses caused by natural disasters and to prevent environmental degradation, robust policy measures should be developed to avoid the currently predominant cropping patterns that erode biodiversity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Why revisit your cost-accounting strategy.

PubMed

Arredondo, Ricky

2014-07-01

Healthcare entities seeking to develop effective cost-accounting systems should take six steps to avoid potential pitfalls: Secure broad executive-level support for the effort. Ensure systems are in place to analyze the disparate data. Define measurable objectives to ensure that implementation achieves desired results. Give due consideration to implementation planning. Train support staff sufficiently to avoid underutilization. Develop a sufficiently broad base of staff support for the system.

Economic consequences incurred by living kidney donors: a Canadian multi-center prospective study.

PubMed

Klarenbach, S; Gill, J S; Knoll, G; Caulfield, T; Boudville, N; Prasad, G V R; Karpinski, M; Storsley, L; Treleaven, D; Arnold, J; Cuerden, M; Jacobs, P; Garg, A X

2014-04-01

Some living kidney donors incur economic consequences as a result of donation; however, these costs are poorly quantified. We developed a framework to comprehensively assess economic consequences from the donor perspective including out-of-pocket cost, lost wages and home productivity loss. We prospectively enrolled 100 living kidney donors from seven Canadian centers between 2004 and 2008 and collected and valued economic consequences ($CAD 2008) at 3 months and 1 year after donation. Almost all (96%) donors experienced economic consequences, with 94% reporting travel costs and 47% reporting lost pay. The average and median costs of lost pay were $2144 (SD 4167) and $0 (25th-75th percentile 0, 2794), respectively. For other expenses (travel, accommodation, medication and medical), mean and median costs were $1780 (SD 2504) and $821 (25th-75th percentile 242, 2271), respectively. From the donor perspective, mean cost was $3268 (SD 4704); one-third of donors incurred cost >$3000, and 15% >$8000. The majority of donors (83%) reported inability to perform usual household activities for an average duration of 33 days; 8% reported out-of-pocket costs for assistance with these activities. The economic impact of living kidney donation for some individuals is large. We advocate for programs to reimburse living donors for their legitimate costs. © 2014 The Authors. American Journal of Transplantation Published by Wiley Periodicals, Inc. on behalf of American Society of Transplant Surgeons.

Modular space station phase B extension program cost and schedules. Volume 1: Cost and schedule estimating process and results

NASA Technical Reports Server (NTRS)

Frassinelli, G. J.

1972-01-01

Cost estimates and funding schedules are presented for a given configuration and costing ground rules. Cost methodology is described and the cost evolution from a baseline configuration to a selected configuration is given, emphasizing cases in which cost was a design driver. Programmatic cost avoidance techniques are discussed.

A meta-analytic examination of the goal orientation nomological net.

PubMed

Payne, Stephanie C; Youngcourt, Satoris S; Beaubien, J Matthew

2007-01-01

The authors present an empirical review of the literature concerning trait and state goal orientation (GO). Three dimensions of GO were examined: learning, prove performance, and avoid performance along with presumed antecedents and proximal and distal consequences of these dimensions. Antecedent variables included cognitive ability, implicit theory of intelligence, need for achievement, self-esteem, general self-efficacy, and the Big Five personality characteristics. Proximal consequences included state GO, task-specific self-efficacy, self-set goal level, learning strategies, feedback seeking, and state anxiety. Distal consequences included learning, academic performance, task performance, and job performance. Generally speaking, learning GO was positively correlated, avoid performance GO was negatively correlated, and prove performance GO was uncorrelated with these variables. Consistent with theory, state GO tended to have stronger relationships with the distal consequences than did trait GO. Finally, using a meta-correlation matrix, the authors found that trait GO predicted job performance above and beyond cognitive ability and personality. These results demonstrate the value of GO to organizational researchers. 2007 APA, all rights reserved

Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain.

PubMed

Barón Esquivias, Gonzalo; Escolar Albaladejo, Ginés; Zamorano, José Luis; Betegón Nicolás, Lourdes; Canal Fontcuberta, Cristina; de Salas-Cansado, Marina; Rubio-Rodríguez, Darío; Rubio-Terrés, Carlos

2015-08-01

Cost-effectiveness analysis of apixaban (5 mg twice daily) vs acenocoumarol (5mg/day) in the prevention of stroke in patients with nonvalvular atrial fibrillation in Spain. Markov model covering the patient's entire lifespan with 10 health states. Data on the efficacy and safety of the drugs were provided by the ARISTOTLE trial. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. The Spanish National Health System and society. Information on the cost of the drugs, complications, and the management of the disease was obtained from Spanish sources. In a cohort of 1000 patients with nonvalvular atrial fibrillation, administration of apixaban rather than acenocoumarol would avoid 18 strokes, 71 hemorrhages (28 intracranial or major), 2 myocardial infarctions, 1 systemic embolism, and 23 related deaths. Apixaban would prolong life (by 0.187 years) and result in more quality-adjusted life years (by 0.194 years) per patient. With apixaban, the incremental costs for the Spanish National Health System and for society would be € 2,488 and € 1,826 per patient, respectively. Consequently, the costs per life year gained would be € 13,305 and € 9,765 and the costs per quality-adjusted life year gained would be € 12,825 and € 9,412 for the Spanish National Health System and for society, respectively. The stability of the baseline case was confirmed by sensitivity analyses. According to this analysis, apixaban may be cost-effective in the prevention of stroke in patients with nonvalvular atrial fibrillation compared with acenocoumarol. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective.

PubMed

Effertz, Tobias; Engel, Susanne; Verheyen, Frank; Linder, Roland

2016-12-01

With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately €29.39 billion and the indirect costs to an additional €33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of €166,911 and each woman of €206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy.

Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study

PubMed Central

2012-01-01

Introduction Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs). Methods Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT. Results A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert). Conclusions In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided. PMID:22314204

Human, free-operant avoidance of “time out” from monetary reinforcement1

PubMed Central

Baron, Alan; Kaufman, Arnold

1966-01-01

To assess the aversive effects of withdrawing monetary reinforcement, human subjects were exposed to a free-operant avoidance procedure in which periods of no reinforcement occurred if the subject failed to respond, and each response postponed withdrawal of reinforcement. Avoidance behavior was developed either through specific instructions about the consequence of responding or through preliminary escape-avoidance training. In all cases, rates of response were found to be a positively accelerated function of decreases in the duration by which responding postponed reinforcement withdrawal. The findings with respect to the function relating avoidance behavior to the interval of postponement were viewed as similar to those obtained when shock is used as the aversive event in free-operant avoidance conditioning. PMID:5964512

48 CFR 31.105 - Construction and architect-engineer contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., include unallowable interest costs, or use improper cost of money rates or computations. Contracting... contracts, including cost-reimbursement subcontracts thereunder; (2) Negotiating indirect cost rates; (3... appropriate they serve to express the parties' understanding and avoid possible subsequent disputes or...

The Use of Parenteral Nutrition Support in an Acute Care Hospital and the Cost Implications of Short-term Parenteral Nutrition.

PubMed

Wong, Alvin Tc; Ong, Jeannie Pl; Han, Hsien Hwei

2016-06-01

Parenteral nutrition (PN) is indicated for patients who are unable to progress to oral or enteral nutrition. There are no local studies done on estimating the cost of PN in acute settings. The aims of this study are to describe the demographics, costs of PN and manpower required; and to determine the avoidable PN costs for patients and hospital on short-term PN. Patient data between October 2011 and December 2013 were reviewed. Data collected include demographics, length of stay (LOS), and the indication/duration of PN. PN administration cost was based on the cost of the PN bags, blood tests and miscellaneous items, adjusted to subsidy levels. Manpower costs were based on the average hourly rate. Costs for PN and manpower were approximately S$1.2 million for 2791 PN days. Thirty-six cases (18.8%) of 140 PN days were short-term and considered to be avoidable where patients progressed to oral/enteral diet within 5 days. These short-term cases totalled $59,154.42, where $42,183.15 was payable by the patients. The daily costs for PN is also significantly higher for patients on short-term PN (P <0.001). In our acute hospital, 90% of patients referred for PN were surgical patients. Majority of the cost comes from the direct daily cost of the bag and blood tests, while extensive manpower cost was borne by the hospital; 18.8% of our cohort had short-term avoidable PN. Daily PN may cost up to 60% more in patients receiving short-term PN. Clinicians should assess patient's suitability for oral/enteral feeding to limit the use of short-term PN.

Anesthetic management of external cephalic version.

PubMed

Chalifoux, Laurie A; Sullivan, John T

2013-09-01

Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery. Copyright © 2013 Elsevier Inc. All rights reserved.

[Cost-benefit analysis of a school-based smoking prevention program].

PubMed

Hormigo Amaro, Jordi; García-Altés, Anna; López, M José; Bartoll, Xavier; Nebot, Manel; Ariza, Carles

2009-01-01

To analyze the efficiency of a school-based smoking prevention program in Barcelona (PASE.bcn program). A cost-benefit analysis was performed. As costs we included those corresponding to the design and implementation of the program. As benefits we considered healthcare costs and the productivity losses avoided. This study was conducted from a societal perspective, and the estimations of costs and benefits related to 2005. Assuming an effectiveness of 1%, the PASE.bcn program would achieve a total benefit of 1,558,311.46euro. The healthcare benefits per prevented smoker were 1997.57euro, and the indirect benefits per prevented smoker were 21,260.80euro. Given the total cost of the school-based program (68,526.03euro), the cost-benefit ratio was 22.74. From a societal perspective, the benefits of school-based tobacco prevention programs, in terms of healthcare costs and productivity losses avoided, are far greater than the costs. These results support universal application of this type of intervention.

Social Approach and Autistic Behavior in Children with Fragile X Syndrome

ERIC Educational Resources Information Center

Roberts, Jane E.; Weisenfeld, Leigh Anne H.; Hatton, Deborah D.; Heath, Morgan; Kaufmann, Walter E.

2007-01-01

Social avoidance is a core phenotypic characteristic of fragile X syndrome (FXS) that has critical cognitive and social consequences. However, no study has examined modulation of multiple social avoidant behaviors in children with FXS. In the current study, we introduce the "Social Approach Scale" (SAS), an observation scale that includes physical…

Space Station: Delays in dealing with space debris may reduce safety and increase costs

NASA Astrophysics Data System (ADS)

1992-06-01

The majority of NASA's current designs for protecting the space station and crew from debris are outdated and its overall debris protection strategy is insufficient. NASA's contractors have designed the station using a 1984 model of the space environment that is obsolete, significantly underestimating the increasing amount of debris that the station will encounter during its 30-year lifetime. In February 1992, NASA directed its space centers to incorporate an updated 1991 model into their designs. However, the agency has not yet made critical decisions on how to implement this change. Preliminary evaluations show that incorporating the 1991 model using currently established safety criteria could entail a major redesign of some components, with significant cost impact and schedule delays. NASA's overall protection strategy for space debris is insufficient. While NASA has concentrated its protection on shielding the space station from small debris and plans to augment this initial shielding in orbit, it has not yet developed designs or studied the cost and operational impact of augmenting its protection with additional shielding. Further, current designs do not provide the capability of warning or protecting the crew from imminent collision with mid-size debris. Finally, although some capabilities exist for maneuvering the station away from large debris, the agency lacks collision-avoidance plans and debris-tracking equipment. In developing a comprehensive strategy to protect the station from the more severe debris environment, NASA cannot avoid some difficult decisions. These decisions involve tradeoffs between how much the agency is willing to pay to protect the station, the schedule delays it may incur, and the risk to station safety it is willing to accept. It is important that these decisions be made before NASA completes its critical design reviews in early 1993. At that time key designs will be made final and manufacturing will begin. Without a comprehensive strategy, NASA will have decided to build the station, knowing the consequences of this decision on station and crew safety, and on life-cycle station cost.

No evidence of inbreeding avoidance despite demonstrated survival costs in a polygynous rodent.

PubMed

Olson, L E; Blumstein, D T; Pollinger, J R; Wayne, R K

2012-02-01

Individuals are generally predicted to avoid inbreeding because of detrimental fitness effects. However, several recent studies have shown that limited inbreeding is tolerated by some vertebrate species. Here, we examine the costs and benefits of inbreeding in a largely polygynous rodent, the yellow-bellied marmot (Marmota flaviventris). We use a pedigree constructed from 8 years of genetic data to determine the relatedness of all marmots in our study population and examine offspring survival, annual male reproductive success, relatedness between breeding pairs and the effects of group composition on likelihood of male reproduction to assess inbreeding in this species. We found decreased survival in inbred offspring, but equal net reproductive success among males that inbred and those that avoided it. Relatedness between breeding pairs was greater than that expected by chance, indicating that marmots do not appear to avoid breeding with relatives. Further, male marmots do not avoid inbreeding: males mate with equal frequency in groups composed of both related and unrelated females and in groups composed of only female relatives. Our results demonstrate that inbreeding can be tolerated in a polygynous species if the reproductive costs of inbreeding are low and individuals that mate indiscriminately do not suffer decreased reproductive success. © 2011 Blackwell Publishing Ltd.

The challenges for scientists in avoiding plagiarism.

PubMed

Fisher, E R; Partin, K M

2014-01-01

Although it might seem to be a simple task for scientists to avoid plagiarism and thereby an allegation of research misconduct, assessment of trainees in the Responsible Conduct of Research and recent findings from the National Science Foundation Office of Inspector General regarding plagiarism suggests otherwise. Our experiences at a land-grant academic institution in assisting researchers in avoiding plagiarism are described. We provide evidence from a university-wide multi-disciplinary course that understanding how to avoid plagiarism in scientific writing is more difficult than it might appear, and that a failure to learn the rules of appropriate citation may cause dire consequences. We suggest that new strategies to provide training in avoiding plagiarism are required.

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence.

PubMed

Rafia, Rachid; Dodd, Peter J; Brennan, Alan; Meier, Petra S; Hope, Vivian D; Ncube, Fortune; Byford, Sarah; Tie, Hiong; Metrebian, Nicola; Hellier, Jennifer; Weaver, Tim; Strang, John

2016-09-01

To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources. A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. Data on attendance to vaccination from a UK cluster randomized trial. Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%. © 2016 Society for the Study of Addiction.

Relationship Between Quality of Comorbid Condition Care and Costs for Cancer Survivors

PubMed Central

Snyder, Claire F.; Herbert, Robert J.; Blackford, Amanda L.; Neville, Bridget A.; Wolff, Antonio C.; Carducci, Michael A.; Earle, Craig C.

2016-01-01

Purpose: To estimate the association between cancer survivors’ comorbid condition care quality and costs; to determine whether the association differs between cancer survivors and other patients. Methods: Using the SEER–Medicare-linked database, we identified survivors of breast, prostate, and colorectal cancers who were diagnosed in 2004, enrolled in Medicare fee-for-service for at least 12 months before diagnosis, and survived ≥ 3 years. Quality of care was assessed using nine process indicators for chronic conditions, and a composite indicator representing seven avoidable outcomes. Total costs on the basis of Medicare amount paid were grouped as inpatient and outpatient. We examined the association between care quality and costs for cancer survivors, and compared this association among 2:1 frequency-matched noncancer controls, using comparisons of means and generalized linear regressions. Results: Our sample included 8,661 cancer survivors and 17,332 matched noncancer controls. Receipt of recommended care was associated with higher outpatient costs for eight indicators, and higher inpatient and total costs for five indicators. For three measures (visit every 6 months for patients with chronic obstructive pulmonary disease or diabetes, and glycosylated hemoglobin or fructosamine every 6 months for patients with diabetes), costs for cancer survivors who received recommended care increased less than for noncancer controls. The absence of avoidable events was associated with lower costs of each type. An annual eye examination for patients with diabetes was associated with lower inpatient costs. Conclusion: Higher-quality processes of care may not reduce short-term costs, but the prevention of avoidable outcomes reduces costs. The association between quality and cost was similar for cancer survivors and noncancer controls. PMID:27165487

A Cost-effectiveness Analysis of Early vs Late Tracheostomy.

PubMed

Liu, C Carrie; Rudmik, Luke

2016-10-01

The timing of tracheostomy in critically ill patients requiring mechanical ventilation is controversial. An important consideration that is currently missing in the literature is an evaluation of the economic impact of an early tracheostomy strategy vs a late tracheostomy strategy. To evaluate the cost-effectiveness of the early tracheostomy strategy vs the late tracheostomy strategy. This economic analysis was performed using a decision tree model with a 90-day time horizon. The economic perspective was that of the US health care third-party payer. The primary outcome was the incremental cost per tracheostomy avoided. Probabilities were obtained from meta-analyses of randomized clinical trials. Costs were obtained from the published literature and the Healthcare Cost and Utilization Project database. A multivariate probabilistic sensitivity analysis was performed to account for uncertainty surrounding mean values used in the reference case. The reference case demonstrated that the cost of the late tracheostomy strategy was $45 943.81 for 0.36 of effectiveness. The cost of the early tracheostomy strategy was $31 979.12 for 0.19 of effectiveness. The incremental cost-effectiveness ratio for the late tracheostomy strategy compared with the early tracheostomy strategy was $82 145.24 per tracheostomy avoided. With a willingness-to-pay threshold of $50 000, the early tracheostomy strategy is cost-effective with 56% certainty. The adaptation of an early vs a late tracheostomy strategy depends on the priorities of the decision-maker. Up to a willingness-to-pay threshold of $80 000 per tracheostomy avoided, the early tracheostomy strategy has a higher probability of being the more cost-effective intervention.

76 FR 68306 - Airworthiness Directives; Bombardier, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... another country to identify and correct an unsafe condition on an aviation product. The MCAI describes the... axle thrust face, damage to the protective coating and consequent stress corrosion. In both cases, the... coating and consequent stress corrosion. In both cases, the MLG did not collapse. In order to avoid future...

Female genital mutilation/cutting type IV in Cambodia: a case report.

PubMed

Abdulcadir, Jasmine; Irion, Olivier; de Tejada, Begoña Martinez

2015-12-01

Nontherapeutic female genital modifications can cause short- and long-term consequences. Caregivers should promote women's self knowledge on genitals' anatomy and physiology, and psychophysical and sexual health. They should also inform on possible negative consequences of vulvar nontherapeutic alterations requested and avoid the medicalization of female genital mutilation.

Understanding Clinical Anger and Violence: The Anger Avoidance Model

ERIC Educational Resources Information Center

Gardner, Frank L.; Moore, Zella E.

2008-01-01

Although anger is a primary emotion and holds clear functional necessities, the presence of anger and its behavioral manifestations of aggression/violence can have serious emotional, health, and social consequences. Despite such consequences, the construct of clinical anger has to date suffered from few theoretical and treatment advancements and…

Measuring Virtual Simulations Value in Training Exercises - USMC Use Case

DTIC Science & Technology

2015-12-04

and cost avoidance and Capt Jonathan Richardson, PM TRASYS, who was the primary author for the After-Action Documentation and Analysis Report ...REFERENCES Cermak J. & McGurk M. (2010, July). Putting a Value On Training. McKinsey Quarterly. Retrieved June 10, 2015 from http://www.mckinsey.com...www.hqmc.marines.mil/Portals/142/Docs/2015CPG_Color.pdf Gordon, S. & Cooley, T. (2013) Phase One Final Report : Cost Avoidance Study of USMC Simulation

Impact of pharmacy student interventions in an urban family medicine clinic.

PubMed

Ginzburg, Regina

2014-06-17

To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions. A prospective, unblinded study was conducted to determine the number and cost avoidance value of clinical interventions made by pharmacy students completing advanced pharmacy practice experiences (APPEs) in an urban family medicine clinic. Eighteen students completed this experience in the 8 months studied. Of the 718 interventions performed, 77% were accepted by physicians, including 58% of the 200 interventions that required immediate action. Projected avoidance was estimated at $61,855. The clinical interventions by pharmacy students were generally well received by healthcare providers and resulted in significant cost savings. Pharmacy students can play an important role in a family medicine clinic.

Targeted Provision of Oral Iron: The Evolution of a Practical Screening Option123

PubMed Central

Crowley, Caitlin R.; Solomons, Noel W.; Schümann, Klaus

2012-01-01

Universal oral iron supplementation, undertaken according to 1998 WHO guidelines, produced adverse consequences among some children in malaria-endemic areas. Prompted by the Pemba trial, which revealed excessive hospitalizations and deaths, WHO advised that iron supplementation in such regions be accompanied by previous screening for iron deficiency. This agenda, however, poses issues of cost, benefit, acceptability, technical feasibility, and reliability of such screening. The cost of equipment and personnel is balanced against savings from iron supplements spared and treatment for morbidity averted. Costs aside, the most efficacious acceptable screening approach for avoiding hospitalization and deaths must be fielded. Screening before supplementation can be used to assess hematological, iron, and possible inflammatory status to differentiate the source of decreased hemoglobin concentration. Iron deficiency has often been inferred from hematological status markers. The need for extraction of blood, albeit capillary in origin, and high assay costs limit the use of validated methods in screening. Noninvasive methods, i.e., not requiring the extraction of blood, provide the most acceptable and potentially least expensive approach for determining hematological or iron status. Although a noninvasive technique for iron and inflammatory status would be the ideal, it is unattained. Field-friendly, skin-probe hemoglobin devices, derived from instruments for clinical settings, are being developed and tested for eventual rollout in malarial areas. Given a firm grounding for the theoretical requirements needed to advance the screening agenda, evaluation and monitoring of the performance of screening devices can proceed hand in hand. PMID:22797993

Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice.

PubMed

O'Mahony, James F; Newall, Anthony T; van Rosmalen, Joost

2015-12-01

Time is an important aspect of health economic evaluation, as the timing and duration of clinical events, healthcare interventions and their consequences all affect estimated costs and effects. These issues should be reflected in the design of health economic models. This article considers three important aspects of time in modelling: (1) which cohorts to simulate and how far into the future to extend the analysis; (2) the simulation of time, including the difference between discrete-time and continuous-time models, cycle lengths, and converting rates and probabilities; and (3) discounting future costs and effects to their present values. We provide a methodological overview of these issues and make recommendations to help inform both the conduct of cost-effectiveness analyses and the interpretation of their results. For choosing which cohorts to simulate and how many, we suggest analysts carefully assess potential reasons for variation in cost effectiveness between cohorts and the feasibility of subgroup-specific recommendations. For the simulation of time, we recommend using short cycles or continuous-time models to avoid biases and the need for half-cycle corrections, and provide advice on the correct conversion of transition probabilities in state transition models. Finally, for discounting, analysts should not only follow current guidance and report how discounting was conducted, especially in the case of differential discounting, but also seek to develop an understanding of its rationale. Our overall recommendations are that analysts explicitly state and justify their modelling choices regarding time and consider how alternative choices may impact on results.

Nonisothermal glass molding for the cost-efficient production of precision freeform optics

NASA Astrophysics Data System (ADS)

Vu, Anh-Tuan; Kreilkamp, Holger; Dambon, Olaf; Klocke, Fritz

2016-07-01

Glass molding has become a key replication-based technology to satisfy intensively growing demands of complex precision optics in the today's photonic market. However, the state-of-the-art replicative technologies are still limited, mainly due to their insufficiency to meet the requirements of mass production. This paper introduces a newly developed nonisothermal glass molding in which a complex-shaped optic is produced in a very short process cycle. The innovative molding technology promises a cost-efficient production because of increased mold lifetime, less energy consumption, and high throughput from a fast process chain. At the early stage of the process development, the research focuses on an integration of finite element simulation into the process chain to reduce time and labor-intensive cost. By virtue of numerical modeling, defects including chill ripples and glass sticking in the nonisothermal molding process can be predicted and the consequent effects are avoided. In addition, the influences of process parameters and glass preforms on the surface quality, form accuracy, and residual stress are discussed. A series of experiments was carried out to validate the simulation results. The successful modeling, therefore, provides a systematic strategy for glass preform design, mold compensation, and optimization of the process parameters. In conclusion, the integration of simulation into the entire nonisothermal glass molding process chain will significantly increase the manufacturing efficiency as well as reduce the time-to-market for the mass production of complex precision yet low-cost glass optics.

[Prevention of Occupational Injuries Related to Hands: Calculation of Subsequent Injury Costs for the Austrian Social Occupational Insurance Institution (AUVA)].

PubMed

Rauner, M S; Mayer, B; Schaffhauser-Linzatti, M M

2015-08-01

Occupational injuries cause short-term, direct costs as well as long-term follow-up costs over the lifetime of the casualties. Due to shrinking budgets accident insurance companies focus on cost reduction programmes and prevention measures. For this reason, a decision support system for consequential cost calculation of occupational injuries was developed for the main Austrian social occupational insurance institution (AUVA) during three projects. This so-called cost calculation tool combines the traditional instruments of accounting with quantitative methods such as micro-simulation. The cost data are derived from AUVA-internal as well as external economic data sources. Based on direct and indirect costs, the subsequent occupational accident costs from the time of an accident and, if applicable, beyond the death of the individual casualty are predicted for the AUVA, the companies in which the casualties are working, and the other economic sectors. By using this cost calculation tool, the AUVA classifies risk groups and derives related prevention campaigns. In the past, the AUVA concentrated on falling, accidents at construction sites and in agriculture/forestry, as well as commuting accidents. Currently, among others, a focus on hand injuries is given and first prevention programmes have been initiated. Hand injuries represent about 38% of all casualties with average costs of about 7,851 Euro/case. Main causes of these accidents are cutting injuries in production, agriculture, and forestry. Beside a low, but costly, number of amputations with average costs of more than 100,000 Euro/case, bone fractures and strains burden the AUVA-budget with about 17,500 and 10,500 € per case, respectively. Decision support systems such as this cost calculation tool represent necessary instruments to identify risk groups and their injured body parts, causes of accidents, and economic activities, which highly burden the budget of an injury company, and help derive countermeasures to avoid injuries. Target-group specific, suitable prevention measures for hand injuries can reduce accidents in a cost-effective way and lower their consequences. © Georg Thieme Verlag KG Stuttgart · New York.

Individual and Sex Differences in the Consequences of Victimization: Moderation by Approach and Avoidance Motivation

ERIC Educational Resources Information Center

Llewellyn, Nicole; Rudolph, Karen D.

2014-01-01

Peer victimization is a known risk factor for various forms of maladjustment; however, the specific type of maladjustment may depend on individual differences in youth. This 2-wave longitudinal study examined the hypothesis that social approach-avoidance motivation, together with sex, would moderate the contribution of 3rd-grade victimization to…

House Construction: How To Reduce Costs

Treesearch

Jerry O. Newman; Norman C. Teter; Constance D. O' Brien

1969-01-01

You're building a house and want to keep down the cost. How can you do it? First, plan carefully "on paper" before you start construction. By doing so, you can avoid costly mistakesinthebuildingandinthe purchase of materials. Careful planning and proper design will reduce not only the initial cost but also the cost of furnishings, utilities, and...

75 FR 25981 - Cost Accounting Standards: Harmonization of Cost Accounting Standards 412 and 413 With the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-10

...), invites public comments concerning the harmonization of Cost Accounting Standards 412 and 413 with the... cost that is based on currently accrued benefits that have been valued using corporate bond rates... that avoid undue cost or contribution volatility. The Board agrees with the public comments that since...

Dutasteride plus tamsulosin fixed-dose combination first-line therapy versus tamsulosin monotherapy in the treatment of benign prostatic hyperplasia: a budget impact analysis in the Greek healthcare setting.

PubMed

Geitona, Maria; Karabela, Pinelopi; Katsoulis, Ioannis A; Kousoulakou, Hara; Lyberopoulou, Eleni; Bitros, Eleftherios; Xaplanteris, Loukas; Papanicolaou, Sotiria

2014-09-26

The purpose of this study was to explore the budget impact of dutasteride plus tamsulosin fixed-dose combination (DUT + TAM FDC) versus tamsulosin monotherapy, in the treatment of patients with benign prostatic hyperplasia (BPH) from the perspective of the Greek healthcare insurance system. A Microsoft Excel-based model was developed to estimate the financial consequences of adopting DUT + TAM FDC within the Greek healthcare setting. The model, compared six mutually exclusive health states in two alternative treatment options: current standard of care and the introduction of DUT + TAM FDC in the market. The model used clinical inputs from the CombAT study; data on resource use associated with the management of BPH in Greece were derived from expert panel, and unit cost data were derived from official reimbursement tariffs. A payer perspective was taken into account. As patient distribution data between public and private sectors are not available in Greece two scenarios were investigated, considering the whole eligible population in each scenario. A 4 year time horizon was taken into account and included treatment costs, number of transurethral resections of the prostate (TURPs) and acute urinary retention (AUR) episodes avoided. The clinical benefit from the market adoption of DUT + TAM FDC in Greece was 1,758 TURPs and 972 episodes of AUR avoided cumulatively in a four year period. The increase in total costs from the gradual introduction of DUT + TAM FDC to the Greek healthcare system ranges from €1.3 million in the first year to €5.8 million in the fourth year, for the public sector, and €1.2 million to €4.0 million, for the private sector. This represents an increase of 1.91% to 7.94% for the public sector and 1.10% 3.29% in the private sector, during the 4-year time horizon. Budget impact analysis (BIA) results indicated that the gradual introduction of DUT + TAM FDC, would increase the overall budget of the disease, however providing better clinical outcomes. DUT + TAM FDC drug acquisition cost is partly offset by the reduction in the costs associated with the treatment of the disease.

Vision Amniotic Leak Detector (ALD) to Eliminate Amniotic Fluid Leakage as a Cause of Vaginal Wetness in Pregnancy: A NICE Medical Technology Guidance.

PubMed

Ray, A F; Peirce, S C; Wilkes, A R; Carolan-Rees, G

2015-10-01

In prelabour rupture of membranes (PROM) or preterm PROM the amniotic membranes rupture prior to labour. Where this is not overt a speculum examination is undertaken to confirm diagnosis. The Vision Amniotic Leak Detector (ALD) is a panty liner that can diagnose amniotic fluid as a cause of vaginal wetness. It was evaluated by the UK National Institute for Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme. The sponsor (CommonSense Ltd) identified five studies, of which three were deemed within scope by the External Assessment Centre (EAC). Two of these three used an inappropriate comparator. The EAC recalculated the diagnostic accuracy of Vision ALD using speculum examination as the comparator: sensitivity of 97% (95% CI 93-99%), negative predictive value of 96% (95% CI 92-98%). A negative result would therefore allow patients to be discharged with confidence. In the sponsor's cost-consequence model only patients with a positive Vision ALD result would have a speculum examination, producing a cost saving of around £10 per patient. The EAC felt that some costs were unjustified and the model did not include infection outcomes or use in a community setting. The EAC revised the sponsor's model and found the results were most sensitive to clinician costs. Vision ALD was associated with savings of around £15-£25 per patient when administration in lower-cost community healthcare avoided a referral to a higher-cost secondary-care centre. NICE published guidance MTG15 in July 2013 recommending that the case for adopting Vision ALD was supported by the evidence.

Changing of the Bulbs.

ERIC Educational Resources Information Center

Baba, Keith

1995-01-01

Explains how a school's use of compact fluorescents can reduce operating costs and maintain performance. Indicates that energy cost savings can repay the initial costs of buying incandescent bulbs in as short as 12 months with continuing savings thereafter. Tips for avoiding costly mistakes in lighting retrofits are highlighted. (GR)

Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program.

PubMed

Morphew, Tricia; Scott, Lyne; Li, Marilyn; Galant, Stanley P; Wong, Webster; Garcia Lloret, Maria I; Jones, Felita; Bollinger, Mary Elizabeth; Jones, Craig A

2013-08-01

Underserved populations have limited access to care. Improved access to effective asthma care potentially improves quality of life and reduces costs associated with emergency department (ED) visits. The purpose of this study is to examine return on investment (ROI) for the Breathmobile Program in terms of improved patient quality-adjusted life years saved and reduced costs attributed to preventable ED visits for 2010, with extrapolation to previous years of operation. It also examines cost-benefit related to reduced morbidity (ED visits, hospitalizations, and school absenteeism) for new patients to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits). This is a retrospective analysis of data for 15,986 pediatric patients, covering 88,865 visits, participating in 4 Southern California Breathmobile Programs (November 16, 1995-December 31, 2010). The ROI calculation expressed the cost-benefit ratio as the net benefits (ED costs avoided+relative value of quality-adjusted life years saved) over the per annum program costs (∼$500,000 per mobile). The ROI across the 4 California programs in 2010 was $6.73 per dollar invested. Annual estimated emergency costs avoided in the 4 regions were $2,541,639. The relative value of quality-adjusted life years saved was $24,381,000. For patients new to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits), total annual morbidity costs avoided per patient were $1395. This study suggests that mobile health care is a cost-effective strategy to deliver medical care to underserved populations, consistent with the Triple Aims of Therapy.

Cost and benefit estimates of partially-automated vehicle collision avoidance technologies.

PubMed

Harper, Corey D; Hendrickson, Chris T; Samaras, Constantine

2016-10-01

Many light-duty vehicle crashes occur due to human error and distracted driving. Partially-automated crash avoidance features offer the potential to reduce the frequency and severity of vehicle crashes that occur due to distracted driving and/or human error by assisting in maintaining control of the vehicle or issuing alerts if a potentially dangerous situation is detected. This paper evaluates the benefits and costs of fleet-wide deployment of blind spot monitoring, lane departure warning, and forward collision warning crash avoidance systems within the US light-duty vehicle fleet. The three crash avoidance technologies could collectively prevent or reduce the severity of as many as 1.3 million U.S. crashes a year including 133,000 injury crashes and 10,100 fatal crashes. For this paper we made two estimates of potential benefits in the United States: (1) the upper bound fleet-wide technology diffusion benefits by assuming all relevant crashes are avoided and (2) the lower bound fleet-wide benefits of the three technologies based on observed insurance data. The latter represents a lower bound as technology is improved over time and cost reduced with scale economies and technology improvement. All three technologies could collectively provide a lower bound annual benefit of about $18 billion if equipped on all light-duty vehicles. With 2015 pricing of safety options, the total annual costs to equip all light-duty vehicles with the three technologies would be about $13 billion, resulting in an annual net benefit of about $4 billion or a $20 per vehicle net benefit. By assuming all relevant crashes are avoided, the total upper bound annual net benefit from all three technologies combined is about $202 billion or an $861 per vehicle net benefit, at current technology costs. The technologies we are exploring in this paper represent an early form of vehicle automation and a positive net benefit suggests the fleet-wide adoption of these technologies would be beneficial from an economic and social perspective. Copyright © 2016 Elsevier Ltd. All rights reserved.

Vaccination against herpes zoster and postherpetic neuralgia in France: a cost-effectiveness analysis.

PubMed

Bresse, Xavier; Annemans, Lieven; Préaud, Emmanuelle; Bloch, Karine; Duru, Gérard; Gauthier, Aline

2013-06-01

This study assesses the cost-effectiveness of vaccination against herpes zoster (HZ) and postherpetic neuralgia in France, using a published Markov model. The cost-effectiveness of vaccinating individuals aged from 65 years or between 70 and 79 years was evaluated over their lifetime, from a third-party payer perspective. French-specific data were combined with results from clinical studies and international quality-of-life-based (EuroQol five-dimension questionnaire) utilities from the literature. HZ vaccination was highly cost effective in both populations. Incremental cost-effective ratios were estimated between €9513 and 12,304 per quality-adjusted life year gained, corresponding to €2240-2651 per HZ case avoided and €3539-4395 per postherpetic neuralgia case avoided. In addition to epidemiological and clinical evidence, economic evidence also supports the implementation of HZ vaccination in France.

[QUATERNARY PREVENTION: AN ATTEMPT TO AVOID THE EXCESSES OF MEDICINE].

PubMed

Noble, María

2015-01-01

Seduced by technology, biometrics, practical guidelines and the use of medication, medicine has been driven away from the subject of its care. Quaternary prevention is, among other voices around the world, trying to denounce the consequent excesses of medical practice given by this situation. There are visible excesses, such as the long list of studies being performed on patients without indication, and others, much more subtle, as excessive prevention and the continuous and progressive medicalization of life itself that are rooted in our culture and demanded by a society that requests certainty at almost any cost. Quaternary prevention proposes a series of actions leaning towards avoiding and diminishing the damage produced by health care activities, in order to protect the subject of overdiagnosis and overtreatment; offering also ethical and viable alternatives in which the balance of risks and benefits (based on the best evidences) respects the autonomy of the subject by properly informing and allowing him to decide among the best options he has; altogether in a process that contemplates a rational and equitable use of resources. In order to achieve this, reliable sources of information and a medical education not dependent on industries related to technology or pharmaceuticals, are vital; in conjuction with a medicine that restablishes the subject as its main and central interest.

[Quaternary prevention: An attempt to avoid the excesses of Medicine].

PubMed

Noble, María

2015-09-01

Seduced by technology, biometrics, practical guidelines and the use of medication, medicine has been driven away from the subject of its care. Quaternary prevention is, among other voices around the world, trying to denounce the consequent excesses of medical practice given by this situation. There are visible excesses, such as the long list of studies being performed on patients without indication, and others, much more subtle, as excessive prevention and the continuous and progressive medicalization of life itself that are rooted in our culture and demanded by a society that requests certainty at almost any cost. Quaternary prevention proposes a series of actions leaning towards avoiding and diminishing the damage produced by health care activities, in order to protect the subject of overdiagnosis and overtreatment; offering also ethical and viable alternatives in which the balance of risks and benefits (based on the best evidences) respects the autonomy of the subject by properly informing and allowing him to decide among the best options he has; altogether in a process that contemplates a rational and equitable use of resources. In order to achieve this, reliable sources of information and a medical education not dependent on industries related to technology or pharmaceuticals, are vital; in conjuction with a medicine that restablishes the subject as its main and central interest.

The Instability of Astrophysics Witnessed in the Twentieth Century

NASA Astrophysics Data System (ADS)

Harwit, Martin

2014-01-01

Scientific progress entails instabilities that advance a field; but excessive instability, often arising from misunderstandings, thwarts planning and adds cost. The history of 20th century astronomy provides insight on several factors that make astronomy and astrophysics exceptionally unstable. A fundamental source of instability is astronomy’s inability, sometimes for decades at a time, to pursue discoveries of rare events systematically. Such delays inject levels of uncertainty in an observational science that are more readily avoided in the experimental sciences. Beneficial instabilities can arise through the import of novel theories and tools from sister sciences, industry or the military. Such imports, however, can also destabilize the field. Astronomy comprises many distinct disciplines, which need to interact coherently for a broader understanding of the Cosmos to emerge. As the complexity of these disciplines’ undertakings increases, and their respective uses of tools and vocabularies diverge, misunderstandings arise to threaten coherence. Misinformation can then cascade back and forth, with consequences similar to those of failures in electrical power grinds and financial meltdowns. A balance needs to be sought, which protects astrophysics against such failures, while permitting ready discourse so the whole field can benefit from genuine advances in its respective disciplines. I will discuss means by which the benefits of instabilities advancing the field may be retained while avoiding more damaging instabilities.

Anxiety sensitivity moderates behavioral avoidance in anxious youth.

PubMed

Lebowitz, Eli R; Shic, Frederick; Campbell, Daniel; Basile, Krista; Silverman, Wendy K

2015-11-01

Individuals who are high in anxiety sensitivity (AS) are motivated to avoid sensations of anxiety. Consequently, AS is hypothesized to contribute to overall avoidance of any feared stimuli. No studies have yet examined whether fear of a stimulus is a stronger predictor of behavioral avoidance in individuals who are high in AS compared to individuals who are low in AS. We examined whether AS moderates the association between fear of spiders and behavioral avoidance of spider stimuli in 50 clinically anxious youth. Fear of spiders significantly predicted avoidance of spider stimuli in youth high in AS but not in youth low in AS. These results provide support for the role of AS in avoidant behavior and help to explain the link between AS and the anxiety disorders. The results have implications for exposure-based anxiety treatments and highlight the importance of increasing anxious patients' ability to tolerate sensations of anxiety. Copyright © 2015 Elsevier Ltd. All rights reserved.

California's High School Dropouts: Examining the Fiscal Consequences

ERIC Educational Resources Information Center

Stuit, David A.; Springer, Jeffrey A.

2010-01-01

This report analyzes the economic and social costs of the high school dropout problem in California from the perspective of a state taxpayer. The authors' analysis considers the consequences of this problem in terms of labor market, tax revenue, public health, and incarceration costs. The authors' quantification of these costs reveals the sizeable…

The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review

PubMed Central

Muszbek, N; Brixner, D; Benedict, A; Keskinaslan, A; Khan, Z M

2008-01-01

Objectives To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions. Methods English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively. Results Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified. Conclusions Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue. PMID:18199282

Avoiding and identifying errors and other threats to the credibility of health economic models.

PubMed

Tappenden, Paul; Chilcott, James B

2014-10-01

Health economic models have become the primary vehicle for undertaking economic evaluation and are used in various healthcare jurisdictions across the world to inform decisions about the use of new and existing health technologies. Models are required because a single source of evidence, such as a randomised controlled trial, is rarely sufficient to provide all relevant information about the expected costs and health consequences of all competing decision alternatives. Whilst models are used to synthesise all relevant evidence, they also contain assumptions, abstractions and simplifications. By their very nature, all models are therefore 'wrong'. As such, the interpretation of estimates of the cost effectiveness of health technologies requires careful judgements about the degree of confidence that can be placed in the models from which they are drawn. The presence of a single error or inappropriate judgement within a model may lead to inappropriate decisions, an inefficient allocation of healthcare resources and ultimately suboptimal outcomes for patients. This paper sets out a taxonomy of threats to the credibility of health economic models. The taxonomy segregates threats to model credibility into three broad categories: (i) unequivocal errors, (ii) violations, and (iii) matters of judgement; and maps these across the main elements of the model development process. These three categories are defined according to the existence of criteria for judging correctness, the degree of force with which such criteria can be applied, and the means by which these credibility threats can be handled. A range of suggested processes and techniques for avoiding and identifying these threats is put forward with the intention of prospectively improving the credibility of models.

The cost-effectiveness of beta-radiation therapy for treatment of in-stent restenosis: an analysis at 290-day follow-up.

PubMed

Beusterien, Kathleen M; Plante, Kathryn M; Waksman, Ron; Raizner, Albert E; Annis, Marijke; Goss, Thomas F

2002-01-01

We studied the cost-effectiveness of percutaneous coronary intervention (PCI) plus beta-radiation (Radiotherapy) vs. PCI alone for treating in-stent restenosis. We analyzed medical resource data collected at US sites during the Intimal Hyperplasia Inhibition with beta In-stent Trial (INHIBIT) to compare the incremental costs between Radiotherapy and PCI alone for each repeat target lesion revascularization (TLR) avoided. Costs were assigned for cardiac-related medical services using the Medicare payer perspective. Radiotherapy increased initial inpatient costs by US$3360 (P<.001). In the Radiotherapy and PCI alone groups, the mean per-patient rates for TLR were 0.13 vs. 0.30 (P=.001), and mean per-patient total costs were US$19,286 vs. US$18,349 (P<.001), respectively. The incremental cost of Radiotherapy relative to PCI alone was US$5512 per TLR avoided, which compares favorably to the observed mean per-patient cost of treating restenosis (US$16,852). beta-radiation is a cost-effective adjunct to PCI in treating patients with in-stent restenosis.

Quasi-experimental study designs series-paper 4: uses and value.

PubMed

Bärnighausen, Till; Tugwell, Peter; Røttingen, John-Arne; Shemilt, Ian; Rockers, Peter; Geldsetzer, Pascal; Lavis, John; Grimshaw, Jeremy; Daniels, Karen; Brown, Annette; Bor, Jacob; Tanner, Jeffery; Rashidian, Arash; Barreto, Mauricio; Vollmer, Sebastian; Atun, Rifat

2017-09-01

Quasi-experimental studies are increasingly used to establish causal relationships in epidemiology and health systems research. Quasi-experimental studies offer important opportunities to increase and improve evidence on causal effects: (1) they can generate causal evidence when randomized controlled trials are impossible; (2) they typically generate causal evidence with a high degree of external validity; (3) they avoid the threats to internal validity that arise when participants in nonblinded experiments change their behavior in response to the experimental assignment to either intervention or control arm (such as compensatory rivalry or resentful demoralization); (4) they are often well suited to generate causal evidence on long-term health outcomes of an intervention, as well as nonhealth outcomes such as economic and social consequences; and (5) they can often generate evidence faster and at lower cost than experiments and other intervention studies. Copyright © 2017 Elsevier Inc. All rights reserved.

HealthMarts, HIPCs (health insurance purchasing cooperatives), MEWAs (multiple employee welfare arrangements), and AHPs (association health plans): a guide for the perplexed.

PubMed

Hall, M A; Wicks, E K; Lawlor, J S

2001-01-01

This paper considers how pending proposals to authorize new forms of group purchasing arrangements for health insurance would fit and function within the existing, highly complex market and regulatory landscape and whether these proposals are likely to meet their stated objectives and avoid unintended consequences. Cost savings are more likely to result from increased risk segmentation than through true market efficiencies. Thus, these proposals could erode previous market reforms whose goal is increased risk pooling. On the other hand, these proposals contain important enhancements, clarifications, and simplification of state and federal regulatory oversight of group purchasing vehicles. Also, they address some of the problems that have hampered the performance of purchasing cooperatives. On balance, although these proposals should receive cautious and careful consideration, they are not likely to produce a significant overall reduction in premiums or increase in coverage.

Is it adequate to carry out a chest-CT in patients with mild-moderate chest trauma?

PubMed

García de Pereda de Blas, V; Carreras Aja, M; Carbajo Azabal, S; Arana-Arri, E

2017-10-12

Mild-moderate blunt chest trauma is defined as a blunt chest trauma that is not caused by a high-energy mechanism, causing thoracic tenderness with or without rib fractures and that has no immediate life-threatening consequences for the patient. It is a frequent clinical situation in the emergency department. The most common radiological techniques that are used in this context are chest X-ray and thoracic computed tomography (CT). The CT scan is set as the gold standard. However, there are no current clinical-radiological guidelines that establish the adequacy of the requests of the CT scan. Therefore, we decided to search for evidence-based recommendations to improve the adequacy of the chest X-ray and CT scan in our daily practice in order to reduce the costs and avoid unnecessary radiation exposure. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Deterrence and transmission as mechanisms ensuring reliability of gossip.

PubMed

Giardini, Francesca

2012-10-01

Spreading information about the members of one's group is one of the most universal human behaviors. Thanks to gossip, individuals can acquire the information about their peers without sustaining the burden of costly interactions with cheaters, but they can also create and revise social bonds. Gossip has also several positive functions at the group level, promoting cohesion and norm compliance. However, gossip can be unreliable, and can be used to damage others' reputation or to circulate false information, thus becoming detrimental to people involved and useless for the group. In this work, we propose a theoretical model in which reliability of gossip depends on the joint functioning of two distinct mechanisms. Thanks to the first, i.e., deterrence, individuals tend to avoid informational cheating because they fear punishment and the disruption of social bonds. On the other hand, transmission provides humans with the opportunity of reducing the consequences of cheating through a manipulation of the source of gossip.

Health economic review of recombinant activated factor VII for treatment of bleeding episodes in hemophilia patients with inhibitors.

PubMed

Stephens, Jennifer M; Joshi, Ashish V; Sumner, Michael; Botteman, Marc F

2007-06-01

Severe hemophilia with inhibitors is a rare disease with substantial clinical, humanistic and economic consequences. This review provides an overview of the role of recombinant activated factor VII (rFVIIa) versus plasma-derived bypassing agents for hemophilia with inhibitors and summarizes the 13 formal economic analyses (6 burden of illness and 7 comparative studies) that have been published in this indication. The findings suggest that the economic impact of rFVIIa has occurred primarily during hospitalization to manage major bleeding episodes and to allow for elective orthopedic surgeries that would not have been attempted prior to rFVIIa. Comparative analyses for on-demand treatment suggest that the total cost of treating a bleeding episode with rFVIIa may be lower than with plasma-based agents due to faster bleeding resolution, higher initial efficacy rates and avoidance of second and third lines of treatment.

Advertising to the enemy: enhanced floral fragrance increases beetle attraction and reduces plant reproduction.

PubMed

Theis, Nina; Adler, Lynn S

2012-02-01

Many organisms face challenges in avoiding predation while searching for mates. For plants, emitting floral fragrances to advertise reproductive structures could increase the attraction of detrimental insects along with pollinators. Very few studies have experimentally evaluated the costs and benefits of fragrance emission with explicit consideration of how plant fitness is affected by both pollinators and florivores. To determine the reproductive consequences of increasing the apparency of reproductive parts, we manipulated fragrance, pollination, and florivores in the wild Texas gourd, Cucurbita pepo var. texana. With enhanced fragrance we found an increase in the attraction of florivores, rather than pollinators, and a decrease in seed production. This study is the first to demonstrate that enhanced floral fragrance can increase the attraction of detrimental florivores and decrease plant reproduction, suggesting that florivory as well as pollination has shaped the evolution of floral scent.

A Novel General Imaging Formation Algorithm for GNSS-Based Bistatic SAR.

PubMed

Zeng, Hong-Cheng; Wang, Peng-Bo; Chen, Jie; Liu, Wei; Ge, LinLin; Yang, Wei

2016-02-26

Global Navigation Satellite System (GNSS)-based bistatic Synthetic Aperture Radar (SAR) recently plays a more and more significant role in remote sensing applications for its low-cost and real-time global coverage capability. In this paper, a general imaging formation algorithm was proposed for accurately and efficiently focusing GNSS-based bistatic SAR data, which avoids the interpolation processing in traditional back projection algorithms (BPAs). A two-dimensional point target spectrum model was firstly presented, and the bulk range cell migration correction (RCMC) was consequently derived for reducing range cell migration (RCM) and coarse focusing. As the bulk RCMC seriously changes the range history of the radar signal, a modified and much more efficient hybrid correlation operation was introduced for compensating residual phase errors. Simulation results were presented based on a general geometric topology with non-parallel trajectories and unequal velocities for both transmitter and receiver platforms, showing a satisfactory performance by the proposed method.

Compaction behavior of out-of-autoclave prepreg materials

NASA Astrophysics Data System (ADS)

Serrano, Léonard; Olivier, Philippe; Cinquin, Jacques

2017-10-01

The main challenges with composite parts manufacturing are related to the curing means, mainly autoclaves, the length of their cycles and their operating costs. In order to decrease this dependency, out of autoclave materials have been considered as a solution for high production rate parts such as spars, flaps, etc… However, most out-of-autoclave process do not possess the same maturity as their counterpart, especially concerning part quality1. Some pre-cure processes such as compaction and ply lay-up are usually less of a concern for autoclave manufacturing: the pressure applied during the cycle participates to reduce the potential defects (porosity caused by a poor quality lay-up, bad compaction, entrapped air or humidity…). For out-of-autoclave parts, those are crucial steps which may have many consequences on the final quality of the laminate2. In order to avoid this quality loss, those steps must be well understood.

Readiness: observations and comments from a medical team deployment.

PubMed

Popper, S E; Noble, D E; Mason, L J; Schaffer, L A; Glover, J G; Barkley, M S

1997-02-01

The evolving strategy of the United States in dealing with the changing world order calls for a force structure capable of fighting and winning two nearly simultaneous major regional conflicts and conducting a range of other military operations. Readiness is a key factor in this new strategy. Consequently, major paradigm shifts are occurring within the Air Force Medical Service. Maintaining current and accurate medical records on personnel to meet deployment requirements is a significant challenge. Historically, time and resources are consumed determining the deployability of troops prior to a deployment. This adds to the cost of doing business and increases the time required to clear the deploying team, even though there is an established process to avoid these very problems. The experience of a recent medical team deployment to Bosnia is discussed. Future directions given the implementation of TRI-CARE, the Preventive Health Assessment Program, and the Strategic Health Resourcing Plan are also considered.

A Novel General Imaging Formation Algorithm for GNSS-Based Bistatic SAR

PubMed Central

Zeng, Hong-Cheng; Wang, Peng-Bo; Chen, Jie; Liu, Wei; Ge, LinLin; Yang, Wei

2016-01-01

Global Navigation Satellite System (GNSS)-based bistatic Synthetic Aperture Radar (SAR) recently plays a more and more significant role in remote sensing applications for its low-cost and real-time global coverage capability. In this paper, a general imaging formation algorithm was proposed for accurately and efficiently focusing GNSS-based bistatic SAR data, which avoids the interpolation processing in traditional back projection algorithms (BPAs). A two-dimensional point target spectrum model was firstly presented, and the bulk range cell migration correction (RCMC) was consequently derived for reducing range cell migration (RCM) and coarse focusing. As the bulk RCMC seriously changes the range history of the radar signal, a modified and much more efficient hybrid correlation operation was introduced for compensating residual phase errors. Simulation results were presented based on a general geometric topology with non-parallel trajectories and unequal velocities for both transmitter and receiver platforms, showing a satisfactory performance by the proposed method. PMID:26927117

Electronic health records: postadoption physician satisfaction and continued use.

PubMed

Wright, Edward; Marvel, Jon

2012-01-01

One goal of public-policy makers in general and health care managers in particular is the adoption and efficient utilization of electronic health record (EHR) systems throughout the health care industry. Consequently, this investigation focused on the effects of known antecedents of technology adoption on physician satisfaction with EHR technology and the continued use of such systems. The American Academy of Family Physicians provided support in the survey of 453 physicians regarding their satisfaction with their EHR use experience. A conceptual model merging technology adoption and computer user satisfaction models was tested using structural equation modeling. Results indicate that effort expectancy (ease of use) has the most substantive effect on physician satisfaction and the continued use of EHR systems. As such, health care managers should be especially sensitive to the user and computer interface of prospective EHR systems to avoid costly and disruptive system selection mistakes.

Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review.

PubMed

Barnard, Katharine; Thomas, Sian; Royle, Pamela; Noyes, Kathryn; Waugh, Norman

2010-07-15

Many children with type 1 diabetes have poor glycaemic control. Since the Diabetes Control and Complications Trial (DCCT) showed that tighter control reduces complication rates, there has been more emphasis on intensified insulin therapy. We know that patients and families are afraid of hypoglycaemia. We hypothesised that fear of hypoglycaemia might take precedence over concern about long-term complications, and that behaviour to avoid hypoglycaemia might be at the cost of poorer control, and aimed to evaluate the effectiveness of any interventions designed to prevent that. The objective of this review was to systematically review studies concerning the extent and consequences of fear of hypoglycaemia in parents of children under 12 years of age with type 1 diabetes, and interventions to reduce it. MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of EASD, ADA and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK CRN, scrutiny of bibliographies of retrieved papers and contact with experts in the field.Inclusions: Relevant studies of any design of parents of children under 12 years of age with Type 1 diabetes were included. The key outcomes were the extent and impact of fear, hypoglycaemia avoidance behaviour in parents due to parental fear of hypoglycaemia in their children, the effect on diabetes control, and the impact of interventions to reduce this fear and hypoglycaemia avoidance behaviour. Eight articles from six studies met the inclusion criteria. All were cross sectional studies and most were of good quality. Parental fear of hypoglycaemia, anxiety and depression were reported to be common. There was a paucity of evidence on behaviour to avoid hypoglycaemia, but there were some suggestions that higher than desirable blood glucose levels might be permitted in order to avoid hypoglycaemia. No studies reporting interventions to reduce parental fear of hypoglycaemia were found. The evidence base was limited. Parents of children with Type 1 diabetes reported considerable parental fear of hypoglycaemia, affecting both parental health and quality of life. There is some suggestion that hypoglycaemia avoidance behaviours by parents might adversely affect glycaemic control. Trials of interventions to reduce parental anxiety and hypoglycaemia avoidance behaviour are needed. We suggest that there should be a trial of structured education for parents of young children with Type 1 diabetes.

Cost savings from a telemedicine model of care in northern Queensland, Australia.

PubMed

Thaker, Darshit A; Monypenny, Richard; Olver, Ian; Sabesan, Sabe

2013-09-16

To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services. Retrospective cost-savings analysis; and a one-way sensitivity analysis performed to test the robustness of findings in net savings. Records of all patients managed by means of teleoncology at the Townsville Cancer Centre (TCC) and its six rural satellite centres in northern Queensland, Australia between 1 March 2007 and 30 November 2011. Costs for set-up and staffing to manage the service, and savings from avoidance of travel expenses for specialist oncologists, patients and their escorts, and for aeromedical retrievals. There were 605 teleoncology consultations with 147 patients over 56 months, at a total cost of $442 276. The cost for project establishment was $36 000, equipment/maintenance was $143 271, and staff was $261 520. The estimated travel expense avoided was $762 394; this figure included the costs of travel for patients and escorts of $658 760, aeromedical retrievals of $52 400 and travel for specialists of $47 634, as well as an estimate of accommodation costs for a proportion of patients of $3600. This resulted in a net saving of $320 118. Costs would have to increase by 72% to negate the savings. The teleoncology model of care at the TCC resulted in net savings, mainly due to avoidance of travel costs. Such savings could be redirected to enhancing rural resources and service capabilities. This teleoncology model is applicable to geographically distant areas requiring lengthy travel.

Allergen avoidance.

PubMed

Woodcock, A; Custovic, A

2000-12-09

Allergen exposure is a risk factor for sensitisation, prevalence and severity of allergic disease. Effective allergen avoidance strategies have been devised. The cost-benefit in public health terms should be established by prospective controlled studies that are under way around the world.

Evidence for frequent incest in a cooperatively breeding mammal.

PubMed

Nichols, H J; Cant, M A; Hoffman, J I; Sanderson, J L

2014-12-01

As breeding between relatives often results in inbreeding depression, inbreeding avoidance is widespread in the animal kingdom. However, inbreeding avoidance may entail fitness costs. For example, dispersal away from relatives may reduce survival. How these conflicting selection pressures are resolved is challenging to investigate, but theoretical models predict that inbreeding should occur frequently in some systems. Despite this, few studies have found evidence of regular incest in mammals, even in social species where relatives are spatio-temporally clustered and opportunities for inbreeding frequently arise. We used genetic parentage assignments together with relatedness data to quantify inbreeding rates in a wild population of banded mongooses, a cooperatively breeding carnivore. We show that females regularly conceive to close relatives, including fathers and brothers. We suggest that the costs of inbreeding avoidance may sometimes outweigh the benefits, even in cooperatively breeding species where strong within-group incest avoidance is considered to be the norm.

Evidence for frequent incest in a cooperatively breeding mammal

PubMed Central

Nichols, H. J.; Cant, M. A.; Hoffman, J. I.; Sanderson, J. L.

2014-01-01

As breeding between relatives often results in inbreeding depression, inbreeding avoidance is widespread in the animal kingdom. However, inbreeding avoidance may entail fitness costs. For example, dispersal away from relatives may reduce survival. How these conflicting selection pressures are resolved is challenging to investigate, but theoretical models predict that inbreeding should occur frequently in some systems. Despite this, few studies have found evidence of regular incest in mammals, even in social species where relatives are spatio-temporally clustered and opportunities for inbreeding frequently arise. We used genetic parentage assignments together with relatedness data to quantify inbreeding rates in a wild population of banded mongooses, a cooperatively breeding carnivore. We show that females regularly conceive to close relatives, including fathers and brothers. We suggest that the costs of inbreeding avoidance may sometimes outweigh the benefits, even in cooperatively breeding species where strong within-group incest avoidance is considered to be the norm. PMID:25540153

Fear of feces? Trade-offs between disease risk and foraging drive animal activity around raccoon latrines

USGS Publications Warehouse

Weinstein, Sara B.; Moura, Chad W.; Mendez, Jon Francis; Lafferty, Kevin D.

2017-01-01

Fear of predation alters prey behavior, which can indirectly alter entire landscapes. A parasite-induced ecology of fear might also exist if animals avoid parasite-contaminated resources when infection costs outweigh foraging benefits. To investigate whether animals avoid parasite contaminated sites, and if such avoidance balances disease costs and foraging gains, we monitored animal behavior at raccoon latrines – sites that concentrate both seeds and pathogenic parasite eggs. Using wildlife cameras, we documented over 40 potentially susceptible vertebrate species in latrines and adjacent habitat. Latrine contact rates reflected background activity, diet preferences and disease risk. Disease-tolerant raccoons and rats displayed significant site attraction, while susceptible birds and small mammals avoided these high-risk sites. This suggests that parasites, like predators, might create a landscape of fear for vulnerable hosts. Such non-consumptive parasite effects could alter disease transmission, population dynamics, and even ecosystem structure.

Congenital Toxoplasmosis: A Plea for a Neglected Disease

PubMed Central

Wallon, Martine; Peyron, François

2018-01-01

Maternal infection by Toxoplasma gondii during pregnancy may have serious consequences for the fetus, ranging from miscarriage, central nervous system involvement, retinochoroiditis, or subclinical infection at birth with a risk of late onset of ocular diseases. As infection in pregnant women is usually symptomless, the diagnosis relies only on serological tests. Some countries like France and Austria have organized a regular serological testing of pregnant women, some others have no prenatal program of surveillance. Reasons for these discrepant attitudes are many and debatable. Among them are the efficacy of antenatal treatment and cost-effectiveness of such a program. A significant body of data demonstrated that rapid onset of treatment after maternal infection reduces the risk and severity of fetal infection. Recent cost-effectiveness studies support regular screening. This lack of consensus put both pregnant women and care providers in a difficult situation. Another reason why congenital toxoplasmosis is disregarded in some countries is the lack of precise information about its impact on the population. Precise estimations on the burden of the disease can be achieved by systematic screening that will avoid bias or underreporting of cases and provide a clear view of its outcome. PMID:29473896

On the Use of Low-Cost Radar Networks for Collision Warning Systems Aboard Dumpers

PubMed Central

González-Partida, José-Tomás; León-Infante, Francisco; Blázquez-García, Rodrigo; Burgos-García, Mateo

2014-01-01

The use of dumpers is one of the main causes of accidents in construction sites, many of them with fatal consequences. These kinds of work machines have many blind angles that complicate the driving task due to their large size and volume. To guarantee safety conditions is necessary to use automatic aid systems that can detect and locate the different objects and people in a work area. One promising solution is a radar network based on low-cost radar transceivers aboard the dumper. The complete system is specified to operate with a very low false alarm rate to avoid unnecessary stops of the dumper that reduce its productivity. The main sources of false alarm are the heavy ground clutter, and the interferences between the radars of the network. This article analyses the clutter for LFM signaling and proposes the use of Offset Linear Frequency Modulated Continuous Wave (OLFM-CW) as radar signal. This kind of waveform can be optimized to reject clutter and self-interferences. Jointly, a data fusion chain could be used to reduce the false alarm rate of the complete radar network. A real experiment is shown to demonstrate the feasibility of the proposed system. PMID:24577521

On the use of low-cost radar networks for collision warning systems aboard dumpers.

PubMed

González-Partida, José-Tomás; León-Infante, Francisco; Blázquez-García, Rodrigo; Burgos-García, Mateo

2014-02-26

The use of dumpers is one of the main causes of accidents in construction sites, many of them with fatal consequences. These kinds of work machines have many blind angles that complicate the driving task due to their large size and volume. To guarantee safety conditions is necessary to use automatic aid systems that can detect and locate the different objects and people in a work area. One promising solution is a radar network based on low-cost radar transceivers aboard the dumper. The complete system is specified to operate with a very low false alarm rate to avoid unnecessary stops of the dumper that reduce its productivity. The main sources of false alarm are the heavy ground clutter, and the interferences between the radars of the network. This article analyses the clutter for LFM signaling and proposes the use of Offset Linear Frequency Modulated Continuous Wave (OLFM-CW) as radar signal. This kind of waveform can be optimized to reject clutter and self-interferences. Jointly, a data fusion chain could be used to reduce the false alarm rate of the complete radar network. A real experiment is shown to demonstrate the feasibility of the proposed system.

49 CFR 1152.36 - Submission of revenue and cost data.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-freight cars j. Revenue taxes k. Property taxes 6. Off-branch costs a. Off-branch costs (other than return.... Holding gain (loss) XXXX 16. Total return on value (line 14 minus 15) 3 XXXX 17. Avoidable loss from...

49 CFR 1152.36 - Submission of revenue and cost data.

Code of Federal Regulations, 2011 CFR

2011-10-01

...-freight cars j. Revenue taxes k. Property taxes 6. Off-branch costs a. Off-branch costs (other than return.... Holding gain (loss) XXXX 16. Total return on value (line 14 minus 15) 3 XXXX 17. Avoidable loss from...

49 CFR 1152.36 - Submission of revenue and cost data.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-freight cars j. Revenue taxes k. Property taxes 6. Off-branch costs a. Off-branch costs (other than return.... Holding gain (loss) XXXX 16. Total return on value (line 14 minus 15) 3 XXXX 17. Avoidable loss from...

49 CFR 1152.36 - Submission of revenue and cost data.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-freight cars j. Revenue taxes k. Property taxes 6. Off-branch costs a. Off-branch costs (other than return.... Holding gain (loss) XXXX 16. Total return on value (line 14 minus 15) 3 XXXX 17. Avoidable loss from...

49 CFR 1152.36 - Submission of revenue and cost data.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-freight cars j. Revenue taxes k. Property taxes 6. Off-branch costs a. Off-branch costs (other than return.... Holding gain (loss) XXXX 16. Total return on value (line 14 minus 15) 3 XXXX 17. Avoidable loss from...

No evidence for inbreeding avoidance in a natural population of song sparrows (Melospiza melodia).

PubMed

Keller, L F; Arcese, P

1998-09-01

We studied mate choice and inbreeding avoidance a natural population of song sparrows (Melospiza melodia) on Mandarte Island, Canada. Inbreeding occurred regularly: 59% all matings were between known relatives. We tested for inbreeding avoidance by comparing the observed levels of inbreeding to those expected if mate choice had been random with respect to relatedness. Independent of our assumptions about the availability of mates in the random mating model, we found that the expected and observed distributions of inbreeding coefficients were similar, as was the expected and observed frequency of close (f >/= 0.125) inbreeding. Furthermore, there was no difference in relatedness observed pairs and those that would have resulted had birds mated instead with their nearest neighbors. The only evidence to suggest any inbreeding avoidance was a reduced rate of parent-offspring matings as compared to one random mating model but not the other. Hence, despite substantial inbreeding depression in this population, we found little evidence for inbreeding avoidance through mate choice. We present a simple model to suggest that variation in inbreeding avoidance behaviors in birds may arise from differences in survival rates: in species with low survival rates, the costs of forfeiting matings to avoid inbreeding may exceed the costs of inbreeding.

Relative Luminance and Figure-Background Segmentation Problems: Using AMLA to Avoid Nondiscernible Stimulus Pairs in Common and Color Blind Observers

ERIC Educational Resources Information Center

Jover, Julio Lillo; Moreira, Humberto

2005-01-01

Four experiments evaluated AMLA temporal version accuracy to measure relative luminosity in people with and without color blindness and, consequently, to provide the essential information to avoid poor figure-background combinations in any possible "specific screen-specific observer" pair. Experiment 1 showed that two very different apparatus, a…

The Relation between Youth Fear and Avoidance of Crime in School and Academic Experiences

ERIC Educational Resources Information Center

Barrett, Kimberly L.; Jennings, Wesley G.; Lynch, Michael J.

2012-01-01

Despite decades of research analyzing fear of crime among adults, little is known about youth fear of crime in general and youth fear of crime in school, specifically. Moreover, among existing studies most emphasize causes of fear, with little discussion of avoidance or the academic consequences of these feelings and behaviors in school. This…

Health economic evaluation of an infection prevention and control program: are quality and patient safety programs worth the investment?

PubMed

Raschka, Stefanie; Dempster, Linda; Bryce, Elizabeth

2013-09-01

The effect of regional consolidation of an infection prevention and control (IPC) program on reduction of selected health care-acquired infections (HAIs), the economic burden of these illnesses, and where the potential for greatest financial benefit in reducing infection rates lies was assessed. Cost-benefit analysis (in Canadian $) was used to evaluate the effectiveness of a regional IPC program in preventing incident cases of HAIs. The costs of managing these infections, as well as the operational costs of the IPC program were compared against reductions in HAI rates over a 4-year period. Benefits were calculated as cost avoided by reducing HAI cases year over year. The Health Authority spent more than $66.3 million managing 24,937 HAI cases over the 4-year evaluation period. Urinary tract infections, methicillin-resistant Staphylococcus aureus, and bacteremias incurred the greatest costs. A reduction of 4,739 HAI cases led to avoided costs of $9.1 million in 4 years; the IPC program budget was $6.7 million during this period. Regionalization of the IPC program with standardized policies, procedures, and initiatives led to a 19% reduction in selected HAIs over 4 years and a cost avoidance of at least $9 million. This was particularly evident in years 3 and 4 of the program when $7.2 million (79% of the total) savings were realized. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain

PubMed Central

Jiménez-Ruiz, Carlos A; Solano-Reina, Segismundo; Signes-Costa, Jaime; de Higes-Martinez, Eva; Granda-Orive, José I; Lorza-Blasco, José J; Riesco-Miranda, Juan A; Altet-Gomez, Neus; Barrueco, Miguel; Oyagüez, Itziar; Rejas, Javier

2015-01-01

The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain. PMID:26451100

Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain.

PubMed

Jiménez-Ruiz, Carlos A; Solano-Reina, Segismundo; Signes-Costa, Jaime; de Higes-Martinez, Eva; Granda-Orive, José I; Lorza-Blasco, José J; Riesco-Miranda, Juan A; Altet-Gomez, Neus; Barrueco, Miguel; Oyagüez, Itziar; Rejas, Javier

2015-01-01

The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain.

The effect of in-office waiting time on physician visit frequency among working-age adults.

PubMed

Tak, Hyo Jung; Hougham, Gavin W; Ruhnke, Atsuko; Ruhnke, Gregory W

2014-10-01

Disparities in unmet health care demand resulting from socioeconomic, racial, and financial factors have received a great deal of attention in the United States. However, out-of-pocket costs alone do not fully reflect the total opportunity cost that patients must consider as they seek medical attention. While there is an extensive literature on the price elasticity of demand for health care, empirical evidence regarding the effect of waiting time on utilization is sparse. Using the nationally representative 2003 Community Tracking Study Household Survey, the most recent iteration containing respondents' physician office visit frequency and estimated in-office waiting time in the United States (N = 23,484), we investigated the association between waiting time and calculated time cost with the number of physician visits among a sample of working-age adults. To avoid the bias that literature suggests would result from excluding respondents with zero physician visits, we imputed waiting time for the essential inclusion of such individuals. On average, respondents visited physician offices 3.55 times, during which time they waited 28.7 min. The estimates from a negative binomial model indicated that a doubling of waiting time was associated with a 7.7 percent decrease (p-value < 0.001) in physician visit frequency. For women and unemployed respondents, who visited physicians more frequently, the decrease was even larger, suggesting a stronger response to greater waiting times. We believe this finding reflects the discretionary nature of incremental visits in these groups, and a consequent lower perceived marginal benefit of additional visits. The results suggest that in-office waiting time may have a substantial influence on patients' propensity to seek medical attention. Although there is a belief that expansions in health insurance coverage increase health care utilization by reducing financial barriers to access, our results suggest that unintended consequences may arise if in-office waiting time increases. Copyright © 2014 Elsevier Ltd. All rights reserved.

Health system reform in rural China: voices of healthworkers and service-users.

PubMed

Zhou, Xu Dong; Li, Lu; Hesketh, Therese

2014-09-01

Like many other countries China is undergoing major health system reforms, with the aim of providing universal health coverage, and addressing problems of low efficiency and inequity. The first phase of the reforms has focused on strengthening primary care and improving health insurance coverage and benefits. The aim of the study was to explore the impacts of these reforms on healthworkers and service-users at township level, which has been the major target of the first phase of the reforms. From January to March 2013 we interviewed eight health officials, 80 township healthworkers and 80 service-users in eight counties in Zhejiang and Yunnan provinces, representing rich and poor provinces respectively. Thematic analysis identified key themes around the impacts of the health reforms. We found that some elements of the reforms may actually be undermining primary care. While the new health insurance system was popular among service-users, it was criticised for contributing to fast-growing medical costs, and for an imbalance of benefits between outpatient and inpatient services. Salary reform has guaranteed healthworkers' income, but greatly reduced their incentives. The essential drug list removed perverse incentives to overprescribe, but led to falls in income for healthworkers, and loss of autonomy for doctors. Serious problems with drug procurement also emerged. The unintended consequences have included a brain drain of experienced healthworkers from township hospitals, and patients have flowed to county hospitals at greater cost. In conclusion, in the short term resources must be found to ensure rural healthworkers feel appropriately remunerated and have more clinical autonomy, measures for containment of the medical costs must be taken, and drug procurement must show increased transparency and accountability. More importantly the study shows that all countries undergoing health reforms should elicit the views of stakeholders, including service-users, to avoid and address unintended consequences. Copyright © 2014. Published by Elsevier Ltd.

Effects of optimism on creativity under approach and avoidance motivation

PubMed Central

Icekson, Tamar; Roskes, Marieke; Moran, Simone

2014-01-01

Focusing on avoiding failure or negative outcomes (avoidance motivation) can undermine creativity, due to cognitive (e.g., threat appraisals), affective (e.g., anxiety), and volitional processes (e.g., low intrinsic motivation). This can be problematic for people who are avoidance motivated by nature and in situations in which threats or potential losses are salient. Here, we review the relation between avoidance motivation and creativity, and the processes underlying this relation. We highlight the role of optimism as a potential remedy for the creativity undermining effects of avoidance motivation, due to its impact on the underlying processes. Optimism, expecting to succeed in achieving success or avoiding failure, may reduce negative effects of avoidance motivation, as it eases threat appraisals, anxiety, and disengagement—barriers playing a key role in undermining creativity. People experience these barriers more under avoidance than under approach motivation, and beneficial effects of optimism should therefore be more pronounced under avoidance than approach motivation. Moreover, due to their eagerness, approach motivated people may even be more prone to unrealistic over-optimism and its negative consequences. PMID:24616690

Evolution of Inbreeding Avoidance and Inbreeding Preference through Mate Choice among Interacting Relatives.

PubMed

Duthie, A Bradley; Reid, Jane M

2016-12-01

While extensive population genetic theory predicts conditions favoring evolution of self-fertilization versus outcrossing, there is no analogous theory that predicts conditions favoring evolution of inbreeding avoidance or inbreeding preference enacted through mate choice given obligate biparental reproduction. Multiple interacting processes complicate the dynamics of alleles underlying such inbreeding strategies, including sexual conflict, distributions of kinship, genetic drift, purging of mutation load, direct costs, and restricted kin discrimination. We incorporated these processes into an individual-based model to predict conditions where selection should increase or decrease frequencies of alleles causing inbreeding avoidance or inbreeding preference when females or males controlled mating. Selection for inbreeding avoidance occurred given strong inbreeding depression when either sex chose mates, while selection for inbreeding preference occurred given very weak inbreeding depression when females chose but never occurred when males chose. Selection for both strategies was constrained by direct costs and restricted kin discrimination. Purging was negligible, but allele frequencies were strongly affected by drift in small populations, while selection for inbreeding avoidance was weak in larger populations because inbreeding risk decreased. Therefore, while selection sometimes favored alleles underlying inbreeding avoidance or preference, evolution of such strategies may be much more restricted and stochastic than is commonly presumed.

Montana's High School Dropouts: Examining the Fiscal Consequences. State Research

ERIC Educational Resources Information Center

Stuit, David A.; Springer, Jeffrey A.

2010-01-01

This report analyzes the economic and social costs of the high school dropout problem in Montana from the perspective of a state taxpayer. The majority of the authors' analysis considers the consequences of this problem in terms of labor market, tax revenue, and public service costs. In quantifying these costs, the authors seek to inform public…

Trajectories of attachment in older age: interpersonal trauma and its consequences.

PubMed

Bachem, Rahel; Levin, Yafit; Solomon, Zahava

2018-06-04

Previous studies suggest that attachment insecurities may increase after trauma exposure, an effect documented only at a group level. This study explores the heterogeneity of changes over time and examines the associations of the nature of the traumatic event (interpersonal and nonpersonal), and its consequences (posttraumatic stress disorder [PTSD] and loneliness) with attachment trajectories. Two groups of Israeli veterans participated: 164 former prisoners-of-war and 185 combat veterans. Attachment was assessed at four points (1991-2015). Risk factors were evaluated in 1991. Using latent growth mixture modeling, trajectories of attachment insecurities were explored. Three avoidance trajectories (stability, decrease, inverse u-shaped) and two anxiety trajectories (stability, decrease) were identified. The inverse u-shaped avoidance trajectory was associated with captivity, humiliation, loneliness, and PTSD, and stable avoidance was associated with loneliness. Stable anxiety was associated with captivity and loneliness. Attachment insecurities can change during aging and persist decades after a trauma. Trauma-related risk factors are related to more deleterious trajectories.

[FACTORS WHICH INFLUENCE THE LEAN MASS LOSS IN CANCER PATIENTS].

PubMed

Sánchez Sánchez, Eduardo; Muñoz Alferez, Maria José

2015-10-01

cancer is an important illness in the sanitary field due to phisic and functional consequences involved in it. Among these consequences there is the malnutrition which can cause a loss of lean mass and with it a decrease in the Quality of Life, an increase in hospital stays, social and health costs and so on. The aim of this research is to know which factors can influence in the loss of the lean mass. it is a cross-sectional study in a sample of 72 patients who receive a radiotherapy with curative intent during a period from February 07th and May 14th, 2014. from this pattern Of the total 64 patients were studied, of which 43.7% of the patients presented loss of lean mass, with 21.8% the percentage of patients losing < 2%, 4.7% those with a loss between 2-5% and > 5%, 17.2% of patients. Among the factors studied that can influence the loss of lean mass, only the presence of digestive symptoms have statistical significance (OR = 3.3 or 6.6, as we take as a reference the percentage loss). the aim of the health staff who are working with these patients is to avoid the consequences that accompanies the loss of lean mass. For all this, it is very important to act before the digestive symptoms, by anticipating to them, or early implementation of an individualized nutritional intervention. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Where are the Sunday babies? II. Declining weekend birth rates in Switzerland.

PubMed

Lerchl, Alexander; Reinhard, Sarah C

2008-02-01

Birth dates from almost 3 million babies born between 1969 and 2005 in Switzerland were analyzed for the weekday of birth. As in other countries but with unprecedented amplitude, a very marked non-random distribution was discovered with decreasing numbers of births on weekends, reaching -17.9% in 2005. While most of this weekend births avoidance rate is due to fewer births on Sundays (up to -21.7%), the downward trend is primarily a consequence of decreasing births on Saturdays (up to -14.5%). For 2005, these percentages mean that 3,728 fewer babies are born during weekends than could be expected from equal distribution. Most interestingly and surprisingly, weekend birth-avoiding rates are significantly correlated with birth numbers (r = 0.86), i.e. the lower the birth number per year, the lower the number of weekend births. The increasing avoidance of births during weekends is discussed as being a consequence of increasing numbers of caesarean sections and elective labor induction, which in Switzerland reach 29.2 and 20.5%, respectively, in 2004. This hypothesis is supported by the observation that both primary and secondary caesarean sections are significantly correlated with weekend birth avoidance rates. It is therefore likely that financial aspects of hospitals are a factor determining the avoidance of weekend births by increasing the numbers of caesarean sections.

Where are the Sunday babies? II. Declining weekend birth rates in Switzerland

NASA Astrophysics Data System (ADS)

Lerchl, Alexander; Reinhard, Sarah C.

2008-02-01

Birth dates from almost 3 million babies born between 1969 and 2005 in Switzerland were analyzed for the weekday of birth. As in other countries but with unprecedented amplitude, a very marked non-random distribution was discovered with decreasing numbers of births on weekends, reaching -17.9% in 2005. While most of this weekend births avoidance rate is due to fewer births on Sundays (up to -21.7%), the downward trend is primarily a consequence of decreasing births on Saturdays (up to -14.5%). For 2005, these percentages mean that 3,728 fewer babies are born during weekends than could be expected from equal distribution. Most interestingly and surprisingly, weekend birth-avoiding rates are significantly correlated with birth numbers ( r = 0.86), i.e. the lower the birth number per year, the lower the number of weekend births. The increasing avoidance of births during weekends is discussed as being a consequence of increasing numbers of caesarean sections and elective labor induction, which in Switzerland reach 29.2 and 20.5%, respectively, in 2004. This hypothesis is supported by the observation that both primary and secondary caesarean sections are significantly correlated with weekend birth avoidance rates. It is therefore likely that financial aspects of hospitals are a factor determining the avoidance of weekend births by increasing the numbers of caesarean sections.

Recalculating the Economic Cost of Suicide

ERIC Educational Resources Information Center

Yang, Bijou; Lester, David

2007-01-01

These authors argue that estimates of the net economic cost of suicide should go beyond accounting for direct medical costs and indirect costs from loss of earnings by those who commit suicide. There are potential savings from (a) not having to treat the depressive and other psychiatric disorders of those who kill themselves; (b) avoidance of…

Financial Impact of Direct-Acting Oral Anticoagulants in Medicaid: Budgetary Assessment Based on Number Needed to Treat.

PubMed

Fairman, Kathleen A; Davis, Lindsay E; Kruse, Courtney R; Sclar, David A

2017-04-01

Faced with rising healthcare costs, state Medicaid programs need short-term, easily calculated budgetary estimates for new drugs, accounting for medical cost offsets due to clinical advantages. To estimate the budgetary impact of direct-acting oral anticoagulants (DOACs) compared with warfarin, an older, lower-cost vitamin K antagonist, on 12-month Medicaid expenditures for nonvalvular atrial fibrillation (NVAF) using number needed to treat (NNT). Medicaid utilization files, 2009 through second quarter 2015, were used to estimate OAC cost accounting for generic/brand statutory minimum (13/23%) and assumed maximum (13/50%) manufacturer rebates. NNTs were calculated from clinical trial reports to estimate avoided medical events for a hypothetical population of 500,000 enrollees (approximate NVAF prevalence × Medicaid enrollment) under two DOAC market share scenarios: 2015 actual and 50% increase. Medical service costs were based on published sources. Costs were inflation-adjusted (2015 US$). From 2009-2015, OAC reimbursement per claim increased by 173 and 279% under maximum and minimum rebate scenarios, respectively, while DOAC market share increased from 0 to 21%. Compared with a warfarin-only counterfactual, counts of ischemic strokes, intracranial hemorrhages, and systemic embolisms declined by 36, 280, and 111, respectively; counts of gastrointestinal hemorrhages increased by 794. Avoided events and reduced monitoring, respectively, offset 3-5% and 15-24% of increased drug cost. Net of offsets, DOAC-related cost increases were US$258-US$464 per patient per year (PPPY) in 2015 and US$309-US$579 PPPY after market share increase. Avoided medical events offset a small portion of DOAC-related drug cost increase. NNT-based calculations provide a transparent source of budgetary-impact information for new medications.

Cost-Effectiveness Analysis of Nasal Continuous Positive Airway Pressure Versus Nasal High Flow Therapy as Primary Support for Infants Born Preterm.

PubMed

Huang, Li; Roberts, Calum T; Manley, Brett J; Owen, Louise S; Davis, Peter G; Dalziel, Kim M

2018-05-01

To compare the cost-effectiveness of 2 common "noninvasive" modes of respiratory support for infants born preterm. An economic evaluation was conducted as a component of a multicenter, randomized control trial from 2013 to 2015 enrolling infants born preterm at ≥28 weeks of gestation with respiratory distress, <24 hours old, who had not previously received endotracheal intubation and mechanical ventilation or surfactant. The economic evaluation was conducted from a healthcare sector perspective and the time horizon was from birth until death or first discharge. The cost-effectiveness of continuous positive airway pressure (CPAP) vs high-flow with "rescue" CPAP backup and high-flow without rescue CPAP backup (as sole primary support) were analyzed by using the hospital cost of inpatient stay in a tertiary center and the rates of endotracheal intubation and mechanical ventilation during admission. Hospital inpatient cost records for 435 infants enrolled in all Australian centers were obtained. With "rescue" CPAP backup, an incremental cost-effectiveness ratio was estimated of A$179 000 (US$123 000) per ventilation avoided if CPAP was used compared with high flow. Without rescue CPAP backup, cost per ventilation avoided was A$7000 (US$4800) if CPAP was used compared with high flow. As sole primary support, CPAP is highly likely to be cost-effective compared with high flow. Neonatal units choosing to use only one device should apply CPAP as primary respiratory support. Compared with high-flow with rescue CPAP backup, CPAP is unlikely to be cost-effective if willingness to pay per ventilation avoided is less than A$179 000 (US$123 000). Copyright © 2018 Elsevier Inc. All rights reserved.

A Budget Impact Model of Hemophilia Bypassing Agent Prophylaxis Relative to Recombinant Factor VIIa On-Demand.

PubMed

Mehta, Darshan A; Oladapo, Abiola O; Epstein, Joshua D; Novack, Aaron R; Neufeld, Ellis J; Hay, Joel W

2016-02-01

Hemophilia patients use factor-clotting concentrates (factor VIII for hemophilia A and factor IX for hemophilia B) for improved blood clotting. These products are used to prevent or stop bleeding episodes. However, some hemophilia patients develop inhibitors (i.e., the patient's immune system develops antibodies against these factor concentrates). Hence, these patients do not respond well to the factor concentrates. A majority of hemophilia patients with inhibitors are managed on-demand with the following bypassing agents: recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrate (aPCC). The recently published U.S. registries Dosing Observational Study in Hemophilia (DOSE) and Hemostasis and Thrombosis Research Society (HTRS) reported higher rFVIIa on-demand use for bleed management than previously described. To estimate aPCC and rFVIIa prophylaxis costs relative to rFVIIa on-demand treatment cost based on rFVIIa doses reported in U.S. registries. A literature-based cost model was developed assuming a base case on-demand annual bleed rate (ABR) of 28.7 per inhibitor patient, which was taken from a randomized phase 3 clinical trial. The doses for rFVIIa on-demand were taken from the median dose per bleed reported by the DOSE and HTRS registries. Model inputs for aPCC and rFVIIa prophylaxis (i.e., dosing and efficacy) were derived from respective randomized clinical trials. Cost analysis was from the U.S. payer perspective, and only direct drug costs were considered. The drug cost was based on the Medicare Part B 2014 average sale price (ASP). Two-way sensitivity and threshold analyses were performed by simultaneously varying on-demand ABR, prophylaxis efficacy, and unit drug cost. In addition to studying relative costs associated with on-demand and prophylaxis treatments, relative cost per bleeding episode avoided were also calculated for aPCC and rFVIIa prophylaxis treatments. The prophylaxis efficacy reported in the trials were used to determine the number of bleeding episodes avoided. Based on the median on-demand dose of 695 mcg per kg per bleed, reported by the DOSE registry, the annual rFVIIa on-demand cost was $34,009 per kg of body weight. The annual rFVIIa on-demand cost was $22,020 per kg of body weight when the median dose of 450 mcg per kg per bleed reported by the HTRS registry was considered. The annual cost rose to $38,461 per kg of body weight when the rFVIIa on-demand dose of 786 mcg per kg per bleed among patients infusing an initial dose ≥ 250 mcg per kg was considered. The aPCC (85 units per kg per every other day) and rFVIIa (90 mcg per kg per every day) annual prophylaxis costs were $26,536 and $60,700, respectively. Also, aPCC and rFVIIa prophyaxis treatments were estimated to prevent a total of 20.8 and 12.9 annual bleeding episodes, respectively. When compared with the on-demand dose of 695 mcg per kg per bleed (DOSE registry), the annual aPCC and rFVIIa prophylaxis costs were 21.9% lower and 78.4% higher, respectively. Additionally, aPCC prophylaxis saved $360 per kg for each bleeding episode avoided. rFVIIa prophylaxis cost $2,066 per kg for each bleeding episode avoided. Compared with the on-demand dose of 450 mcg per kg per bleed (HTRS registry), aPCC and rFVIIa prophylaxis costs were 20.5% and 174.9% higher, respectively. In this case, aPCC and rFVIIa prophylaxis treatment costs were $217 per kg and $2,995 per kg, respectively, for each bleeding episode avoided. aPCC and rFVIIa prophylaxis costs were 31.0% lower and 57.8% higher, respectively, when compared with the rFVIIa on-demand dose of 786 mcg per kg per bleed, among patients infusing an initial dose ≥ 250 mcg per kg (HTRS registry). In this case, aPCC prophylaxis saved $573 per kg for each bleeding episode avoided, while rFVIIa prophylaxis costs $1,724 per kg for each bleeding episode avoided. Results of the 2-way sensitivity analyses were robust in the majority of the scenarios considered. aPCC prophylaxis may be cost saving for managing hemophilia patients with inhibitors who bleed frequently and infuse significant quantities of rFVIIa on-demand.

Fear Appeals, Engagement, and Examination Performance: The Role of Challenge and Threat Appraisals

ERIC Educational Resources Information Center

Putwain, David W.; Symes, Wendy; Wilkinson, Hannah M.

2017-01-01

Background: Fear appeals are persuasive messages that draw attention to the negative consequences (e.g., academic failure) that follow a particular course of action (e.g., not engaging in lessons) and how negative consequences can be avoided with an alternate course of action. Previous studies have shown that when fear appeals are appraised as…

Development of a module for Cost-Benefit analysis of risk reduction measures for natural hazards for the CHANGES-SDSS platform

NASA Astrophysics Data System (ADS)

Berlin, Julian; Bogaard, Thom; Van Westen, Cees; Bakker, Wim; Mostert, Eric; Dopheide, Emile

2014-05-01

Cost benefit analysis (CBA) is a well know method used widely for the assessment of investments either in the private and public sector. In the context of risk mitigation and the evaluation of risk reduction alternatives for natural hazards its use is very important to evaluate the effectiveness of such efforts in terms of avoided monetary losses. However the current method has some disadvantages related to the spatial distribution of the costs and benefits, the geographical distribution of the avoided damage and losses, the variation in areas that are benefited in terms of invested money and avoided monetary risk. Decision-makers are often interested in how the costs and benefits are distributed among different administrative units of a large area or region, so they will be able to compare and analyse the cost and benefits per administrative unit as a result of the implementation of the risk reduction projects. In this work we first examined the Cost benefit procedure for natural hazards, how the costs are assessed for several structural and non-structural risk reduction alternatives, we also examined the current problems of the method such as the inclusion of cultural and social considerations that are complex to monetize , the problem of discounting future values using a defined interest rate and the spatial distribution of cost and benefits. We also examined the additional benefits and the indirect costs associated with the implementation of the risk reduction alternatives such as the cost of having a ugly landscape (also called negative benefits). In the last part we examined the current tools and software used in natural hazards assessment with support to conduct CBA and we propose design considerations for the implementation of the CBA module for the CHANGES-SDSS Platform an initiative of the ongoing 7th Framework Programme "CHANGES of the European commission. Keywords: Risk management, Economics of risk mitigation, EU Flood Directive, resilience, prevention, cost benefit analysis, spatial distribution of costs and benefits

Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice

PubMed Central

2013-01-01

Background Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders (PD). However, more research is needed to confirm the cost-effectiveness of such extensive programmes over other, presumably simpler, treatment formats. Methods This study compared health service costs and psychosocial functioning for PD patients randomly allocated to either a day-hospital-based treatment programme combining individual and group psychotherapy in a step-down format, or outpatient individual psychotherapy at a specialist practice. It included 107 PD patients, 46% of whom had borderline PD, and 40% of whom had avoidant PD. Costs included the two treatment conditions and additional primary and secondary in- and outpatient services. Psychosocial functioning was assessed using measures of global (observer-rated GAF) and occupational (self-report) functioning. Repeated assessments over three years were analysed using mixed models. Results The costs of step-down treatment were higher than those of outpatient treatment, but these high costs were compensated by considerably lower costs of other health services. However, costs and clinical gains depended on the type of PD. For borderline PD patients, cost-effectiveness did not differ by treatment condition. Health service costs declined during the trial, and functioning improved to mild impairment levels (GAF > 60). For avoidant PD patients, considerable adjuvant health services expanded the outpatient format. Clinical improvements were nevertheless superior to the step-down condition. Conclusion Our results indicate that decisions on treatment format should differentiate between PD types. For borderline PD patients, the costs and gains of step-down and outpatient treatment conditions did not differ. For avoidant PD patients, the outpatient format was a better alternative, leaning, however, on costly additional health services in the early phase of treatment. Trial registration Clinical Trials NCT00378248 PMID:24268099

Approach/Avoidance Orientations Affect Self-Construal and Identification with In-group

PubMed Central

Nussinson, Ravit; Häfner, Michael; Seibt, Beate; Strack, Fritz; Trope, Yaacov

2011-01-01

Approach and avoidance are two basic motivational orientations. Their activation influences cognitive and perceptive processes: Previous work suggests that an approach orientation instigates a focus on larger units as compared to avoidance. Study 1 confirms this assumption using a paradigm that more directly taps a person’s tendency to represent objects as belonging to small or large units than prior studies. It was further predicted that the self should also be represented as belonging to larger units, and hence be more interdependent under approach than under avoidance. Study 2 supports this prediction. As a consequence of this focus on belonging to larger units, it was finally predicted that approach results in a stronger identification with one’s in-group than avoidance. Studies 3 and 4 support that prediction. PMID:22844229

Masculinity impediments: Internalized masculinity contributes to healthcare avoidance in men and women.

PubMed

Himmelstein, Mary S; Sanchez, Diana T

2016-07-01

Gender beliefs contribute to men's healthcare avoidance, but little research examines these outcomes in women. This article models healthcare avoidance related to masculine contingencies of self-worth in men and women. Nested path modelling tested relationships between social role beliefs, masculine contingencies of self-worth, barriers to help seeking and avoidance of health care in university and non-university-student adult samples. Results indicated social role beliefs predicted masculine contingencies of self-worth in men but not in women. Regardless of gender, masculine contingencies of self-worth predicted barriers to help seeking, which predicted healthcare avoidance in both men and women. Thus, masculine contingencies of self-worth have downstream consequences for men and women through barriers to help seeking. © The Author(s) 2014.

Collision avoidance system cost-benefit analysis : volume I - technical manual

DOT National Transportation Integrated Search

1981-09-01

Collision-avoidance systems under development in the U.S.A., Japan and Germany were evaluated. The performance evaluation showed that the signal processing and the control law of a system were the key parameters that decided the system's capability, ...

Levelized Cost and Levelized Avoided Cost of New Generation Resources in the Annual Energy Outlook

EIA Publications

2017-01-01

This paper presents average values of levelized costs for generating technologies entering service in 2019, 2022, and 2040 as represented in the National Energy Modeling System (NEMS) for the Annual Energy Outlook 2017 (AEO2017) Reference case.

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

32 CFR 162.3 - Definition.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Benefits resulting from PECIs are classified as savings or as cost avoidance: (1) Savings. Benefits that... achieved. Examples include costs for manpower authorizations and or funded work-year reductions, reduced or... manpower or costs that would be necessary, if present management practices were continued. The effect of...

Cost and Consequences of Sedentary Living: New Battleground for an Old Enemy.

ERIC Educational Resources Information Center

Booth, Frank W.; Chakravarthy, Manu V.

2002-01-01

This report itemizes the costs and consequences of sedentary living, providing cost reasons to fight a war on sedentary lifestyles. It begins by explaining that 70 percent of U.S. adults are sedentary (undertaking no leisure time physical activity or less than 30 minutes of physical activity per day), and it notes how sedentary living increases…

Interpersonal conflict: strategies and guidelines for resolution.

PubMed

Wolfe, D E; Bushardt, S C

1985-02-01

Historically, management theorists have recommended the avoidance or suppression of conflict. Modern management theorists recognize interpersonal conflict as an inevitable byproduct of growth and change. The issue is no longer avoidance of conflict but the strategy by which conflict is resolved. Various strategies of conflict resolution and the consequences of each are discussed in this article, along with guidelines for the effective use of confrontation strategy.

Constrained trajectory optimization for kinematically redundant arms

NASA Technical Reports Server (NTRS)

Carignan, Craig R.; Tarrant, Janice M.

1990-01-01

Two velocity optimization schemes for resolving redundant joint configurations are compared. The Extended Moore-Penrose Technique minimizes the joint velocities and avoids obstacles indirectly by adjoining a cost gradient to the solution. A new method can incorporate inequality constraints directly to avoid obstacles and singularities in the workspace. A four-link arm example is used to illustrate singularity avoidance while tracking desired end-effector paths.

Cost-effectiveness analysis of early versus non-early intervention in acute migraine based on evidence from the 'Act when Mild' study.

PubMed

Slof, John

2012-05-01

In spite of the important progress made in the abortive treatment of acute migraine episodes since the introduction of triptans, reduction of pain and associated symptoms is in many cases still not as effective nor as fast as would be desirable. Recent research pays more attention to the timing of the treatment, and taking triptans early in the course of an attack when pain is still mild has been found more efficacious than the usual strategy of waiting for the attack to develop to a higher pain intensity level. To investigate the cost effectiveness of early versus non-early intervention with almotriptan in acute migraine. An economic evaluation was conducted from the perspectives of French society and the French public health system based on patient-level data collected in the AwM (Act when Mild) study, a placebo-controlled trial that compared the response to early and non-early treatment of acute migraine with almotriptan. Incremental cost-effectiveness ratios (ICERs) were determined in terms of QALYs, migraine hours and productive time lost. Costs were expressed in Euros (year 2010 values). Bootstrapping was used to derive cost-effectiveness acceptability curves. Early treatment has shown to lead to shorter attack duration, less productive time lost, better quality of life, and is, with 92% probability, overall cost saving from a societal point of view. In terms of drug costs only, however, non-early treatment is less expensive. From the public health system perspective, the (bootstrap) mean ICER of early treatment amounts to €0.38 per migraine hour avoided, €1.29 per hour of productive time lost avoided, and €14,296 per QALY gained. Considering willingness-to-pay values of approximately €1 to avoid an hour of migraine, €10 to avoid the loss of a productive hour, or €30,000 to gain one QALY, the approximate probability that early treatment is cost effective is 90%, 90% and 70%, respectively. These results remain robust in different scenarios for the major elements of the economic evaluation. Compared with non-early treatment, a strategy of early treatment of acute migraine with almotriptan when pain is still mild is, with high probability, cost saving from the French societal perspective and can be considered cost effective from the public health system point of view.

Impact of pharmacist interventions on cost avoidance in an ambulatory cancer center.

PubMed

Randolph, Laura A; Walker, Cheri K; Nguyen, Ann T; Zachariah, Subi R

2018-01-01

Objective To provide a foundation to justify the presence of a full-time clinical pharmacist in the ambulatory cancer center in addition to an existing centralized pharmacist through cost avoidance calculation and patient and staff satisfaction surveys. Methods The prospective, pilot study took place in an ambulatory cancer center over four weeks in 2014. Cost avoidance values were assigned to interventions performed by a pharmacy resident, who was present in the ambulatory cancer center during clinic hours, along with a centralized oncology pharmacist routinely working with the cancer center. Anonymous patient and staff satisfaction surveys based on a 5-point Likert scale were distributed to assess the perceived benefit of a pharmacist located in the ambulatory cancer center. Results Data collection took place over approximately one month. After evaluation of 962 interventions from both pharmacists, the estimated cost avoidance was US$282,741 per pharmacist per year, yielding a net benefit of US$138,441. The most common interventions made by the resident included chemotherapy regimen review (n = 290, 69%) and patient counseling (n = 102, 24%), while the majority of the centralized pharmacist's interventions was chemotherapy regimen review (n = 525, 97%). Results from the anonymous patient and staff surveys revealed an overall positive perception of the pharmacy resident while in the ambulatory cancer center. Conclusion A full-time clinical pharmacist in an ambulatory cancer center is both financially beneficial and positively perceived by patients and staff.

Avoided electricity subsidy payments can finance substantial appliance efficiency incentive programs: Case study of Mexico

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leventis, Greg; Gopal, Anand; Rue du Can, Stephane de la

Numerous countries use taxpayer funds to subsidize residential electricity for a variety of socioeconomic objectives. These subsidies lower the value of energy efficiency to the consumer while raising it for the government. Further, while it would be especially helpful to have stringent Minimum Energy Performance Standards (MEPS) for appliances and buildings in this environment, they are hard to strengthen without imposing a cost on ratepayers. In this secondbest world, where the presence of subsidies limits the government’s ability to strengthen standards, we find that avoided subsidies are a readily available source of financing for energy efficiency incentive programs. Here, wemore » introduce the LBNL Energy Efficiency Revenue Analysis (LEERA) model to estimate the appliance efficiency improvements that can be achieved in Mexico by the revenue neutral financing of incentive programs from avoided subsidy payments. LEERA uses the detailed techno-economic analysis developed by LBNL for the Super-efficient Equipment and Appliance Deployment (SEAD) Initiative to calculate the incremental costs of appliance efficiency improvements. We analyze Mexico’s tariff structures and the long-run marginal cost of supply to calculate the marginal savings for the government from appliance efficiency. We find that avoided subsidy payments alone can finance incentive programs that cover the full incremental cost of refrigerators that are 27% more efficient and TVs that are 32% more efficient than baseline models. We find less substantial market transformation potential for room ACs primarily because AC energy savings occur at less subsidized tariffs.« less

The influence of approach-avoidance motivational orientation on conflict adaptation.

PubMed

Hengstler, Maikel; Holland, Rob W; van Steenbergen, Henk; van Knippenberg, Ad

2014-06-01

To deal effectively with a continuously changing environment, our cognitive system adaptively regulates resource allocation. Earlier findings showed that an avoidance orientation (induced by arm extension), relative to an approach orientation (induced by arm flexion), enhanced sustained cognitive control. In avoidance conditions, performance on a cognitive control task was enhanced, as indicated by a reduced congruency effect, relative to approach conditions. Extending these findings, in the present behavioral studies we investigated dynamic adaptations in cognitive control-that is, conflict adaptation. We proposed that an avoidance state recruits more resources in response to conflicting signals, and thereby increases conflict adaptation. Conversely, in an approach state, conflict processing diminishes, which consequently weakens conflict adaptation. As predicted, approach versus avoidance arm movements affected both behavioral congruency effects and conflict adaptation: As compared to approach, avoidance movements elicited reduced congruency effects and increased conflict adaptation. These results are discussed in line with a possible underlying neuropsychological model.

The development of a public optometry system in Mozambique: a Cost Benefit Analysis.

PubMed

Thompson, Stephen; Naidoo, Kovin; Harris, Geoff; Bilotto, Luigi; Ferrão, Jorge; Loughman, James

2014-09-23

The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa. A CBA methodology was applied across the period 2009-2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate. Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049. This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.

Neonatal hypoglycaemia: learning from claims

PubMed Central

Hawdon, Jane M; Beer, Jeanette; Sharp, Deborah; Upton, Michele

2017-01-01

Objectives Neonatal hypoglycaemia is a potential cause of neonatal morbidity, and on rare but tragic occasions causes long-term neurodevelopmental harm with consequent emotional and practical costs for the family. The organisational cost to the NHS includes the cost of successful litigation claims. The purpose of the review was to identify themes that could alert clinicians to common pitfalls and thus improve patient safety. Design The NHS Litigation Authority (NHS LA) Claims Management System was reviewed to identify and review 30 claims for injury secondary to neonatal hypoglycaemia, which were notified to the NHS LA between 2002 and 2011. Setting NHS LA. Patients Anonymised documentation relating to 30 neonates for whom claims were made relating to neonatal hypoglycaemia. Dates of birth were between 1995 and 2010. Interventions Review of documentation held on the NHS LA database. Main outcome measures Identifiable risk factors for hypoglycaemia, presenting clinical signs, possible deficits in care, financial costs of litigation. Results All claims related to babies of at least 36 weeks’ gestation. The most common risk factor for hypoglycaemia was low birth weight or borderline low birth weight, and the most common reported presenting sign was abnormal feeding behaviour. A number of likely deficits in care were reported, all of which were avoidable. In this 10-year reporting period, there were 25 claims for which damages were paid, with a total financial cost of claims to the NHS of £162 166 677. Conclusions Acknowledging that these are likely to be the most rare but most seriously affected cases, the clinical themes arising from these cases should be used for further development of training and guidance to reduce harm and redivert NHS funds from litigation to direct care. PMID:27553590

Hospital cost accounting: implementing the system successfully.

PubMed

Burik, D; Duvall, T J

1985-05-01

To successfully implement a cost accounting system, certain key steps should be undertaken. These steps include developing and installing software; developing cost center budgets and inter-cost center allocations; developing service item standard costs; generating cost center level and patient level standard cost reports and reconciling these costs to actual costs; generating product line profitability reports and reconciling these reports to the financial statements; and providing ad hoc reporting capabilities. By following these steps, potential problems in the implementation process can be anticipated and avoided.

Comparing outcomes and costs between contingent and combined first-trimester screening strategies for Down's syndrome.

PubMed

Martín, I; Gibert, M J; Aulesa, C; Alsina, M; Casals, E; Bauça, J M

2015-06-01

To compare a contingent strategy with a combined strategy for prenatal detection of Down's syndrome (DS) in terms of cost, outcomes and safety. The contingent strategy was based on a simulation, removing measurement of the free beta subunit of human chorionic gonadotropin (free βhCG) and calculating the DS risk retrospectively in 32,371 pregnant women who had been screened with the combined strategy in the first trimester. In the contingent strategy, a risk between 1:31 and 1:1000 in the first trimester indicated further testing in the second trimester (alpha-fetoprotein, inhibin A, unconjugated oestriol and free βhCG). The cut-off risk values for the contingent and combined strategies in the first trimester were 1:30 and 1:250, respectively, and the cut-off risk value for integrated screening in the second trimester was 1:250. Costs were compared in terms of avoided DS births, and the ratio of loss of healthy fetuses following invasive procedures per avoided DS birth was calculated. The combined strategy had sensitivity of 40/44 (90.9%) and a false-positive rate of 2.8%. Corresponding values for the contingent strategy were 39/44 (88.6%) and 1.3%, respectively. Only 11% of pregnant women required tests in the second trimester, and the approximate cost reduction for each avoided DS birth was 5000€. The ratio of lost healthy fetuses following invasive procedures per avoided DS birth improved by up to 0.65. The contingent strategy has similar effectiveness to the combined strategy, but has lower costs and fewer invasive procedures. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

75 FR 68044 - Regulation To Mitigate the Misfueling of Vehicles and Engines With Gasoline Containing Greater...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-04

... (RVP) to accompany the transfer of gasoline blended with ethanol and a national survey of retail... Addition 3. General PTD Requirements C. Retail Fuel Dispenser Label and Fuel Ethanol Content Survey D.... Labeling Costs 2. PTD Costs 3. Survey Costs 4. Avoided Motor Vehicle and Nonroad Product Repair Costs G...

Collision avoidance system cost-benefit analysis : volume III - appendices F-M

DOT National Transportation Integrated Search

1981-09-01

Collision-avoidance systems under development in the U.S.A., Japan and Germany were evaluated. The performance evaluation showed that the signal processing and the control law of a system were the key parameters that decided the system's capability, ...

Collision avoidance system cost-benefit analysis : volume II - appendices A-E

DOT National Transportation Integrated Search

1981-09-01

Collision-avoidance systems under development in the U.S.A., Japan and Germany were evaluated. The performance evaluation showed that the signal processing and the control law of a system were the key parameters that decided the system's capability, ...

Trade-offs between predator avoidance and electric shock avoidance in hermit crabs demonstrate a non-reflexive response to noxious stimuli consistent with prediction of pain.

PubMed

Magee, Barry; Elwood, Robert W

2016-09-01

Arthropods have long been thought to respond to noxious stimuli by reflex reaction. One way of testing if this is true is to provide the animal with a way to avoid the stimulus but to vary the potential cost of avoidance. If avoidance varies with potential cost then a decision making process is evident and the behaviour is not a mere reflex. Here we examine the responses of hermit crabs to electric shock within their shell when also exposed to predator or non-predator odours or to no odour. The electric shocks start with low voltage but increase in voltage with each repetition to determine how odour affects the voltage at which the shell is abandoned. There was no treatment effect on the voltage at which hermit crabs left their shells, however, those exposed to predator odours were less likely to evacuate their shells compared with no odour or low concentrations of non-predator odour. However, highly concentrated non-predator also inhibited evacuation. The data show that these crabs trade-off avoidance of electric shock with predator avoidance. They are thus not responding purely by reflex and the data are thus consistent with predictions of pain but do not prove pain. Copyright © 2016 Elsevier B.V. All rights reserved.

A Parametric Study on Using Active Debris Removal to Stabilize the Future LEO Debris Environment

NASA Technical Reports Server (NTRS)

Liou, J.C.

2010-01-01

Recent analyses of the instability of the orbital debris population in the low Earth orbit (LEO) region and the collision between Iridium 33 and Cosmos 2251 have reignited the interest in using active debris removal (ADR) to remediate the environment. There are; however, monumental technical, resources, operational, legal, and political challenges in making economically viable ADR a reality. Before a consensus on the need for ADR can be reached, a careful analysis of the effectiveness of ADR must be conducted. The goal is to demonstrate the feasibility of using ADR to preserve the future environment and to guide its implementation to maximize the benefit-cost ratio. This paper describes a comprehensive sensitivity study on using ADR to stabilize the future LEO debris environment. The NASA long-term, orbital debris evolutionary model, LEGEND, is used to quantify the effects of many key parameters. These parameters include (1) the starting epoch of ADR implementation, (2) various target selection criteria, (3) the benefits of collision avoidance maneuvers, (4) the consequence of targeting specific inclination or altitude regimes, (5) the consequence of targeting specific classes of vehicles, and (6) the timescale of removal. Additional analyses on the importance of postmission disposal and how future launches might affect the requirements to stabilize the environment are also included.

Determinants of emigration and their impact on survival during dispersal in fox and jackal populations

PubMed Central

Kapota, Dror; Dolev, Amit; Bino, Gilad; Yosha, Dotan; Guter, Amichai; King, Roni; Saltz, David

2016-01-01

Animals disperse in response to poor resource conditions as a strategy of escaping harsh competition and stress, but may also disperse under good resource conditions, as these provide better chances of surviving dispersal and gaining fitness benefits such as avoiding kin competition and inbreeding. Individual traits should mediate the effect of resources, yielding a complex condition-dependent dispersal response. We investigated how experimental food reductions in a food-rich environment around poultry-growing villages interact with individual-traits (age, gender, body-mass) in two sympatric canids, red foxes and golden jackals, to jointly affect emigration propensity and survival during dispersal. Sub-adult foxes emigrated more frequently from the food-rich habitat than from the pristine, food-limited habitat, while adult foxes showed the opposite trend. During dispersal, adults exhibited lower survival while sub-adults did not experience additional mortality costs. Although fox mortality rates increased in response to food reduction, dispersal remained unchanged, while jackals showed strong dispersal response in two of the three repetitions. Jackal survival under food reduction was lowest for the dispersing individuals. While resources are an important dispersal determinant, different age classes and species experience the same resource environment differently and consequently have different motivations, yielding different dispersal responses and consequences. PMID:27050564

Behavioral economics and regulatory analysis.

PubMed

Robinson, Lisa A; Hammitt, James K

2011-09-01

Behavioral economics has captured the interest of scholars and the general public by demonstrating ways in which individuals make decisions that appear irrational. While increasing attention is being focused on the implications of this research for the design of risk-reducing policies, less attention has been paid to how it affects the economic valuation of policy consequences. This article considers the latter issue, reviewing the behavioral economics literature and discussing its implications for the conduct of benefit-cost analysis, particularly in the context of environmental, health, and safety regulations. We explore three concerns: using estimates of willingness to pay or willingness to accept compensation for valuation, considering the psychological aspects of risk when valuing mortality-risk reductions, and discounting future consequences. In each case, we take the perspective that analysts should avoid making judgments about whether values are "rational" or "irrational." Instead, they should make every effort to rely on well-designed studies, using ranges, sensitivity analysis, or probabilistic modeling to reflect uncertainty. More generally, behavioral research has led some to argue for a more paternalistic approach to policy analysis. We argue instead for continued focus on describing the preferences of those affected, while working to ensure that these preferences are based on knowledge and careful reflection. © 2011 Society for Risk Analysis.

Simplified Life-Cycle Cost Estimation

NASA Technical Reports Server (NTRS)

Remer, D. S.; Lorden, G.; Eisenberger, I.

1983-01-01

Simple method for life-cycle cost (LCC) estimation avoids pitfalls inherent in formulations requiring separate estimates of inflation and interest rates. Method depends for validity observation that interest and inflation rates closely track each other.

Apparent impact: the hidden cost of one-shot trades

NASA Astrophysics Data System (ADS)

Mastromatteo, Iacopo

2015-06-01

We study the problem of the execution of a moderate size order in an illiquid market within the framework of a solvable Markovian model. We suppose that in order to avoid impact costs, a trader decides to execute her order through a unique trade, waiting for enough liquidity to accumulate at the best quote. We find that despite the absence of a proper price impact, such trader faces an execution cost arising from a non-vanishing correlation among volume at the best quotes and price changes. We characterize analytically the statistics of the execution time and its cost by mapping the problem to the simpler one of calculating a set of first-passage probabilities on a semi-infinite strip. We finally argue that price impact cannot be completely avoided by conditioning the execution of an order to a more favorable liquidity scenario.

Optimal global value of information trials: better aligning manufacturer and decision maker interests and enabling feasible risk sharing.

PubMed

Eckermann, Simon; Willan, Andrew R

2013-05-01

Risk sharing arrangements relate to adjusting payments for new health technologies given evidence of their performance over time. Such arrangements rely on prospective information regarding the incremental net benefit of the new technology, and its use in practice. However, once the new technology has been adopted in a particular jurisdiction, randomized clinical trials within that jurisdiction are likely to be infeasible and unethical in the cases where they would be most helpful, i.e. with current evidence of positive while uncertain incremental health and net monetary benefit. Informed patients in these cases would likely be reluctant to participate in a trial, preferring instead to receive the new technology with certainty. Consequently, informing risk sharing arrangements within a jurisdiction is problematic given the infeasibility of collecting prospective trial data. To overcome such problems, we demonstrate that global trials facilitate trialling post adoption, leading to more complete and robust risk sharing arrangements that mitigate the impact of costs of reversal on expected value of information in jurisdictions who adopt while a global trial is undertaken. More generally, optimally designed global trials offer distinct advantages over locally optimal solutions for decision makers and manufacturers alike: avoiding opportunity costs of delay in jurisdictions that adopt; overcoming barriers to evidence collection; and improving levels of expected implementation. Further, the greater strength and translatability of evidence across jurisdictions inherent in optimal global trial design reduces barriers to translation across jurisdictions characteristic of local trials. Consequently, efficiently designed global trials better align the interests of decision makers and manufacturers, increasing the feasibility of risk sharing and the expected strength of evidence over local trials, up until the point that current evidence is globally sufficient.

Energy Portfolio Assessment Tool (EPAT): Sustainable Energy Planning Using the WEF Nexus Approach - Texas Case Study

NASA Astrophysics Data System (ADS)

Mroue, A. M.

2017-12-01

The future energy portfolio at the national and subnational levels should consider its impact on water resources and environment. Although energy resources are the main contributors to the national economic growth, these resources must not exploit other primary natural resources. A study of the connections between energy and natural systems, such as water, environment and land is required prior to proceeding to energy development. Policy makers are in need of a tool quantifying the interlinkages across energy, water and the environment, while demonstrating the consequent trade-offs across the nexus systems. The Energy Portfolio Assessment Tool (EPAT) is a tool that enables the policy maker to create different energy portfolio scenarios with various energy and electricity sources, and evaluate the scenario's sustainability environmentally and economically. The Water-Energy-Food nexus systematic approach is the foundation of the EPAT framework. The research evaluates the impact of the current and projected Texas energy portfolios on water and the environment, taking into consideration energy production, electricity generation and policy change. The three scenarios to be assessed include EIA projections for energy production, and EIA projections for electricity generation with and without the Clean Power Plan (CPP). Each scenario is accompanied by tradeoffs across water, land, emissions, energy revenue and electricity cost. The CPP succeeds in mitigating the emissions of the electricity portfolio, but leads to an increase in water consumption and land use. The cost of electricity generation is almost identical with and without environmental conservation. Revenue from energy production increased, but results are majorly influenced by commodity price. Therefore, conservation policies should move from the silo to the nexus mentality to avoid unintended consequences as improving one part of the nexus could end up worsening the other parts.

Array-type miniature interferometer as the core optical microsystem of an optical coherence tomography device for tissue inspection

NASA Astrophysics Data System (ADS)

Passilly, Nicolas; Perrin, Stéphane; Lullin, Justine; Albero, Jorge; Bargiel, Sylwester; Froehly, Luc; Gorecki, Christophe; Krauter, Johann; Osten, Wolfgang; Wang, Wei-Shan; Wiemer, Maik

2016-04-01

Some of the critical limitations for widespread use in medical applications of optical devices, such as confocal or optical coherence tomography (OCT) systems, are related to their cost and large size. Indeed, although quite efficient systems are available on the market, e.g. in dermatology, they equip only a few hospitals and hence, are far from being used as an early detection tool, for instance in screening of patients for early detection of cancers. In this framework, the VIAMOS project aims at proposing a concept of miniaturized, batch-fabricated and lower-cost, OCT system dedicated to non-invasive skin inspection. In order to image a large skin area, the system is based on a full-field approach. Moreover, since it relies on micro-fabricated devices whose fields of view are limited, 16 small interferometers are arranged in a dense array to perform multi-channel simultaneous imaging. Gaps between each channel are then filled by scanning of the system followed by stitching. This approach allows imaging a large area without the need of large optics. It also avoids the use of very fast and often expensive laser sources, since instead of a single point detector, almost 250 thousands pixels are used simultaneously. The architecture is then based on an array of Mirau interferometers which are interesting for their vertical arrangement compatible with vertical assembly at the wafer-level. Each array is consequently a local part of a stack of seven wafers. This stack includes a glass lens doublet, an out-of-plane actuated micro-mirror for phase shifting, a spacer and a planar beam-splitter. Consequently, different materials, such as silicon and glass, are bonded together and well-aligned thanks to lithographic-based fabrication processes.

Cost effectiveness of a systematic guidelines-based approach to the prevention and management of vascular disease in a primary care setting.

PubMed

Kamboj, Laveena; Oh, Paul; Levine, Mitchell; Kammila, Srinu; Casey, William; Harterre, Don; Goeree, Ron

2016-01-15

In Ontario, Canada, the Comprehensive Vascular Disease Prevention and Management Initiative (CVDPMI) was undertaken to improve the vascular health in communities. The CVDPMI significantly improved cardiovascular (CV) risk factor profiles from baseline to follow-up visits including the 10 year Framingham Risk Score (FRS). Although the CVDPMI improved CV risk, the economic value of this program had not been evaluated. We examined the cost effectiveness of the CVDPMI program compared to no CVDPMI program in adult patients identified at risk for an initial or subsequent vascular event in a primary care setting. A one year and a ten year cost effectiveness analyses were conducted. To determine the uncertainty around the cost per life year gained ratio, a non-parametric bootstrap analysis was conducted. The overall population base case analysis at one year resulted in a cost per CV event avoided of $70,423. FRS subgroup analyses showed the high risk cohort (FRS >20%) had an incremental cost effectiveness ratio (ICER) that was dominant. In the moderate risk subgroup (FRS 10%-20%) the ICER was $47,439 per CV event avoided and the low risk subgroup (FRS <10%) showed a highly cost ineffective result of greater than $5 million per CV event avoided. The ten year analysis resulted in a dominant ICER. At one year, the CVDPMI program is economically acceptable for patients at moderate to high risk for CV events. The CVDPMI results in increased life expectancy at an incremental cost saving to the healthcare system over a ten year period. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

How to Avoid the Negative Consequences of Restructuring the Network of Rural Schools

ERIC Educational Resources Information Center

Suvorova, Galina

2004-01-01

Because of the destruction of the agricultural sector of Russia's economy, there is no demand for workers in the countryside, and, as a consequence, the able-bodied population is leaving the countryside and the birth rate has gone down drastically. These factors have resulted in the liquidation of kindergartens and small-enrollment schools and a…

Health impact and monetary cost of exposure to particulate matter emitted from biomass burning in large cities.

PubMed

Sarigiannis, Dimosthenis Α; Karakitsios, Spyros P; Kermenidou, Marianthi V

2015-08-15

The study deals with the assessment of health impact and the respective economic cost attributed to particulate matter (PM) emitted into the atmosphere from biomass burning for space heating, focusing on the differences between the warm and cold seasons in 2011-2012 and 2012-2013 in Thessaloniki (Greece). Health impact was assessed based on estimated exposure levels and the use of established WHO concentration-response functions (CRFs) for all-cause mortality, infant mortality, new chronic bronchitis cases, respiratory and cardiac hospital admissions. Monetary cost was based on the valuation of the willingness-to-pay/accept (WTP/WTA), to avoid or compensate for the loss of welfare associated with illness. Results showed that long term mortality during the 2012-2013 winter increased by 200 excess deaths in a city of almost 900,000 inhabitants or 3540 years of life lost, corresponding to an economic cost of almost 200-250m€. New chronic bronchitis cases dominate morbidity estimates (490 additional new cases corresponding to a monetary cost of 30m€). Estimated health and monetary impacts are more severe during the cold season, despite its smaller duration (4 months). Considering that the increased ambient air concentrations (and the integral of outdoor/indoor exposure) are explained by shifting from oil to biomass for domestic heating purposes, several alternative scenarios were evaluated. Policy scenario analysis revealed that significant public health and monetary benefits (up to 2b€ in avoided mortality and 130m€ in avoided illness) might be obtained by limiting the biomass share in the domestic heat energy mix. Fiscal policy affecting fuels/technologies used for domestic heating needs to be reconsidered urgently, since the net tax loss from avoided oil taxation due to reduced consumption was further compounded by the public health cost of increased mid-term morbidity and mortality. Copyright © 2015 Elsevier B.V. All rights reserved.

The opportunity cost of time modulates cognitive effort.

PubMed

Otto, A Ross; Daw, Nathaniel D

2018-05-08

A spate of recent work demonstrates that humans seek to avoid the expenditure of cognitive effort, much like physical effort or economic resources. Less is clear, however, about the circumstances dictating how and when people decide to expend cognitive effort. Here we adopt a popular theory of opportunity costs and response vigor and to elucidate this question. This account, grounded in Reinforcement Learning, formalizes a trade-off between two costs: the harder work assumed necessary to emit faster actions and the opportunity cost inherent in acting more slowly (i.e., the delay that results to the next reward and subsequent rewards). Recent work reveals that the opportunity cost of time-operationalized as the average reward rate per unit time, theorized to be signaled by tonic dopamine levels, modulates the speed with which a person responds in a simple discrimination tasks. We extend this framework to cognitive effort in a diverse range of cognitive tasks, for which 1) the amount of cognitive effort demanded from the task varies from trial to trial and 2) the putative expenditure of cognitive effort holds measureable consequences in terms of accuracy and response time. In the domains of cognitive control, perceptual decision-making, and task-switching, we found that subjects tuned their level of effort exertion in accordance with the experienced average reward rate: when the opportunity cost of time was high, subjects made more errors and responded more quickly, which we interpret as a withdrawal of cognitive effort. That is, expenditure of cognitive effort appeared to be modulated by the opportunity cost of time. Further, and consistent with our account, the strength of this modulation was predicted by individual differences in efficacy of cognitive control. Taken together, our results elucidate the circumstances dictating how and when people expend cognitive effort. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cost-Effectiveness of Peginterferon Beta-1a and Alemtuzumab in Relapsing-Remitting Multiple Sclerosis.

PubMed

Dashputre, Ankur A; Kamal, Khalid M; Pawar, Gauri

2017-06-01

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system, affecting 2.5 million people globally and 400,000 people in the United States. While no cure exists for MS, the goal is to manage the disease using disease-modifying therapies (DMTs), which have been shown to slow disease progression and prevent relapses. Relapsing-remitting MS (RRMS) is the most common form of MS at the time of diagnosis. Peginterferon beta-1a (PEG) and alemtuzumab (ALT) were recently approved and have demonstrated good clinical outcomes, including reduced relapse rates in clinical trials. High costs associated with these DMTs necessitates cost-effectiveness analyses to understand their overall value in RRMS management. To assess the cost-effectiveness of (a) Model 1: PEG relative to intramuscular interferon beta-1a (IM IFN), subcutaneous interferon beta-1b (SC IFN), glatiramer acetate 20 mg per mL (GA), fingolimod (FIN), natalizumab (NAT), and dimethyl fumarate (DMF), and (b) Model 2: ALT relative to subcutaneous interferon beta-1a 44 μg (IFN beta-1a 44 μg). Both analyses were conducted from a U.S. third-party payer perspective. Two static decision models were used to compare the cost-effectiveness of PEG and ALT over a 1-year and a 2-year time horizon, respectively. Model inputs were drug acquisition costs (wholesale acquisition cost from RED BOOK); drug administration and monitoring costs (package inserts and Centers for Medicare & Medicaid Services 2015 Physician Fee Schedule); relapse rates and relapse rate reduction (clinical trials); and cost of managing relapses (published literature). All costs were adjusted to 2015 U.S. dollars using the medical care component of the Consumer Price Index. Outcomes measured were total cost of therapy per patient, cost per relapse avoided, and incremental cost-effectiveness ratios (ICERs) calculated as cost per relapse avoided. Sensitivity analysis was conducted to test model robustness given the uncertainty of model inputs and study assumptions. Model 1 results showed that PEG dominated IM IFN and GA, compared with SC IFN; PEG had an ICER of $1,978,000 per relapse avoided. Compared with FIN, NAT, and DMF, PEG was less expensive and less effective. Model 2 showed that ALT had an ICER of $25,276 per relapse avoided relative to IFN beta-1a 44 μg. In patients with RRMS, PEG is a viable alternative when compared with the DMTs in our model. Deciding whether to choose PEG over other DMTs would depend on multiple factors. On the other hand, ALT had an ICER of $25,276 cost per relapse avoided relative to IFN beta-1a 44 μg. The study results will assist payers in evaluating different medication choices for effective therapy. No outside funding supported this study. Kamal has received research funding from Novartis Pharmaceuticals and the College of Psychiatric and Neurologic Pharmacists and also serves as a consultant for the Lynx Group. Dashputre and Pawar report no conflicts of interest. Study concept and design were primarily contributed by Dashputre, along with Kamal and Pawar. Dashputre took the lead in data collection, along with Kamal, and data analysis was performed by Dashputre, Kamal, and Pawar. The manuscript was written and revised primarily by Dashputre, along with Kamal and Pawar.

18 CFR 292.304 - Rates for purchases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PRODUCTION AND COGENERATION Arrangements Between Electric Utilities and Qualifying Cogeneration and Small... reasonable to the electric consumer of the electric utility and in the public interest; and (ii) Not... requires any electric utility to pay more than the avoided costs for purchases. (b) Relationship to avoided...

Avoiding or restricting defectors in public goods games?

PubMed

Han, The Anh; Pereira, Luís Moniz; Lenaerts, Tom

2015-02-06

When creating a public good, strategies or mechanisms are required to handle defectors. We first show mathematically and numerically that prior agreements with posterior compensations provide a strategic solution that leads to substantial levels of cooperation in the context of public goods games, results that are corroborated by available experimental data. Notwithstanding this success, one cannot, as with other approaches, fully exclude the presence of defectors, raising the question of how they can be dealt with to avoid the demise of the common good. We show that both avoiding creation of the common good, whenever full agreement is not reached, and limiting the benefit that disagreeing defectors can acquire, using costly restriction mechanisms, are relevant choices. Nonetheless, restriction mechanisms are found the more favourable, especially in larger group interactions. Given decreasing restriction costs, introducing restraining measures to cope with public goods free-riding issues is the ultimate advantageous solution for all participants, rather than avoiding its creation. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial.

PubMed

Whitty, Jennifer A; McInnes, Elizabeth; Bucknall, Tracey; Webster, Joan; Gillespie, Brigid M; Banks, Merrilyn; Thalib, Lukman; Wallis, Marianne; Cumsille, Jose; Roberts, Shelley; Chaboyer, Wendy

2017-10-01

Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Eight tertiary hospitals in Australia. Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be -$2320 (95%CI -$3900, -$1175) per patient, suggesting the care bundle was not a cost-effective use of resources. A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Vaccination strategies for future influenza pandemics: a severity-based cost effectiveness analysis

PubMed Central

2013-01-01

Background A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. Methods A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. Results Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination further improved effectiveness and cost effectiveness. Conclusions The effectiveness and cost effectiveness consequences of the time-critical interplay of pandemic dynamics, vaccine availability and intervention timing has been quantified. For moderate and extreme pandemics, vaccination combined with rapidly activated antiviral and social distancing interventions of sufficient duration is cost effective from the perspective of life years saved. PMID:23398722

Pembrolizumab as second-line therapy in non-small cell lung cancer in northern Norway: budget impact and expected gain—a model-based analysis

PubMed Central

Norum, Jan; Antonsen, Margareth Aarag; Tollåli, Terje; Al-Shibli, Khalid; Andersen, Gry; Svanqvist, Kristin Helene; Helbekkmo, Nina

2017-01-01

Background Pembrolizumab is a new drug approved in several countries for second-line therapy in non-small cell lung cancer (NSCLC) being programmed cell death ligand (PD-L1) positive. This drug has a high cost, and the cost-effectiveness ratio has been debated. Patients and methods The budget impact to the Northern Norwegian Regional Health Authority trust of implementing pembrolizumab in second-line therapy in patients with PD-L1-positive NSCLC was calculated. A model was developed employing data from the Cancer Registry of Norway, the KEYNOTE-010 study, the price list from The Hospital Pharmacy of North Norway, the cost of analysing PD-L1 expression and the cost of travelling. Today’s cost of second-line therapy was compared with the new standard employing pembrolizumab. The sale price of pembrolizumab in Norway was not published due to price confidentiality. Norwegian krone (NKr) was converted into Euros (€) at a rate of 1€=Nkr 8.8138. (Bank of Norway, 21 February 2017). Results 105 new patients were identified available for pembrolizumab per year. The annual cost of pembrolizumab was €5.2 million, hospital pharmacy administration costs €0.1 million, PD-L1 testing €0.3 million, oncologist/pulmonologist/nurses €0.2 million, radiology €0.06 million and transportation €0.4 million. Savings due to avoided present second-line therapy was calculated €0.4 million. Consequently, the cost of implementing pembrolizumab was €5.5 million and the annual budget impact was €5.0 million. A mean gain of at least 9 months per patient treated was necessary to make pembrolizumab cost-effective. Conclusions The net budget impact of pembrolizumab was €5.0 million. The expenditure could not be indicated cost-effective. Price confidentiality is a growing problem in health economics and it has become a ‘menu without prices’ setting. PMID:29209527

Vaccination strategies for future influenza pandemics: a severity-based cost effectiveness analysis.

PubMed

Kelso, Joel K; Halder, Nilimesh; Milne, George J

2013-02-11

A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination further improved effectiveness and cost effectiveness. The effectiveness and cost effectiveness consequences of the time-critical interplay of pandemic dynamics, vaccine availability and intervention timing has been quantified. For moderate and extreme pandemics, vaccination combined with rapidly activated antiviral and social distancing interventions of sufficient duration is cost effective from the perspective of life years saved.

Cost effectiveness of enoxaparin as prophylaxis against venous thromboembolic complications in acutely ill medical inpatients: modelling study from the hospital perspective in Germany.

PubMed

Schädlich, Peter K; Kentsch, Michael; Weber, Manfred; Kämmerer, Wolfgang; Brecht, Josef Georg; Nadipelli, Vijay; Huppertz, Eduard

2006-01-01

To estimate, from the hospital perspective in Germany, the cost effectiveness of the low-molecular-weight heparin (LMWH) subcutaneous enoxaparin sodium 40 mg once daily (ENOX) relative to no pharmacological prophylaxis (NPP) and relative to subcutaneous unfractionated heparin (UFH) 5,000 IU three times daily (low-dose UFH [LDUFH]). Each is used in addition to elastic bandages/compression stockings and physiotherapy in the prevention of venous thromboembolic events (VTE) in immobilised acutely ill medical inpatients without impaired renal function or extremes of body weight. The incremental cost-effectiveness ratios (ICERs) of the 'additional cost for ENOX per clinical VTE avoided versus NPP' and 'additional cost for ENOX per episode of major bleeding avoided versus LDUFH' were chosen as target variables. The target variables were quantified using a modelling approach based on the decision-tree technique. Resource use during thromboprophylaxis, diagnosis and treatment of VTEs, episode of major bleeding and secondary pneumonia after pulmonary embolism (PE) was collected from a hospital survey. Costs were exclusively those to hospitals incurred by staff expenses, drugs, devices, disposables, laboratory tests and equipment for diagnostic procedures. These costs were determined by multiplying utilised resource items by the price or tariff of each item as of the first quarter of 2003. Safety and efficacy values of the comparators were taken from the MEDENOX (prophylaxis in MEDical patients with ENOXaparin) and the THE-PRINCE (THromboEmbolism-PRevention IN Cardiac or respiratory disease with Enoxaparin) trials and from a meta-analysis. The evaluation encompassed 8 (6-14) days of thromboprophylaxis plus time to treat VTE and episode of major bleeding in hospital. Point estimates of all model parameters were applied exclusively in the base-case analysis. There were incremental costs of euro 1,106 for ENOX per clinical VTE avoided versus NPP (1 euro approximately equals 1.07 US dollars; average of the first quarter of 2003). ENOX dominated LDUFH: cost savings of euro 55,825 were obtained and 7.7 episodes of major bleeding were avoided by ENOX compared with LDUFH, each per 1000 patients. In comprehensive sensitivity analyses, the robustness of the model and its results was shown. Results of this evaluation suggest that, in immobilised acutely ill medical inpatients, ENOX may offer hospitals in Germany a very cost-effective option for thromboprophylaxis compared with NPP and a cost-saving alternative compared with LDUFH.

The costs and consequences of assisted reproductive technology: an economic perspective.

PubMed

Connolly, Mark P; Hoorens, Stijn; Chambers, Georgina M

2010-01-01

Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.

The neglected topic: presentation of cost information in patient decision AIDS.

PubMed

Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

2015-05-01

Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. © The Author(s) 2015.

Out-of-pocket cost of drug abuse consequences: results from Iranian National Mental Health Survey.

PubMed

Amin-Esmaeili, Masoumeh; Hefazi, Mitra; Radgoodarzi, Reza; Motevalian, Abbas; Sharifi, Vandad; Hajebi, Ahmad; Rahimi-Movaghar, Afarin

2017-05-01

Drug abuse has significant cost to the individual, the family and the society. This study aimed to assess out of-pocket costs of consequences of drug use disorder. Data were drawn from the Iranian Mental Health Survey (IranMHS) through face-to-face interviews with 7841 respondents aged 15-64 years. We used a bottom-up cost-ofillness method for economic analysis. Out-of-pocket costs for treatment of mental and drug problems, treatment of medical illnesses, as well as costs of crimes were assessed. The average of total annual expense was US$ 2120.6 for those with drug use disorder, which was 23.5% of annual income of an average Iranian family in the year 2011. The average of total out-of-pocket cost was US$ 674.6 for those with other mental disorder and US$ 421.9 for those with no mental disorder. Catastrophic payment was reported in 47.6% of the patients with drug use disorder and 14.4% of those with other mental disorder. Thus, considerable amount of family resources are spent on the consequences of drug use.

Adjusting Mitigation Pathways to Stabilize Climate at 1.5°C and 2.0°C Rise in Global Temperatures to Year 2300

NASA Astrophysics Data System (ADS)

Goodwin, Philip; Brown, Sally; Haigh, Ivan David; Nicholls, Robert James; Matter, Juerg M.

2018-03-01

To avoid the most dangerous consequences of anthropogenic climate change, the Paris Agreement provides a clear and agreed climate mitigation target of stabilizing global surface warming to under 2.0°C above preindustrial, and preferably closer to 1.5°C. However, policy makers do not currently know exactly what carbon emissions pathways to follow to stabilize warming below these agreed targets, because there is large uncertainty in future temperature rise for any given pathway. This large uncertainty makes it difficult for a cautious policy maker to avoid either: (1) allowing warming to exceed the agreed target or (2) cutting global emissions more than is required to satisfy the agreed target, and their associated societal costs. This study presents a novel Adjusting Mitigation Pathway (AMP) approach to restrict future warming to policy-driven targets, in which future emissions reductions are not fully determined now but respond to future surface warming each decade in a self-adjusting manner. A large ensemble of Earth system model simulations, constrained by geological and historical observations of past climate change, demonstrates our self-adjusting mitigation approach for a range of climate stabilization targets ranging from 1.5°C to 4.5°C, and generates AMP scenarios up to year 2300 for surface warming, carbon emissions, atmospheric CO2, global mean sea level, and surface ocean acidification. We find that lower 21st century warming targets will significantly reduce ocean acidification this century, and will avoid up to 4 m of sea-level rise by year 2300 relative to a high-end scenario.

Are we preventing flood damage eco-efficiently? An integrated method applied to post-disaster emergency actions.

PubMed

Petit-Boix, Anna; Arahuetes, Ana; Josa, Alejandro; Rieradevall, Joan; Gabarrell, Xavier

2017-02-15

Flood damage results in economic and environmental losses in the society, but flood prevention also entails an initial investment in infrastructure. This study presents an integrated eco-efficiency approach for assessing flood prevention and avoided damage. We focused on ephemeral streams in the Maresme region (Catalonia, Spain), which is an urbanized area affected by damaging torrential events. Our goal was to determine the feasibility of post-disaster emergency actions implemented after a major event through an integrated hydrologic, environmental and economic approach. Life cycle assessment (LCA) and costing (LCC) were used to determine the eco-efficiency of these actions, and their net impact and payback were calculated by integrating avoided flood damage. Results showed that the actions effectively reduced damage generation when compared to the registered water flows and rainfall intensities. The eco-efficiency of the emergency actions resulted in 1.2kgCO 2 eq. per invested euro. When integrating the avoided damage into the initial investment, negative net impacts were obtained (e.g., -5.2E+05€ and -2.9E+04kgCO 2 eq. per event), which suggests that these interventions contributed with environmental and economic benefits to the society. The economic investment was recovered in two years, whereas the design could be improved to reduce their environmental footprint, which is recovered in 25years. Our method and results highlight the effects of integrating the environmental and economic consequences of decisions at an urban scale and might help the administration and insurance companies in the design of prevention plans and climate change adaptation. Copyright © 2016 Elsevier B.V. All rights reserved.

Not Another Budget Cut! Money-Saving Ideas for Campus Organizations.

ERIC Educational Resources Information Center

Oxendine, W. H. "Butch," Jr.

1997-01-01

Twenty ideas for reducing program costs are offered to campus activities programmers. They include using technology wisely, avoiding excess outlay of funds, trading for services, seeking donations and sponsors, co-sponsoring events, buying supplies in bulk, requesting discounts, avoiding unnecessary sales taxes, using telephone services…

Valuing reduced antibiotic use for pediatric acute otitis media.

PubMed

Meropol, Sharon B

2008-04-01

The 2004 American Academy of Pediatrics acute otitis media guidelines urge parents to weigh the benefits of reduced antibiotic use, adverse drug events, and future resistance versus risks of extra costs and sick days resulting from guideline use. The value of decreased antibiotic resistance has not been quantified. The objective was to perform cost-utility analysis, estimating the resistance value of implementing the guidelines for acute otitis media treatment for children <2 years of age. Outcomes were described with a common denominator and the value of avoiding resistance was estimated using a parental perspective. Decision analysis results were used for outcome probabilities. Published utilities were used to describe outcomes in quality-adjusted life-day units. The minimum resistance benefit value, where the benefits of the American Academy of Pediatrics guidelines would at least balance their costs, was defined as the guidelines' incremental costs minus their other benefits. For a child 2 to <6 months of age presenting to a primary care physician with possible otitis media, parents would need to value the resistance benefit at 0.77 quality-adjusted life-days per antibiotic prescription avoided for the guidelines' benefits to balance their costs. For the 6- to <24-month-old group, results were 0.67 quality-adjusted life-days per prescription avoided. Results were sensitive to the dollar cost utility; when willingness to pay ranged from $20,000 to $200,000 per quality-adjusted life-year, results ranged from 0.36 and 0.30 quality-adjusted life-days up to 4.10 and 3.57 quality-adjusted life-days for the 2- to <6-month-old and 6- to <24-month-old groups, respectively. Costs were driven by missed parent work days. From a societal perspective, trading 0.30 to 4 quality-adjusted life-days to avoid 1 antibiotic course might be desirable; from a parental perspective, this may not be as desirable. Parent demand for antibiotics may be rational when driven by the value of parent time. Other approaches that have the potential to reduce antibiotic use, such as wider use of influenza vaccine and improved rapid viral diagnostic techniques, might be more successful.

Understanding the experiences of people with disfigurements: An integration of four models of social and psychological functioning.

PubMed

Kent, G

2000-05-01

Both psychological (Cash, 1996; Partridge, 1998; Leary et al ., 1998) and sociological (Goffman, 1968) models have been used to explain the personal and social consequences of cosmetic blemishes. In this study, people with the skin disease vitiligo were asked to describe a situation in which their condition had recently affected their lives. Consistent with theories of body image disturbance, incidents usually involved a triggering event when concerns about appearance were raised due to bodily exposure or enacted stigma. These events led respondents to be vigilant to others' behaviour, to be self-conscious and to attribute the cause of the event to their appearance. Theories of social anxiety could be used to account for how the respondents used impression management strategies such as avoidance and concealment. Respondents described how they could be uncertain as to how to deal with others' behaviour, illustrating the relevance of social skills models. In addition, avoidance/concealment had a number of social and personal costs, including the loss of valued activities, reluctance to develop intimate relationships and continuing anxiety. Thus, theories of body image, social anxiety, social skills and the sociology of stigma could be used to understand the respondents' experiences. It seems likely that therapeutic interventions based on different models are useful because they influence different aspects of the above process.

The population impact of obesity, sedentary lifestyle, and tobacco and alcohol consumption on the prevalence of type 2 diabetes: Analysis of a health population survey in Chile, 2010.

PubMed

Bertoglia, María P; Gormaz, Juan G; Libuy, Matías; Sanhueza, Dérgica; Gajardo, Abraham; Srur, Andrea; Wallbaum, Magdalena; Erazo, Marcia

2017-01-01

To estimate the impact of tobacco use, sedentary lifestyle, obesity and alcohol consumption on type 2 diabetes mellitus (T2DM) prevalence in the Chilean population. The study-included 5,293 subjects with fasting glycaemia levels from the nationwide cross-sectional health survey in 2010, commissioned by the Ministry of Health, Chile. Crude and Adjusted Odds Ratio to T2DM and its corresponding 95% confidence interval were estimated through logistic regressions. Attributable fractions and population attributable fractions were estimated. T2DM prevalence was 9.5%. Sedentary lifestyles and obesity were significant risk factors for T2DM. 52,4% of T2DM could be avoided if these individuals were not obese, and at a population level, 23% of T2DM could be preventable if obesity did not exist. A 64% of T2DM is explained by sedentariness, and if people would become active, a 62,2% of the cases of diabetes could be avoided. About 79% of T2DM cases in Chile could be prevented with cost-effective strategies focused on preventing sedentary lifestyle and obesity. It's therefore urgent to implement evidence-based public health polices, aimed to decrease the prevalence of T2DM, by controlling its risk factors and consequently, reducing the complications from T2DM.

What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?

PubMed

Moffatt-Bruce, Susan D; Hefner, Jennifer L; Mekhjian, Hagop; McAlearney, John S; Latimer, Tina; Ellison, Chris; McAlearney, Ann Scheck

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735-a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.

Business Case Analysis for Replacing the Mazak 30Y Mill-Turn Machine in SM-39. Summary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Booth, Steven Richard; Dinehart, Timothy Grant; Benson, Faith Ann

2015-03-19

Business case studies are being looked at to support procurement of new machines and capital equipment in the SM-39 and TA-03-0102 machine shops. The first effort conducted economic analysis of replacing the Mazak 30Y Mill-Turn Machine located in SM-39. To determine the value of switching machinery, a baseline scenario was compared with a future scenario where new machinery was purchased and installed. The conditions under the two scenarios were defined via interviews with subject matter experts in terms of one-time and periodic costs. The results of the analysis were compiled in a life-cycle cost/benefit table. The costs of procuring, installing,more » and maintaining a new machine were balanced against the costs avoided by replacing older machinery. Productivity savings were included as a measure to show the costs avoided by being able to produce parts at a quicker and more efficient pace.« less

Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

PubMed

Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F

2017-06-01

Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P < .001) and may be attributed to a shift in the patient population, with more patients having malabsorption as the indication for therapy in 2010 ( P = .003). There were more than twice as many episodes of dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

Being alexithymic: Necessity or convenience. Negative emotionality × avoidant coping interactions and alexithymia.

PubMed

Bilotta, Elena; Giacomantonio, Mauro; Leone, Luigi; Mancini, Francesco; Coriale, Giovanna

2016-09-01

We aimed to clarify the associations between negative emotionality, avoidant coping, and alexithymia. We hypothesized that negative emotionality and avoidance strategies would interact negatively in associating with alexithymia. We examined, in one study conducted in Italy and another in the US (total N = 415), the associations among avoidant coping, negative emotionality, and alexithymia, using cross-sectional designs. Study 1: Participants completed paper-and-pencil measures of alexithymia, avoidant coping, and negative emotionality. Study 2: Participants completed the above-mentioned measures plus a measure of experiential avoidance (EA), by means of an online questionnaire. As expected, an antagonistic avoidant coping × negative emotionality interaction was found to relate to alexithymia in both studies. In Study 2, EA mediated the effects of such interaction on alexithymia (mediated moderation). The interaction found implied that alexithymia would be adopted as a defence against negative affect or as a consequence of avoidant strategies. The studies suggested that two different psychological pathways to alexithymia may be at work: Preference for avoidance and negative emotionality. This result appeared theoretically relevant and may stimulate further research. Alexithymia may develop from habitual avoidance, regardless of negative emotionality. Practitioners could consider addressing negative emotional regulation or automatic and habitual avoidant responses in dealing with alexithymic patients. © 2015 The British Psychological Society.

SAVANT: Solar Array Verification and Analysis Tool Demonstrated

NASA Technical Reports Server (NTRS)

Chock, Ricaurte

2000-01-01

The photovoltaics (PV) industry is now being held to strict specifications, such as end-oflife power requirements, that force them to overengineer their products to avoid contractual penalties. Such overengineering has been the only reliable way to meet such specifications. Unfortunately, it also results in a more costly process than is probably necessary. In our conversations with the PV industry, the issue of cost has been raised again and again. Consequently, the Photovoltaics and Space Environment Effects branch at the NASA Glenn Research Center at Lewis Field has been developing a software tool to address this problem. SAVANT, Glenn's tool for solar array verification and analysis is in the technology demonstration phase. Ongoing work has proven that more efficient and less costly PV designs should be possible by using SAVANT to predict the on-orbit life-cycle performance. The ultimate goal of the SAVANT project is to provide a user-friendly computer tool to predict PV on-orbit life-cycle performance. This should greatly simplify the tasks of scaling and designing the PV power component of any given flight or mission. By being able to predict how a particular PV article will perform, designers will be able to balance mission power requirements (both beginning-of-life and end-of-life) with survivability concerns such as power degradation due to radiation and/or contamination. Recent comparisons with actual flight data from the Photovoltaic Array Space Power Plus Diagnostics (PASP Plus) mission validate this approach.

Global economic potential for reducing carbon dioxide emissions from mangrove loss.

PubMed

Siikamäki, Juha; Sanchirico, James N; Jardine, Sunny L

2012-09-04

Mangroves are among the most threatened and rapidly disappearing natural environments worldwide. In addition to supporting a wide range of other ecological and economic functions, mangroves store considerable carbon. Here, we consider the global economic potential for protecting mangroves based exclusively on their carbon. We develop unique high-resolution global estimates (5' grid, about 9 × 9 km) of the projected carbon emissions from mangrove loss and the cost of avoiding the emissions. Using these spatial estimates, we derive global and regional supply curves (marginal cost curves) for avoided emissions. Under a broad range of assumptions, we find that the majority of potential emissions from mangroves could be avoided at less than $10 per ton of CO(2). Given the recent range of market price for carbon offsets and the cost of reducing emissions from other sources, this finding suggests that protecting mangroves for their carbon is an economically viable proposition. Political-economy considerations related to the ability of doing business in developing countries, however, can severely limit the supply of offsets and increases their price per ton. We also find that although a carbon-focused conservation strategy does not automatically target areas most valuable for biodiversity, implementing a biodiversity-focused strategy would only slightly increase the costs.

Repeated intermittent ulipristal acetate in the treatment of uterine fibroids: a cost-effectiveness analysis.

PubMed

Geale, Kirk; Saridogan, Ertan; Lehmann, Matthieu; Arriagada, Pablo; Hultberg, Marcus; Henriksson, Martin

2017-01-01

There are limited treatment options available for women with moderate to severe symptoms of uterine fibroids (UFs) who wish to avoid surgery. For these women, treatment with standard pharmaceuticals such as contraceptives is often insufficient to relieve symptoms, and patients may require surgery despite their wish to avoid it. Clinical trials demonstrate that ulipristal acetate 5 mg (UPA) is an effective treatment for this patient group, but its cost-effectiveness has not been assessed in this population. A decision-analytic model was developed to simulate a cohort of patients in this population under treatment with UPA followed by surgery as needed compared to treatment with iron and non-steroidal anti-inflammatory drug (NSAID) followed by surgery as needed (best supportive care, BSC). The analysis took the perspective of the National Health Service (NHS) in England, UK, and was based on the published UPA clinical trials. Results were calculated for the long-term costs and quality-adjusted life years (QALYs) for each treatment arm and combined into an incremental cost-effectiveness ratio (ICER) as the primary outcome. The impact of parameter uncertainty on the results was assessed using scenario, deterministic, and probabilistic sensitivity analyses. The results show that treating patients with the UPA strategy, instead of the BSC strategy, results in an additional cost of £1,115 and a gain of 0.087 QALYs, resulting in an ICER of £12,850. Given commonly accepted cost-effectiveness thresholds in England, the use of UPA as a repeated, intermittent treatment for women with moderate to severe symptoms of UF wishing to avoid surgery is likely to be a cost-effective intervention when compared to BSC.

Optimizing Value and Avoiding Problems in Building Schools.

ERIC Educational Resources Information Center

Brevard County School Board, Cocoa, FL.

This report describes school design and construction delivery processes used by the School Board of Brevard County (Cocoa, Florida) that help optimize value, avoid problems, and eliminate the cost of maintaining a large facility staff. The project phases are examined from project definition through design to construction. Project delivery…

Interspecific interference competition at the resource patch scale: do large herbivores spatially avoid elephants while accessing water?

PubMed

Ferry, Nicolas; Dray, Stéphane; Fritz, Hervé; Valeix, Marion

2016-11-01

Animals may anticipate and try to avoid, at some costs, physical encounters with other competitors. This may ultimately impact their foraging distribution and intake rates. Such cryptic interference competition is difficult to measure in the field, and extremely little is known at the interspecific level. We tested the hypothesis that smaller species avoid larger ones because of potential costs of interference competition and hence expected them to segregate from larger competitors at the scale of a resource patch. We assessed fine-scale spatial segregation patterns between three African herbivore species (zebra Equus quagga, kudu Tragelaphus strepsiceros and giraffe Giraffa camelopardalis) and a megaherbivore, the African elephant Loxodonta africana, at the scale of water resource patches in the semi-arid ecosystem of Hwange National Park, Zimbabwe. Nine waterholes were monitored every two weeks during the dry season of a drought year, and observational scans of the spatial distribution of all herbivores were performed every 15 min. We developed a methodological approach to analyse such fine-scale spatial data. Elephants increasingly used waterholes as the dry season progressed, as did the probability of co-occurrence and agonistic interaction with elephants for the three study species. All three species segregated from elephants at the beginning of the dry season, suggesting a spatial avoidance of elephants and the existence of costs of being close to them. However, contrarily to our expectations, herbivores did not segregate from elephants the rest of the dry season but tended to increasingly aggregate with elephants as the dry season progressed. We discuss these surprising results and the existence of a trade-off between avoidance of interspecific interference competition and other potential factors such as access to quality water, which may have relative associated costs that change with the time of the year. © 2016 The Authors. Journal of Animal Ecology © 2016 British Ecological Society.

In the absence of a "landscape of fear": How lions, hyenas, and cheetahs coexist.

PubMed

Swanson, Alexandra; Arnold, Todd; Kosmala, Margaret; Forester, James; Packer, Craig

2016-12-01

Aggression by top predators can create a "landscape of fear" in which subordinate predators restrict their activity to low-risk areas or times of day. At large spatial or temporal scales, this can result in the costly loss of access to resources. However, fine-scale reactive avoidance may minimize the risk of aggressive encounters for subordinate predators while maintaining access to resources, thereby providing a mechanism for coexistence. We investigated fine-scale spatiotemporal avoidance in a guild of African predators characterized by intense interference competition. Vulnerable to food stealing and direct killing, cheetahs are expected to avoid both larger predators; hyenas are expected to avoid lions. We deployed a grid of 225 camera traps across 1,125 km 2 in Serengeti National Park, Tanzania, to evaluate concurrent patterns of habitat use by lions, hyenas, cheetahs, and their primary prey. We used hurdle models to evaluate whether smaller species avoided areas preferred by larger species, and we used time-to-event models to evaluate fine-scale temporal avoidance in the hours immediately surrounding top predator activity. We found no evidence of long-term displacement of subordinate species, even at fine spatial scales. Instead, hyenas and cheetahs were positively associated with lions except in areas with exceptionally high lion use. Hyenas and lions appeared to actively track each, while cheetahs appear to maintain long-term access to sites with high lion use by actively avoiding those areas just in the hours immediately following lion activity. Our results suggest that cheetahs are able to use patches of preferred habitat by avoiding lions on a moment-to-moment basis. Such fine-scale temporal avoidance is likely to be less costly than long-term avoidance of preferred areas: This may help explain why cheetahs are able to coexist with lions despite high rates of lion-inflicted mortality, and highlights reactive avoidance as a general mechanism for predator coexistence.

Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.

PubMed

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-02-01

This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Annual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20-29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Imperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. Copyright © 2013 Elsevier Inc. All rights reserved.

Cost-effectiveness of atorvastatin in the prevention of cardiovascular events in diabetic patients: a French adaptation of CARDS.

PubMed

Lafuma, Antoine; Colin, Xavier; Solesse, Anne

2008-05-01

We estimated the cost-effectiveness of atorvastatin in the primary prevention of cardiovascular events in patients with type 2 diabetes using data from the Collaborative AtoRvastatin Diabetes Study (CARDS). A total of 2838 patients aged 40-75 years with type 2 diabetes and no documented history of cardiovascular disease and without elevated low-density-lipoprotein cholesterol were recruited in the UK and in Ireland. Patients were randomly allocated to atorvastatin 10mg daily (n=1428) or placebo (n=1410) and were followed up for a median of 3.9 years. Direct treatment costs and effectiveness were analysed to provide estimates of cost per event avoided and cost per life-year gained over the trial period and over a patient's lifetime. The incremental cost-effectiveness ratio over the trial period was estimated to be Euro 3862 per clinical event avoided. Over the patient's lifetime, the incremental cost per life-year gained was Euro 2506 when considering cardiovascular deaths, and Euro 1418 per year when considering all-cause death. Primary prevention of cardiovascular disease with atorvastatin is cost-effective in patients with type 2 diabetes, with the incremental cost-effectiveness ratio for this intervention falling within the current acceptance threshold.

Burden of unintended pregnancy in the United States: Potential savings with increased use of long-acting reversible contraception

PubMed Central

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-01-01

Background This study evaluated the total costs of unintended pregnancy (UP) in the United States from a third -party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. Study Design An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all US women requiring reversible contraception: the pattern of contraceptive use and rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Results Annual medical costs of UP in the United States were estimated to be $4.5 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20–29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Conclusions Imperfect contraceptive adherence leads to substantial unintended pregnancy and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. PMID:22959904

Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing.

PubMed

Miller, Ted R; Zaloshnja, Eduard; Spicer, Rebecca S

2007-05-01

Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective in the workplace.

Determinants of FDI Localization in China: A County-Level Analysis for the Pharmaceutical Industry

PubMed Central

Li, Su; Angelino, Antonio; Yin, Haitao

2017-01-01

Foreign direct investments (FDIs) have been widely recognized as a crucial feature of the Chinese industrial development process. Over the past decades, China has been attracting huge amounts of inward FDIs as a consequence of both spontaneous market dynamics and place-based preferential policies at the sub-national level. However, the Chinese market exhibits large dissimilarities in terms of FDI localization across territories that are worth investigating at a more disaggregated level. In this regards, our study explores the determinants of attraction of inward FDIs in China, at the county level. It focuses on the pharmaceutical industry and attempts to assess whether factors related to location advantages, agglomeration dynamics, information cost effects and environmental regulation costs affect foreign firms’ localization choices as well as invested amounts in that location. By means of discrete choice models, our paper confirms the findings of the prevalent literature about the positive effects of location advantages on pharmaceutical FDI attraction. Different from our expectations, a higher proportion of foreign enterprises do not stimulate significant effects on FDI localization, while preferential policies and sectoral agglomeration are positively correlated with the localization of pharmaceutical foreign firms. Finally, our results suggest that investing firms tend to avoid areas with strict environment regulation. PMID:28867815

Determinants of FDI Localization in China: A County-Level Analysis for the Pharmaceutical Industry.

PubMed

Li, Su; Angelino, Antonio; Yin, Haitao; Spigarelli, Francesca

2017-08-30

Foreign direct investments (FDIs) have been widely recognized as a crucial feature of the Chinese industrial development process. Over the past decades, China has been attracting huge amounts of inward FDIs as a consequence of both spontaneous market dynamics and place-based preferential policies at the sub-national level. However, the Chinese market exhibits large dissimilarities in terms of FDI localization across territories that are worth investigating at a more disaggregated level. In this regards, our study explores the determinants of attraction of inward FDIs in China, at the county level. It focuses on the pharmaceutical industry and attempts to assess whether factors related to location advantages, agglomeration dynamics, information cost effects and environmental regulation costs affect foreign firms' localization choices as well as invested amounts in that location. By means of discrete choice models, our paper confirms the findings of the prevalent literature about the positive effects of location advantages on pharmaceutical FDI attraction. Different from our expectations, a higher proportion of foreign enterprises do not stimulate significant effects on FDI localization, while preferential policies and sectoral agglomeration are positively correlated with the localization of pharmaceutical foreign firms. Finally, our results suggest that investing firms tend to avoid areas with strict environment regulation.

The mixed mating system of the sea palm kelp Postelsia palmaeformis: few costs to selfing

PubMed Central

Barner, Allison K.; Pfister, Catherine A.; Wootton, J. Timothy

2011-01-01

Naturally isolated populations have conflicting selection pressures for successful reproduction and inbreeding avoidance. These species with limited seasonal reproductive opportunities may use selfing as a means of reproductive assurance. We quantified the frequency of selfing and the fitness consequences for inbred versus outcrossed progeny of an annual kelp, the sea palm (Postelsia palmaeformis). Using experimentally established populations and microsatellite markers to assess the extent of selfing in progeny from six founding parents, we found the frequency of selfing was higher than expected in every population, and few fitness costs were detected in selfed offspring. Despite a decline in heterozygosity of 30 per cent in the first generation of selfing, self-fertilization did not affect individual size or reproduction, and correlated only with a marginally significant decline in survival. Our results suggest both that purging of deleterious recessive alleles may have already occurred and that selfing may be key to reproductive assurance in this species with limited dispersal. Postelsia has an alteration of a free-living diploid and haploid stage, where the haploid stage may provide increased efficiency for purging the genetic load. This life history is shared by many seaweeds and may thus be an important component of mating system evolution in the sea. PMID:20961896

Ways to make "usual" and "successful" aging synonymous. Preventive gerontology.

PubMed Central

Hazzard, W R

1997-01-01

Preventive gerontology is the study and practice of those elements of lifestyle, environment, and health care management that will provide the maximal longevity of highest quality for individuals and the population. As such, it focuses on a personalized hygiene agenda that varies in its emphasis according to a person's age, sex, and risk factor profile. It includes a matrix of strategies relating to diet, exercise, and the avoidance of substance abuse and adverse environmental exposure. Preventive gerontology carries differential emphases according to the life stage of a person, featuring long-term, low-cost, and low-risk lifestyle strategies in youth and middle age (generally to age 75) and more short-term, low-risk interventions in old age (> 75), especially secondary prevention, according to individualized estimates of risk, cost, and benefit. The aggregate effect of widespread application of this approach--especially insofar as it is coupled with a rising level of education and continued psychosocial development--will be progressive congruency between usual and successful aging. A by-product will also be an ever-advancing median age of the population and, inevitably, a growth in long-term health and social service needs. Responsible planning for this consequence of success in the 21st century will require a rededication of North Americans to care for those in need regardless of age. PMID:9348749

Personal digital assistant applications for the healthcare provider.

PubMed

Keplar, Kristine E; Urbanski, Christopher J

2003-02-01

To review some common medical applications available for personal digital assistants (PDAs), with brief discussion of the different PDA operating systems and memory requirements. Key search terms included handheld, PDA, personal digital assistants, and medical applications. The literature was accessed through MEDLINE (1999-August 2002). Other information was obtained through secondary sources such as Web sites describing common PDAs. Medical applications available on PDAs are numerous and include general drug references, specialized drug references (e.g., pediatrics, geriatrics, cardiology, infectious disease), diagnostic guides, medical calculators, herbal medication references, nursing references, toxicology references, and patient tracking databases. Costs and memory requirements for these programs can vary; consequently, the healthcare provider must limit the medication applications that are placed on the handheld computer. This article attempts to systematically describe the common medical applications available for the handheld computer along with cost, memory and download requirements, and Web site information. This review found many excellent PDA drug information applications offering many features which will aid the healthcare provider. Very likely, after using these PDA applications, the healthcare provider will find them indispensable, as their multifunctional capabilities can save time, improve accuracy, and allow for general business procedures as well as being a quick reference tool. To avoid the benefits of this technology might be a step backward.

Evaluation of the air quality benefits of the subway system in São Paulo, Brazil.

PubMed

Silva, Cacilda Bastos Pereira da; Saldiva, Paulo Hilário Nascimento; Amato-Lourenço, Luis Fernando; Rodrigues-Silva, Fernando; Miraglia, Simone Georges El Khouri

2012-06-30

Air pollution is a severe problem in major urban areas due to increasing numbers of vehicles, reduced road capacity and few investments in public transportation, especially in developing countries. Public transportation has a special role in avoiding congestion and consequent environmental and health impacts but is considered expensive. The objective of this paper was to analyze the benefits of the São Paulo subway in terms of the air pollution in the city through strikes events, analyzing both the health outcomes and the related economic burden. For the strike events, increases in air pollutant concentrations during the strike day was observed when compared to a similar day in terms of day of the week and meteorological conditions. Increases in mortality were also observed and the associated economic burden calculated. Despite the elevated construction and operation costs of the subway, when environment and social values are considered, cost-benefit analysis results would indicate a worthwhile investment. The consideration of these aspects is essential to sustainable transportation analyses, and in the case of the São Paulo subway, our analysis clearly demonstrated the important role of this system in the city's environmental, social and economic attributes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cost-effectiveness of droxidopa in patients with neurogenic orthostatic hypotension: post-hoc economic analysis of Phase 3 clinical trial data.

PubMed

François, Clément; Hauser, Robert A; Aballéa, Samuel; Dorey, Julie; Kharitonova, Elizaveta; Hewitt, L Arthur

2016-01-01

Falls are associated with neurogenic orthostatic hypotension (nOH) and are an economic burden on the US healthcare system. Droxidopa is approved by the US FDA to treat symptomatic nOH. This study estimates the cost-effectiveness of droxidopa vs standard of care from a US payer perspective. A Markov model was used to predict numbers of falls and treatment responses using data from a randomized, double-blind trial of patients with Parkinson's disease and nOH who received optimized droxidopa therapy or placebo for 8 weeks. The severity of falls, utility values, and injury-related costs were derived from published studies. Model outcomes included number of falls, number of quality-adjusted life-years (QALYs), and direct costs. Incremental cost-effectiveness ratios (ICERs) were calculated. Outcomes were extrapolated over 12 months. Patients receiving droxidopa had fewer falls compared with those receiving standard of care and gained 0.33 QALYs/patient. Estimated droxidopa costs were $30,112, with estimated cost savings resulting from fall avoidance of $14,574 over 12 months. Droxidopa was cost-effective vs standard of care, with ICERs of $47,001/QALY gained, $24,866 per avoided fall with moderate/major injury, and $1559 per avoided fall with no/minor injury. The main drivers were fall probabilities and fear of fall-related inputs. A limitation of the current study is the reliance on falls data from a randomized controlled trial where the placebo group served as the proxy for standard of care. Data from a larger patient population, reflecting 'real-life' patient use and/or comparison with other agents used to treat nOH, would have been a useful complement, but these data were not available. Using Markov modeling, droxidopa appears to be a cost-effective option compared with standard of care in US clinical practice for the treatment of nOH.

Costs and effects of long-acting risperidone compared with oral atypical and conventional depot formulations in Germany.

PubMed

Laux, Gerd; Heeg, Bart; van Hout, Ben A; Mehnert, Angelika

2005-01-01

Schizophrenia is one of the most expensive psychiatric conditions because of high direct and indirect costs associated with the nature of the illness, its resistance to treatment and the consequences of relapse. Long-acting risperidone is a new formulation of an atypical antipsychotic drug that also offers the improvements in compliance associated with haloperidol depot. The aim of this simulation study was to compare the benefits and costs of three pharmacological treatment strategies comprising first-line treatment with long-acting risperidone injection, a haloperidol depot or an oral atypical antipsychotic agent, over a 5-year period in Germany. A discrete event simulation model was developed to compare three treatment scenarios from the perspective of major third-party payers (sickness funds and social security 'Sozialversicherung'). The scenarios comprised first-line treatment with haloperidol depot (scenario 1), long-acting risperidone (scenario 2) and oral olanzapine (scenario 3). Switches to second or third-line options were allowed when side-effects occurred or a patient suffered more than a fixed number of relapses. The model accounted for fixed patient characteristics, and on the basis of these, simulated patient histories according to several time-dependent variables. The time horizon for this model was limited to 5 years, and in accordance with German guidelines, costs and effects were discounted by between 3 and 10%. Direct costs included medication, type of physician visits and treatment location. Indirect costs were not included. Information on treatment alternatives, transition probabilities, model structure and healthcare utilization were derived from the literature and an expert panel. Outcomes were expressed in terms of the number and duration of psychotic episodes, cumulative symptom scores, costs, and quality-adjusted life-years (QALY). Univariate sensitivity analyses were carried out, as were subgroup analyses based on disease severity and for patients at high risk of being non-compliant. The long-acting risperidone strategy was calculated to avoid 0.23 and 0.33 relapses per patient, decrease the cumulative symptom score by 25 and 33 points, and decrease the costs by 2017 Euro and 6096 Euro per patient (1608 Euro and 5422 Euro discounted), compared with the haloperidol depot and olanzapine strategies, respectively, over a 5-year period (year of costing 2004). Among high-risk non-compliant patients, long-acting risperidone was estimated to avoid 0.23 and 0.47 relapses and save 4822 Euro and 10,646 Euro per patient (4107 Euro and 9490 Euro discounted), compared with the haloperidol depot and olanzapine strategies, respectively. Sensitivity analyses showed that the results were robust and mainly sensitive to changes in the reported relative effectiveness of atypical and conventional formulations for preventing symptom recurrence, and in the relative compliance with oral and long-acting formulations. In this model, long-acting risperidone is a dominant strategy compared with a haloperidol depot or oral atypical antipsychotic agent, being both more effective and less costly over a 5-year period. Results for long-acting risperidone are even more favourable among patients at high risk of being noncompliant or with more severe disease.

Development challenges of secondary and small airports in California.

DOT National Transportation Integrated Search

2012-06-01

This study investigates the development of secondary and smaller airports in California. Low-Cost Carrier (LCC) business is growing at these airports because they offer reduced operating costs, and they have adequate capacity to help LCCs avoid battl...

Better health outcomes at lower costs: the benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia's Northern Territory.

PubMed

Zhao, Yuejen; Thomas, Susan L; Guthridge, Steven L; Wakerman, John

2014-10-04

Indigenous residents living in remote communities in Australia's Northern Territory experience higher rates of preventable chronic disease and have poorer access to appropriate health services compared to other Australians. This study compared health outcomes and costs at different levels of primary care utilisation to determine if primary care represents an efficient use of resources for Indigenous patients with common chronic diseases namely hypertension, diabetes, ischaemic heart disease, chronic obstructive pulmonary disease and renal disease. This was an historical cohort study involving a total of 14,184 Indigenous residents, aged 15 years and over, who lived in remote communities and used a remote clinic or public hospital from 2002 to 2011. Individual level demographic and clinical data were drawn from primary care and hospital care information systems using a unique patient identifier. A propensity score was used to improve comparability between high, medium and low primary care utilisation groups. Incremental cost-effectiveness ratios and acceptability curves were used to analyse four health outcome measures: total and, avoidable hospital admissions, deaths and years of life lost. Compared to the low utilisation group, medium and high levels of primary care utilisation were associated with decreases in total and avoidable hospitalisations, deaths and years of life lost. Higher levels of primary care utilisation for renal disease reduced avoidable hospitalisations by 82-85%, deaths 72-75%, and years of life lost 78-81%. For patients with ischaemic heart disease, the reduction in avoidable hospitalisations was 63-78%, deaths 63-66% and years of life lost 69-73%. In terms of cost-effectiveness, primary care for renal disease and diabetes ranked as more cost-effective, followed by hypertension and ischaemic heart disease. Primary care for chronic obstructive pulmonary disease was the least cost-effective of the five conditions. Primary care in remote Indigenous communities was shown to be associated with cost-savings to public hospitals and health benefits to individual patients. Investing $1 in primary care in remote Indigenous communities could save $3.95-$11.75 in hospital costs, in addition to health benefits for individual patients. These findings may have wider applicability in strengthening primary care in the face of high chronic disease prevalence globally.

A Management Project to Determine the Potential Cost Avoidance Due to the Application of Managed Care Mechanisms on CHAMPUS Inpatient Mental Health Care in Colorado Springs, Colorado

DTIC Science & Technology

1990-05-11

PROJECT TO DETERMINE THE POTENTIAL COST AVOIDANCE 0 aDUE TO THE APPLICATION OF MANAGED CARE MECHANISMS C 0 ON CHAMPUS INPATIENT MENTAL HEALTH CARE IN m...endeavor to make this project clear, M z -4 consistent and accurate. I would also like to thank Captain Mike mx ~ T Rogers and his staff in the Evans...D-1 E. Diagnostic Criteria and Treatment Screens for Diagnoses Code 2962, Major Depression ........ E-1 Mental Health 1 Abstract Managed

Long-term economic consequences of child maltreatment: a population-based study.

PubMed

Thielen, Frederick W; Ten Have, Margreet; de Graaf, Ron; Cuijpers, Pim; Beekman, Aartjan; Evers, Silvia; Smit, Filip

2016-12-01

Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with staggering long-term economic costs, rendering lack of action very costly. Our data lends credibility to the hypothesis that mastery may help to cushion the adverse consequences of child maltreatment. Further research on mastery may help to ameliorate individual burden and in addition offer some economic benefits.

A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis.

PubMed

Kip, Michelle M A; Kusters, Ron; IJzerman, Maarten J; Steuten, Lotte M G

2015-01-01

Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice. A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided. The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa € 3503 per patient, indicating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs. Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistance.

Applicability of fluidized bed reactor in recalcitrant compound degradation through advanced oxidation processes: a review.

PubMed

Tisa, Farhana; Abdul Raman, Abdul Aziz; Wan Daud, Wan Mohd Ashri

2014-12-15

Treatment of industrial waste water (e.g. textile waste water, phenol waste water, pharmaceutical etc) faces limitation in conventional treatment procedures. Advanced oxidation processes (AOPs) do not suffer from the limits of conventional treatment processes and consequently degrade toxic pollutants more efficiently. Complexity is faced in eradicating the restrictions of AOPs such as sludge formation, toxic intermediates formation and high requirement for oxidants. Increased mass-transfer in AOPs is an alternate solution to this problem. AOPs combined with Fluidized bed reactor (FBR) can be a potential choice compared to fixed bed or moving bed reactor, as AOP catalysts life-span last for only maximum of 5-10 cycles. Hence, FBR-AOPs require lesser operational and maintenance cost by reducing material resources. The time required for AOP can be minimized using FBR and also treatable working volume can be increased. FBR-AOP can process from 1 to 10 L of volume which is 10 times more than simple batch reaction. The mass transfer is higher thus the reaction time is lesser. For having increased mass transfer sludge production can be successfully avoided. The review study suggests that, optimum particle size, catalyst to reactor volume ratio, catalyst diameter and liquid or gas velocity is required for efficient FBR-AOP systems. However, FBR-AOPs are still under lab-scale investigation and for industrial application cost study is needed. Cost of FBR-AOPs highly depends on energy density needed and the mechanism of degradation of the pollutant. The cost of waste water treatment containing azo dyes was found to be US$ 50 to US$ 500 per 1000 gallons where, the cost for treating phenol water was US$ 50 to US$ 800 per 1000 gallons. The analysis for FBR-AOP costs has been found to depend on the targeted pollutant, degradation mechanism (zero order, 1st order and 2nd order) and energy consumptions by the AOPs. Copyright © 2014 Elsevier Ltd. All rights reserved.

EDOVE: Energy and Depth Variance-Based Opportunistic Void Avoidance Scheme for Underwater Acoustic Sensor Networks

PubMed Central

Eun, Yongsoon

2017-01-01

Underwater Acoustic Sensor Network (UASN) comes with intrinsic constraints because it is deployed in the aquatic environment and uses the acoustic signals to communicate. The examples of those constraints are long propagation delay, very limited bandwidth, high energy cost for transmission, very high signal attenuation, costly deployment and battery replacement, and so forth. Therefore, the routing schemes for UASN must take into account those characteristics to achieve energy fairness, avoid energy holes, and improve the network lifetime. The depth based forwarding schemes in literature use node’s depth information to forward data towards the sink. They minimize the data packet duplication by employing the holding time strategy. However, to avoid void holes in the network, they use two hop node proximity information. In this paper, we propose the Energy and Depth variance-based Opportunistic Void avoidance (EDOVE) scheme to gain energy balancing and void avoidance in the network. EDOVE considers not only the depth parameter, but also the normalized residual energy of the one-hop nodes and the normalized depth variance of the second hop neighbors. Hence, it avoids the void regions as well as balances the network energy and increases the network lifetime. The simulation results show that the EDOVE gains more than 15% packet delivery ratio, propagates 50% less copies of data packet, consumes less energy, and has more lifetime than the state of the art forwarding schemes. PMID:28954395

EDOVE: Energy and Depth Variance-Based Opportunistic Void Avoidance Scheme for Underwater Acoustic Sensor Networks.

PubMed

Bouk, Safdar Hussain; Ahmed, Syed Hassan; Park, Kyung-Joon; Eun, Yongsoon

2017-09-26

Underwater Acoustic Sensor Network (UASN) comes with intrinsic constraints because it is deployed in the aquatic environment and uses the acoustic signals to communicate. The examples of those constraints are long propagation delay, very limited bandwidth, high energy cost for transmission, very high signal attenuation, costly deployment and battery replacement, and so forth. Therefore, the routing schemes for UASN must take into account those characteristics to achieve energy fairness, avoid energy holes, and improve the network lifetime. The depth based forwarding schemes in literature use node's depth information to forward data towards the sink. They minimize the data packet duplication by employing the holding time strategy. However, to avoid void holes in the network, they use two hop node proximity information. In this paper, we propose the Energy and Depth variance-based Opportunistic Void avoidance (EDOVE) scheme to gain energy balancing and void avoidance in the network. EDOVE considers not only the depth parameter, but also the normalized residual energy of the one-hop nodes and the normalized depth variance of the second hop neighbors. Hence, it avoids the void regions as well as balances the network energy and increases the network lifetime. The simulation results show that the EDOVE gains more than 15 % packet delivery ratio, propagates 50 % less copies of data packet, consumes less energy, and has more lifetime than the state of the art forwarding schemes.

Reformation of PURPA contracts: Strategies for success in power marketing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scalzo, P.J.

With the passage of the Energy Policy Act of 1992, real competition entered into the world of electric utilities. A slide presentations is given on reformation of Public Utility Regulatory Policies Act (PURPA) Contracts for success in power marketing strategies. Two ways to compete: Be the least cost provider or add value and `sell hard`. The PURPA vision was to increase efficiency in power generation, utilize renewable or waste fuels, and bolster the independent producers. Cogenerators and small power producers qualified. Utility planners predicted, avoided cost, utility loads, and oil and gas prices to increase. However, avoided costs, and oilmore » and gase prices declined. Two scenarios are discussed for contract reformation: Contract buyouts, and renegotiation of contracts. Options for for dealing with existing fuel agreements are presented.« less

The economic impact of state ordered avoided cost rates for photovoltaic generated electricity

NASA Astrophysics Data System (ADS)

Bottaro, D.; Wheatley, N. J.

Various methods the states have devised to implement federal policy regarding the Public Utility Regulatory Policies Act (PURPA) of 1978, which requires that utilities pay their full 'avoided costs' to small power producers for the energy and capacity provided, are examined. The actions of several states are compared with rates estimated using utility expansion and rate-setting models, and the potential break-even capital costs of a photovoltaic system are estimated using models which calculate photovoltaic worth. The potential for the development of photovoltaics has been increased by the PURPA regulations more from the guarantee of utility purchase of photovoltaic power than from the high buy-back rates paid. The buy-back rate is high partly because of the surprisingly high effective capacity of photovoltaic systems in some locations.

Operation and maintenance cost-cutting

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hollingshead, T.W.

This presentation by Timothy W. Hollingshead, Technical Services Manager, Pacific Gas and Electric, is about cutting costs in the Operation and Maintenance phase of geothermal energy production. The necessity of cost control, keeping workers well-trained and avoiding OSHA fines, taking advantages of new technologies, and establishing predictive maintenance programs are some of the issues discussed in this article.

Improving Learning and Reducing Costs: Fifteen Years of Course Description

ERIC Educational Resources Information Center

Twigg, Carol A.

2015-01-01

Recognizing that tuition increases can no longer be used as a safety valve to avoid dealing with the underlying issues of why costs increase so much, campuses have begun the hard work of cost containment. After sharpening priorities, sometimes making tough choices in light of those priorities, campuses are still groping for ways to wrestle costs…

Antimicrobial Stewardship and Urinary Tract Infections

PubMed Central

Abbo, Lilian M.; Hooton, Thomas M.

2014-01-01

Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections. PMID:27025743

You may worry, but can you recognize threats when you see them?; Neuroticism, threat identifications, and negative affect.

PubMed

Tamir, Maya; Robinson, Michael D; Solberg, Emily Crawford

2006-10-01

The present studies sought to investigate the hedonic consequences of threat-identification skills at low and high levels of neuroticism. Such skills were assessed in terms of both speed (Study 1) and accuracy (Study 2) of identifying threatening objects in cognitive tasks. As predicted, threat-identification skills interacted with trait neuroticism in predicting subjective experiences. Specifically, individuals high in neuroticism experienced lower levels of negative affect during their everyday lives if they were also skilled in identifying threats in the cognitive tasks (Studies 1-2). Such skills did not matter at low levels of neuroticism. This interactive pattern was also replicated in the context of life domain satisfaction (Study 2). The results support the view that avoidance motivation encompasses multiple component processes, including some that are cognitive in nature, and specifically extends self-regulatory views of neuroticism. Of most importance, our data indicate that threat-identification skills can be hedonically beneficial, rather than costly, at high levels of neuroticism.

Severity of killer whale behavioral responses to ship noise: a dose-response study.

PubMed

Williams, Rob; Erbe, Christine; Ashe, Erin; Beerman, Amber; Smith, Jodi

2014-02-15

Critical habitats of at-risk populations of northeast Pacific "resident" killer whales can be heavily trafficked by large ships, with transits occurring on average once every hour in busy shipping lanes. We modeled behavioral responses of killer whales to ship transits during 35 "natural experiments" as a dose-response function of estimated received noise levels in both broadband and audiogram-weighted terms. Interpreting effects is contingent on a subjective and seemingly arbitrary decision about severity threshold indicating a response. Subtle responses were observed around broadband received levels of 130 dB re 1 μPa (rms); more severe responses are hypothesized to occur at received levels beyond 150 dB re 1 μPa, where our study lacked data. Avoidance responses are expected to carry minor energetic costs in terms of increased energy expenditure, but future research must assess the potential for reduced prey acquisition, and potential population consequences, under these noise levels. Copyright © 2013 Elsevier Ltd. All rights reserved.

Food that makes you different: the stigma experienced by adolescents with celiac disease.

PubMed

Olsson, Cecilia; Lyon, Phil; Hörnell, Agneta; Ivarsson, Anneli; Sydner, Ylva Mattsson

2009-07-01

For adolescents with celiac disease (CD), a gluten-free diet (GFD) is crucial for health, but compliance is problematic and noncompliance is common even among those aware of the risks. To better understand their lives with the disease, Swedish CD adolescents were invited to take part in focus group discussions. Data were analyzed for recurrent stigma-related themes across the groups. Adolescents described an awareness of being different from others that was produced by meal appearance and the poor availability of gluten-free food. The GFD often required discussions and special requests, so eating in public had the effect of making an invisible condition visible, and thereby creating a context for felt or enacted stigma. Maintaining invisibility avoided negative consequences of stigma, and other strategies were used to reduce the costs of visibility. The results of the study show that the GFD can produce stigma experiences in adolescence, and that dietary compliance (or lack thereof) can be understood in terms of dealing with GFD concealment and disclosure.

Hyperthyroidism and pulmonary hypertension: an important association.

PubMed

Vallabhajosula, Sailaja; Radhi, Saba; Cevik, Cihan; Alalawi, Raed; Raj, Rishi; Nugent, Kenneth

2011-12-01

Pulmonary hypertension is a complex disorder with multiple etiologies. The World Health Organization Group 5 (unclear multifactorial mechanisms) includes patients with thyroid disorders. The authors reviewed the literature on the association between hyperthyroidism and pulmonary hypertension and identified 20 publications reporting 164 patients with treatment outcomes. The systolic pulmonary artery (PA) pressures in these patients ranged from 28 to 78 mm Hg. They were treated with antithyroid medications, radioactive iodine and surgery. The mean pretherapy PA systolic pressure was 39 mm Hg; the mean posttreatment pressure was 30 mm Hg. Pulmonary hypertension should be considered in hyperthyroid patients with dyspnea. All patients with pulmonary hypertension should be screened for hyperthyroidism, because the treatment of hyperthyroidism can reduce PA pressures, potentially avoid the side-effects and costs with current therapies for pulmonary hypertension and limit the consequences of untreated hyperthyroidism. However, the long-term outcome in these patients is uncertain, and this issue needs more study. Changes in the pulmonary circulation and molecular regulators of vascular remodeling likely explain this association.

Ultrasound-Guided Percutaneous Catheter Drainage of Large Breast Abscesses in Lactating Women: How to Preserve Breastfeeding Safely.

PubMed

Falco, Giuseppe; Foroni, Monica; Castagnetti, Fabio; Marano, Luigi; Bordoni, Daniele; Rocco, Nicola; Marchesi, Vanessa; Iotti, Valentina; Vacondio, Rita; Ferrari, Guglielmo

2016-12-01

Management of breast abscess in lactating women remains controversial. During pregnancy, women may develop different kinds of benign breast lesions that could require a surgical incision performed under general anesthesia with consequent breastfeeding interruption. The purpose of this study was to prospectively evaluate the management of large breast abscesses with ultrasound-assisted drainage aiming at breastfeeding preservation. 34 lactating women with a diagnosis of unilateral breast abscess have been treated with an ultrasound (US)-assisted drainage of the abscess. A pigtail catheter was inserted into the fluid collection using the Seldinger technique under US guide and connected to a three stop way to allow drainage and irrigation of the cavity until its resolution. All procedures have been found safe and well tolerated. No recurrence was observed and breastfeeding was never interrupted. The described technique allows to avoid surgery and to preserve breastfeeding in well-selected patients with a safe, well-tolerated and cost-effective procedure.

Cost-effectiveness analysis of the introduction of the human papillomavirus vaccine in Honduras.

PubMed

Aguilar, Ida Berenice Molina; Mendoza, Lourdes Otilia; García, Odalys; Díaz, Iris; Figueroa, Jacqueline; Duarte, Rosa María; Perdomo, Gabriel; Garcia, Ana Gabriela Felix; Janusz, Cara Bess

2015-05-07

Cervical cancer is the leading cause of cancer deaths in Honduras. With the availability of a vaccine to prevent human papillomavirus (HPV), the causative agent for cervical cancer, the Honduran Secretary of Health undertook a cost-effectiveness analysis of introducing the HPV vaccine to support their national decision-making process. A national multidisciplinary team conducted this analysis with the CERVIVAC model, developed by the London School of Hygiene and Tropical Medicine in collaboration with the Pan American Health Organization's ProVac Initiative. The cumulative costs and health benefits of introducing the HPV vaccine were assessed over the lifetime of one single cohort of 11-year-old girls. We assumed a three-dose series with 95% vaccination coverage of the cohort using a mixture of school-based and facility-based delivery. To estimate national cervical cancer cases and deaths, we used United Nations demographic projections and GLOBOCAN estimates based on registry data from El Salvador, Guatemala, and Nicaragua. Based on estimates from the World Health Organization (WHO) and the Division of Intensified Cooperation with Countries (ICO), we assumed that 70% of cervical cancer would be due to vaccine types HPV16 and HPV18. We used a vaccine dose price of US$ 13.45 and evidence from the scientific literature to estimate vaccine effectiveness. National information was used to estimate health service utilization and costs of cervical cancer treatment. All costs and health benefits were discounted at 3%. Upon fully vaccinating 86,906 11-year old girls, 2250 (undiscounted) cervical cancer cases and 1336 (undiscounted) deaths would be prevented over the lifetime of the cohort. After discounting future health benefits at 3% per year, the equivalent cases and deaths prevented were 421 and 170. HPV vaccination is estimated to cost around US$ 5 million per vaccinated cohort, but this would be offset by around US$ 1 million in avoided costs borne by the government to treat cervical cancer. Furthermore, 4349 discounted disability adjusted life years (DALYs) could be avoided at a cost of US$ 926 per DALY avoided, making HPV vaccination in Honduras a highly cost-effective intervention. The net cost of HPV vaccination per DALY avoided is less than the WHO threshold for cost-effectiveness. However, at a cost of around US$ 5 million per vaccinated cohort, an important element to consider in this discussion is the budgetary implications that the introduction of the HPV vaccine would cause for the country. When comparing the costs and benefits of HPV vaccine introduction in Honduras, it is clear that this intervention would be highly cost-effective and that the intervention would greatly reduce cervical cancer disease. For these reasons, it is in the country's best interest to explore financing opportunities that could support the vaccine's introduction. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Treatment of Capital Costs in Educational Projects

ERIC Educational Resources Information Center

Bezeau, Lawrence

1975-01-01

Failure to account for the cost and depreciation of capital leads to suboptimal investments in education, specifically to excessively capital intensive instructional technologies. This type of error, which is particularly serious when planning for developing countries, can be easily avoided. (Author)

Cost-effectiveness of childhood rotavirus vaccination in Germany.

PubMed

Aidelsburger, Pamela; Grabein, Kristin; Böhm, Katharina; Dietl, Markus; Wasem, Jürgen; Koch, Judith; Ultsch, Bernhard; Weidemann, Felix; Wichmann, Ole

2014-04-07

Rotavirus (RV) causes a highly contagious gastroenteritis especially in children under five years of age. Since 2006 two RV-vaccines are available in Europe (Rotarix(®) and RotaTeq(®)). To support informed decision-making within the German Standing Committee on Vaccination (STIKO) the cost-effectiveness of these two vaccines was evaluated for the German healthcare setting. A Markov model was developed to evaluate the cost-effectiveness from the statutory health insurance (SHI) and from the societal perspective. RV-cases prevented, RV-associated hospitalizations avoided, and quality-adjusted life years (QALY) gained were considered as health outcomes. RV-incidences were calculated based on data from the national mandatory disease reporting system. RV-vaccine efficacy was determined as pooled estimates based on data from randomized controlled trials. Vaccine list prices and price catalogues were used for cost-assessment. Effects and costs were discounted with an annual discount rate of 3%. The base-case analysis (SHI-perspective) resulted in an incremental cost-effectiveness and cost-utility ratio for Rotarix(®) of € 184 per RV-case prevented, € 2457 per RV-associated hospitalization avoided, and € 116,973 per QALY gained. For RotaTeq(®), the results were € 234 per RV-case prevented, € 2622 per RV-associated hospitalization avoided, and € 142,732 per QALY gained. Variation of various parameters in sensitivity analyses showed effects on the ICERs without changing the overall trend of base-case results. When applying base-case results to the 2012 birthcohort in Germany with 80% vaccination coverage, an estimated 206,000-242,000 RV-cases and 18,000 RV-associated hospitalizations can be prevented in this birthcohort over five years for an incremental cost of 44.5-48.2 million €. Our analyses demonstrate that routine RV-vaccination could prevent a substantial number of RV-cases and hospitalizations in the German healthcare system, but the saved treatment costs are counteracted by costs for vaccination. However, with vaccine prices reduced by ∼62-66%, RV-vaccination could even become a cost-saving preventive measure. Copyright © 2014 Elsevier Ltd. All rights reserved.

Estimation of marginal costs at existing waste treatment facilities.

PubMed

Martinez-Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus; Riber, Christian; Kamuk, Bettina; Astrup, Thomas F

2016-04-01

This investigation aims at providing an improved basis for assessing economic consequences of alternative Solid Waste Management (SWM) strategies for existing waste facilities. A bottom-up methodology was developed to determine marginal costs in existing facilities due to changes in the SWM system, based on the determination of average costs in such waste facilities as function of key facility and waste compositional parameters. The applicability of the method was demonstrated through a case study including two existing Waste-to-Energy (WtE) facilities, one with co-generation of heat and power (CHP) and another with only power generation (Power), affected by diversion strategies of five waste fractions (fibres, plastic, metals, organics and glass), named "target fractions". The study assumed three possible responses to waste diversion in the WtE facilities: (i) biomass was added to maintain a constant thermal load, (ii) Refused-Derived-Fuel (RDF) was included to maintain a constant thermal load, or (iii) no reaction occurred resulting in a reduced waste throughput without full utilization of the facility capacity. Results demonstrated that marginal costs of diversion from WtE were up to eleven times larger than average costs and dependent on the response in the WtE plant. Marginal cost of diversion were between 39 and 287 € Mg(-1) target fraction when biomass was added in a CHP (from 34 to 303 € Mg(-1) target fraction in the only Power case), between -2 and 300 € Mg(-1) target fraction when RDF was added in a CHP (from -2 to 294 € Mg(-1) target fraction in the only Power case) and between 40 and 303 € Mg(-1) target fraction when no reaction happened in a CHP (from 35 to 296 € Mg(-1) target fraction in the only Power case). Although average costs at WtE facilities were highly influenced by energy selling prices, marginal costs were not (provided a response was initiated at the WtE to keep constant the utilized thermal capacity). Failing to systematically address and include costs in existing waste facilities in decision-making may unintendedly lead to higher overall costs at societal level. To avoid misleading conclusions, economic assessment of alternative SWM solutions should not only consider potential costs associated with alternative treatment but also include marginal costs associated with existing facilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implications of Transaction Costs for Acquisition Program Cost Breaches

DTIC Science & Technology

2013-06-01

scope of the work, communicating the basis on which the estimate is built, identifying the quality of the data, determining the level of risk, and...projects such as bases, schools, missile storage facilities, maintenance facilities, medical/ dental clinics, libraries, and military family housing...was established as a threshold for measuring cost growth. This prevents a program from rebaselining to avoid a Nunn- McCurdy cost threshold breach. In

Behavioral consequences of predator stress in the rat elevated T-maze.

PubMed

Bulos, Erika Mondin; Pobbe, Roger Luis Henschel; Zangrossi, Helio

2015-07-01

Analyses of the behavioral reactions of rodents to predators have greatly contributed to the understanding of defense-related human psychopathologies such as anxiety and panic.We here investigated the behavioral consequences of exposing male Wistar rats to a live cat using the elevated T-maze test of anxiety. This test allows the measurement of two defensive responses: inhibitory avoidance and escape, which in terms of pathology have been associated with generalized anxiety and panic disorders, respectively. For comparative reasons, the effects of exposure to the cat were also assessed in the elevated plus-maze. The results showed that a 5-min exposure to the cat selectively facilitated inhibitory avoidance acquisition, an anxiogenic effect, without affecting escape expression in the elevated T-maze. This was seen immediately but not 30 min after contact with the predator. This short-lived anxiogenic effect was also detected in the elevated plus-maze. Previous administration of the benzodiazepine anxiolytic diazepam (2 mg/kg) decreased the immediate avoidance response to the predator and the neophobic reaction to a dummy cat used as a control stimulus. The drug also impaired inhibitory avoidance acquisition in the elevated T-maze, indicating an anxiolytic effect, without affecting escape performance. The results indicate that the state of anxiety evoked during contact with the predator generalizes to both elevated plus- and T-mazes, impacting on defensive responses associated with generalized anxiety disorder.

7 CFR 701.36 - Schemes and devices and claims avoidances.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Schemes and devices and claims avoidances. 701.36... RELATED PROGRAMS PREVIOUSLY ADMINISTERED UNDER THIS PART § 701.36 Schemes and devices and claims..., any scheme or device designed to evade the maximum cost-share limitation that applies to the ECP or to...

Pre-treatment predictors and in-treatment factors associated with change in avoidant and dependent personality disorder traits among patients with social phobia.

PubMed

Borge, Finn-Magnus; Hoffart, Asle; Sexton, Harold; Martinsen, Egil; Gude, Tore; Hedley, Liv Margaret; Abrahamsen, Gun

2010-01-01

We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment and in-treatment factors associated with such changes in 77 patients, randomized to medication-free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were assessed at pre-treatment and at one-year post-treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained significant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre-treatment use of anxiolytics predicted larger changes in both PD dimensions.

Comparison of Simplexa universal direct PCR with cytotoxicity assay for diagnosis of Clostridium difficile infection: performance, cost, and correlation with disease.

PubMed

Landry, Marie L; Ferguson, David; Topal, Jeffrey

2014-01-01

Simplexa Clostridium difficile universal direct PCR, a real-time PCR assay for the detection of the C. difficile toxin B (tcdB) gene using the 3M integrated cycler, was compared with a two-step algorithm which includes the C. Diff Chek-60 glutamate dehydrogenase (GDH) antigen assay followed by cytotoxin neutralization. Three hundred forty-two liquid or semisolid stools submitted for diagnostic C. difficile testing, 171 GDH antigen positive and 171 GDH antigen negative, were selected for the study. All samples were tested by the C. Diff Chek-60 GDH antigen assay, cytotoxin neutralization, and Simplexa direct PCR. Of 171 GDH-positive samples, 4 were excluded (from patients on therapy or from whom duplicate samples were obtained) and 88 were determined to be true positives for toxigenic C. difficile. Of the 88, 67 (76.1%) were positive by the two-step method and 86 (97.7%) were positive by PCR. Seventy-nine were positive by the GDH antigen assay only. Of 171 GDH antigen-negative samples, none were positive by PCR. One antigen-negative sample positive by the cytotoxin assay only was deemed a false positive based on chart review. Simplexa C. difficile universal direct PCR was significantly more sensitive for detecting toxigenic C. difficile bacteria than cytotoxin neutralization (P = 0.0002). However, most PCR-positive/cytotoxin-negative patients did not have clear C. difficile disease. The estimated cost avoidance provided by a more rapid molecular diagnosis was outweighed by the cost of isolating and treating PCR-positive/cytotoxin-negative patients. The costs, clinical consequences, and impact on nosocomial transmission of treating and/or isolating patients positive for toxigenic C. difficile by PCR but negative for in vivo toxin production merit further study.

Body temperatures of hibernating little brown bats reveal pronounced behavioural activity during deep torpor and suggest a fever response during white-nose syndrome.

PubMed

Mayberry, Heather W; McGuire, Liam P; Willis, Craig K R

2018-03-01

Hibernating animals use torpor [reduced body temperature (T b ) and metabolic rate] to reduce energy expenditure during winter. Periodic arousals to normal T b are energetically expensive, so hibernators trade off arousal benefits against energetic costs. This is especially important for bats with white-nose syndrome (WNS), a fungal disease causing increased arousal frequency. Little brown bats (Myotis lucifugus) with WNS show upregulation of endogenous pyrogens and sickness behaviour. Therefore, we hypothesized that WNS should cause a fever response characterized by elevated T b . Hibernators could also accrue some benefits of arousals with minimal T b increase, thus avoiding full arousal costs. We compared skin temperature (T sk ) of captive Myotis lucifugus inoculated with the WNS-causing fungus to T sk of sham-inoculated controls. Infected bats re-warmed to higher T sk during arousals which is consistent with a fever response. Torpid T sk did not differ. During what we term "cold arousals", bats exhibited movement following T sk increases of only 2.2 ± 0.3 °C, compared to >20 °C increases during normal arousals. Cold arousals occurred in both infected and control bats, suggesting they are not a pathophysiological consequence of WNS. Fever responses are energetically costly and could exacerbate energy limitation and premature fat depletion for bats with WNS. Cold arousals could represent an energy-saving mechanism for both healthy and WNS-affected bats when complete arousals are unnecessary or too costly. A few cold arousals were observed mid-hibernation, typically in response to disturbances. Cold arousals may, therefore, represent a voluntary restriction of arousal temperature instead of loss of thermoregulatory control.

Improving population management through pharmacist-primary care integration: a pilot study.

PubMed

Kennedy, Amanda G; Chen, Harry; Corriveau, Michele; MacLean, Charles D

2015-02-01

Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach.

Cost-Effectiveness Analysis of Isavuconazole vs. Voriconazole as First-Line Treatment for Invasive Aspergillosis.

PubMed

Harrington, Rachel; Lee, Edward; Yang, Hongbo; Wei, Jin; Messali, Andrew; Azie, Nkechi; Wu, Eric Q; Spalding, James

2017-01-01

Invasive aspergillosis (IA) is associated with a significant clinical and economic burden. The phase III SECURE trial demonstrated non-inferiority in clinical efficacy between isavuconazole and voriconazole. No studies have evaluated the cost-effectiveness of isavuconazole compared to voriconazole. The objective of this study was to evaluate the costs and cost-effectiveness of isavuconazole vs. voriconazole for the first-line treatment of IA from the US hospital perspective. An economic model was developed to assess the costs and cost-effectiveness of isavuconazole vs. voriconazole in hospitalized patients with IA. The time horizon was the duration of hospitalization. Length of stay for the initial admission, incidence of readmission, clinical response, overall survival rates, and experience of adverse events (AEs) came from the SECURE trial. Unit costs were from the literature. Total costs per patient were estimated, composed of drug costs, costs of AEs, and costs of hospitalizations. Incremental costs per death avoided and per additional clinical responders were reported. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted. Base case analysis showed that isavuconazole was associated with a $7418 lower total cost per patient than voriconazole. In both incremental costs per death avoided and incremental costs per additional clinical responder, isavuconazole dominated voriconazole. Results were robust in sensitivity analysis. Isavuconazole was cost saving and dominant vs. voriconazole in most DSA. In PSA, isavuconazole was cost saving in 80.2% of the simulations and cost-effective in 82.0% of the simulations at the $50,000 willingness to pay threshold per additional outcome. Isavuconazole is a cost-effective option for the treatment of IA among hospitalized patients. Astellas Pharma Global Development, Inc.

Stent fracture in the superficial femoral and proximal popliteal arteries: literature summary and economic impacts.

PubMed

Neil, Nancy

2013-06-01

To summarize available evidence regarding stent fracture in the femoropopliteal region. We searched PubMed, 2000-2011, using MeSH search terms "stents," "popliteal artery," and "femoral artery." We identified 29 original studies reporting 0% to 65% incidence of stent fracture. Fracture-related repeat revascularization could be avoided in the absence of device failure. Recently published data suggest that even a 5% rate of fracture-related reintervention would generate $118.4 million in health care cost in the United States. These excess procedures would also result in major complications and deaths that might have been avoided in the absence of stent fracture. Reported incidence and clinical relevance of femoropopliteal stent fractures vary across studies. Stent fracture may lead to repeat revascularization. These reinterventions create considerable--and potentially avoidable--economic burden for patients and payers. Further, these costs are effectively invisible wherever stent fractures are not systematically documented as the reason for reintervention.

Overview of the arthritis Cost Consequence Evaluation System (ACCES): a pharmacoeconomic model for celecoxib.

PubMed

Pettitt, D; Goldstein, J L; McGuire, A; Schwartz, J S; Burke, T; Maniadakis, N

2000-12-01

Pharmacoeconomic analyses have become useful and essential tools for health care decision makers who increasingly require such analyses prior to placing a drug on a national, regional or hospital formulary. Previous health economic models of non-steroidal anti-inflammatory drugs (NSAIDs) have been restricted to evaluating a narrow range of agents within specific health care delivery systems using medical information derived from homogeneous clinical trial data. This paper summarizes the Arthritis Cost Consequence Evaluation System (ACCES)--a pharmacoeconomic model that has been developed to predict and evaluate the costs and consequences associated with the use of celecoxib in patients with arthritis, compared with other NSAIDs and NSAIDs plus gastroprotective agents. The advantage of this model is that it can be customized to reflect local practice patterns, resource utilization and costs, as well as provide context-specific health economic information to a variety of providers and/or decision makers.

Excise tax avoidance: the case of state cigarette taxes.

PubMed

DeCicca, Philip; Kenkel, Donald; Liu, Feng

2013-12-01

We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20% smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. Copyright © 2013 Elsevier B.V. All rights reserved.

Excise Tax Avoidance: The Case of State Cigarette Taxes

PubMed Central

DeCicca, Philip; Kenkel, Donald; Liu, Feng

2013-01-01

We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower-tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20 percent smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. PMID:24140760

Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States.

PubMed

Cawley, John; Meyerhoefer, Chad; Gillingham, Leah G; Kris-Etherton, Penny; Jones, Peter J H

2017-02-01

Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats. A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000-2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS. Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ∼ $25.7 billion (95% CI = $6.0-$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI = $1.8-$14.0 billion), Medicare saving $9.4 billion (95% CI = $2.1-$16.7 billion), Medicaid saving $1.4 billion (95% CI = $0.2-$2.5 billion), and patients saving $2.2 billion (95% CI = $0.5-$3.8 billion). The annual savings in terms of reduced job absenteeism ranges from a lower bound of $600 million (95% CI = $100 million to $1.0 billion) to an upper bound of $1.2 billion (95% CI = $0.2-$2.1 billion) for 2010. The data cover only the non-institutionalized population. Decreased costs due to any decreases in the severity of heart disease are not included. Cost savings do not include any reduction in informal care at home. Diets high in saturated fat impose substantial medical care costs and job absenteeism costs, and substantial savings could be achieved by substituting MUFA for saturated fat.

A Low-Cost, Effective, Fumes Exhaust System.

ERIC Educational Resources Information Center

Jacobs, C. O.

1979-01-01

Discusses the importance of avoiding welding fumes. The sources of these fumes are presented in a table. Criticizes currently used ventilation systems and reviews the Occupational Safety and Health Act requirements. Describes a low-cost exhaust system developed for agricultural mechanics laboratories. (LRA)

Middle-Aged Thinking.

ERIC Educational Resources Information Center

Nixon, Charles W.

1998-01-01

Examines renovation issues involving 30- and 40-year-old school facilities. Explores ways a school district can renovate old buildings to first-class cost-effective facilities while avoiding excessive transition costs. Discussions include installation of new technology and the resulting wiring demands, and developing more energy-efficient heating…

Cost effectiveness of budesonide/formoterol added to tiotropium bromide versus placebo added to tiotropium bromide in patients with chronic obstructive pulmonary disease: Australian, Canadian and Swedish healthcare perspectives.

PubMed

Mittmann, Nicole; Hernandez, Paul; Mellström, Carl; Brannman, Lance; Welte, Tobias

2011-05-01

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disease associated with increasing morbidity and mortality and an economic burden that stretches beyond the patient to healthcare systems. Avoiding exacerbations and subsequent hospitalizations is an important clinical aim and can avoid significant costs associated with the disease. International guidelines recommend the addition of an inhaled corticosteroid (ICS) to a long-acting β₂-adrenoceptor agonist (LABA) for patients with severe to very severe COPD and a history of exacerbations. To evaluate retrospectively over a 3-month period, the cost effectiveness of budesonide/formoterol added to tiotropium bromide (tiotropium) compared with placebo added to tiotropium in COPD patients eligible for ICS/LABA combination therapy, based on the CLIMB study (NCT00496470). A cost-effectiveness analysis of data from the 12-week, randomized, double-blind CLIMB study of COPD patients (n = 659; eligible for ICS/LABA; aged ≥ 40 years) comparing budesonide/formoterol (Symbicort® Turbuhaler® 320/9 μg twice daily) added to tiotropium (18 μg daily) or placebo added to tiotropium was conducted. A severe exacerbation was defined as a requirement for systemic glucocorticosteroids and/or ED visit and/or hospitalization. The effectiveness variable used for this analysis was the number of severe exacerbations avoided. Direct costs (medications, hospitalizations, ED and GP visits) were calculated by applying year 2009 unit costs from Australia ($A), Canada ($Can) and Sweden (Swedish krona [SEK]) to the study's pooled resource use. One-way sensitivity analyses for each country's mean incremental cost-effectiveness ratio and sensitivity to overall exacerbations were conducted. Bootstrapping was performed to estimate the variation around resource use, exacerbations and each country's mean incremental cost-effectiveness ratio. The mean number of severe exacerbations per patient 3-month period was 0.11 in the budesonide/formoterol added to tiotropium arm and 0.29 in the placebo added to tiotropium arm--a 62% reduction in the rate of severe exacerbations. Treatment with budesonide/formoterol added to tiotropium costs less in Australia and Canada (-$A90 [-€58] and -$Can4.51 [-€3]) and only slightly more in Sweden (SEK444 [€43]), i.e. the savings associated with fewer exacerbations more than offset the additional budesonide/formoterol drug cost in Australia and Canada, and partially offset it in Sweden. In the Australian and Canadian perspectives, budesonide/formoterol added to tiotropium was a dominant treatment (fewer exacerbations at a lower cost) compared with placebo added to tiotropium. In Sweden, the estimated incremental cost per avoided exacerbation was SEK2502 (€244.40). Budesonide/formoterol added to tiotropium was the dominant strategy compared with placebo added to tiotropium based on a 12-week study in COPD patients eligible for ICS/LABA combination therapy in Australia and Canada, and appears to be a cost-effective strategy in Sweden.

Avoiding Cancer Risk Information

PubMed Central

Emanuel, Amber S.; Kiviniemi, Marc T.; Howell, Jennifer L.; Hay, Jennifer L.; Waters, Erika A.; Orom, Heather; Shepperd, James A.

2015-01-01

RATIONALE Perceived risk for health problems such as cancer is a central construct in many models of health decision making and a target for behavior change interventions. However, some portion of the population actively avoids cancer risk information. The prevalence of, explanations for, and consequences of such avoidance are not well understood. OBJECTIVE We examined the prevalence and demographic and psychosocial correlates of cancer risk information avoidance preference in a nationally representative sample. We also examined whether avoidance of cancer risk information corresponds with avoidance of cancer screening. RESULTS Based on our representative sample, 39% of the population indicated that they agreed or strongly agreed that they would “rather not know [their] chance of getting cancer.” This preference was stronger among older participants, female participants, and participants with lower levels of education. Preferring to avoid cancer risk information was stronger among participants who agreed with the beliefs that everything causes cancer, that there’s not much one can do to prevent cancer, and that there are too many recommendations to follow. Finally, the preference to avoid cancer risk information was associated with lower levels of screening for colon cancer. CONCLUSION These findings suggest that cancer risk information avoidance is a multi-determined phenomenon that is associated with demographic characteristics and psychosocial individual differences and also relates to engagement in cancer screening. PMID:26560410

Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.

PubMed

Nijs, Jo; Roussel, Nathalie; Van Oosterwijck, Jessica; De Kooning, Margot; Ickmans, Kelly; Struyf, Filip; Meeus, Mira; Lundberg, Mari

2013-08-01

Severe exacerbation of symptoms following physical activity is characteristic for chronic-fatigue syndrome (CFS) and fibromyalgia (FM). These exacerbations make it understandable for people with CFS and FM to develop fear of performing body movement or physical activity and consequently avoidance behaviour toward physical activity. The aims of this article were to review what measures are available for measuring fear of movement and avoidance behaviour, the prevalence fear of movement and avoidance behaviour toward physical activity and the therapeutic options with fear of movement and avoidance behaviour toward physical activity in patients with CFS and FM. The review revealed that fear of movement and avoidance behaviour toward physical activity is highly prevalent in both the CFS and FM population, and it is related to various clinical characteristics of CFS and FM, including symptom severity and self-reported quality of life and disability. It appears to be crucial for treatment (success) to identify CFS and FM patients displaying fear of movement and avoidance behaviour toward physical activity. Individually tailored cognitive behavioural therapy plus exercise training, depending on the patient's classification as avoiding or persisting, appears to be the most promising strategy for treating fear of movement and avoidance behaviour toward physical activity in patients with CFS and FM.

NASA and ESA Collaboration on Alternative to Nitric Acid Passivation: Parameter Optimization of Citric Acid Passivation for Stainless Steel Alloys

NASA Technical Reports Server (NTRS)

Kessel, Kurt R.

2016-01-01

National Aeronautics and Space Administration (NASA) Headquarters chartered the Technology Evaluation for Environmental Risk Mitigation Principal Center (TEERM) to coordinate agency activities affecting pollution prevention issues identified during system and component acquisition and sustainment processes. The primary objectives of NASA TEERM are to: Reduce or eliminate the use of hazardous materials or hazardous processes at manufacturing, remanufacturing, and sustainment locations. Avoid duplication of effort in actions required to reduce or eliminate hazardous materials through joint center cooperation and technology sharing. Corrosion is an extensive problem that affects the National Aeronautics and Space Administration (NASA) and the European Space Agency (ESA). The damaging effects of corrosion result in steep costs, asset downtime affecting mission readiness, and safety risks to personnel. Consequently, it is vital to reduce corrosion costs and risks in a sustainable manner. NASA and ESA have numerous structures and equipment that are fabricated from stainless steel. The standard practice for protection of stainless steel is a process called passivation. Passivation is defined by The American Heritage Dictionary of the English Language as to treat or coat (a metal) in order to reduce the chemical reactivity of its surface. Passivation works by forming a shielding outer (metal oxide) layer that reduces the impact of destructive environmental factors such as air or water. Consequently, this process necessitates a final product that is very clean and free of iron and other contaminants. Typical passivation procedures call for the use of nitric acid; however, there are a number of environmental, worker safety, and operational issues associated with its use. Citric acid is an alternative to nitric acid for the passivation of stainless steels. Citric acid offers a variety of benefits including increased safety for personnel, reduced environmental impact, and reduced operational cost. The primary objective of this effort is to qualify citric acid as an environmentally-preferable alternative to nitric acid for the passivation of stainless steel alloys. While citric acid use has become more prominent in industry, there is little evidence that citric acid is a technically sound passivation agent, especially for the unique and critical applications encountered by NASA and ESA.

Chemical Safety Alert: First Responders’ Environmental Liability Due To Mass Decontamination Runoff

EPA Pesticide Factsheets

CERCLA's good Samaritan provisions protect responders such as the Chemical Weapons Improved Response Team during lifesaving actions. Once imminent threats are addressed, responders should contain contamination and avoid/mitigate environmental consequences.

Avoiding Braess' Paradox Through Collective Intelligence

NASA Technical Reports Server (NTRS)

Wolpert , David H.; Tumer, Kagan

1999-01-01

In an Ideal Shortest Path Algorithm (ISPA), at each moment each router in a network sends all of its traffic down the path that will incur the lowest cost to that traffic. In the limit of an infinitesimally small amount of traffic for a particular router, its routing that traffic via an ISPA is optimal, as far as cost incurred by that traffic is concerned. We demonstrate though that in many cases, due to the side-effects of one router's actions on another routers performance, having routers use ISPA's is suboptimal as far as global aggregate cost is concerned, even when only used to route infinitesimally small amounts of traffic. As a particular example of this we present an instance of Braess' paradox for ISPA'S, in which adding new links to a network decreases overall throughput. We also demonstrate that load-balancing, in which the routing decisions are made to optimize the global cost incurred by all traffic currently being routed, is suboptimal as far as global cost averaged across time is concerned. This is also due to "side-effects", in this case of current routing decision on future traffic. The theory of COllective INtelligence (COIN) is concerned precisely with the issue of avoiding such deleterious side-effects. We present key concepts from that theory and use them to derive an idealized algorithm whose performance is better than that of the ISPA, even in the infinitesimal limit. We present experiments verifying this, and also showing that a machine-learning-based version of this COIN algorithm in which costs are only imprecisely estimated (a version potentially applicable in the real world) also outperforms the ISPA, despite having access to less information than does the ISPA. In particular, this COIN algorithm avoids Braess' paradox.

Costs of colour change in fish: food intake and behavioural decisions.

PubMed

Rodgers, Gwendolen M; Gladman, Nicholas W; Corless, Hannah F; Morrell, Lesley J

2013-07-15

Many animals, particularly reptiles, amphibians, fish and cephalopods, have the ability to change their body colour, for functions including thermoregulation, signalling and predator avoidance. Many fish plastically darken their body colouration in response to dark visual backgrounds, and this functions to reduce predation risk. Here, we tested the hypotheses that colour change in fish (1) carries with it an energetic cost and (2) affects subsequent shoal and habitat choice decisions. We demonstrate that guppies (Poecilia reticulata) change colour in response to dark and light visual backgrounds, and that doing so carries an energetic cost in terms of food consumption. By increasing food intake, however, guppies are able to maintain growth rates and meet the energetic costs of changing colour. Following colour change, fish preferentially choose habitats and shoals that match their own body colouration, and maximise crypsis, thus avoiding the need for further colour change but also potentially paying an opportunity cost associated with restriction to particular habitats and social associates. Thus, colour change to match the background is complemented by behavioural strategies, which should act to maximise fitness in variable environments.

Fiscal scarcity and the inevitability of bedside budget balancing.

PubMed

Morreim, E H

1989-05-01

Until recently, generous third-party reimbursements enabled physicians to pursue each patient's interests with little regard to costs. Conscious rationing was required only episodically as some particular commodity, eg, transplant organs, was too scarce to meet demand, or as some patients lacked basic access to the health care system. Cost containment and the economic reorganization of medicine introduce a new sort of scarcity, requiring a different sort of rationing. "Fiscal scarcity," the general contraction of health care dollars, means that because every medical decision has its cost, every decision is now subject to scrutiny for its economic as well as its medical wisdom. Therefore, every detail of medicine is an allocation problem. Many observers argue that physicians can nevertheless avoid directly trading patients' interests against economic considerations: through "efficiency protocols" that eliminate marginal benefits, through turning economic rationing decisions over to outside parties, through avoiding cost constraints until society has established a just health care allocation system. This article shows that none of these proposals permits the physician to escape cost-cutting at the bedside.

Problems and limitations of voluntary cleanup programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, S.F.

1995-12-31

At least a dozen states have already implemented voluntary cleanup programs (VCPs). Provisions to promote state VCPs were prominent in the EPA`s 1994 proposed revisions to CERCLA and in current legislative initiatives. Under the VCP, property owners voluntarily enroll to investigate and remediate contaminated sites with the aegis of a state agency and thus avoid involvement with the federal Superfund program. When the state agency is satisfied with the condition of the site, it issues a certificate to the owner. The VCP is meant to mitigate unintended consequences of CERCLA such as the economic abandonment of urban industrial sites inmore » favor of unpolluted suburban sites. The VCP concept has been combined with other reforms including cleanup standards, financial incentives, and independent action. The effectiveness of voluntary cleanup programs is limited by the costs of investigation and cleanup relative to the value of the property in question. It is also limited when property has environmental problems outside the traditional focus of state Superfund agencies on soil and groundwater contamination. VCPs also have potential unintended consequences of their own. The VCP concept is consistent with a 15 year trend of increasing government attention and involvement with sites of diminishing health and environmental significance. VCP may reinforce the perception of liability and unwittingly raise the standard of due diligence in property assessments, especially if combined with generic cleanup standard.« less

Practical guidelines for workload assessment

NASA Technical Reports Server (NTRS)

Tattersall, Andrew J.

1994-01-01

The practical problems that might be encountered in carrying out workload evaluations in work settings have been outlined. Different approaches have been distinguished that may determine the type of research design used and provide assistance in the difficult choice between workload assessment techniques. One approach to workload assessment is to examine the short-term consequences of combining various tasks. Theoretical models of attention allocation will underpin specific studies of interference and the consequences of task demand and task conflict for performance. A further approach with a different temporal orientation may lead us to a better understanding of the relationships between work demands and strain through the analysis of individual differences in cognitive control processes. The application of these processes may depend on individual differences in long term styles and short term strategies, but may be used to prevent decrements in work performance under difficult conditions. However, control may attract costs as well as benefits in terms of changes in effective state and physiological activity. Thus, strain associated with work demands may only be measurable in the form of tradeoffs between performance and other domains of individual activity. The methodological implications are to identify patterns of adjustment to workload variations using repeated measures and longitudinal sampling of performance as well as subjective and physiological measures. Possible enhancements to workplace design must take into account these human factors considerations of workload in order to avoid potential decrements in individual performance and associated organizational problems.

Competition in human groups-Impact on group cohesion, perceived stress and outcome satisfaction.

PubMed

Boos, Margarete; Franiel, Xaver; Belz, Michael

2015-11-01

This study on competition in human groups was performed within the context of the competitive outcome interdependence concept: the degree to which personal outcomes among group members are affected by the consequences of task performance of others, e.g. when one group member gains a high reward for a task, this lowers the available reward for other group members. Our computer-based multi-participant game empirically assessed how competitive versus neutral conditions influenced the reward-maximising behaviour of 200 undergraduate students functioning in ten-person groups - each playing two games (1 neutral and 1 competitive), their perceived pay satisfaction as well as perceived stress levels and sense of calmness within the games' task to search for coins. Participants were represented by black dots moving on a virtual playground. Results showed that competition led to reward-maximising but fellow group member disadvantaging behaviour, and all participants experienced lower pay satisfaction, higher stress levels and less calmness. We conclude that short-term behavioural consequences of positive individual competitive behaviour were gained at the above-mentioned potential long-term negative costs for all group members. This implies group paradigms aimed at sustainability should avoid introducing competitive factors that at best result in short-lived gains and at worst cause widespread dissatisfaction, stress and a pervasive lack of calmness. Copyright © 2015. Published by Elsevier B.V.

Psychopathic individuals exhibit but do not avoid regret during counterfactual decision making

PubMed Central

Baskin-Sommers, Arielle; Stuppy-Sullivan, Allison M.; Buckholtz, Joshua W.

2016-01-01

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost–benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior. PMID:27911790

Cost-effectiveness analysis of strategies using new immunological diagnostic tests of latent tuberculosis infection before TNF-blockers therapy.

PubMed

Freund, Romain; Granger, Benjamin; Francois, Cécile; Carcelain, Guislaine; Ravaud, Philippe; Mariette, Xavier; Fautrel, Bruno

2018-02-01

Several tests have been proposed to detect latent tuberculosis (LTB). To evaluate the cost-effectiveness of different interferon-gamma release assays based strategies used to screen LTB before tumour necrosis factor (TNF) blockers initiation. Consecutive patients with rheumatoid arthritis, spondyloarthritis or Crohn's disease for whom TNF-blockers were considered, were recruited in 15 tertiary care centres. All were screened for LTB with tuberculin skin test (TST), QuantiFERON TB Gold ® in tube (QFT) and T-SPOT.TB ® (TSpot) on the same day. Cost-minimization and cost-effectiveness analysis, testing 8 screening test combinations, were conducted. Effectiveness was defined as the percentage of LTB treatment avoided and compared with TST alone. Cost were elicited in the payer perspective, included all the costs related to the screening procedure. No tuberculosis reactivation was observed after TNF-blocker initiation. TST followed by QFT if TST was positive was found as the best screening strategy, i.e. the less costly (-54€ compared to reference) and most effective (effectiveness 0.93), resulting in an incremental cost-effectiveness ratio of -192€ per treatment avoided. A probabilistic sensitivity analysis confirmed this result in 72.3% of simulations. TST followed by QFT if TST was positive is the most cost-effective strategy in screening for LTB in patients before starting anti-TNF therapy. NCT00811343. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Cost effectiveness of recycling: A systems model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tonjes, David J., E-mail: david.tonjes@stonybrook.edu; Waste Reduction and Management Institute, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000; Center for Bioenergy Research and Development, Advanced Energy Research and Technology Center, Stony Brook University, 1000 Innovation Rd., Stony Brook, NY 11794-6044

Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have alsomore » found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eichman, Josh; Flores-Espino, Francisco

Flexible operation of electrolysis systems represents an opportunity to reduce the cost of hydrogen for a variety of end-uses while also supporting grid operations and thereby enabling greater renewable penetration. California is an ideal location to realize that value on account of growing renewable capacity and markets for hydrogen as a fuel cell electric vehicle (FCEV) fuel, refineries, and other end-uses. Shifting the production of hydrogen to avoid high cost electricity and participation in utility and system operator markets along with installing renewable generation to avoid utility charges and increase revenue from the Low Carbon Fuel Standard (LCFS) program canmore » result in around $2.5/kg (21%) reduction in the production and delivery cost of hydrogen from electrolysis. This reduction can be achieved without impacting the consumers of hydrogen. Additionally, future strategies for reducing hydrogen cost were explored and include lower cost of capital, participation in the Renewable Fuel Standard program, capital cost reduction, and increased LCFS value. Each must be achieved independently and could each contribute to further reductions. Using the assumptions in this study found a 29% reduction in cost if all future strategies are realized. Flexible hydrogen production can simultaneously improve the performance and decarbonize multiple energy sectors. The lessons learned from this study should be used to understand near-term cost drivers and to support longer-term research activities to further improve cost effectiveness of grid integrated electrolysis systems.« less

Elements of Regolith Simulant's Cost Structure

NASA Technical Reports Server (NTRS)

Rickman, Douglas L.

2009-01-01

The cost of lunar regolith simulants is much higher than many users anticipate. After all, it is nothing more than broken rock. This class will discuss the elements which make up the cost structure for simulants. It will also consider which elements can be avoided under certain circumstances and which elements might be altered by the application of additional research and development.

Costing and competition.

PubMed

Bates, K; Brignall, S

1994-01-01

Working for patients established a new system of contracts between providers and purchasers of healthcare, with prices based on full costs, avoiding cross-subsidization. The new regime necessitates greatly improved costing systems, to improve the efficiency of service provision by creating price competition between providers. Ken Bates and Stan Brignall argue that non-price competition also occurs, with providers 'differentiating' on quality of service/product, flexibility or innovation.

Cascading costs: an economic nitrogen cycle.

PubMed

Moomaw, William R; Birch, Melissa B L

2005-09-01

The chemical nitrogen cycle is becoming better characterized in terms of fluxes and reservoirs on a variety of scales. Galloway has demonstrated that reactive nitrogen can cascade through multiple ecosystems causing environmental damage at each stage before being denitrified to N(2). We propose to construct a parallel economic nitrogen cascade (ENC) in which economic impacts of nitrogen fluxes can be estimated by the costs associated with each stage of the chemical cascade. Using economic data for the benefits of damage avoided and costs of mitigation in the Chesapeake Bay basin, we have constructed an economic nitrogen cascade for the region. Since a single ton of nitrogen can cascade through the system, the costs also cascade. Therefore evaluating the benefits of mitigating a ton of reactive nitrogen released needs to consider the damage avoided in all of the ecosystems through which that ton would cascade. The analysis reveals that it is most cost effective to remove a ton of nitrogen coming from combustion since it has the greatest impact on human health and creates cascading damage through the atmospheric, terrestrial, aquatic and coastal ecosystems. We will discuss the implications of this analysis for determining the most cost effective policy option for achieving environmental quality goals.

Cascading costs: an economic nitrogen cycle.

PubMed

Moomaw, William R; Birch, Melissa B L

2005-12-01

The chemical nitrogen cycle is becoming better characterized in terms of fluxes and reservoirs on a variety of scales. Galloway has demonstrated that reactive nitrogen can cascade through multiple ecosystems causing environmental damage at each stage before being denitrified to N2. We propose to construct a parallel economic nitrogen cascade (ENC) in which economic impacts of nitrogen fluxes can be estimated by the costs associated with each stage of the chemical cascade. Using economic data for the benefits of damage avoided and costs of mitigation in the Chesapeake Bay basin, we have constructed an economic nitrogen cascade for the region. Since a single tonne of nitrogen can cascade through the system, the costs also cascade. Therefore evaluating the benefits of mitigating a tonne of reactive nitrogen released needs to consider the damage avoided in all of the ecosystems through which that tonne would cascade. The analysis reveals that it is most cost effective to remove a tonne of nitrogen coming from combustion since it has the greatest impact on human health and creates cascading damage through the atmospheric, terrestrial, aquatic and coastal ecosystems. We will discuss the implications of this analysis for determining the most cost effective policy option for achieving environmental quality goals.

Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals.

PubMed

Banks, M D; Graves, N; Bauer, J D; Ash, S

2013-01-01

This study estimates the economic outcomes of a nutrition intervention to at-risk patients compared with standard care in the prevention of pressure ulcer. Statistical models were developed to predict 'cases of pressure ulcer avoided', 'number of bed days gained' and 'change to economic costs' in public hospitals in 2002-2003 in Queensland, Australia. Input parameters were specified and appropriate probability distributions fitted for: number of discharges per annum; incidence rate for pressure ulcer; independent effect of pressure ulcer on length of stay; cost of a bed day; change in risk in developing a pressure ulcer associated with nutrition support; annual cost of the provision of a nutrition support intervention for at-risk patients. A total of 1000 random re-samples were made and the results expressed as output probability distributions. The model predicts a mean 2896 (s.d. 632) cases of pressure ulcer avoided; 12, 397 (s.d. 4491) bed days released and corresponding mean economic cost saving of euros 2 869 526 (s.d. 2 078 715) with a nutrition support intervention, compared with standard care. Nutrition intervention is predicted to be a cost-effective approach in the prevention of pressure ulcer in at-risk patients.

Cost-effectiveness of an advance notification letter to increase colorectal cancer screening.

PubMed

Cronin, Paula; Goodall, Stephen; Lockett, Trevor; O'Keefe, Christine M; Norman, Richard; Church, Jody

2013-07-01

The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year. This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio. An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained. An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.

Developing hydropower in Washington state. Volume 2: An electricity marketing manual

NASA Astrophysics Data System (ADS)

James, J. W.; McCoy, G. A.

1982-03-01

An electricity marketing manual for the potential small and micro-hydroelectric project developer within the state of Washington is presented. Public utility regulatory policies (PURPA) requires electric utilities to interconnect with and pay a rate based on their full avoided costs for the purchase of electrical output from qualifying small power production facilities. The determination of avoided costs, as business organizational considerations, utility interface concerns, interconnection requirements, metering options, and liability and wheeling are discussed. The utility responses are summarized, legislation which is of importance to hydropower developers and the powers and functions of the authorities responsible for enforcing the mandate of PURPA are described.

A practical approach to instrument selection, evaluation, basic financial management and implementation in pathology and research.

PubMed

Mina, Ashraf; Favaloro, Emmanuel J; Koutts, Jerry

2008-01-01

In response to increasingly complex demands in terms of productivity and budgets, there is a critical need to avoid mistakes during instrument selection that will be financially costly, and adversely affect customers, staff, productivity and test turnaround time. As there is no "one size fits all", guidelines must be appropriate to permit informed decision making. A Medline search was conducted to assess background knowledge in this area, using the terms "laboratory instrument selection" and "laboratory instrument evaluation". Searches returned over 800 articles, of which only seven were directly related to the topic of the search, with most outdated, and suggesting a paucity of appropriate information. Additional resources used included the American Association of Clinical Chemistry (AACC) website and the Internet. Appropriate criteria for instrument selection were established in the current report based on subjective and objective (technical) evaluations. Additionally, a sound and simple financial approach is also suggested to help in making informed decisions and avoid costly mistakes. We propose that such a process as outlined in our report will protect laboratories from making costly and avoidable mistakes in the acquisition of major equipment.

You Can't See the Real Me: Attachment Avoidance, Self-Verification, and Self-Concept Clarity.

PubMed

Emery, Lydia F; Gardner, Wendi L; Carswell, Kathleen L; Finkel, Eli J

2018-03-01

Attachment shapes people's experiences in their close relationships and their self-views. Although attachment avoidance and anxiety both undermine relationships, past research has primarily emphasized detrimental effects of anxiety on the self-concept. However, as partners can help people maintain stable self-views, avoidant individuals' negative views of others might place them at risk for self-concept confusion. We hypothesized that avoidance would predict lower self-concept clarity and that less self-verification from partners would mediate this association. Attachment avoidance was associated with lower self-concept clarity (Studies 1-5), an effect that was mediated by low self-verification (Studies 2-3). The association between avoidance and self-verification was mediated by less self-disclosure and less trust in partner feedback (Study 4). Longitudinally, avoidance predicted changes in self-verification, which in turn predicted changes in self-concept clarity (Study 5). Thus, avoidant individuals' reluctance to trust or become too close to others may result in hidden costs to the self-concept.

The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

PubMed

Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

2011-01-01

Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

Automated Spacecraft Conjunction Assessment at Mars and the Moon

NASA Technical Reports Server (NTRS)

Berry, David; Guinn, Joseph; Tarzi, Zahi; Demcak, Stuart

2012-01-01

Conjunction assessment and collision avoidance are areas of current high interest in space operations. Most current conjunction assessment activity focuses on the Earth orbital environment. Several of the world's space agencies have satellites in orbit at Mars and the Moon, and avoiding collisions there is important too. Smaller number of assets than Earth, and smaller number of organizations involved, but consequences similar to Earth scenarios.This presentation will examine conjunction assessment processes implemented at JPL for spacecraft in orbit at Mars and the Moon.

Avoiding the Energy Crunch.

ERIC Educational Resources Information Center

Rowland, Dave

2001-01-01

Explores strategies for upgrading facility energy equipment that can cut energy costs and help substantially cover the costs of capital asset improvements. Discusses use of performance contracts to help schools leverage their operating budgets. Highlights how energy savings helped one school district finance $9.4 million in retrofits. (GR)

Modeling the Fear Effect in Predator-Prey Interactions with Adaptive Avoidance of Predators.

PubMed

Wang, Xiaoying; Zou, Xingfu

2017-06-01

Recent field experiments on vertebrates showed that the mere presence of a predator would cause a dramatic change of prey demography. Fear of predators increases the survival probability of prey, but leads to a cost of prey reproduction. Based on the experimental findings, we propose a predator-prey model with the cost of fear and adaptive avoidance of predators. Mathematical analyses show that the fear effect can interplay with maturation delay between juvenile prey and adult prey in determining the long-term population dynamics. A positive equilibrium may lose stability with an intermediate value of delay and regain stability if the delay is large. Numerical simulations show that both strong adaptation of adult prey and the large cost of fear have destabilizing effect while large population of predators has a stabilizing effect on the predator-prey interactions. Numerical simulations also imply that adult prey demonstrates stronger anti-predator behaviors if the population of predators is larger and shows weaker anti-predator behaviors if the cost of fear is larger.

Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine–American College of Physicians Curriculum.

PubMed

Smith, Cynthia D

2012-08-21

Health care expenditures are projected to reach nearly 20% of the U.S. gross domestic product by 2020. Up to $765 billion of this spending has been identified as potentially avoidable; many of the avoidable costs have been attributed to unnecessary services. Postgraduate trainees have historically received little specific training in the stewardship of health care resources and minimal feedback on resource utilization and its effect on the cost of care. This article describes a new curriculum that was developed collaboratively by the Alliance for Academic Internal Medicine and the American College of Physicians to address this training gap. The curriculum introduces a simple, stepwise framework for delivering high-value care and focuses on teaching trainees to incorporate high-value, cost-conscious care principles into their clinical practice. It consists of ten 1-hour, case-based, interactive sessions designed to be flexibly incorporated into the existing conference structure of a residency training program.

Cost-effective bidirectional digitized radio-over-fiber systems employing sigma delta modulation

NASA Astrophysics Data System (ADS)

Lee, Kyung Woon; Jung, HyunDo; Park, Jung Ho

2016-11-01

We propose a cost effective digitized radio-over-fiber (D-RoF) system employing a sigma delta modulation (SDM) and a bidirectional transmission technique using phase modulated downlink and intensity modulated uplink. SDM is transparent to different radio access technologies and modulation formats, and more suitable for a downlink of wireless system because a digital to analog converter (DAC) can be avoided at the base station (BS). Also, Central station and BS share the same light source by using a phase modulation for the downlink and an intensity modulation for the uplink transmission. Avoiding DACs and light sources have advantages in terms of cost reduction, power consumption, and compatibility with conventional wireless network structure. We have designed a cost effective bidirectional D-RoF system using a low pass SDM and measured the downlink and uplink transmission performance in terms of error vector magnitude, signal spectra, and constellations, which are based on the 10MHz LTE 64-QAM standard.

Ozone Contamination in Aircraft Cabins. Appendix B: Overview papers. Flight 8 planning to avoid high ozone

NASA Technical Reports Server (NTRS)

Belmont, A. D.

1979-01-01

The problem of preventing cabin ozone from exceeding a given standard was investigated. Statistical analysis of vertical distribution of ozone is summarized. The cost, logistics, maintenance, ability to forecast ozone, and avoiding high ozone concentrations are presented. Filtering approaches and the requirements to remove ozone toxicity are discussed.

Predicting differences in the perceived relevance of crime's costs and benefits in a test of rational choice theory.

PubMed

Bouffard, Jeffrey A

2007-08-01

Previous hypothetical scenario tests of rational choice theory have presented all participants with the same set of consequences, implicitly assuming that these consequences would be relevant for each individual. Recent research demonstrates that those researcher-presented consequences do not accurately reflect those considered by study participants and that there is individual variation in the relevance of various consequences. Despite this and some theoretical propositions that such differences should exist, little empirical research has explored the possibility of predicting such variation. This study allows participants to develop their own set of relevant consequences for three hypothetical offenses and examines how several demographic and theoretical variables impact those consequences' relevance. Exploratory results suggest individual factors impact the perceived relevance of several cost and benefit types, even among a relatively homogenous sample of college students. Implications for future tests of rational choice theory, as well as policy implications are discussed.

Discrimination and avoidance learning in adult mice following developmental exposure to diisopropylfluorophosphate.

PubMed

Levi, Yifat; Kofman, Ora; Schwebel, Margalit; Shaldubina, Alona

2008-02-01

Exposure to acetylcholinesterase inhibitors during development was shown in the past to induce sex-dependent changes in locomotion and specific cognitive and emotional tests in rodents. Adult mice that had been treated with 0.5 mg/kg diisopropylfluorphosphate (DFP), on post-natal days 14-20 were tested on active avoidance and a set-shifting task. DFP pre-treatment did not affect the active avoidance task, but impaired performance on the extra-dimensional shift task. DFP-treated females showed more general deficits in the acquisition of simple discrimination, intra-dimensional shift, extra-dimensional shift and reversal learning. These data suggest that pre-weanling exposure to cholinesterase inhibitors may have long-term consequences on attentional capabilities.

Retrospective Assessment of Cost Savings From Prevention

PubMed Central

Grosse, Scott D.; Berry, Robert J.; Tilford, J. Mick; Kucik, James E.; Waitzman, Norman J.

2016-01-01

Introduction Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997–1998. Methods Estimates of annual numbers of live-born spina bifida cases in 1995–1996 relative to 1999–2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. Results The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. Conclusions The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. PMID:26790341

Attention-Deficit/Hyperactivity Disorder Subtype Differentially Predicts Smoking Expectancies in Adolescents

PubMed Central

Foster, Ida; Racicot, Simon; McGrath, Jennifer J.

2017-01-01

Purpose Attention deficit hyperactivity disorder (ADHD) is an established risk factor for smoking; however, no studies have considered whether precursors to smoking behavior differ among adolescents with ADHD. Smoking expectancies are beliefs about the potential consequences of smoking, and they develop before smoking initiation. ADHD characteristics may contribute to the formation of expectancies and eventual smoking behavior. We evaluated whether clinical levels of ADHD subtypes differentially predicted smoking expectancies. Methods Adolescents (n = 221; age mean = 12.67 years) completed the Smoking Expectancy Scale for Adolescents, answered standardized questions about their smoking behavior, and provided expired breath samples to verify never-smoking status. Parents completed the Conners’ Parent Rating Scale for ADHD symptoms of inattention and hyperactivity/impulsivity. Results Adolescents with clinical levels of inattention were significantly less likely to endorse negative consequences, including Expected Costs (odds ratio [OR] = .16), Appearance–Presentation Costs (OR = .29), Social Costs (OR = .19), Health Costs (OR = .21), and Addiction Costs (OR = .39). Inattentive female adolescents were significantly more likely to endorse Weight Control as a consequence. Adolescents with clinical levels of hyperactivity/impulsivity were more likely to endorse positive consequences, including Expected Benefits (OR = 5.31), Affect Control (OR = 2.60), and Boredom Reduction (OR = 3.14); they were less likely to endorse Social Costs (OR = .27). Conclusions ADHD subtype differentially predicted smoking expectancies. Adolescents with ADHD may be more vulnerable to developing pro-smoking expectancies due to subtype-related deficits in neurocognitive processing. These findings have potential implications for developing targeted smoking prevention programs. PMID:22999841

Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).

PubMed

Sabin, Lora L; Knapp, Anna B; MacLeod, William B; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H; Gill, Christopher J

2012-01-01

The Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

Cost effectiveness of a pharmacist-led information technology intervention for reducing rates of clinically important errors in medicines management in general practices (PINCER).

PubMed

Elliott, Rachel A; Putman, Koen D; Franklin, Matthew; Annemans, Lieven; Verhaeghe, Nick; Eden, Martin; Hayre, Jasdeep; Rodgers, Sarah; Sheikh, Aziz; Avery, Anthony J

2014-06-01

We recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at £79 (US$131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs. We developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon. The PINCER intervention generated £2,679 less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): -£3,037 per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at £4.20 less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of -£3,936 (standard error £2,970). At a ceiling 'willingness-to-pay' of £20,000/QALY, PINCER reaches 59 % probability of being cost effective. PINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.

Costs and Cost-Effectiveness of Training Traditional Birth Attendants to Reduce Neonatal Mortality in the Lufwanyama Neonatal Survival Study (LUNESP)

PubMed Central

Sabin, Lora L.; Knapp, Anna B.; MacLeod, William B.; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H.; Gill, Christopher J.

2012-01-01

Background The Lufwanyama Neonatal Survival Project (“LUNESP”) was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. Methods and Findings We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011–2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as ‘conservative’ and ‘optimistic’ scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Conclusions Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was ‘highly cost effective’. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care. PMID:22545117

The economic burden of inadequate consumption of vegetables and fruit in Canada.

PubMed

Ekwaru, John Paul; Ohinmaa, Arto; Loehr, Sarah; Setayeshgar, Solmaz; Thanh, Nguyen Xuan; Veugelers, Paul J

2017-02-01

Public health decision makers not only consider health benefits but also economic implications when articulating and issuing lifestyle recommendations. Whereas various estimates exist for the economic burden of physical inactivity, excess body weight and smoking, estimates of the economic burden associated with our diet are rare. In the present study, we estimated the economic burden attributable to the inadequate consumption of vegetables and fruit in Canada. We accessed the Canadian Community Health Survey to assess the inadequacy in the consumption of vegetables and fruit and published meta-analyses to assemble risk estimates for chronic diseases. Based on these inadequacy and risk estimates, we calculated the population-attributable fraction and avoidable direct and indirect costs to society. Direct costs include those for hospital care, physician services and drugs in 2015. About 80 % of women and 89 % of men consume inadequate amounts of vegetables and fruit. We estimated this to result in an economic burden of $CAN 3·3 billion per year, of which 30·5 % is direct health-care costs and 69·5 % is indirect costs due to productivity losses. A modest 1 percentage point annual reduction in the prevalence of inadequate vegetables and fruit consumption over the next 20 years would avoid approximately $CAN 10·8 billion, and an increase of one serving of vegetables and fruit per day would avoid approximately $CAN 9·2 billion. Further investments in the promotion of vegetables and fruit will prevent chronic disease and substantially reduce direct and indirect health-care costs.

Getting the lead out: understanding risks in the distribution ...

EPA Pesticide Factsheets

This presentation discusses the importance of the water distribution system as a component of the source-to-tap continuum in public health protection. Issues covered include: understanding source water quality changes and their impacts throughout the system; use of mitigation measures such as filters); and holistic approaches and/or strategies that could be used to avoid unintended consequences of decisions from source to tap. Invited presentation on topics indicated as of interest. With exposure to lead as the context, this presentation discusses the importance of the water distribution system as a component of the source-to-tap continuum in public health protection. Issues covered include: understanding source water quality changes and their impacts throughout the system; use of mitigation measures such as filters); and holistic approaches and/or strategies that could be used to avoid unintended consequences of decisions from source to tap.

Grief and mourning gone awry: pathway and course of complicated grief.

PubMed

Shear, M Katherine

2012-06-01

Complicated grief is a recently recognized condition that occurs in about 7% of bereaved people. People with this condition are caught up in rumination about the circumstances of the death, worry about its consequences, or excessive avoidance of reminders of the loss. Unable to comprehend the finality and consequences of the loss, they resort to excessive avoidance of reminders of the loss as they are tossed helplessly on waves of intense emotion. People with complicated grief need help, and clinicians need to know how to recognize the symptoms and how to provide help. This paper provides a framework to help clinicans understand bereavement, grief, and mourning. Evidence-based diagnostic criteria are provided to help clinicians recognize complicated grief, and differentiate it from depression as well as anxiety disorder. We provide an overview of risk factors and basic assumptions and principles that can guide treatment.

Grief and mourning gone awry: pathway and course of complicated grief

PubMed Central

Shear, M. Katherine

2012-01-01

Complicated grief is a recently recognized condition that occurs in about 7% of bereaved people. People with this condition are caught up in rumination about the circumstances of the death, worry about its consequences, or excessive avoidance of reminders of the loss. Unable to comprehend the finality and consequences of the loss, they resort to excessive avoidance of reminders of the loss as they are tossed helplessly on waves of intense emotion. People with complicated grief need help, and clinicians need to know how to recognize the symptoms and how to provide help. This paper provides a framework to help clinicans understand bereavement, grief, and mourning. Evidence-based diagnostic criteria are provided to help clinicians recognize complicated grief, and differentiate it from depression as well as anxiety disorder. We provide an overview of risk factors and basic assumptions and principles that can guide treatment. PMID:22754284

Instability in interacting dark sector: an appropriate holographic Ricci dark energy model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Herrera, Ramón; Hipólito-Ricaldi, W.S.; Videla, Nelson, E-mail: ramon.herrera@pucv.cl, E-mail: wiliam.ricaldi@ufes.br, E-mail: nelson.videla@ing.uchile.cl

In this paper we investigate the consequences of phantom crossing considering the perturbative dynamics in models with interaction in their dark sector. By mean of a general study of gauge-invariant variables in comoving gauge, we relate the sources of instabilities in the structure formation process with the phantom crossing. In order to illustrate these relations and its consequences in more detail, we consider a specific case of an holographic dark energy interacting with dark matter. We find that in spite of the model is in excellent agreement with observational data at background level, however it is plagued of instabilities inmore » its perturbative dynamics. We reconstruct the model in order to avoid these undesirable instabilities, and we show that this implies a modification of the concordance model at background. Also we find drastic changes on the parameters space in our model when instabilities are avoided.« less

Avoidance threshold to oil water-soluble fraction by a juvenile marine teleost fish.

PubMed

Claireaux, Guy; Quéau, Pierre; Marras, Stefano; Le Floch, Stéphane; Farrell, Anthony P; Nicolas-Kopec, Annabelle; Lemaire, Philippe; Domenici, Paolo

2018-03-01

When oil spills occur, behavior is the first line of defense for a fish to avoid being contaminated. We determined the avoidance threshold of the European seabass (Dicentrarchus labrax) to the water-soluble fraction (WSF) of oil using a dual-flow choice box. The results showed that a plume of 20%-diluted WSF (total polycyclic aromatic hydrocarbon [PAH] concentration: 8.54 μg L -1 ) triggered a significant avoidance response that was detected within 7.5 min of introducing WSF-contaminated water into the experimental setup. However, the ecological relevance of seabass capacity to detect and avoid WSF remains to be established. In the short term, such a response is indeed liable to reduce seabass contact time with oil-contaminated water and thus preserve their functional integrity. In the long term, however, avoidance may contribute to the displacement of a population into a possibly less auspicious environment, with consequences very similar to those of contaminant exposure, that is, disturbed population dynamics and demography. Environ Toxicol Chem 2018;37:854-859. © 2017 SETAC. © 2017 SETAC.

A framework for the identification of long-term social avoidance in longitudinal datasets

PubMed Central

Levengood, Alexis; Foroughirad, Vivienne; Mann, Janet; Krzyszczyk, Ewa

2017-01-01

Animal sociality is of significant interest to evolutionary and behavioural ecologists, with efforts focused on the patterns, causes and fitness outcomes of social preference. However, individual social patterns are the consequence of both attraction to (preference for) and avoidance of conspecifics. Despite this, social avoidance has received far less attention than social preference. Here, we detail the necessary steps to generate a spatially explicit, iterative null model which can be used to identify non-random social avoidance in longitudinal studies of social animals. We specifically identify and detail parameters which will influence the validity of the model. To test the usability of this model, we applied it to two longitudinal studies of social animals (Eastern water dragons (Intellegama lesueurii) and bottlenose dolphins (Tursiops aduncus)) to identify the presence of social avoidances. Using this model allowed us to identify the presence of social avoidances in both species. We hope that the framework presented here inspires interest in addressing this critical gap in our understanding of animal sociality, in turn allowing for a more holistic understanding of social interactions, relationships and structure. PMID:28879006

Animal to human translational paradigms relevant for approach avoidance conflict decision making.

PubMed

Kirlic, Namik; Young, Jared; Aupperle, Robin L

2017-09-01

Avoidance behavior in clinical anxiety disorders is often a decision made in response to approach-avoidance conflict, resulting in a sacrifice of potential rewards to avoid potential negative affective consequences. Animal research has a long history of relying on paradigms related to approach-avoidance conflict to model anxiety-relevant behavior. This approach includes punishment-based conflict, exploratory, and social interaction tasks. There has been a recent surge of interest in the translation of paradigms from animal to human, in efforts to increase generalization of findings and support the development of more effective mental health treatments. This article briefly reviews animal tests related to approach-avoidance conflict and results from lesion and pharmacologic studies utilizing these tests. We then provide a description of translational human paradigms that have been developed to tap into related constructs, summarizing behavioral and neuroimaging findings. Similarities and differences in findings from analogous animal and human paradigms are discussed. Lastly, we highlight opportunities for future research and paradigm development that will support the clinical utility of this translational work. Copyright © 2017 Elsevier Ltd. All rights reserved.

A framework for the identification of long-term social avoidance in longitudinal datasets.

PubMed

Strickland, Kasha; Levengood, Alexis; Foroughirad, Vivienne; Mann, Janet; Krzyszczyk, Ewa; Frère, Celine H

2017-08-01

Animal sociality is of significant interest to evolutionary and behavioural ecologists, with efforts focused on the patterns, causes and fitness outcomes of social preference. However, individual social patterns are the consequence of both attraction to (preference for) and avoidance of conspecifics. Despite this, social avoidance has received far less attention than social preference. Here, we detail the necessary steps to generate a spatially explicit, iterative null model which can be used to identify non-random social avoidance in longitudinal studies of social animals. We specifically identify and detail parameters which will influence the validity of the model. To test the usability of this model, we applied it to two longitudinal studies of social animals (Eastern water dragons ( Intellegama lesueurii ) and bottlenose dolphins ( Tursiops aduncus )) to identify the presence of social avoidances. Using this model allowed us to identify the presence of social avoidances in both species. We hope that the framework presented here inspires interest in addressing this critical gap in our understanding of animal sociality, in turn allowing for a more holistic understanding of social interactions, relationships and structure.

Health Care Costs and the Socioeconomic Consequences of Work Injuries in Brazil: A Longitudinal Study

PubMed Central

SANTANA, Vilma Sousa; FERNANDES DE SOUZA, Luis Eugênio Portela; PINTO, Isabela Cardoso de Matos

2013-01-01

Work injuries are a worldwide public health problem but little is known about their socioeconomic impact. This prospective longitudinal study estimates the direct health care costs and socioeconomic consequences of work injuries for 406 workers identified in the emergency departments of the two largest public hospitals in Salvador, Brazil, from June through September 2005. After hospital discharge workers were followed up monthly until their return to work. Most insured workers were unaware of their rights or of how to obtain insurance benefits (81.6%). Approximately half the cases suffered loss of earnings, and women were more frequently dismissed than men. The most frequently reported family consequences were: need for a family member to act as a caregiver and difficulties with daily expenses. Total costs were US$40,077.00 but individual costs varied widely, according to injury severity. Out-of-pocket costs accounted for the highest proportion of total costs (50.5%) and increased with severity (57.6%). Most out-of-pocket costs were related to transport and purchasing medicines and other wound care products. The second largest contribution (40.6%) came from the public National Health System − SUS. Employer participation was negligible. Health care funding must be discussed to alleviate the economic burden of work injuries on workers. PMID:23803496

Consequent use of IT tools as a driver for cost reduction and quality improvements

NASA Astrophysics Data System (ADS)

Hein, Stefan; Rapp, Roberto; Feustel, Andreas

2013-10-01

The semiconductor industry drives a lot of efforts in the field of cost reductions and quality improvements. The consequent use of IT tools is one possibility to support these goals. With the extensions of its 150mm Fab to 200mm Robert Bosch increased the systematic use of data analysis and Advanced Process Control (APC).

Universal public finance of tuberculosis treatment in India: an extended cost-effectiveness analysis.

PubMed

Verguet, Stéphane; Laxminarayan, Ramanan; Jamison, Dean T

2015-03-01

Universal public finance (UPF)-government financing of an intervention irrespective of who is receiving it-for a health intervention entails consequences in multiple domains. First, UPF increases intervention uptake and hence the extent of consequent health gains. Second, UPF generates financial consequences including the crowding out of private expenditures. Finally, UPF provides insurance either by covering catastrophic expenditures, which would otherwise throw households into poverty or by preventing diseases that cause them. This paper develops a method-extended cost-effectiveness analysis (ECEA)-for evaluating the consequences of UPF in each of these domains. It then illustrates ECEA with an evaluation of UPF for tuberculosis treatment in India. Using plausible values for key parameters, our base case ECEA concludes that the health gains and insurance value of UPF would accrue primarily to the poor. Reductions in out-of-pocket expenditures are more uniformly distributed across income quintiles. A variant on our base case suggests that lowering costs of borrowing for the poor could potentially achieve some of the health gains of UPF, but at the cost of leaving the poor more deeply in debt. © 2014 The Authors. Health Economics published by John Wiley Ltd.

[Economic evaluation of routine vaccination of 15 month old children against chicken-pox-zoster].

PubMed

Forcén, T; Garuz, R; Cabasés, J; Ruiz de Ocenda, M; Martínez, J A; Izko, J

2000-01-01

An economic, cost-effectiveness evaluation was carried out that compared a hypothetical program of routine mass vaccination against the chicken-pox-zoster virus in children aged 15 months in the Foral Community of Navarra against the present strategy of vaccination that is restricted to the high risk population. Decision trees based on Markov models were used to calculate the costs of the health care of cases of infection and the costs of the effects of the vaccination program. The efficacy of the vaccination is 90-95%, and the scenario produces an immunogenicity of at least ten years, with a coverage of 90%. Account was taken of both the direct costs of health care and the indirect costs, with 1995 Pesetas taken as a constant, due to the loss in productivity of a family member, and a social view point was adopted for evaluating the study The index of cost-effectiveness reflects the additional cost or saving for each case of avoided infection brought about by vaccinating the children in comparison with vaccinating only those persons belonging to the high risk population sectors. The cost per avoided case is situated between 3,500 Ptas and 4,000 Ptas. For each Peseta invested in the vaccination program there would be a reimbursement of 0.45 Pesetas. The routine vaccination program produces an incremental cost. Only in the case of a reduction in the price of the vaccine by more than 50% would the cost-effectiveness index offer a net social profit.

Evaluating an in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail community-dwelling older people: Design of a randomised control trial [NCT01358032

PubMed Central

2011-01-01

Background Concerns about falls are frequently reported by older people. These concerns can have serious consequences such as an increased risk of falls and the subsequent avoidance of activities. Previous studies have shown the effectiveness of a multicomponent group programme to reduce concerns about falls. However, owing to health problems older people may not be able to attend a group programme. Therefore, we adapted the group approach to an individual in-home programme. Methods/Design A two-group randomised controlled trial has been developed to evaluate the in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail older people living in the community. Persons were eligible for study if they were 70 years of age or over, perceived their general health as fair or poor, had at least some concerns about falls and associated avoidance of activity. After screening for eligibility in a random sample of older people, eligible persons received a baseline assessment and were subsequently allocated to the intervention or control group. Persons assigned to the intervention group were invited to participate in the programme, while those assigned to the control group received care as usual. The programme consists of seven sessions, comprising three home visits and four telephone contacts. The sessions are aimed at instilling adaptive and realistic views about falls, as well as increasing activity and safe behaviour. An effect evaluation, a process evaluation and an economic evaluation are conducted. Follow-up measurements for the effect evaluation are carried out 5 and 12 months after the baseline measurement. The primary outcomes of the effect evaluation are concerns about falls and avoidance of activity as a result of these concerns. Other outcomes are disability and falls. The process evaluation measures: the population characteristics reached; protocol adherence by facilitators; protocol adherence by participants (engagement in exposure and homework); opinions about the programme of participants and facilitators; perceived benefits and achievements; and experienced barriers. The economic evaluation examines the impact on health-care utilisation, as well as related costs. Discussion A total number of 389 participants is included in the study. Final results are expected in 2012. Trial registration NCT01358032 PMID:21933436

Relations between psychological avoidance, symptom severity and embarrassment in essential tremor.

PubMed

Holding, Sophie J; Lew, Adina R

2015-03-01

Research with community- and clinic-based samples of essential tremor (ET) sufferers has identified embarrassment as a common consequence of the condition, leading to social anxiety and avoidance. We sought to ascertain whether psychological avoidance was related to embarrassment in ET, and whether any such relation was independent of symptom severity. Establishing whether psychological avoidance is related to embarrassment in ET would be a first indicator that mindfulness-based therapeutic approaches may be appropriate for sufferers of ET. Ninety-two participants were recruited through online support groups run by the International Tremor Foundation and the UK National Tremor Foundation, with the self-reported inclusion criteria being a clinical diagnosis of ET. Participants completed three validated questionnaires concerning ET-related embarrassment, ET symptom severity and psychological avoidance. Females had slightly higher embarrassment scores than males, and symptom severity and psychological avoidance made significant moderate (each accounting for 10-15% of variance approximately), but independent contributions to embarrassment scores. These results suggest that to address the potentially debilitating effects of embarrassment in ET, both symptom severity and psychological avoidance need to be targeted, with intervention research being required. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Heart Disease Patients' Averting Behavior, Costs of Illness, and Willingness to Pay to Avoid Angina Episodes - Final Report (1988)

EPA Pesticide Factsheets

This report examines the cost effectiveness of control options which reduce nitrate deposition to the Chesapeake watershed and to the tidal Bay. The report analyzes current estimates of the reductions expected in the ozone transport region.

Grief processing and deliberate grief avoidance: a prospective comparison of bereaved spouses and parents in the United States and the People's Republic of China.

PubMed

Bonanno, George A; Papa, Anthony; Lalande, Kathleen; Zhang, Nanping; Noll, Jennie G

2005-02-01

In this study, the authors measured grief processing and deliberate grief avoidance and examined their relationship to adjustment at 4 and 18 months of bereavement for 2 types of losses (spouse, child) in 2 cultures (People's Republic of China, United States). Three hypotheses were compared: the traditional grief work assumption, a conditional grief work hypothesis, and a view of grief processing as a form of rumination absent among resilient individuals. Although cultural differences in grief processing and avoidance were observed, the factor structure of these measures proved invariant across cultures. Consistent with the grief work as rumination hypothesis, both grief processing and deliberate grief avoidance predicted poor long-term adjustment for U.S. participants. Furthermore, initial grief processing predicted later grief processing in both cultures. However, among the participants in the People's Republic of China, neither grief processing nor deliberate avoidance evidenced clear psychological consequences. Copyright 2005 APA.

Uav Positioning and Collision Avoidance Based on RSS Measurements

NASA Astrophysics Data System (ADS)

Masiero, A.; Fissore, F.; Guarnieri, A.; Pirotti, F.; Vettore, A.

2015-08-01

In recent years, Unmanned Aerial Vehicles (UAVs) are attracting more and more attention in both the research and industrial communities: indeed, the possibility to use them in a wide range of remote sensing applications makes them a very flexible and attractive solution in both civil and commercial cases (e.g. precision agriculture, security and control, monitoring of sites, exploration of areas difficult to reach). Most of the existing UAV positioning systems rely on the use of the GPS signal. Despite this can be a satisfactory solution in open environments where the GPS signal is available, there are several operating conditions of interest where it is unavailable or unreliable (e.g. close to high buildings, or mountains, in indoor environments). Consequently, a different approach has to be adopted in these cases. This paper considers the use ofWiFi measurements in order to obtain position estimations of the device of interest. More specifically, to limit the costs for the devices involved in the positioning operations, an approach based on radio signal strengths (RSS) measurements is considered. Thanks to the use of a Kalman filter, the proposed approach takes advantage of the temporal dynamic of the device of interest in order to improve the positioning results initially provided by means of maximum likelihood estimations. The considered UAVs are assumed to be provided with communication devices, which can allow them to communicate with each other in order to improve their cooperation abilities. In particular, the collision avoidance problem is examined in this work.

Physiological and ecological consequences of sleeping-site selection by the Galapagos land iguana (Conolophus pallidus)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Christian, K.A.; Tracy, C.R.

1984-01-01

Field observations and biophysical models were combined to analyze sleeping-site selection by Galapagos land iguanas (Conolophus pallidus). Iguanas slept in different kinds of sleeping sites during different seasons. In the coolest season (garua), adult land iguanas were found in sleeping sites that were warmer than the coolest sites available. This may be because the garua season (cool, overcast, and foggy) is a time when environmental conditions mitigate against rapid warm-up in the mornings, so lizards may regulate nighttime body temperatures so that it is easier to warm up to preferred daytime body temperatures. In the warmest season, adult iguanas weremore » found in the coolest sleeping sites available. This observation is consistent with hypotheses of voluntary hypothermia, which can be advantageous in energy conservation and in avoiding detrimental effects associated with maintenance of constant body temperatures throughout the day and night. Juvenile iguanas were found sleeping in rock crevices regardless of the ambient thermal environments. Such sites are likely to be important as refugia for this life stage, which, unlike the adult stage, is vulnerable to predation. It was concluded that selection of sleeping sites is a process that may help in avoidance of predation, optimization of body temperature at the end of the sleeping period, and reduction of metabolic costs during sleeping. The importance of some of these factors may change with the thermal milieu (e.g., season).« less

The population impact of obesity, sedentary lifestyle, and tobacco and alcohol consumption on the prevalence of type 2 diabetes: Analysis of a health population survey in Chile, 2010

PubMed Central

Gormaz, Juan G.; Libuy, Matías; Sanhueza, Dérgica; Gajardo, Abraham; Srur, Andrea; Wallbaum, Magdalena

2017-01-01

Aim To estimate the impact of tobacco use, sedentary lifestyle, obesity and alcohol consumption on type 2 diabetes mellitus (T2DM) prevalence in the Chilean population. Methods The study-included 5,293 subjects with fasting glycaemia levels from the nationwide cross-sectional health survey in 2010, commissioned by the Ministry of Health, Chile. Crude and Adjusted Odds Ratio to T2DM and its corresponding 95% confidence interval were estimated through logistic regressions. Attributable fractions and population attributable fractions were estimated. Results T2DM prevalence was 9.5%. Sedentary lifestyles and obesity were significant risk factors for T2DM. 52,4% of T2DM could be avoided if these individuals were not obese, and at a population level, 23% of T2DM could be preventable if obesity did not exist. A 64% of T2DM is explained by sedentariness, and if people would become active, a 62,2% of the cases of diabetes could be avoided. Interpretation About 79% of T2DM cases in Chile could be prevented with cost-effective strategies focused on preventing sedentary lifestyle and obesity. It’s therefore urgent to implement evidence-based public health polices, aimed to decrease the prevalence of T2DM, by controlling its risk factors and consequently, reducing the complications from T2DM. PMID:28542472

Staphylococcus aureus and Staphylococcus epidermidis infections on implants.

PubMed

Oliveira, W F; Silva, P M S; Silva, R C S; Silva, G M M; Machado, G; Coelho, L C B B; Correia, M T S

2018-02-01

Infections are one of the main reasons for removal of implants from patients, and usually need difficult and expensive treatments. Staphylococcus aureus and Staphylococcus epidermidis are the most frequently detected pathogens. We reviewed the epidemiology and pathogenesis of implant-related infections. Relevant studies were identified by electronic searching of the following databases: PubMed, ScienceDirect, Academic Google, and CAPES Journal Portal. This review reports epidemiological studies of implant infections caused by S. aureus and S. epidermidis. We discuss some methodologies used in the search for new compounds with antibiofilm activity and the main strategies for biomaterial surface modifications to avoid bacterial plaque formation and consequent infection. S. aureus and S. epidermidis are frequently involved in infections in catheters and orthopaedic/breast implants. Different methodologies have been used to test the potential antibiofilm properties of compounds; for example, crystal violet dye is widely used for in-vitro biofilm quantification due to its low cost and good reproducibility. Changes in the surface biomaterials are necessary to prevent biofilm formation. Some studies have investigated the immobilization of antibiotics on the surfaces of materials used in implants. Other approaches have been used as a way to avoid the spread of bacterial resistance to antimicrobials, such as the functionalization of these surfaces with silver and natural compounds, as well as the electrical treatment of these substrates. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

PubMed

Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

People, planet and profit: Unintended consequences of legacy building materials.

PubMed

Zimmer, Anthony T; Ha, HakSoo

2017-12-15

Although an explosion of new building materials are being introduced into today's market, adequate up-front research into their chemical and physical properties as well as their potential health and environmental consequences is lacking. History has provided us with several examples where building materials were broadly deployed into society only to find that health and environmental problems resulted in unintended sustainability consequences. In the following paper, we use lead and asbestos as legacy building materials to show their similar historical trends and sustainability consequences. Our research findings show unintended consequences such as: increased remediation and litigation costs; adverse health effects; offshoring of related industries; and impediments to urban revitalization. As numerous new building materials enter today's market, another building material may have already been deployed, representing the next "asbestos." This paper also proposes an alternative methodology that can be applied in a cost-effective way into existing and upcoming building materials, to minimize and prevent potential unintended consequences and create a pathway for sustainable communities. For instance, our findings show that this proposed methodology could have prevented the unintended incurred sustainability costs of approximately $272-$359 billion by investing roughly $24 million in constant 2014 U.S. dollars on up-front research into lead and asbestos. Published by Elsevier Ltd.

Cost effectiveness of pegfilgrastim versus filgrastim after high-dose chemotherapy and autologous stem cell transplantation in patients with lymphoma and myeloma: an economic evaluation of the PALM Trial.

PubMed

Perrier, Lionel; Lefranc, Anne; Pérol, David; Quittet, Philippe; Schmidt-Tanguy, Aline; Siani, Carole; de Peretti, Christian; Favier, Bertrand; Biron, Pierre; Moreau, Philippe; Bay, Jacques Olivier; Lissandre, Séverine; Jardin, Fabrice; Espinouse, Daniel; Sebban, Catherine

2013-04-01

Use of the recombinant human granulocyte colony-stimulating factor (rhG-CSF) filgrastim accelerates neutrophil recovery following myelosuppressive chemotherapy. Since filgrastim requires multiple daily administrations, forms of rhG-CSF with a longer half life, including pegfilgrastim, have been developed. Pegfilgrastim is safe and effective in supporting neutrophil recovery and reducing febrile neutropenia after conventional chemotherapy. Pegfilgrastim has also been successfully used to support patients undergoing peripheral blood stem cell (PBSC) transplantation for haematological malignancies. To our knowledge, no cost-effectiveness analysis (CEA) of pegfilgrastim in this setting has been published yet. We undertook a CEA to compare a single injection of pegfilgrastim versus repeated administrations of filgrastim in patients who had undergone PBSC transplantation for lymphoma or myeloma. The CEA was set in France and covered a period of 100 ± 10 days from transplant. The CEA was designed as part of an open-label, multicentre, randomized phase II trial. Costs were assessed from the hospital's point of view and are expressed in 2009 euros. Costs computation focused on inpatient, outpatient, and home care. Costs in the two arms of the study were compared using the Mann-Whitney test. When differences were statistically significant, multiple regression analyses were performed in order to identify cost drivers. Incremental cost-effectiveness ratios (ICER) were calculated for the major endpoints of the trial; i.e., duration of febrile neutropenia (absolute neutrophil count [ANC] <0.5 × 10(9)/L and temperature ≥38 °C), duration of neutropenia (ANC <1.0 × 10(9)/L and ANC <0.5 × 10(9)/L), duration of thrombopenia (platelets <50 × 10(9)/L and <20 × 10(9)/L), and days with a temperature ≥38 °C). Uncertainty around the ICER was captured by a probabilistic analysis using a non-parametric bootstrap method. 151 patients were enrolled at ten French centres from October 2008 to September 2009. The mean total cost in the pegfilgrastim arm of the study (n = 74) was 25,024 (SD 9,945). That in the filgrastim arm (n = 76) was 28,700 (SD 20,597). Pegfilgrastim strictly dominated filgrastim for days of febrile neutropenia avoided, days of neutropenia (ANC <1.0 × 10(9)/L) avoided, days of thrombopenia (platelets <20 × 10(9)/L) avoided, and days with temperature ≥38 °C) avoided. Pegfilgrastim was less costly and less effective than filgrastim for the number of days with ANC <0.5 × 10(9)/L avoided and the number of days with platelets <50.0 × 10(9)/L avoided. Taking uncertainty into account, the probabilities that pegfilgrastim strictly dominated filgrastim were 67 % for febrile neutropenia, 86 % for neutropenia (ANC <1.0 × 10(9)/L), 59 % for thrombopenia (platelets <20 × 10(9)/L), 86 % for temperature ≥38 °C, 32 % for neutropenia (ANC <0.5 × 10(9)/L), and 43 % for thrombopenia (platelets <50 × 10(9)/L). Conversely, the probability that filgrastim strictly dominated pegfilgrastim for neutropenia (ANC <0.5 × 10(9)/L) is 5 %. This study found no evidence that the use of pegfilgrastim is associated with greater cost in lymphoma and myeloma patients after high-dose chemotherapy and PBSC transplantation.

Asymptotically Optimal Motion Planning for Learned Tasks Using Time-Dependent Cost Maps

PubMed Central

Bowen, Chris; Ye, Gu; Alterovitz, Ron

2015-01-01

In unstructured environments in people’s homes and workspaces, robots executing a task may need to avoid obstacles while satisfying task motion constraints, e.g., keeping a plate of food level to avoid spills or properly orienting a finger to push a button. We introduce a sampling-based method for computing motion plans that are collision-free and minimize a cost metric that encodes task motion constraints. Our time-dependent cost metric, learned from a set of demonstrations, encodes features of a task’s motion that are consistent across the demonstrations and, hence, are likely required to successfully execute the task. Our sampling-based motion planner uses the learned cost metric to compute plans that simultaneously avoid obstacles and satisfy task constraints. The motion planner is asymptotically optimal and minimizes the Mahalanobis distance between the planned trajectory and the distribution of demonstrations in a feature space parameterized by the locations of task-relevant objects. The motion planner also leverages the distribution of the demonstrations to significantly reduce plan computation time. We demonstrate the method’s effectiveness and speed using a small humanoid robot performing tasks requiring both obstacle avoidance and satisfaction of learned task constraints. Note to Practitioners Motivated by the desire to enable robots to autonomously operate in cluttered home and workplace environments, this paper presents an approach for intuitively training a robot in a manner that enables it to repeat the task in novel scenarios and in the presence of unforeseen obstacles in the environment. Based on user-provided demonstrations of the task, our method learns features of the task that are consistent across the demonstrations and that we expect should be repeated by the robot when performing the task. We next present an efficient algorithm for planning robot motions to perform the task based on the learned features while avoiding obstacles. We demonstrate the effectiveness of our motion planner for scenarios requiring transferring a powder and pushing a button in environments with obstacles, and we plan to extend our results to more complex tasks in the future. PMID:26279642

Elements of Regolith Simulant's Cost Structure--Why Rock Is NOT Cheap

NASA Technical Reports Server (NTRS)

Rickman, Douglas L.

2009-01-01

The cost of lunar regolith simulants is much higher than many users anticipate. After all, it is nothing more than broken rock. This class will discuss the elements which make up the cost structure for simulants. It will also consider which elements can be avoided under certain circumstances and which elements might be altered by the application of additional research and development.

Cost-effectiveness of drug-eluting coronary stents in Quebec, Canada.

PubMed

Brophy, James M; Erickson, Lonny J

2005-01-01

The aim of this investigation was to assess the incremental cost-effectiveness of replacing bare metal coronary stents (BMS) with drug-eluting stents (DES) in the Province of Quebec, Canada. The strategy used was a cost-effectiveness analysis from the perspective of the health-care provider, in the province of Quebec, Canada (population 7.5 million). The main outcome measure was the cost per avoided revascularization intervention. Based on the annual Quebec rate of 14,000 angioplasties with an average of 1.7 stents per procedure and a purchase cost of $2,600 Canadian dollar (CDN) for DES, 100 percent substitution of BMS with DES would require an additional $45.1 million CDN of funding. After the benefits of reduced repeat revascularization interventions are included, the incremental cost would be $35.2 million CDN. The cost per avoided revascularization intervention (18 percent coronary artery bypass graft, 82 percent percutaneous coronary intervention [PCI]) would be $23,067 CDN. If DES were offered selectively to higher risk populations, for example, a 20 percent subgroup with a relative restenosis risk of 2.5 times the current bare metal rate, the incremental cost of the program would be $4.9 million CDN at a cost of $7,800 per avoided revascularization procedure. Break-even costs for the program would occur at DES purchase cost of $1,161 for 100 percent DES use and $1,627 for selective 20 percent DES use for high-risk patients for restenosis (RR = 2.5). Univariate and Monte Carlo sensitivity analyses indicate that the parameters most affecting the analysis are the capacity to select patients at high risk of restenosis, the average number of stents used per PCI, baseline restenosis rates for BMS, the effectiveness ratio of restenosis prevention for DES versus BMS, the cost of DES, and the revascularization rate after initial PCI. Sensitivity analyses suggest little additional health benefits but escalating cost-effectiveness ratios once a DES penetration of 40 percent has been attained. Under current conditions in Quebec, Canada, selective use of DES in high-risk patients is the most acceptable strategy in terms of cost-effectiveness. Results of such an analysis would be expected to be similar in other countries with key model parameters similar to those used in this model. This model provides an example of how to evaluate the cost-effectiveness of selective use of a new technology in high-risk patients.

Integrated Silicon Carbide Power Electronic Block

DOE Office of Scientific and Technical Information (OSTI.GOV)

Radhakrishnan, Rahul

2017-11-07

Research involved in this project is aimed at monolithically integrating an anti-parallel diode to the SiC MOSFET switch, so as to avoid having to use an external anti-parallel diode in power circuit applications. SiC MOSFETs are replacing Si MOSFETs and IGBTs in many applications, yet the high bandgap of the body diode in SiC MOSFET and consequent need for an external anti-parallel diode increases costs and discourages circuit designers from adopting this technology. Successful demonstration and subsequent commercialization of this technology would reduce SiC MOSFET cost and additionally reduce component count as well as other costs at the power circuitmore » level. In this Phase I project, we have created multiple device designs, set up a process for device fabrication at the 150mm SiC foundry XFAB Texas, demonstrated unit-processes for device fabrication in short loops and started full flow device fabrication. Key findings of the development activity were: The limits of coverage of photoresist over the topology of thick polysilicon structures covered with oxide, which required larger feature dimensions to overcome; and The insufficient process margin for removing oxide spacers from polysilicon field ring features which could result in loss of some features without further process development No fundamental obstacles were uncovered during the process development. Given sufficient time for additional development it is likely that processes could be tuned to realize the monolithically integrated SiC JBS diode and MOSFET. Sufficient funds were not available in this program to resolve processing difficulties and fabricate the devices.« less

Impacts of 12-dose regimen for latent tuberculosis infection: Treatment completion rate and cost-effectiveness in Taiwan.

PubMed

Huang, Yi-Wen; Yang, Shun-Fa; Yeh, Yen-Po; Tsao, Thomas Chang-Yao; Tsao, Shih-Ming

2016-08-01

Treatment of latent tuberculosis infection (LTBI) is essential for eradicating tuberculosis (TB). Moreover, the patient adherence is crucial in determining the effectiveness of TB control. Isoniazid given by DOTS daily for 9 months (9H) is the standard treatment for LTBI in Taiwan. However, the completion rate is low due to the long treatment period and its side effects. The combined regimen using a high dose of rifapentine/isoniazid once weekly for 12 weeks (3HP) has been used as an alternative treatment option for LTBI in the United States. This may result in a higher completion rate. In this pilot study, patient adherence and cost of these 2 treatment regimens were investigated. Thus, we aimed to assess the treatment completion rate and costs of 3HP and compare to those with 9H.Data from 691 cases of LTBI treatments including 590 cases using the conventional regimen and 101 cases with rifapentine/Isoniazid were collected. The cost was the sum of the cost of treatment with Isoniazid for 9 months or with rifapentin/Isoniazid for 3 months of all contacts. The effectiveness was the cost of cases of tuberculosis avoided.In this study, the treatment completion rate for patients prescribed with the 3 months rifapentine/isoniazid regimen (97.03%) was higher than those given the conventional 9-month isoniazid regimen (87.29%) (P <0.001). The cost of 3HP and 9H was US$261.24 and US$717.3, respectively. The cost-effectiveness ratio with isoniazid for 9 months was US$ 15392/avoided 1 case of tuberculosis and US$ 5225/avoided 1 case of tuberculosis with 3HP. In addition, when compared with the conventional regimen, there were fewer patients discontinued with rifapentine/isoniazid regimen due to undesirable side effects.This was the first study to compare the 2 treatment regimens in Taiwan, and it showed that a short-term high-dosage rifapentine/isoniazid treatment regimen reduced costs and resulted in higher treatment completion than the standard LTBI isoniazid treatment.

Neonatal hypoglycaemia: learning from claims.

PubMed

Hawdon, Jane M; Beer, Jeanette; Sharp, Deborah; Upton, Michele

2017-03-01

Neonatal hypoglycaemia is a potential cause of neonatal morbidity, and on rare but tragic occasions causes long-term neurodevelopmental harm with consequent emotional and practical costs for the family. The organisational cost to the NHS includes the cost of successful litigation claims. The purpose of the review was to identify themes that could alert clinicians to common pitfalls and thus improve patient safety. The NHS Litigation Authority (NHS LA) Claims Management System was reviewed to identify and review 30 claims for injury secondary to neonatal hypoglycaemia, which were notified to the NHS LA between 2002 and 2011. NHS LA. Anonymised documentation relating to 30 neonates for whom claims were made relating to neonatal hypoglycaemia. Dates of birth were between 1995 and 2010. Review of documentation held on the NHS LA database. Identifiable risk factors for hypoglycaemia, presenting clinical signs, possible deficits in care, financial costs of litigation. All claims related to babies of at least 36 weeks' gestation. The most common risk factor for hypoglycaemia was low birth weight or borderline low birth weight, and the most common reported presenting sign was abnormal feeding behaviour. A number of likely deficits in care were reported, all of which were avoidable. In this 10-year reporting period, there were 25 claims for which damages were paid, with a total financial cost of claims to the NHS of £162 166 677. Acknowledging that these are likely to be the most rare but most seriously affected cases, the clinical themes arising from these cases should be used for further development of training and guidance to reduce harm and redivert NHS funds from litigation to direct care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Cross-cultural Study of the Back Pain Beliefs of Female Undergraduate Healthcare Students.

PubMed

Burnett, Angus; Sze, Ching Ching; Tam, Suet May; Yeung, Ka Man; Leong, Michelle; Wang, Wendy Tj; Tan, B-K; O'sullivan, Peter

2009-01-01

To determine if country (Australia, Taiwan, Singapore), undergraduate healthcare course (physiotherapy, nursing), low back pain (LBP) history, and year of course influenced various back pain beliefs in undergraduate female healthcare students. Three hundred and 82 female undergraduate nursing and physiotherapy students completed questionnaires examining; the inevitability of future life with low back trouble, the LBP beliefs held by healthcare providers and fear avoidance beliefs related to physical activity. Also participants completed questionnaires to determine their LBP status. General linear models were used to determine whether differences existed for back beliefs scores. Differences were evident in the future consequence of LBP between countries (P<0.001), undergraduate course (P<0.001), and LBP status (P=0.021). Healthcare provider beliefs were found to be significantly influenced by course only (P<0.001). Fear avoidance beliefs related to physical activity were influenced by country (P=0.002) and undergraduate course (P<0.001). When compared with white Australians, Taiwanese and Singaporean Chinese displayed more negative back beliefs regarding the future consequence of LBP (P<0.001) and more fear avoidant beliefs toward physical activity (P=0.021 and P<0.001, respectively). Further, nursing students had more negative back pain beliefs than physiotherapy students (P<0.001) and, the experience of LBP was associated with more positive beliefs on the future consequence of back trouble (P=0.021). Findings of this study highlight the importance of country, education, and LBP experience on back pain beliefs. The more negative back pain beliefs found in Taiwan and Singapore may reflect current pain beliefs and management attitudes.

Global consequences of unsafe abortion.

PubMed

Singh, Susheela

2010-11-01

Unsafe abortion is a significant cause of death and ill health in women in the developing world. A substantial body of research on these consequences exists, although studies are of variable quality. However, unsafe abortion has a number of other significant consequences that are much less widely recognized. These include the economic consequences, the immediate costs of providing medical care for abortion-related complications, the costs of medical care for longer-term health consequences, lost productivity to the country, the impact on families and the community, and the social consequences that affect women and families. This article will review the scientific evidence on the consequences of unsafe abortion, highlight gaps in the evidence base, suggest areas where future research efforts are needed, and speculate on the future situation regarding consequences and evidence over the next 5-10 years. The information provided is useful and timely given the current heightened interest in the issue of unsafe abortion, growing from the recent focus of national and international agencies on reducing maternal mortality by 75% by 2015 (as one of the Millennium Development Goals established in 2000).

The Capital Costs Conundrum: Why Are Capital Costs Ignored and What Are the Consequences?

ERIC Educational Resources Information Center

Winston, Gordon C.

1993-01-01

Colleges and universities historically have ignored the capital costs associated with institutional administration in their estimates of overall and per-student costs. This neglect leads to distortion of data, misunderstandings, and uninformed decision making. The real costs should be recognized in institutional accounting. (MSE)

A cost-consequences analysis of an adherence focused pharmacist-led medication review service.

PubMed

Desborough, James A; Sach, Tracey; Bhattacharya, Debi; Holland, Richard C; Wright, David J

2012-02-01

The aim of this project was to conduct an economic evaluation of the Norfolk Medicines Support Service (NMSS), a pharmacist-led medication review service for patients identified in primary care as non-adherent. The cost-consequences analysis was based on a before and after evaluation of the NMSS. Participants completed a self-reported adherence and health-related quality of life questionnaire prior to the review, at 6 weeks and 6 months. Service provision, prescribing and secondary care costs were considered and the mean cost before and after the intervention was calculated. One-hundred and seventeen patients were included in the evaluation. The mean cost per patient of prescribing and hospital admissions in the 6 months prior to the intervention was £2190 and in the 6 months after intervention £1883. This equates to a mean cost saving of £307 per patient (parametric 95% confidence interval: £1269 to £655). The intervention reduced emergency hospital admissions and increased medication adherence but no significant change in health-related quality of life was observed. The costs of providing this medication review service were offset by the reduction in emergency hospital admissions and savings in medication cost, assuming the findings of the evaluation were real and the regression to the mean phenomenon was not involved. This cost-consequences approach provides a transparent descriptive summary for decision-makers to use as the basis for resource allocation decisions. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region

ERIC Educational Resources Information Center

McGregor, Margaret J.; Baumbusch, Jennifer; Abu-Laban, Riyad B.; McGrail, Kimberlyn M.; Andrusiek, Dug; Globerman, Judith; Berg, Shannon; Cox, Michelle B.; Salomons, Kia; Volker, Jan; Ronald, Lisa

2011-01-01

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with…

40 CFR 1042.850 - Exemptions and hardship relief.

Code of Federal Regulations, 2010 CFR

2010-07-01

... regulations in this chapter to avoid the impending violation. (2) Send the Designated Compliance Officer a... without significant modification of your vessel, you may ask us to determine that a remanufacturing system is not considered available for your vessel because the cost would exceed the total marginal cost...

Making a Low-Cost Soda Can Ethanol Burner for Out-of-Laboratory Flame Test Demonstrations and Experiments

ERIC Educational Resources Information Center

Yu, Henson L. Lee; Domingo, Perfecto N., Jr.; Yanza, Elliard Roswell S.; Guidote, Armando M., Jr.

2015-01-01

This article demonstrates how to make a low-cost ethanol burner utilizing soda cans. It burns with a light blue flame suitable for out-of-laboratory flame test demonstrations where interference from a yellow flame needs to be avoided.

77 FR 69673 - Self-Regulatory Organizations; Chicago Stock Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-20

... Organizations; Chicago Stock Exchange, Inc.; Notice of Filing and Immediate Effectiveness of Proposed Rule... costs and burdens associated with handling and recording orders that were rarely executed. \\5\\ The... actually exacerbated the operational costs which the Exchange sought to avoid by creating the order...

The Effects of Source Water Quality on Drinking Water Treatment Costs: A Review and Synthesis of Empirical Literature - Ecological Economics

EPA Science Inventory

Watershed protection, and associated in situ water quality improvements, has received considerable attention as a means of mitigating health risks and avoiding expenditures at drinking water treatment plants (DWTPs). This study reviews the extant cost function literature linking ...

An Insurance Crisis Looms--Again.

ERIC Educational Resources Information Center

Henke, Cliff

1993-01-01

The insurance industry has experienced a round of claims costs as a result of recent natural disasters. These costs are passed on to customers. To avoid higher premiums, student-transportation systems can take the following money-saving steps: raise the deductible; beef up driver training; focus on driver retention; and get the fleet's loss…

Research Libraries' Costs of Doing Business (and Strategies for Avoiding Them)

ERIC Educational Resources Information Center

Greenstein, Daniel

2004-01-01

With today's relatively flat budgets, research libraries are finding their buying power further diminished by the hyperinflationary costs of library materials. Yet technology innovation, coupled with organizational restructuring, is enabling libraries not only to provide more high-quality information services but also to achieve unparalleled…

Legionnaire's disease avoidance planning.

PubMed

Broadbent, Clive

2007-09-01

Hospital-acquired infection is the cause of about 5,000 deaths a year in the UK. In New Zealand, there are more than three times as many such deaths as from the annual road toll. The costs in loss of income, in pain and suffering and in direct costs to hospitals are staggering.

Creating mold-free buildings: a key to avoiding health effects of indoor molds.

PubMed

Small, Bruce M

2003-08-01

In view of the high costs of building diagnostics and repair subsequent to water damage--as well as the large medical diagnostic and healthcare costs associated with mold growth in buildings--commitment to a philosophy of proactive preventive maintenance for home, apartment, school, and commercial buildings could result in considerable cost savings and avoidance of major health problems among building occupants. The author identifies common causes of mold growth in buildings and summarizes key building design and construction principles essential for preventing mold contamination indoors. Physicians and healthcare workers must be made aware of conditions within buildings that can give rise to mold growth, and of resulting health problems. Timely advice provided to patients already sensitized by exposure to molds could save these individuals, and their families, from further exposures as a result of inadequate building maintenance or an inappropriate choice of replacement housing.

Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine.

PubMed

Sanders, Gillian D; Neumann, Peter J; Basu, Anirban; Brock, Dan W; Feeny, David; Krahn, Murray; Kuntz, Karen M; Meltzer, David O; Owens, Douglas K; Prosser, Lisa A; Salomon, Joshua A; Sculpher, Mark J; Trikalinos, Thomas A; Russell, Louise B; Siegel, Joanna E; Ganiats, Theodore G

2016-09-13

Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses. The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

Is Accelerated Partner Therapy (APT) a cost-effective alternative to routine patient referral partner notification in the UK? Preliminary cost-consequence analysis of an exploratory trial.

PubMed

Roberts, Tracy E; Tsourapas, Angelos; Sutcliffe, Lorna; Cassell, Jackie; Estcourt, Claudia

2012-02-01

To undertake a cost-consequence analysis to assess two new models of partner notification (PN), known as Accelerated Partner Therapy (APT Hotline and APT Pharmacy), as compared with routine patient referral PN, for sex partners of people with chlamydia, gonorrhoea and non-gonococcal urethritis. Comparison of costs and outcomes alongside an exploratory trial involving two genitourinary medicine clinics and six community pharmacies. Index patients selected the PN method (APT Hotline, APT Pharmacy or routine PN) for their partners. Clinics and pharmacies recorded cost and resource use data including duration of consultation and uptake of treatment pack. Cost data were collected prospectively for two out of three interventions, and data were synthesised and compared in terms of effectiveness and costs. Routine PN had the lowest average cost per partner treated (approximately £46) compared with either APT Hotline (approximately £54) or APT Pharmacy (approximately £53) strategies. The cost-consequence analysis revealed that APT strategies were more costly but also more effective at treating partners compared to routine PN. The hotline strategy costs more than both the alternative PN strategies. If we accept that strategies which identify and treat partners the fastest are likely to be the most effective in reducing reinfection and onward transmission, then APT Hotline appears an effective PN strategy by treating the highest number of partners in the shortest duration. Whether the additional benefit is worth the additional cost cannot be determined in this preliminary analysis. These data will be useful for informing development of future randomised controlled trials of APT.

The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France

PubMed Central

Schmid, Ramona

2015-01-01

Objective To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France, and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. Methods The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates, outcomes of unintended pregnancies, and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. Results The cost of an unintended pregnancy in a French minor is estimated to be 1,630 € (range 1,330 € – 1,803 €). Almost 4 million € (3.1 € – 13.7 € million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 € per intake, or 418 € per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. Conclusions Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse, i.e., it is more effective at a lower cost. When taken within 72 hours, ulipristal acetate is a cost- effective alternative to levonorgestrel, given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings, it is worthwhile to provide free access to minors. PMID:26422259

The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France.

PubMed

Schmid, Ramona

2015-01-01

To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France, and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates, outcomes of unintended pregnancies, and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. The cost of an unintended pregnancy in a French minor is estimated to be 1,630 € (range 1,330 € - 1,803 €). Almost 4 million € (3.1 € - 13.7 € million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 € per intake, or 418 € per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse, i.e., it is more effective at a lower cost. When taken within 72 hours, ulipristal acetate is a cost- effective alternative to levonorgestrel, given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings, it is worthwhile to provide free access to minors.

Cognitive factors in panic disorder, agoraphobic avoidance and agoraphobia.

PubMed

Berle, David; Starcevic, Vladan; Hannan, Anthony; Milicevic, Denise; Lamplugh, Claire; Fenech, Pauline

2008-02-01

There remains a lack of consensus regarding the possibility that especially high levels of panic-related cognitions characterise panic disorder with agoraphobia. We administered the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire and the Anxious Thoughts and Tendencies Scale as well as measures of agoraphobic avoidance to patients diagnosed with panic disorder with agoraphobia (n=75) and without agoraphobia (n=26). Patients with panic disorder with agoraphobia did not score significantly higher on any of the cognitive variables than did panic disorder patients without agoraphobia. However, most of the cognitive variables showed small to moderate-strength correlations with self-report measures of agoraphobic avoidance. Our findings suggest that anxiety sensitivity, catastrophising of the consequences of panic and a general anxiety-prone cognitive style, although to some extent associated with agoraphobic avoidance, do not discriminate panic disorder with agoraphobia from panic disorder without agoraphobia.

Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees.

PubMed

Stearns, Sally C; Rozier, R Gary; Kranz, Ashley M; Pahel, Bhavna T; Quiñonez, Rocio B

2012-10-01

To estimate the cost-effectiveness of a medical office-based preventive oral health program in North Carolina called Into the Mouths of Babes (IMB). Observational study using Medicaid claims data (2000-2006). Medical staff delivered IMB services in medical offices, and dentists provided dental services in offices or hospitals. A total of 209 285 children enrolled in Medicaid at age 6 months. Into the Mouths of Babes visits included screening, parental counseling, topical fluoride application, and referral to dentists, if needed. The cost-effectiveness analysis used the Medicaid program perspective and a propensity score-matched sample with regression analysis to compare children with 4 or more vs 0 IMB visits. Dental treatments and Medicaid payments for children up to age 6 years enabled assessment of the likelihood of whether IMB was cost-saving and, if not, the additional payments per hospital episode avoided. Into the Mouths of Babes is 32% likely to be cost-saving, with discounting of benefits and payments. On average, IMB visits cost $11 more than reduced dental treatment payments per person. The program almost breaks even if future benefits from prevention are not discounted, and it would be cost-saving with certainty if IMB services could be provided at $34 instead of $55 per visit. The program is cost-effective with 95% certainty if Medicaid is willing to pay $2331 per hospital episode avoided. Into the Mouths of Babes improves dental health for additional payments that can be weighed against unmeasured hospitalization costs.

A nurse-run walk-in clinic: cost-effective alternative to non-urgent emergency department use by the uninsured.

PubMed

Bicki, Alexandra; Silva, Adam; Joseph, Valerie; Handoko, Ryan; Rico, Sheryl-vi; Burns, Jacqueline; Simonelli, Anna; Harrop, Jordan; Nedow, Jennifer; De Groot, Anne S

2013-12-01

Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.

California-Specific Power-to-Hydrogen and Power-to-Gas Business Case Evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eichman, Joshua D.; Flores-Espino, Francisco

Flexible operation of electrolysis systems represents an opportunity to reduce the cost of hydrogen for a variety of end-uses while also supporting grid operations and thereby enabling greater renewable penetration. California is an ideal location to realize that value on account of growing renewable capacity and markets for hydrogen as a fuel cell electric vehicle (FCEV) fuel, refineries, and other end-uses. Shifting the production of hydrogen to avoid high cost electricity and participation in utility and system operator markets along with installing renewable generation to avoid utility charges and increase revenue from the Low Carbon Fuel Standard (LCFS) program canmore » result in around $2.5/kg (21%) reduction in the production and delivery cost of hydrogen from electrolysis. This reduction can be achieved without impacting the consumers of hydrogen. Additionally, future strategies for reducing hydrogen cost were explored and include lower cost of capital, participation in the Renewable Fuel Standard program, capital cost reduction, and increased LCFS value. Each must be achieved independently and could each contribute to further reductions. Using the assumptions in this study found a 29% reduction in cost if all future strategies are realized. Flexible hydrogen production can simultaneously improve the performance and decarbonize multiple energy sectors. The lessons learned from this study should be used to understand near-term cost drivers and to support longer-term research activities to further improve cost effectiveness of grid integrated electrolysis systems.« less

[Economic evaluation of a program of coordination between levels for complex chronic patients' management].

PubMed

Allepuz Palau, Alejandro; Piñeiro Méndez, Pilar; Molina Hinojosa, José Carlos; Jou Ferre, Victoria; Gabarró Julià, Lourdes

2015-03-01

The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. Dost-effectiveness analysis from the perspective of the health System based on a before-after study. Alt Penedès. Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (€ 1,742.01). 149 patients were included. Admissions dropped from 212 to 145. The ICER was €1,416.3 (94,892.9€/67). Sensitivity analysis showed that in 95% of cases the cost might vary between €70,847.3 and €121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Environmental benefits vs. costs of geologic mapping

USGS Publications Warehouse

Bhagwat, S.B.; Berg, R.C.

1992-01-01

Boone and Winnebago Counties, Illinois, U.S.A., were selected for this study, required by the Illinois State Senate, because mapping and environmental interpretations were completed there in 1981. Costs of geologic mapping in these counties in 1990 dollars were $290,000. Two estimates of costs of statewide mapping were made, one extrapolated from Boone and Winnebago Counties ($21 million), the other estimated on the basis of differences between the Boone/Winnebago program and proposed mapping program for the State of Illinois ($55 million). Benefits of geologic information come in the form of future avoided costs for environmental cleanup. Only the quantifiable data, available from a few sites, were included. Data collection, based on 55 personal interviews in Boone and Winnebago Counties, were grouped into four cumulative categories with increasing variability. Geologic maps alone cannot account for all avoided costs of future cleanup. Therefore, estimated benefits were reduced by 50, 75, and 90 percent in three scenarios. To account for delays in proper utilization of knowledge gained from a mapping program, a 10-yr delay in benefit realization was assumed. All benefits were converted to 1990 dollars. In benefit category 4, benefit-cost ratios for Boone/Winnebago Counties ranged between 5 and 55. Statewide projection of benefits was based on county areas and an aquifer contamination potential score for each county. Statewide benefit-cost ratio in benefit category 4 ranged from 1.2 to 14 ($21 million mapping costs) and from 0.5 to 5.4 ($55 million mapping costs). ?? 1992 Springer-Verlag New York Inc.

Photovoltaics and electric utilities

NASA Astrophysics Data System (ADS)

Bright, R.; Leigh, R.; Sills, T.

1981-12-01

The long term value of grid connected, residential photovoltaic (PV) systems is determined. The value of the PV electricity is defined as the full avoided cost in accordance with the Public Utilities Regulatory Policies Act of 1978. The avoided cost is computed using a long range utility planning approach to measure revenue requirement changes in response to the time phased introduction of PV systems into the grid. A case study approach to three utility systems is used. The changing value of PV electricity over a twenty year period from 1985 is presented, and the fuel and capital savings due to FY are analyzed. These values are translated into measures of breakeven capital investment under several options of power interchange and pricing.

Taking a new biomarker into routine use – A perspective from the routine clinical biochemistry laboratory

PubMed Central

Sturgeon, Catharine; Hill, Robert; Hortin, Glen L; Thompson, Douglas

2010-01-01

There is increasing pressure to provide cost-effective healthcare based on “best practice.” Consequently, new biomarkers are only likely to be introduced into routine clinical biochemistry departments if they are supported by a strong evidence base and if the results will improve patient management and outcome. This requires convincing evidence of the benefits of introducing the new test, ideally reflected in fewer hospital admissions, fewer additional investigations and/or fewer clinic visits. Carefully designed audit and cost-benefit studies in relevant patient groups must demonstrate that introducing the biomarker delivers an improved and more effective clinical pathway. From the laboratory perspective, pre-analytical requirements must be thoroughly investigated at an early stage. Good stability of the biomarker in relevant physiological matrices is essential to avoid the need for special processing. Absence of specific timing requirements for sampling and knowledge of the effect of medications that might be used to treat the patients in whom the biomarker will be measured is also highly desirable. Analytically, automation is essential in modern high-throughput clinical laboratories. Assays must therefore be robust, fulfilling standard requirements for linearity on dilution, precision and reproducibility, both within- and between-run. Provision of measurements by a limited number of specialized reference laboratories may be most appropriate, especially when a new biomarker is first introduced into routine practice. PMID:21137030

Evolution of cannibalism and female's response to oviposition-deterring pheromone in aphidophagous predators.

PubMed

Martini, Xavier; Haccou, Patsy; Olivieri, Isabelle; Hemptinne, Jean-Louis

2009-09-01

1. Egg cannibalism by larvae is common in Coccinellidae and is known to be advantageous for the cannibals. Furthermore, larvae of aphidophagous ladybirds usually produce an oviposition-deterring pheromone (ODP), which inhibits oviposition by adult females. It has been proposed that the response to ODP has evolved because of the high costs of cannibalism. However, this has never been formally proved. 2. In this paper, we study the theoretical evolution of this system. We first look at the conditions under which cannibalism and the response to ODP can evolve. Subsequently, we examine the occurrence of polymorphism both in the production of larval tracks and in the sensitivity of females to specific pheromones. 3. The models predict that the amount of cannibalism should not depend on prey density and that evolution should lead to a continuous increase in cannibalism, and consequently larvae should always cannibalize eggs when possible. In response to the cost of cannibalism, ODP recognition can evolve, so that females avoid laying eggs in patches of prey already occupied by conspecific larvae. The result is an arms race between larvae and adult females, which favours a diversification of ODP pheromones. Our models show that: (i) females should be able to recognize mixtures of hydrocarbons rather than a single molecule; and (ii) females should be more sensitive to the tracks of their own offspring than those of non-related larvae.

Integral pharmacological management of bone mineral disorders in chronic kidney disease (part II): from treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification.

PubMed

Bover, J; Ureña-Torres, P; Lloret, M J; Ruiz, C; DaSilva, I; Diaz-Encarnacion, M M; Mercado, C; Mateu, S; Fernández, E; Ballarin, J

2016-07-01

Chronic kidney disease-mineral and bone disorders (CKD-MBD) are associated with costly complications and dismal hard-outcomes. In two comprehensive articles we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (part 1) and hyperparathyroidism (this part 2), taking into account CKD-accelerated cardiovascular calcification (CVC) processes. Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Here, initial guidance to control hyperparathyroidism is provided, taking into account the presence/absence of CVC. We include also measures for patients at risk of adynamic bone disease or suffering from calciphylaxis. Many epidemiological studies (relating to vitamin D) and thorough analyses of recent randomized clinical trials (of cinacalcet) point towards benefits of attempting to improve biochemical parameters while trying to, at least, avoid progression of CVC by more rational use of intestinal P-binders and low-dose vitamin D derivatives and/or calcimimetics. This approach does not seem to be far away from significantly improving hard-outcomes, at least in the dialysis population. The availability of new drugs and the performance of randomized clinical trials should ultimately lead to define earlier, clearer, and more cost-effective patient stratification and biochemical targets with consequent significant clinical improvements.

Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries.

PubMed

Massad, Eduardo; Behrens, Ben C; Coutinho, Francisco A B; Behrens, Ronald H

2011-05-17

In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used. Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational. The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission. The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

Retrospective Assessment of Cost Savings From Prevention: Folic Acid Fortification and Spina Bifida in the U.S.

PubMed

Grosse, Scott D; Berry, Robert J; Mick Tilford, J; Kucik, James E; Waitzman, Norman J

2016-05-01

Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997-1998. Estimates of annual numbers of live-born spina bifida cases in 1995-1996 relative to 1999-2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. Published by Elsevier Inc.

A cost-effectiveness analysis comparing different strategies to implement noninvasive prenatal testing into a Down syndrome screening program.

PubMed

Ayres, Alice C; Whitty, Jennifer A; Ellwood, David A

2014-10-01

Currently, noninvasive prenatal testing (NIPT) is only recommended in high-risk women following conventional Down syndrome (DS) screening, and it has not yet been included in the Australian DS screening program. To evaluate the cost-effectiveness of different strategies of NIPT for DS screening in comparison with current practice. A decision-analytic approach modelled a theoretical cohort of 300,000 singleton pregnancies. The strategies compared were the following: current practice, NIPT as a second-tier investigation, NIPT only in women >35 years, NIPT only in women >40 years and NIPT for all women. The direct costs (low and high estimates) were derived using both health system costs and patient out-of-pocket expenses. The number of DS cases detected and procedure-related losses (PRL) were compared between strategies. The incremental cost per case detected was the primary measure of cost-effectiveness. Universal NIPT costs an additional $134,636,832 compared with current practice, but detects 123 more DS cases (at an incremental cost of $1,094,608 per case) and avoids 90 PRL. NIPT for women >40 years was the most cost-effective strategy, costing an incremental $81,199 per additional DS case detected and avoiding 95 PRL. The cost of NIPT needs to decrease significantly if it is to replace current practice on a purely cost-effectiveness basis. However, it may be beneficial to use NIPT as first-line screening in selected high-risk patients. Further evaluation is needed to consider the longer-term costs and benefits of screening. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

13 CFR 302.8 - Pre-approval Investment Assistance costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... costs. 302.8 Section 302.8 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION... Assistance costs. Project activities carried out before approval of Investment Assistance shall be carried... application, the disallowance of costs, or other adverse consequences as a result of non-compliance with EDA...

Socioeconomic impact of road traffic injuries in West Africa: exploratory data from Nigeria.

PubMed

Juillard, Catherine; Labinjo, Mariam; Kobusingye, Olive; Hyder, Adnan A

2010-12-01

Road traffic injuries (RTIs) are increasingly contributing to the burden of disease in sub-Saharan Africa, yet little is known about the economic consequences and disability associated with them. To explore cost and disability consequences of RTIs in Nigeria. A population-based survey using two-stage stratified cluster sampling. SUBJECT/SETTING: Information on care-seeking choice, cost of treatment, ability to work, reduction in earnings, and disability were collected on 127 subjects who had suffered an RTI, of 3082 study subjects in seven Nigerian states. Univariate analysis was used to estimate frequency of disability, types of care sought, and trends for work lost, functional ability and cost of treatment. Unadjusted bivariate analysis was performed to explore care-seeking, cost of care, and work lost among disabled and non-disabled people. RTIs resulted in disability for 29.1% of subjects, while 13.5% were unable to return to work. Of the disabled people, 67.6% were unable to perform activities of daily living, 16.7% consequently lost their jobs, and 88.6% had a reduction in earnings. Private physician and hospital treatment were the most common forms of initial treatment sought, but traditional treatment was the most common second form of care sought. Average direct costs of informal and formal treatment were US$6.65 and US$35.64, respectively. Disabled people were more likely to seek formal care (p=0.003) and be unable to work (p=0.002). Economic and functional ramifications must be included in the spectrum of consequences of RTIs to fully appreciate the extent of the burden of disease, implying that health systems should not only address the clinical consequences of RTIs, but the financial ones as well.