[Gaps in effective coverage by socioeconomic status and poverty condition].

PubMed

Gutiérrez, Juan Pablo

2013-01-01

To analyze, in the context of increased health protection in Mexico, the gaps by socioeconomic status and poverty condition on effective coverage of selected preventive interventions. Data from the National Health & Nutrition Survey 2012 and 2006, using previously defined indicators of effective coverage and stratifying them by socioeconomic (SE) status and multidimensional poverty condition. For vaccination interventions, immunological equity has been maintained in Mexico. For indicators related to preventive interventions provided at the clinical setting, effective coverage is lower among those in the lowest SE quintile and among people living in multidimensional poverty. Comparing 2006 and 2012, there is no evidence on gap reduction. While health protection has significantly increased in Mexico, thus reducing SE gaps, those gaps are still important in magnitude for effective coverage of preventive interventions.

Adherence and persistence to prescribed medication therapy among Medicare part D beneficiaries on dialysis: comparisons of benefit type and benefit phase.

PubMed

Park, Haesuk; Rascati, Karen L; Lawson, Kenneth A; Barner, Jamie C; Richards, Kristin M; Malone, Daniel C

2014-08-01

The implementation of Medicare Part D provided insurance coverage for outpatient medications, but when persons reach the "gap," they have very limited or no medication insurance coverage until they reach a second threshold for catastrophic coverage. In addition, some patients have a low-income subsidy (LIS), and their out-of-pocket costs do not reach the threshold for the gap. Little is known about how these Part D types (LIS versus non-LIS) and benefit phases (before the gap, during the gap, after the gap) affect medication adherence and persistence of dialysis patients.  To examine medication use, adherence, and persistence for Medicare-eligible dialysis patients by Part D benefit type and benefit phase.  A retrospective cohort study using data from the U.S. Renal Data System (USRDS) was conducted for Medicare-eligible dialysis patients. Outcomes included medication use, adherence, and persistence. Patients were categorized into 4 cohorts based on their Part D benefit phase that the beneficiaries reached at the end of the year and LIS receipt in 2007: Cohort 1 = non-LIS and did not reach the coverage gap; Cohort 2 = non-LIS and reached the coverage gap; Cohort 3 = non-LIS and reached catastrophic coverage after the gap; and Cohort 4 = received an LIS and none of the LIS patients reached the coverage gap. Outcomes were measured separately for 5 therapeutic classes of outpatient prescription drugs: antihyperglycemics, antihypertensives, antilipidemics, phosphate binders, and calcimimetics.  A total of 11,732 patients met the study inclusion criteria. Patients were distributed among the cohorts as follows: 3,678 (31.3%) patients in Cohort 1 who did not reach the coverage gap; 4,349 (37.1%) patients in Cohort 2 who reached the coverage gap but not catastrophic coverage; 1,310 (11.2%) patients in Cohort 3 who reached catastrophic coverage; and 2,395 (20.4%) patients in Cohort 4 who had an LIS (none of whom reached the gap). Overall, the percentage of patients who were adherent to their medications (≥ 80% medication possession ratio) was low: 39% for antihyperglycemics, 59% for antihypertensives, 54% for antilipidemics, 22% for phosphate binders, and 35% for cinacalcet. There were wide ranges in adherence rates depending on the cohort. For patients on antihyperglycemics, antihypertensives, antilipidemics, phosphate binders, and cinacalcet, the odds ratios for adherence to therapy were 0.76 (95% C I =0.63-0.92), 1.06 (0.94-1.19), 0.80 (0.67-0.95), 0.65 (0.55-0.76), and 0.39 (0.30-0.49), respectively; the hazard ratios for discontinuation of therapy were 1.18 (95% CI 1.06-1.31), 1.01 (0.93-1.10), 1.25 (1.12-1.40), 1.13 (1.05-1.21), and 1.61 (1.75-1.82), respectively, for Cohort 2 patients who reached the coverage gap compared with those in Cohort 4 who received an LIS. In addition, when comparing adherence before and after the benefit gap, patients in Cohort 2 were significantly more likely to be nonadherent to medications for diabetes (relative risk (RR) = 1.71, 95% CI = 1.48-1.99), hypertension (RR = 1.69, 95% CI = 1.54-1.85), hyperlipidemia (RR = 2.01, 95% CI = 1.76-2.29), hyperphosphatemia (RR = 1.74, 95% CI = 1.55-1.95), and hyperparathyroidism (RR = 2.08, 95% CI = 1.66-2.60) after reaching the coverage gap.  More than half of Medicare beneficiaries on dialysis reached the Part D coverage gap in 2007. Our findings suggest that the Part D coverage gap was significantly associated with decreases in adherence and persistence for medications frequently used in patients undergoing dialysis. Patients who reached the coverage gap (Cohort 2) often decreased use of or discontinued critical medications after reaching the coverage gap. Compared with patients who had an LIS (Cohort 4), patients in Cohort 2 had significantly lower medication adherence and persistence levels. The negative impact of the Part D coverage gap (high out-of-pocket cost sharing) on medication adherence and persistence for Medicare-eligible dialysis patients has implications for currently proposed Medicare end-stage renal disease bundled reimbursement payment and requires more research.

Costs in the coverage gap

MedlinePlus

... D costs won’t enter the coverage gap. Brand-name prescription drugs Once you reach the coverage ... than 35% of the plan's cost for covered brand-name prescription drugs. You get these savings if ...

Persistence with biologic therapies in the Medicare coverage gap.

PubMed

Tamariz, Leonardo; Uribe, Claudia L; Luo, Jiacong; Hanna, John W; Ball, Daniel E; Krohn, Kelly; Meadows, Eric S

2011-11-01

To describe persistence with teriparatide and other biologic therapies in Medicare Part D plans with and without a coverage gap. Retrospective (2006) cohort study of Medicare Part D prescription drug plan beneficiaries from a large benefits company. Two plans with a coverage gap (defined as "basic") were combined and compared with a single plan with coverage for generic and branded medications (defined as "complete"). Patients taking alendronate (nonbiologic comparator), teriparatide, etanercept, adalimumab, interferon β-1a, or glatiramer acetate were selected for the study. For patients with complete coverage, equivalent financial thresholds were used to define the "gap."The definition of discontinuation was failure to fill the index prescription after reaching the gap. For alendronate, 27% of 133,260 patients had enrolled in the complete plan. Patients taking biologic therapies had more commonly enrolled in complete plans: teriparatide (66% of 6221), etanercept (58% of 1469), adalimumab (52% of 824), interferon β-1a (60% of 438), and glatiramer acetate (53% of 393). For patients taking either alendronate or teriparatide, discontinuation rates were higher in the basic, versus complete, plan (adjusted odds ratios, 2.02 and 3.56, respectively). Discontinuation did not significantly vary by plan type for etanercept, adalimumab, interferon β-1a, or glatiramer acetate. For patients who reached the coverage gap, discontinuation was more likely for patients taking osteoporosis (OP) medication. Not having a coverage gap was associated with improved persistence with OP treatment.

[Effects of forest gap size and light intensity on herbaceous plants in Pinus koraiensis-dominated broadleaved mixed forest].

PubMed

Duan, Wen-Biao; Wang, Li-Xia; Chen, Li-Xin; Du, Shan; Wei, Quan-Shuai; Zhao, Jian-Hui

2013-03-01

1 m x 1 m fixed quadrats were parallelly arranged with a space of 2 m in each of six forest gaps in Pinus koraiensis-dominated broadleaved mixed forest, taking the gap center as the starting point and along east-west and south-north directions. In each quadrat, the coverage and abundance of herbaceous plants at different height levels were investigated by estimation method in June and September 2011, and the matrix characteristics within the quadrats were recorded. Canopy analyzer was used to take fish-eye photos in the selected overcast days in each month from June to September, 2011, and the relative light intensity was calculated by using Gap Light Analyzer 2.0 software. The differences in the relative light intensity and herbaceous plants coverage and richness between different gaps as well as the correlations between the coverage of each species and the direct light, diffuse light, and matrix were analyzed. The results showed that in opening areas and under canopy, the relative light intensity in large gaps was higher than that in small gaps, and the variation ranges of diffuse light and direct light from gap center to gap edge were bigger in large gaps than in small gaps. The direct light reaching at the ground both in large gaps and in small gaps was higher in the north than in the south direction. In the Z1, Z2, Z3, and Z4 zones, both the coverage and the richness of herbaceous plants were larger in large gaps than in small gaps, and the differences of species richness between large and small gaps reached significant level. The coverage of the majority of the herbaceous plants had significant correlations with diffuse light and matrix, and only the coverage of a few herbaceous plants was correlated with direct light.

7 CFR 4279.131 - Credit quality.

Code of Federal Regulations, 2014 CFR

2014-01-01

... extended. (a) Cash flow. All efforts will be made to structure or restructure debt so that the business has... predominantly cash-flow oriented, and where cash flow and profitability are strong, loan-to-value coverage may be discounted accordingly. A loan primarily based on cash flow must be supported by a successful and...

7 CFR 4279.131 - Credit quality.

Code of Federal Regulations, 2013 CFR

2013-01-01

... extended. (a) Cash flow. All efforts will be made to structure or restructure debt so that the business has... predominantly cash-flow oriented, and where cash flow and profitability are strong, loan-to-value coverage may be discounted accordingly. A loan primarily based on cash flow must be supported by a successful and...

7 CFR 4279.131 - Credit quality.

Code of Federal Regulations, 2012 CFR

2012-01-01

... extended. (a) Cash flow. All efforts will be made to structure or restructure debt so that the business has... predominantly cash-flow oriented, and where cash flow and profitability are strong, loan-to-value coverage may be discounted accordingly. A loan primarily based on cash flow must be supported by a successful and...

Effects of Medicare Part D coverage gap on medication and medical treatment among elderly beneficiaries with depression.

PubMed

Zhang, Yuting; Baik, Seo Hyon; Zhou, Lei; Reynolds, Charles F; Lave, Judith R

2012-07-01

Maintenance antidepressant pharmacotherapy in late life prevents recurrent episodes of major depression. The coverage gap in Medicare Part D could increase the likelihood of reducing appropriate use of antidepressants, thereby exposing older adults to an increased risk for relapse of depressive episodes. To determine whether (1) beneficiaries reduce antidepressant use in the gap, (2) the reduction in antidepressant use is similar to the reduction in heart failure medications and antidiabetics, (3) the provision of generic coverage reduces the risk of reduction of medication use, and (4) medical spending increases in the gap. Observational before-after study with a comparison group design. A 5% random sample of US Medicare beneficiaries 65 years or older with depression (n = 65,223) enrolled in stand-alone Part D plans in 2007. Antidepressant pharmacotherapy, physician, outpatient, and inpatient spending. Being in the gap was associated with comparable reductions in the use of antidepressants, heart failure medications, and antidiabetics. Relative to the comparison group (those who had full coverage in the gap because of Medicare coverage or low-income subsidies), the no-coverage group reduced their monthly antidepressant prescriptions by 12.1% (95% CI, 9.9%-14.3%) from the pregap level, whereas they reduced use of heart failure drugs and antidiabetics by 12.9% and 13.4%, respectively. Those with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9% (95% CI, 4.8%-9.1%); this decrease was entirely attributable to the reduction in the use of brand-name antidepressants. Medicare spending on medical care did not increase for either group relative to the comparison group. The Medicare Part D coverage gap was associated with modest reductions in the use of antidepressants. Those with generic coverage reduced their use of brand-name drugs and did not switch from brand-name to generic drugs. The reduction in antidepressant use was not associated with an increase in nondrug medical spending.

Three-Dimensional Analysis of Deep Space Network Antenna Coverage

NASA Technical Reports Server (NTRS)

Kegege, Obadiah; Fuentes, Michael; Meyer, Nicholas; Sil, Amy

2012-01-01

There is a need to understand NASA s Deep Space Network (DSN) coverage gaps and any limitations to provide redundant communication coverage for future deep space missions, especially for manned missions to Moon and Mars. The DSN antennas are required to provide continuous communication coverage for deep space flights, interplanetary missions, and deep space scientific observations. The DSN consists of ground antennas located at three sites: Goldstone in USA, Canberra in Australia, and Madrid in Spain. These locations are not separated by the exactly 120 degrees and some DSN antennas are located in the bowl-shaped mountainous terrain to shield against radiofrequency interference resulting in a coverage gap in the southern hemisphere for the current DSN architecture. To analyze the extent of this gap and other coverage limitations, simulations of the DSN architecture were performed. In addition to the physical properties of the DSN assets, the simulation incorporated communication forward link calculations and azimuth/elevation masks that constrain the effects of terrain for each DSN antenna. Analysis of the simulation data was performed to create coverage profiles with the receiver settings at a deep space altitudes ranging from 2 million to 10 million km and a spherical grid resolution of 0.25 degrees with respect to longitude and latitude. With the results of these simulations, two- and three-dimensional representations of the area without communication coverage and area with coverage were developed, showing the size and shape of the communication coverage gap projected in space. Also, the significance of this communication coverage gap is analyzed from the simulation data.

7 CFR 4279.229 - Guaranteed loan funding.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... For example, an eligible borrower is applying for a loan guarantee on a $1 million project. The... (d)(1) through (d)(4) of this section. (1) If the loan amount is equal to or less than $125 million... at least 1 year in duration; and (iii) Collateral coverage ratio, total discounted collateral value...

7 CFR 4279.229 - Guaranteed loan funding.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... For example, an eligible borrower is applying for a loan guarantee on a $1 million project. The... (d)(1) through (d)(4) of this section. (1) If the loan amount is equal to or less than $125 million... at least 1 year in duration; and (iii) Collateral coverage ratio, total discounted collateral value...

7 CFR 4279.229 - Guaranteed loan funding.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... For example, an eligible borrower is applying for a loan guarantee on a $1 million project. The... (d)(1) through (d)(4) of this section. (1) If the loan amount is equal to or less than $125 million... at least 1 year in duration; and (iii) Collateral coverage ratio, total discounted collateral value...

DIGESTING THE DOUGHNUT HOLE

PubMed Central

Zissimopoulos, Julie; Goldman, Dana P.

2013-01-01

Despite its success, Medicare Part D has been widely criticized for the gap in coverage, the so-called “doughnut hole”. We compare the use of prescription drugs among beneficiaries subject to the coverage gap with usage among beneficiaries who are not exposed to it. We find that the coverage gap does, indeed, disrupt the use of prescription drugs among seniors with diabetes. But the declines in usage are modest and concentrated among higher cost, brand-name medications. Demand for high cost medications such as antipsychotics, antiasthmatics, and drugs of the central nervous system decline by 8% to 12% in the coverage gap, while use of lower cost medications with high generic penetration such as beta blockers, ACE inhibitors and antidepressants decline by 3% to 4% after reaching the gap. More importantly, lower adherence to medications is not associated with increases in medical service use. PMID:24308883

Improving care for patients on antiretroviral therapy through a gap analysis framework.

PubMed

Massoud, M Rashad; Shakir, Fazila; Livesley, Nigel; Muhire, Martin; Nabwire, Juliana; Ottosson, Amanda; Jean-Baptiste, Rachel; Megere, Humphrey; Karamagi-Nkolo, Esther; Gaudreault, Suzanne; Marks, Pamela; Jennings, Larissa

2015-07-01

To improve quality of care through decreasing existing gaps in the areas of coverage, retention, and wellness of patients receiving HIV care and treatment. The antiretroviral therapy (ART) Framework utilizes improvement methods and the Chronic Care Model to address the coverage, retention, and wellness gaps in HIV care and treatment. This is a time-series study. The ART Framework was applied in five health centers in Buikwe District, Uganda. Quality improvement teams, consisting of healthcare workers and expert patients, were established in each of the five healthcare facilities. The intervention period was October 2010 to September 2012. It consisted of quality improvement teams analyzing their facility and systems of care from the perspective of the Chronic Care Model to identify areas of improvement. They implemented the ART Framework, collected data and assessed outcomes, focused on self-management support for patients, to improve coverage, retention, and wellness gaps in HIV care and treatment. Coverage was defined as every patient who needs ART in the catchment area, receives it. Retention was defined as every patient who receives ART stays on ART, and wellness defined as having a positive clinical, immunological, and/or virological response to treatment without intolerable or unmanageable side-effects. Results from Buikwe show the gaps in coverage, retention, and wellness greatly decreased a gap in coverage of 44-19%, gap in retention of 49-24%, and gap in wellness of 53-14% during a 2-year intervention period. The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.

Digesting the doughnut hole.

PubMed

Joyce, Geoffrey F; Zissimopoulos, Julie; Goldman, Dana P

2013-12-01

Despite its success, Medicare Part D has been widely criticized for the gap in coverage, the so-called "doughnut hole". We compare the use of prescription drugs among beneficiaries subject to the coverage gap with usage among beneficiaries who are not exposed to it. We find that the coverage gap does, indeed, disrupt the use of prescription drugs among seniors with diabetes. But the declines in usage are modest and concentrated among higher cost, brand-name medications. Demand for high cost medications such as antipsychotics, antiasthmatics, and drugs of the central nervous system decline by 8-18% in the coverage gap, while use of lower cost medications with high generic penetration such as beta blockers, ACE inhibitors and antidepressants decline by 3-5% after reaching the gap. More importantly, lower adherence to medications is not associated with increases in medical service use. Copyright © 2013 Elsevier B.V. All rights reserved.

Assessment of DSN Communication Coverage for Space Missions to Potentially Hazardous Asteroids

NASA Technical Reports Server (NTRS)

Kegege, Obadiah; Bittner, David; Gati, Frank; Bhasin, Kul

2012-01-01

A communication coverage gap exists for Deep Space Network (DSN) antennas. This communication coverage gap is on the southern hemisphere, centered at approximate latitude of -47deg and longitude of -45deg. The area of this communication gap varies depending on the altitude from the Earth s surface. There are no current planetary space missions that fall within the DSN communication gap because planetary bodies in the Solar system lie near the ecliptic plane. However, some asteroids orbits are not confined to the ecliptic plane. In recent years, Potentially Hazardous Asteroids (PHAs) have passed within 100,000 km of the Earth. NASA s future space exploration goals include a manned mission to asteroids. It is important to ensure reliable and redundant communication coverage/capabilities for manned space missions to dangerous asteroids that make a sequence of close Earth encounters. In this paper, we will describe simulations performed to determine whether near-Earth objects (NEO) that have been classified as PHAs fall within the DSN communication coverage gap. In the study, we reviewed literature for a number of PHAs, generated binary ephemeris for selected PHAs using JPL s HORIZONS tool, and created their trajectories using Satellite Took Kit (STK). The results show that some of the PHAs fall within DSN communication coverage gap. This paper presents the simulation results and our analyses

Price subsidies and the market for mosquito nets in developing countries: A study of Tanzania's discount voucher scheme.

PubMed

Gingrich, Chris D; Hanson, Kara; Marchant, Tanya; Mulligan, Jo-Ann; Mponda, Hadji

2011-07-01

This study uses a partial equilibrium simulation model to explore how price subsidies for insecticide-treated mosquito nets (ITNs) affect households' purchases of ITNs. The model describes the ITN market in a typical developing country and is applied to the situation in Tanzania, where the Tanzania National Voucher Scheme (TNVS) provides a targeted subsidy to vulnerable population groups by means of a discount voucher. The data for this study come from a nationally-representative household survey completed July-August 2006 covering over 4300 households in 21 districts. The simulation results show the impact of the voucher program on ITN coverage among target households, namely those that experienced the birth of a child. More specifically, the share of target households purchasing an ITN increased from 18 to 62 percent because of the discount voucher. The model also suggests that the voucher program could cause the retail ITN price to rise due to an overall increase in demand. As a result, ITN purchases by households without a voucher may actually decline. The simulation model suggests that additional increases toward the stated goal of 80 percent ITN coverage for pregnant women and children could best be achieved through a combination of "catch up" mass distribution programs and expanding the target group for the voucher program to cover additional households. The model can be employed in other countries considering use of a targeted price subsidy for ITNs, and could be adapted to assess the impact of subsidies for other public health commodities. Copyright © 2011 Elsevier Ltd. All rights reserved.

Demand for prescription drugs under non-linear pricing in Medicare Part D.

PubMed

Jung, Kyoungrae; Feldman, Roger; McBean, A Marshall

2014-03-01

We estimate the price elasticity of prescription drug use in Medicare Part D, which features a non-linear price schedule due to a coverage gap. We analyze patterns of drug utilization prior to the coverage gap, where the "effective price" is higher than the actual copayment for drugs because consumers anticipate that more spending will make them more likely to reach the gap. We find that enrollees' total pre-gap drug spending is sensitive to their effective prices: the estimated price elasticity of drug spending ranges between [Formula: see text]0.14 and [Formula: see text]0.36. This finding suggests that filling in the coverage gap, as mandated by the health care reform legislation passed in 2010, will influence drug utilization prior to the gap. A simulation analysis indicates that closing the gap could increase Part D spending by a larger amount than projected, with additional pre-gap costs among those who do not hit the gap.

[The imperfect equalizing device: Physician care discount cards and physician care out-of-pocket costs in Iceland.].

PubMed

Vilhjálmsson, Rúnar; Sigurðardóttir, Guðrún V

2003-05-01

Research shows that out-of-pocket health care costs in Iceland and other Western European countries have increased in recent years, and unequal access to health services has been documented. In an attempt to contain out-of-pocket-costs and avoid service inequities, Icelandic health authorities have for a number of years issued health care discount cards. The purpose ot the study was to investigate the distribution of out-of-pocket physician costs and discount cards, and the extent to which the cards reach those who are entitled to them. The study is based on a national panel survey titled Health and Living Conditions in Iceland. A random sample of 18-75 year olds was drawn from the National Register. 1924 respondents participated in the first wave (69% response rate) and 1592 of them (83%) in the second wave. Cross-tabular analysis was used to investigate variations in out-of-pocket physician costs and discount card status across sociodemographic groups. 19.9% of the respondents had accumulated out-of-pocket costs that made them eligible for a discount card. Furthermore, there was considerable variation in the percentage of eligible individuals across population groups. The discount card was poorly distributed, as only 45.7% of eligible individuals had actually obtained a card. This lack of coverage was greatest among younger individuals, parents of young children, individuals in larger households, the full-time employed, and those who had more education and income. The purpose of the discount card is to even out and contain out-of-pocket physician care costs, and sustain equal access to physician services. The purpose is no more than partially reached, as only a minority of eligible individuals are actual cardholders. This can be largely explained by the fact that health authorities have done little to promote the card, and make it cumbersome for patients to obtain it.

Gaps in health insurance: why so many Americans experience breaks in coverage and how the Affordable Care Act will help: findings from the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011.

PubMed

Collins, Sara R; Robertson, Ruth; Garber, Tracy; Doty, Michelle M

2012-04-01

The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. Early provisions of the Affordable Care Act are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.

State Medicaid Coverage, ESRD Incidence, and Access to Care

PubMed Central

Goldstein, Benjamin A.; Hall, Yoshio N.; Mitani, Aya A.; Winkelmayer, Wolfgang C.

2014-01-01

The proportion of low-income nonelderly adults covered by Medicaid varies widely by state. We sought to determine whether broader state Medicaid coverage, defined as the proportion of each state’s low-income nonelderly adult population covered by Medicaid, associates with lower state-level incidence of ESRD and greater access to care. The main outcomes were incidence of ESRD and five indicators of access to care. We identified 408,535 adults aged 20–64 years, who developed ESRD between January 1, 2001, and December 31, 2008. Medicaid coverage among low-income nonelderly adults ranged from 12.2% to 66.0% (median 32.5%). For each additional 10% of the low-income nonelderly population covered by Medicaid, there was a 1.8% (95% confidence interval, 1.0% to 2.6%) decrease in ESRD incidence. Among nonelderly adults with ESRD, gaps in access to care between those with private insurance and those with Medicaid were narrower in states with broader coverage. For a 50-year-old white woman, the access gap to the kidney transplant waiting list between Medicaid and private insurance decreased by 7.7 percentage points in high (>45%) versus low (<25%) Medicaid coverage states. Similarly, the access gap to transplantation decreased by 4.0 percentage points and the access gap to peritoneal dialysis decreased by 3.8 percentage points in high Medicaid coverage states. In conclusion, states with broader Medicaid coverage had a lower incidence of ESRD and smaller insurance-related access gaps. PMID:24652791

Canadian policy makers' views on pharmaceutical reimbursement contracts involving confidential discounts from drug manufacturers.

PubMed

Morgan, Steven G; Thomson, Paige A; Daw, Jamie R; Friesen, Melissa K

2013-10-01

Pharmaceutical policy makers are increasingly negotiating reimbursement contracts that include confidential price terms that may be affected by drug utilization volumes, patterns, or outcomes. Though such contracts may offer a variety of benefits, including the ability to tie payment to the actual performance of a product, they may also create potential policy challenges. Through telephone interviews about this type of contract, we studied the views of officials in nine of ten Canadian provinces. Use of reimbursement contracts involving confidential discounts is new in Canada and ideas about power and equity emerged as cross-cutting themes in our interviews. Though confidential rebates can lower prices and thereby increase coverage of new medicines, several policy makers felt they had little power in the decision to negotiate rebates. Study participants explained that the recent rise in the use of rebates had been driven by manufacturers' pricing tactics and precedent set by other jurisdictions. Several policy makers expressed concerns that confidential rebates could result in inter-jurisdictional inequities in drug pricing and coverage. Policy makers also noted un-insured and under-insured patients must pay inflated "list prices" even if rebates are negotiated by drug plans. The establishment of policies for disciplined negotiations, inter-jurisdictional cooperation, and provision of drug coverage for all citizens are potential solutions to the challenges created by this new pharmaceutical pricing paradigm. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Racial gaps in child health insurance coverage in four South American countries: the role of wealth, human capital, and other household characteristics.

PubMed

Wehby, George L; Murray, Jeffrey C; McCarthy, Ann Marie; Castilla, Eduardo E

2011-12-01

OBJECTIVE. To evaluate the extent of racial gaps in child health insurance coverage in South America and study the contribution of wealth, human capital, and other household characteristics to accounting for racial disparities in insurance coverage. DATA SOURCES/STUDY SETTING. Primary data collected between 2005 and 2006 in 30 pediatric practices in Argentina, Brazil, Ecuador, and Chile. DESIGN. Country-specific regression models are used to assess differences in insurance coverage by race. A decomposition model is used to quantify the extent to which wealth, human capital, and other household characteristics account for racial disparities in insurance coverage. DATA COLLECTION/EXTRACTION METHODS. In-person interviews were conducted with the mothers of 2,365 children. PRINCIPAL FINDINGS. The majority of children have no insurance coverage except in Chile. Large racial disparities in insurance coverage are observed. Household wealth is the single most important household-level factor accounting for racial disparities in coverage and is significantly and positively associated with coverage, followed by maternal education and employment/occupational status. Geographic differences account for the largest part of racial disparities in insurance coverage in Argentina and Ecuador. CONCLUSIONS. Increasing the coverage of children in less affluent families is important for reducing racial gaps in health insurance coverage in the study countries. © Health Research and Educational Trust.

Changes in drug utilization during a gap in insurance coverage: an examination of the medicare Part D coverage gap.

PubMed

Polinski, Jennifer M; Shrank, William H; Huskamp, Haiden A; Glynn, Robert J; Liberman, Joshua N; Schneeweiss, Sebastian

2011-08-01

Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the "coverage gap" during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs. We followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n = 217,131 (33%). In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed) versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed). Multivariate logistic regressions compared drug adherence (≤ 80% versus >80% of days covered). Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR]  = 2.00, 95% confidence interval [CI] 1.64-2.43) but less likely to switch a drug (HR  = 0.60, 0.46-0.78) after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR  = 1.07, 0.98-1.18). A lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential medications but not switching drugs in 2006 and 2007. Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes.

Determinants of timely uptake of ITN and SP (IPT) and pregnancy time protected against malaria in Bukoba, Tanzania.

PubMed

Protas, Joyce; Tarimo, D; Moshiro, C

2016-06-21

Insecticides treated nets (ITNs) and intermittent preventive therapy with two doses of sulfadoxine-pyrimethamine (SP IPTp) are the cornerstone for malaria control in pregnancy. Despite the coverage of these interventions being high, it is not known whether they confer optimal protection time against malaria in pregnancy. This study investigated the timing and determinants of timely uptake of SP(IPTp) and ITNs and the pregnancy time protected. A health facility based cross-sectional study was carried out in Bukoba urban district from 16th April to 29 May 2013. Involving pregnant women and post natal mothers attending Reproductive and Child Health (RCH) clinics. Data on their socio-economic background, pregnancy history and attendance to RCH, receipt of a voucher and acquisition of an ITN as well as SP for IPTp were collected. Their responses were validated from the records of antenatal cards. Data was analysed using SPSS computer program version 20. A total of 530 mothers were recruited. The overall uptake of SP IPTp was 96 % and the uptake of two SP (IPTp) doses was 86 %. Timely uptake of 1st dose was predicted by early antenatal booking, [AOR 2.59; 95 % CI 1.51-4.46; P = 0.001], and the availability of SP at the facility [AOR 4.63; 95 % CI 2.51-8.54; P < 0.0001]. Uptake of 2nd dose was independent of any predictor factors. A total of 486 (91.6 %) women received ITNs discount vouchers at different gestational age and of these, less than a quarter (21.4 %) received timely. Timely receipt of discount voucher was highly predicted by early antenatal booking [AOR 200; 95 % CI 80.38-498; P < 0.0001]. Although there is a high coverage of SP IPTp and discount vouchers for ITNs, timely uptake and therefore optimal protection time depended on early antenatal booking, the availability of (SP IPTp) and discount voucher at the health facility.

Closing the gap in Australian Aboriginal infant immunisation rates -- the development and review of a pre-call strategy.

PubMed

Cashman, Patrick M; Allan, Natalie A; Clark, Katrina K; Butler, Michelle T; Massey, Peter D; Durrheim, David N

2016-06-16

Improving timely immunisation is key to closing the inequitable gap in immunisation rates between Aboriginal children and non-Indigenous children. Aboriginal Immunisation Officers were employed in Hunter New England Local Health District (HNELHD), New South Wales (NSW), Australia, to telephone the families of all Aboriginal infants prior to the due date for their first scheduled vaccination. Aboriginal Immunisation Officers contacted the families of Aboriginal children born in the Hunter New England Local Health District (HNELHD) by telephone before their due immunisation date (pre-call) to provide the rationale for timely immunisation, and to facilitate contact with culturally safe local immunisation services if this was required. The impact of this strategy on immunisation coverage rates is reviewed. For the period March 2010 to September 2014 there was a significant increase in immunisation coverage rate for Aboriginal children at 12 months of age in HNELHD (p < 0.0001). The coverage in the rest of NSW Aboriginal children also increased but not significantly (p = 0.218). Over the full study period there was a significant decrease in the immunisation coverage gap between Aboriginal children and non-Indigenous children in HNELHD (p < 0.0001) and the rest of NSW (p = 0.004). The immunisation coverage gap between Aboriginal and non-Indigenous infants decreased at a significantly faster rate in HNELHD than the rest of NSW (p = 0.0001). By the end of the study period in 2014, immunisation coverage in HNELHD Aboriginal infants had surpassed that of non-Indigenous infants by 0.8 %. The employment of Aboriginal immunisation officers may be associated with closing of the gap between Aboriginal and non-Indigenous infants' immunisation coverage in HNELHD and NSW. The pre-call telephone strategy provided accelerated benefit in closing this gap in HNELHD.

Association between the Part D coverage gap and adverse health outcomes.

PubMed

Polinski, Jennifer M; Shrank, William H; Glynn, Robert J; Huskamp, Haiden A; Christopher Roebuck, M; Schneeweiss, Sebastian

2012-08-01

To determine whether Part D coverage gap entry is associated with risk of death or hospitalization for cardiovascular outcomes. Prospective cohort study. Beneficiaries entered the study upon reaching the coverage gap spending threshold and were observed until an outcome reaching the threshold for catastrophic coverage occurred or year's end. Nine thousand four hundred thirty-six exposed individuals (those who were responsible for drug costs in the gap) were compared with 9,436 unexposed individuals (those who received financial assistance) based on propensity score (PS) or high-dimensional propensity score (hdPS). Medicare Part D drug insurance. Three hundred three thousand nine hundred seventy-eight Medicare beneficiaries aged 65 and older in 2006 and 2007 with linked prescription and medical claims who enrolled in stand-alone Part D or retiree drug plans and reached the gap spending threshold. Rates of death and hospitalization for any of five cardiovascular outcomes, including acute coronary syndrome with revascularization (ACS), after reaching the coverage gap spending threshold were compared using Cox proportional hazards models. In PS-matched analyses, exposed beneficiaries had higher, albeit not significantly so, hazard of death (hazard ratio (HR) = 1.25, 95% confidence interval (CI) = 0.98-1.59) and ACS (HR = 1.16, 95% CI = 0.83-1.62) than unexposed beneficiaries. hdPS-matched analyses minimized residual confounding and confirmed results (death: HR = 0.99, 95% CI = 0.78-1.24; ACS: HR = 1.07, 95% CI = 0.81-1.41). Exposed beneficiaries were no more or less likely to experience other outcomes than were those who were unexposed. During the short-term coverage gap period, having no financial assistance to pay for drugs was not associated with greater risk of death or hospitalization for cardiovascular causes, although long-term health consequences remain unclear. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Computer Techniques for Studying Coverage, Overlaps, and Gaps in Collections.

ERIC Educational Resources Information Center

White, Howard D.

1987-01-01

Describes techniques for using the Statistical Package for the Social Sciences (SSPS) to create tables for cooperative collection development across a number of libraries. Specific commands are given to generate holdings profiles focusing on collection coverage, overlaps, gaps, or other areas of interest, from a master bibliographic list. (CLB)

Can even minimal news coverage influence consumer health-related behaviour? A case study of iodized salt sales, Australia.

PubMed

Li, Mu; Chapman, Simon; Agho, Kingsley; Eastman, Creswell J

2008-06-01

Lack of iodine in the diet can cause a spectrum of conditions, known as iodine deficiency disorders (IDD). While iodized salt has been retailed in Australia since the 1960s, sales have remained low, at approximately 10% of total edible salt sales. Salt has never been promoted, advertised or discounted by retailers or manufacturers. Extensive news coverage of health issues has often been shown to influence consumer behaviour. But can even modest news coverage generate changes in consumer health-related behaviour? We report a significant increase (5.2%) in national iodized salt sales after a brief period of television and newspaper reports about IDD and the benefits of using iodized salt during and after the Australian National Iodine Nutrition Study in 2003 and 2004. We conclude that even brief news media exposure can influence health-related decisions.

Another Look at the Great Area-Coverage Controversy of the 1950's

NASA Astrophysics Data System (ADS)

Blanchard, Walter

2005-09-01

In the immediate aftermath of WW2 there sprang up an international argument over the relative merits for aerial navigation of area-coverage radio navaids versus point-source systems. The United States was in favour of point-source whereas the UK proposed area-coverage, systems for which had successfully been demonstrated under very adverse conditions during the war. It rumbled on for many years, not being finally settled until the ICAO Montreal Conference of 1959 decided for point-source. Since then, VOR/DME/ADF/ILS have been the standard aviation radio navaids and there seems little likelihood of any change in the near future, GNSS notwithstanding, if one discounts the phasing-out of ADF. It now seems sufficiently in the past to perhaps allow a dispassionate evaluation of the technical arguments used at the time the political ones can be left to another place and time.

Nonlinear Pricing in Drug Benefits and Medication Use: The Case of Statin Compliance in Medicare Part D

PubMed Central

Jung, Kyoungrae; Feldman, Roger; McBean, A Marshall

2014-01-01

Objective To examine how enrollees' statin compliance responds to expected prices in Medicare Part D, which features a nonlinear price schedule due to a coverage gap. Data Sources/Study Setting Prescription Drug Event data for a 5 percent random sample of Medicare Advantage Prescription Drug Plan enrollees in 2008 who did not receive a low-income subsidy. Study Design We analyze statin compliance prior to the coverage gap, where the “effective price” is higher than the actual copayment for drugs because consumers anticipate that more spending will make them more likely to reach the gap. We construct each enrollee's effective price as her expected price at the end of the year, which is the weighted average between pre-gap and in-gap copayments with the weight being the predicted probability of hitting the gap. Compliance is defined as at least 80 percent of days covered. Principal Findings Part D enrollees' pre-gap statin compliance decreases by 3.7–4.7 percentage points for a $10 increase in the effective price. Conclusion The presence of a coverage gap decreases statin compliance prior to the gap, suggesting that incorporating expected future prices is important to assess the full impact of cost sharing on drug compliance under nonlinear price schedules. PMID:24354765

Closing the Gap Between Formal and Material Health Care Coverage in Colombia

PubMed Central

García, Johnattan

2016-01-01

Abstract This paper explores Colombia’s road toward universal health care coverage. Using a policy-based approach, we show how, in Colombia, the legal expansion of health coverage is not sufficient and requires the development of appropriate and effective institutions. We distinguish between formal and material health coverage in order to underscore that, despite the rapid legal expansion of health care coverage, a considerable number of Colombians—especially those living in poor regions of the country—still lack material access to health care services. As a result of this gap between formal and material coverage, an individual living in a rich region has a much better chance of accessing basic health care than an inhabitant of a poor region. This gap between formal and material health coverage has also resulted in hundreds of thousands of citizens filing lawsuits—tutelas—demanding access to medications and treatments that are covered by the health system, but that health insurance companies—also known as EPS— refuse to provide. We explore why part of the population that is formally insured is still unable to gain material access to health care and has to litigate in order to access mandatory health services. We conclude by discussing the current policy efforts to reform the health sector in order to achieve material, universal health care coverage. PMID:28559676

Gaps in universal health coverage in Malawi: A qualitative study in rural communities

PubMed Central

2014-01-01

Background In sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities’ perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage. Methods We conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers. Results The results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers’ attitudes, distance and transportation difficulties, and perceived poor quality of health services. Conclusions Moving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks. PMID:24884788

Out-of-pocket drug costs and drug utilization patterns of postmenopausal Medicare beneficiaries with osteoporosis.

PubMed

Conwell, Leslie Jackson; Esposito, Dominick; Garavaglia, Susan; Meadows, Eric S; Colby, Margaret; Herrera, Vivian; Goldfarb, Seth; Ball, Daniel; Marciniak, Martin

2011-08-01

The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap. The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis. This retrospective analysis of 2007 pharmacy claims focuses on postmenopausal female Medicare beneficiaries enrolled in full-, partial-, or no-gap exposure standard or Medicare Advantage prescription drug plans (PDPs), retiree drug subsidy (RDS) plans, or the low-income subsidy program. We compared beneficiaries with osteoporosis who were taking teriparatide (Eli Lilly and Company, Indianapolis, Indiana) (n = 5657) with matched samples of beneficiaries who were taking nonteriparatide osteoporosis medications (NTO; n = 16,971) or who had other chronic conditions (OCC; n = 16,971). We measured average monthly prescription drug fills and OOP costs, medication discontinuation, and skipping. More than half the sample reached the coverage gap; OOP costs then rose for teriparatide users enrolled in partial- or full-gap exposure plans (increase of 121% and 186%; $300 and $349) but fell for those in no-gap exposure PDPs or RDS plans (decrease of 49% and 30%; $131 and $40). OOP costs for beneficiaries in partial- or full-gap exposure PDPs increased >120% (increase of $144 and $176) in the NTO group and nearly doubled for the OCC group (increase of $124 and $151); these OOP costs were substantially lower than those for teriparatide users. Both teriparatide users and NTO group members discontinued or skipped medications more often than persons in the OCC group, regardless of plan or benefit design. Medication discontinuation and OOP costs among beneficiaries with osteoporosis were highest for those enrolled in Part D plans with a coverage gap. Providers should be aware of potential cost-related nonadherence among Medicare beneficiaries taking osteoporosis medications. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

Cultural neuroeconomics of intertemporal choice.

PubMed

Takahashi, Taiki; Hadzibeganovic, Tarik; Cannas, Sergio A; Makino, Takaki; Fukui, Hiroki; Kitayama, Shinobu

2009-01-01

According to theories of cultural neuroscience, Westerners and Easterners may have distinct styles of cognition (e.g., different allocation of attention). Previous research has shown that Westerners and Easterners tend to utilize analytical and holistic cognitive styles, respectively. On the other hand, little is known regarding the cultural differences in neuroeconomic behavior. For instance, economic decisions may be affected by cultural differences in neurocomputational processing underlying attention; however, this area of neuroeconomics has been largely understudied. In the present paper, we attempt to bridge this gap by considering the links between the theory of cultural neuroscience and neuroeconomic theory of the role of attention in intertemporal choice. We predict that (i) Westerners are more impulsive and inconsistent in intertemporal choice in comparison to Easterners, and (ii) Westerners more steeply discount delayed monetary losses than Easterners. We examine these predictions by utilizing a novel temporal discounting model based on Tsallis' statistics (i.e. a q-exponential model). Our preliminary analysis of temporal discounting of gains and losses by Americans and Japanese confirmed the predictions from the cultural neuroeconomic theory. Future study directions, employing computational modeling via neural networks, are outlined and discussed.

Saturn's Misbegotten Moonlets

NASA Astrophysics Data System (ADS)

Spitale, Joseph N.

2017-06-01

Saturn's rings are interspersed with numerous narrow (tens of km wide) gaps. Two of the largest of these gaps -- Encke and Keeler -- contain satellites -- Pan and Daphnis -- that maintain their respective gaps via the classical Goldreich/Tremaine-style shepherding mechanism wherein angular momentum is transferred across the essentially empty gap via torques acting between the satellites and the ring. Other prominent gaps are shepherded by resonances with external satellites or planetary modes: Mimas shepherds the outer edge of the B ring, clearing the inner part of the Cassini Division, Titan shepherds the Columbo ringlet / gap, and the Maxwell ringlet / gap is likely maintained by a resonance with a planetary mode. Prior to Cassini, it was expected that all of the gaps would be shepherded in a similar manner.However, many small gaps do not correspond with known resonances, and no satellites were spotted within those gaps during Cassini's prime and extended mission. To address this issue, a series of Cassini imaging observations were planned to examine 11 gaps in the C ring and Cassini division at a resolution and longitudinal coverage sufficient to either discover the shepherds or rule out their presence. The survey discovered no embedded satellites. Longitudinal coverage was incomplete, but within longitudes covered by the survey, satellites are ruled out to sizes in the 100-m range, far too small keep the observed gaps open. It is possible (about even odds) that there could be a larger satellite residing at a longitude not covered in the survey, but the probability that the survey was unfortunate enough to miss significant satellites in all 11 gaps is exceedingly small (~0.002%). Moreover, these gaps appear in earlier imaging sequences, with some high-resolution coverage, so the true probability is smaller yet. Therefore, a new theory is likely needed to explain the presence of the gaps.

Exploring the relationship between population density and maternal health coverage.

PubMed

Hanlon, Michael; Burstein, Roy; Masters, Samuel H; Zhang, Raymond

2012-11-21

Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score's calculation discounts a nation's uninhabited territory under the assumption those areas are irrelevant to service delivery. We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations' Millennial Development Goals.

The Significant Impact of Different Insurance Enrollment Criteria on the HEDIS Chlamydia Screening Measure for Young Women Enrolled in Medicaid and Commercial Insurance Plans.

PubMed

Patel, Chirag G; Tao, Guoyu

2015-10-01

The impact of length of enrollment in a health plan on eligibility of women under the Healthcare Effectiveness Data and Information Set (HEDIS) chlamydia screening measure is not fully understood. We assessed the representativeness of the measure among the proportion of women aged 15 to 24 years with a gap in coverage for Medicaid and commercial health insurance. Truven Health Marketscan Medicaid and commercial health insurance data from 2006 to 2012 were used to make comparisons between proportions of women with a gap in coverage to those enrolled in insurance plans for different numbers of months. Approximately 48% of Medicaid-insured women and 31% of commercially insured women had an at least 2-month gap that disqualified them from eligibility for inclusion in the HEDIS chlamydia screening measure. Extending eligibility to women with at least 6 months of coverage, regardless of gap, would increase the proportion of insured women included in the HEDIS measure to 76% (from 52%) for Medicaid and 83% (from 69%) for commercial insurance, without much effect on chlamydia testing rate. This would make the measure more representative of all insured women. The large proportion of young women who had a 2-month or greater gap in coverage in Medicaid had a significant impact on the overall representativeness of the current HEDIS chlamydia screening measure.

How End-Stage Renal Disease Patients Manage the Medicare Part D Coverage Gap

ERIC Educational Resources Information Center

Kovacs, Pamela J.; Perkins, Nathan; Nuschke, Elizabeth; Carroll, Norman

2012-01-01

Medicare Part D was enacted to help elderly and disabled individuals pay for prescription drugs, but it was structured with a gap providing no coverage in 2010 between $2,830 and $6,440. Patients with end-stage renal disease (ESRD) are especially likely to be affected due to high costs of dialysis-related drugs and the importance of adherence for…

Incorporating shrub and snag specific LiDAR data into GAP wildlife models

Treesearch

Teresa J Lorenz; Kerri T Vierling; Jody Vogeler; Jeffrey Lonneker; Jocelyn Aycrigg

2015-01-01

The U.S. Geological Survey’s Gap Analysis Program (hereafter, GAP) is a nationally based program that uses land cover, vertebrate distributions, and land ownership to identify locations where gaps in conservation coverage exist, and GAP products are commonly used by government agencies, nongovernmental organizations, and private citizens. The GAP land-cover...

Effect of interfacial lattice mismatch on bulk carrier concentration and band gap of InN

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

Kuyyalil, Jithesh; Tangi, Malleswararao; Shivaprasad, S. M.

The issue of ambiguous values of the band gap (0.6 to 2 eV) of InN thin film in literature has been addressed by a careful experiment. We have grown wurtzite InN films by PA-MBE simultaneously on differently modified c-plane sapphire substrates and characterized by complementary structural and chemical probes. Our studies discount Mie resonances caused by metallic In segregation at grain boundaries as the reason for low band gap values ( Almost-Equal-To 0.6 eV) and also the formation of Indium oxides and oxynitrides as the cause for high band gap value ( Almost-Equal-To 2.0 eV). It is observed that polycrystallinitymore » arising from azimuthal miss-orientation of c-oriented wurtzite InN crystals increases the carrier concentration and the band gap values. We have reviewed the band gap, carrier concentration, and effective mass of InN in literature and our own measurements, which show that the Moss-Burstein relation with a non-parabolic conduction band accounts for the observed variation of band gap with carrier concentration.« less

India's Proposed Universal Health Coverage Policy: Evidence for Age Structure Transition Effect and Fiscal Sustainability.

PubMed

Narayana, Muttur Ranganathan

2016-12-01

India's High Level Expert Group on Universal Health Coverage in 2011 recommended a universal, public-funded and national health coverage policy. As a plausible forward-looking macroeconomic reform in the health sector, this policy proposal on universal health coverage (UHC) needs to be evaluated for age structure transition effect and fiscal sustainability to strengthen its current design and future implementation. Macroeconomic analyses of the long-term implications of age structure transition and fiscal sustainability on India's proposed UHC policy. A new measure of age-specific UHC is developed by combining the age profile of public and private health consumption expenditure by using the National Transfer Accounts methodology. Different projections of age-specific public health expenditure are calculated over the period 2005-2100 to account for the age structure transition effect. The projections include changes in: (1) levels of the expenditure as gross domestic product grows, (2) levels and shape of the expenditure as gross domestic product grows and expenditure converges to that of developed countries (or convergence scenario) based on the Lee-Carter model of forecasting mortality rates, and (3) levels of the expenditure as India moves toward a UHC policy. Fiscal sustainability under each health expenditure projection is determined by using the measures of generational imbalance and sustainability gap in the Generational Accounting methodology. Public health expenditure is marked by age specificities and the elderly population is costlier to support for their healthcare needs in the future. Given the discount and productivity growth rates, the proposed UHC is not fiscally sustainable under India's current fiscal policies except for the convergence scenario. However, if the income elasticity of public expenditure on social welfare and health expenditure is less than one, fiscal sustainability of the UHC policy is attainable in all scenarios of projected public health expenditures. These new results strengthen the proposed UHC policy by accounting for age structure transition effect and justifying its sustainability within the framework of India's current fiscal policies. The age structure transition effect is important to incorporate the age-specific cost and benefit of the proposed UHC policy, especially as India moves toward an ageing society. Fiscal sustainability is essential to ensure that the proposed UHC is implementable on a long-term basis and within the framework of current fiscal policies.

Exploring the relationship between population density and maternal health coverage

PubMed Central

2012-01-01

Background Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. Methods We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score’s calculation discounts a nation’s uninhabited territory under the assumption those areas are irrelevant to service delivery. Results We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Conclusions Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations’ Millennial Development Goals. PMID:23170895

Medicare-approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?

PubMed

Chisholm, Marie A; Marshall, Josh; Smith, Kimberly E; Garrett, Charlene J; Turner, Jeanie C

2005-06-01

Post-transplant prescription medications are expensive, often costing over 12,000 dollars annually. Many solid-organ transplant patients have Medicare coverage and patients enrolled in Medicare-approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs. The purpose of this study was to determine whether enrolling renal transplant patients (RTPs) into a MADDC produces significant savings in prescription costs. Two Medicare RTPs, with prescription medication profiles representative of an RTP within 3 months post-transplant and an RTP greater than 5 yr post-transplant, were randomly selected from the Medication Access Program's database. Cost benefit analyses were from the patients' perspective and were performed using the: (i) prescription cost from the Medicare website of MADDCs that listed the greatest and least prescription costs compared with the retail cash price of the same prescription without using the MADDCs; and (ii) MADDCs' annual enrollment fee. The potential cost difference of using MADDCs and not using MADDCs to purchase the prescription medications were calculated. RTPs' monthly out-of-pocket cost for prescription medications ranged from 162 dollars to 340 dollars, and MADDCs offered discounts of 20-37% from retail prices; thus outweighing the MADDC enrollment cost. MADDCs, when selected and used appropriately, can reduce prescription medication cost for RTPs. Card selection is of great importance as discount rates vary greatly among cards, and only under restricted circumstances is a patient allowed to switch to another card. It is imperative that practitioners are aware of these programs and utilize cost-effective prescribing practices.

Vaccine exemptions and the kindergarten vaccination coverage gap.

PubMed

Smith, Philip J; Shaw, Jana; Seither, Ranee; Lopez, Adriana; Hill, Holly A; Underwood, Mike; Knighton, Cynthia; Zhao, Zhen; Ravanam, Megha Shah; Greby, Stacie; Orenstein, Walter A

2017-09-25

Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry. To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten. A national survey of 1465 parents of 5-7year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten. Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%. Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses. Published by Elsevier Ltd.

Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI.

PubMed

Wilson, Elizabeth Ruth; Kyle, Theodore K; Nadglowski, Joseph F; Stanford, Fatima Cody

2017-02-01

Evidence-based obesity treatments, such as bariatric surgery, are not considered essential health benefits under the Affordable Care Act. Employer-sponsored wellness programs with incentives based on biometric outcomes are allowed and often used despite mixed evidence regarding their effectiveness. This study examines consumers' perceptions of their coverage for obesity treatments and exposure to workplace wellness programs. A total of 7,378 participants completed an online survey during 2015-2016. Respondents answered questions regarding their health coverage for seven medical services and exposure to employer wellness programs that target weight or body mass index (BMI). Using χ 2 tests, associations between perceptions of exposure to employer wellness programs and coverage for medical services were examined. Differences between survey years were also assessed. Most respondents reported they did not have health coverage for obesity treatments, but more of the respondents with employer wellness programs reported having coverage. Neither the perception of coverage for obesity treatments nor exposure to wellness programs increased between 2015 and 2016. Even when consumers have exposure to employer wellness programs that target BMI, their health insurance often excludes obesity treatments. Given the clinical and cost-effectiveness of such treatments, reducing that coverage gap may mitigate obesity's individual- and population-level effects. © 2017 The Obesity Society.

The Los Alamos Gap Stick Test

NASA Astrophysics Data System (ADS)

Preston, Daniel; Hill, Larry; Johnson, Carl

2015-06-01

In this paper we describe a novel shock sensitivity test, the Gap Stick Test, which is a generalized variant of the ubiquitous Gap Test. Despite the popularity of the Gap Test, it has some disadvantages: multiple tests must be fired to obtain a single metric, and many tests must be fired to obtain its value to high precision and confidence. Our solution is a test wherein multiple gap tests are joined in series to form a rate stick. The complex re-initiation character of the traditional gap test is thereby retained, but the propagation speed is steady when measured at periodic intervals, and initiation delay in individual segments acts to decrement the average speed. We measure the shock arrival time before and after each inert gap, and compute the average detonation speed through the HE alone (discounting the gap thicknesses). We perform tests for a range of gap thicknesses. We then plot the aforementioned propagation speed as a function of gap thickness. The resulting curve has the same basic structure as a Diameter Effect (DE) curve, and (like the DE curve) terminates at a failure point. Comparison between experiment and hydrocode calculations using ALE3D and the Ignition and Growth reactive burn model calibrated for short duration shock inputs in PBX 9501 is discussed.

Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis.

PubMed

Awasthi, Ashish; Pandey, C M; Chauhan, Rajesh K; Singh, Uttam

2016-08-05

To examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India. Data for the present study are taken from the Annual Health Survey (AHS), 2010-2013 and Census of India, 2011. This study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India. District-level information regarding children aged 12-23 months and ever married women aged 15-49 years has been extracted from the AHS (2010-2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011. 2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index. The result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=-0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009-2013. In regression analysis, the coefficient of determination was 0.24, β=-30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap. There is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services. 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/

Adherence to hormonal contraception among women veterans: differences by race/ethnicity and contraceptive supply.

PubMed

Borrero, Sonya; Zhao, Xinhua; Mor, Maria K; Schwarz, Eleanor B; Good, Chester B; Gellad, Walid F

2013-08-01

The objective of the study was to assess the adherence to hormonal contraception (pill, patch, ring, or injectable) among women veterans and examine the relationships between race/ethnicity and the months of contraceptive supply dispensed with contraceptive adherence. We conducted a retrospective analysis of the Department of Veterans Affairs (VA) national databases to examine the adherence to hormonal contraception over 12 months among women aged 18-45 years who had hormonal contraceptive coverage during the first week of fiscal year 2008. We examined several adherence indicators including gaps between refills and months of contraceptive coverage. Descriptive statistics and multivariable models were used to examine the associations between race/ethnicity and contraceptive supply dispensed with adherence. Our cohort included 6946 women: 47% were white, 6% were Hispanic, 22% were black, and 25% were other race or had missing race information. Most women (83%) received a 3 month supply of contraception at each fill. More than 64% of women had at least 1 gap in coverage of 7 days or longer. Only 22% of women received a full 12 months of contraception without any gaps (perfect adherence). Compared with whites, Hispanics were significantly more likely to experience gaps (64% vs 70%; P = .02), and Hispanics and blacks received fewer months of contraceptive coverage (9.3 vs 8.9 and 9.0, P < .001). Compared with women receiving 3 month supplies, those receiving 1 month supplies had a higher likelihood of a gap (63% vs 72%, P < .001), fewer months of coverage (9.3 vs 6.9, P < .001), and a lower likelihood of perfect adherence (22% vs 11%, P < .001). Adherence to hormonal contraception among women veterans is poor. Efforts to improve contraceptive adherence and lower risk of unintended pregnancy are needed; dispensing more months of supply for hormonal contraception may be a promising strategy. Copyright © 2013 Mosby, Inc. All rights reserved.

Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care.

PubMed

Weaver, Meaghann S; Wichman, Brittany; Bace, Sue; Schroeder, Denice; Vail, Catherine; Wichman, Chris; Macfadyen, Andrew

2018-06-01

The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage ( P < .02) correlated with the gap in home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.

Time Preferences, Mental Health and Treatment Utilization.

PubMed

Eisenberg, Daniel; Druss, Benjamin G

2015-09-01

In all countries of the world, fewer than half of people with mental disorders receive treatment. This treatment gap is commonly attributed to factors such as consumers' limited knowledge, negative attitudes, and financial constraints. In the context of other health behaviors, such as diet and exercise, behavioral economists have emphasized time preferences and procrastination as additional barriers. These factors might also be relevant to mental health. We examine conceptually and empirically how lack of help-seeking for mental health conditions might be related to time preferences and procrastination. Our conceptual discussion explores how the interrelationships between time preferences and mental health treatment utilization could fit into basic microeconomic theory. The empirical analysis uses survey data of student populations from 12 colleges and universities in 2011 (the Healthy Minds Study, N=8,806). Using standard brief measures of discounting, procrastination, and mental health (depression and anxiety symptoms), we examine the conditional correlations between indicators of present-orientation (discount rate and procrastination) and mental health symptoms. The conceptual discussion reveals a number of potential relationships that would be useful to examine empirically. In the empirical analysis depression is significantly associated with procrastination and discounting. Treatment utilization is significantly associated with procrastination but not discounting. The empirical results are generally consistent with the idea that depression increases present orientation (reduces future orientation), as measured by discounting and procrastination. These analyses have notable limitations that will require further examination in future research: the measures are simple and brief, and the estimates may be biased from true causal effects because of omitted variables and reverse causality. There are several possibilities for future research, including: (i) observational, longitudinal studies with detailed data on mental health, time preferences, and help-seeking; (ii) experimental studies that examine immediate or short-term responses and connections between these variables; (iii) randomized trials of mental health therapies that include outcome measures of time preferences and procrastination; and, (iv) intervention studies that test strategies to influence help-seeking by addressing time preferences and present orientation.

Coverage of, and compliance with, mass drug administration under the programme to eliminate lymphatic filariasis in India: a systematic review.

PubMed

Babu, Bontha V; Babu, Gopalan R

2014-09-01

India's mass drug administration (MDA) programme to eliminate lymphatic filariasis (PELF) covers all 250 endemic districts, but compliance with treatment is not adequate for the programme to succeed in eradicating this neglected tropical disease. The objective of our study was to systematically review published studies on the coverage of and compliance with MDA under the PELF in India. We searched several databases-PubMed/Medline, Google Scholar, CINAHL/EBSCO, Web of Knowledge (including Web of Science) and OVID-and by applying selection criteria identified a total of 36 papers to include in the review. Overall MDA coverage rates varied between 48.8% and 98.8%, while compliance rates ranged from 20.8% to 93.7%. The coverage-compliance gap is large in many MDA programmes. The effective level of compliance, ≥65%, was reported in only 10 of a total of 31 MDAs (5 of 20 MDAs in rural areas and 2 of 12 MDAs in urban areas). The review has identified a gap between coverage and compliance, and potentially correctable causes of this gap. These causes need to be addressed if the Indian programme is to advance towards elimination of lymphatic filariasis. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Improving coverage measurement for reproductive, maternal, neonatal and child health: gaps and opportunities.

PubMed

Munos, Melinda K; Stanton, Cynthia K; Bryce, Jennifer

2017-06-01

Regular monitoring of coverage for reproductive, maternal, neonatal, and child health (RMNCH) is central to assessing progress toward health goals. The objectives of this review were to describe the current state of coverage measurement for RMNCH, assess the extent to which current approaches to coverage measurement cover the spectrum of RMNCH interventions, and prioritize interventions for a novel approach to coverage measurement linking household surveys with provider assessments. We included 58 interventions along the RMNCH continuum of care for which there is evidence of effectiveness against cause-specific mortality and stillbirth. We reviewed household surveys and provider assessments used in low- and middle-income countries (LMICs) to determine whether these tools generate measures of intervention coverage, readiness, or quality. For facility-based interventions, we assessed the feasibility of linking provider assessments to household surveys to provide estimates of intervention coverage. Fewer than half (24 of 58) of included RMNCH interventions are measured in standard household surveys. The periconceptional, antenatal, and intrapartum periods were poorly represented. All but one of the interventions not measured in household surveys are facility-based, and 13 of these would be highly feasible to measure by linking provider assessments to household surveys. We found important gaps in coverage measurement for proven RMNCH interventions, particularly around the time of birth. Based on our findings, we propose three sets of actions to improve coverage measurement for RMNCH, focused on validation of coverage measures and development of new measurement approaches feasible for use at scale in LMICs.

Integrating environmental gap analysis with spatial conservation prioritization: a case study from Victoria, Australia.

PubMed

Sharafi, Seyedeh Mahdieh; Moilanen, Atte; White, Matt; Burgman, Mark

2012-12-15

Gap analysis is used to analyse reserve networks and their coverage of biodiversity, thus identifying gaps in biodiversity representation that may be filled by additional conservation measures. Gap analysis has been used to identify priorities for species and habitat types. When it is applied to identify gaps in the coverage of environmental variables, it embodies the assumption that combinations of environmental variables are effective surrogates for biodiversity attributes. The question remains of how to fill gaps in conservation systems efficiently. Conservation prioritization software can identify those areas outside existing conservation areas that contribute to the efficient covering of gaps in biodiversity features. We show how environmental gap analysis can be implemented using high-resolution information about environmental variables and ecosystem condition with the publicly available conservation prioritization software, Zonation. Our method is based on the conversion of combinations of environmental variables into biodiversity features. We also replicated the analysis by using Species Distribution Models (SDMs) as biodiversity features to evaluate the robustness and utility of our environment-based analysis. We apply the technique to a planning case study of the state of Victoria, Australia. Copyright © 2012 Elsevier Ltd. All rights reserved.

Specialist availability in emergencies: contributions of response times and the use of ad hoc coverage in New York State.

PubMed

Rabin, Elaine; Patrick, Lisa

2016-04-01

Nationwide, hospitals struggle to maintain specialist on-call coverage for emergencies. We seek to further understand the issue by examining reliability of scheduled coverage and the role of ad hoc coverage when none is scheduled. An anonymous electronic survey of all emergency department (ED) directors of a large state. Overall and for 10 specialties, respondents were asked to estimate on-call coverage extent and "reliability" (frequency of emergency response in a clinically useful time frame: 2 hours), and use and effect of ad hoc emergency coverage to fill gaps. Descriptive statistics were performed using Fisher exact and Wilcoxon sign rank tests for significance. Contact information was obtained for 125 of 167 ED directors. Sixty responded (48%), representing 36% of EDs. Forty-six percent reported full on-call coverage scheduled for all specialties. Forty-six percent reported consistent reliability. Coverage and reliability were strongly related (P<.01; 33% reported both), and larger ED volume correlated with both (P<.01). Ninety percent of hospitals that had gaps in either employed ad hoc coverage, significantly improving coverage for 8 of 10 specialties. For all but 1 specialty, more than 20% of hospitals reported that specialists are "Never", "Rarely" or "Sometimes" reliable (more than 50% for cardiovascular surgery, hand surgery and ophthalmology). Significant holes in scheduled on-call specialist coverage are compounded by frequent unreliability of on-call specialists, but partially ameliorated by ad hoc specialist coverage. Regionalization may help because a 2-tiered system may exist: larger hospitals have more complete, reliable coverage. Better understanding of specialists' willingness to treat emergencies ad hoc without taking formal call will suggest additional remedies. Copyright © 2015 Elsevier Inc. All rights reserved.

The external costs of a sedentary life-style.

PubMed Central

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

1989-01-01

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

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis

PubMed Central

Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

2017-01-01

Background The risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID) a public health priority. Some of these programs have benefits beyond prevention of HIV—a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT), needle and syringe programs (NSPs), HIV testing and treatment (Test & Treat), and oral HIV pre-exposure prophylaxis (PrEP). Methods and findings We adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars), health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs]), and incremental cost-effectiveness ratios (ICERs) of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively) and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000) infections and cost US$18,000 (95% CI: US$14,000, US$24,000) per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000) infections and cost US$25,000 (95% CI: US$7,000, US$76,000) per QALY gained, 50% Test & Treat coverage could avert up to 6,700 (95% CI: 1,200, 16,000) infections and cost US$27,000 (95% CI: US$15,000, US$48,000) per QALY gained, and 50% PrEP coverage could avert up to 37,000 (22,000, 58,000) infections and cost US$300,000 (95% CI: US$162,000, US$667,000) per QALY gained. When coverage expansions are allowed to include combined investment with other programs and are compared to the next best intervention, the model projects that scaling OAT coverage up to 50%, then scaling NSP coverage to 50%, then scaling Test & Treat coverage to 50% can be cost-effective, with each coverage expansion having the potential to cost less than US$50,000 per QALY gained relative to the next best portfolio. In probabilistic sensitivity analyses, 59% of portfolios prioritized the addition of OAT and 41% prioritized the addition of NSPs, while PrEP was not likely to be a priority nor a cost-effective addition. Our findings are intended to be illustrative, as data on achievable coverage are limited and, in practice, the expansion scenarios considered may exceed feasible levels. We assumed independence of interventions and constant returns to scale. Extensive sensitivity analyses allowed us to assess parameter sensitivity, but the use of a dynamic compartmental model limited the exploration of structural sensitivities. Conclusions We estimate that OAT, NSPs, and Test & Treat, implemented singly or in combination, have the potential to effectively and cost-effectively prevent HIV in US PWID. PrEP is not likely to be cost-effective in this population, based on the scenarios we evaluated. While local budgets or policy may constrain feasible coverage levels for the various interventions, our findings suggest that investments in combined prevention programs can substantially reduce HIV transmission and improve health outcomes among PWID. PMID:28542184

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis.

PubMed

Bernard, Cora L; Owens, Douglas K; Goldhaber-Fiebert, Jeremy D; Brandeau, Margaret L

2017-05-01

The risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID) a public health priority. Some of these programs have benefits beyond prevention of HIV-a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT), needle and syringe programs (NSPs), HIV testing and treatment (Test & Treat), and oral HIV pre-exposure prophylaxis (PrEP). We adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars), health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs]), and incremental cost-effectiveness ratios (ICERs) of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively) and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000) infections and cost US$18,000 (95% CI: US$14,000, US$24,000) per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000) infections and cost US$25,000 (95% CI: US$7,000, US$76,000) per QALY gained, 50% Test & Treat coverage could avert up to 6,700 (95% CI: 1,200, 16,000) infections and cost US$27,000 (95% CI: US$15,000, US$48,000) per QALY gained, and 50% PrEP coverage could avert up to 37,000 (22,000, 58,000) infections and cost US$300,000 (95% CI: US$162,000, US$667,000) per QALY gained. When coverage expansions are allowed to include combined investment with other programs and are compared to the next best intervention, the model projects that scaling OAT coverage up to 50%, then scaling NSP coverage to 50%, then scaling Test & Treat coverage to 50% can be cost-effective, with each coverage expansion having the potential to cost less than US$50,000 per QALY gained relative to the next best portfolio. In probabilistic sensitivity analyses, 59% of portfolios prioritized the addition of OAT and 41% prioritized the addition of NSPs, while PrEP was not likely to be a priority nor a cost-effective addition. Our findings are intended to be illustrative, as data on achievable coverage are limited and, in practice, the expansion scenarios considered may exceed feasible levels. We assumed independence of interventions and constant returns to scale. Extensive sensitivity analyses allowed us to assess parameter sensitivity, but the use of a dynamic compartmental model limited the exploration of structural sensitivities. We estimate that OAT, NSPs, and Test & Treat, implemented singly or in combination, have the potential to effectively and cost-effectively prevent HIV in US PWID. PrEP is not likely to be cost-effective in this population, based on the scenarios we evaluated. While local budgets or policy may constrain feasible coverage levels for the various interventions, our findings suggest that investments in combined prevention programs can substantially reduce HIV transmission and improve health outcomes among PWID.

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies.

PubMed

Utturkar, Sagar M; Klingeman, Dawn M; Hurt, Richard A; Brown, Steven D

2017-01-01

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted. PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences.

Immigrants and Employer-Sponsored Health Insurance

PubMed Central

Buchmueller, Thomas C; Lo Sasso, Anthony T; Lurie, Ithai; Dolfin, Sarah

2007-01-01

Objective To investigate the factors underlying the lower rate of employer-sponsored health insurance coverage for foreign-born workers. Data Sources 2001 Survey of Income and Program Participation. Study Design We estimate probit regressions to determine the effect of immigrant status on employer-sponsored health insurance coverage, including the probabilities of working for a firm that offers coverage, being eligible for coverage, and taking up coverage. Data Extraction Methods We identified native born citizens, naturalized citizens, and noncitizen residents between the ages of 18 and 65, in the year 2002. Principal Findings First, we find that the large difference in coverage rates for immigrants and native-born Americans is driven by the very low rates of coverage for noncitizen immigrants. Differences between native-born and naturalized citizens are quite small and for some outcomes are statistically insignificant when we control for observable characteristics. Second, our results indicate that the gap between natives and noncitizens is explained mainly by differences in the probability of working for a firm that offers insurance. Conditional on working for such a firm, noncitizens are only slightly less likely to be eligible for coverage and, when eligible, are only slightly less likely to take up coverage. Third, roughly two-thirds of the native/noncitizen gap in coverage overall and in the probability of working for an insurance-providing employer is explained by characteristics of the individual and differences in the types of jobs they hold. Conclusions The substantially higher rate of uninsurance among immigrants is driven by the lower rate of health insurance offers by the employers of immigrants. PMID:17355593

Generic drug discount programs: are prescriptions being submitted for pharmacy benefit adjudication?

PubMed

Tungol, Alexandra; Starner, Catherine I; Gunderson, Brent W; Schafer, Jeremy A; Qiu, Yang; Gleason, Patrick P

2012-01-01

  In 2006, pharmacies began offering select generic prescription drugs at discount prices (e.g., $4 for a 30-day supply) through nonmembership and membership programs. As part of the contract in membership generic drug discount programs, the member agrees to forgo submission of the claim to the insurance company. Claims not submitted for insurance adjudication may result in incomplete pharmacy benefit manager (PBM) and health plan data, which could negatively influence adherence reporting and clinical programs. To address potentially missing claims data, the Centers for Medicare Medicaid Services (CMS) encourages Medicare Part D sponsors to incentivize network pharmacies to submit claims directly to the plan for drugs dispensed outside of a member's Part D benefit, unless a member refuses. The extent of PBM and health plan claims capture loss due to generic drug discount programs is unknown. To identify changes in levothyroxine utilizers' prescription claims capture rate following the advent of generic drug discount membership and nonmembership programs. This retrospective concurrent cohort study used claims data from 3.5 million commercially insured members enrolled in health plans located in the central and southern United States with Prime Therapeutics pharmacy benefit coverage. Members were required to be 18 years or older and younger than 60 years as of January 1, 2006, and continuously enrolled from January 1, 2006, through December 31, 2010. Members utilizing generic levothyroxine for at least 120 days during January 1, 2006, through June 30, 2006 (baseline period) from the same pharmacy group with supply on July 1, 2006, were placed into 1 of 3 pharmacy groups: (1) nonmembership (Walmart, Sam's Club, Target, Kroger, City Market, and King Soopers pharmacies), (2) membership (Walgreens, CVS, Albertsons, and Savon pharmacies), or (3) the reference group of all other pharmacies. The index date was defined as July 1, 2006. The levothyroxine claim providing supply on July 1, 2006, was the index claim. Members with a Kmart pharmacy index claim were excluded, since the Kmart membership drug discount program began prior to July 1, 2006. Levothyroxine claims capture nonpersistency, defined as the occurrence of a claim supply end date prior to a 180-day gap, was the primary outcome variable and was assessed from July 1, 2006, through June 30, 2010 (follow-up period). The odds of levothyroxine claims capture nonpersistency by pharmacy group were assessed using a logistic regression analysis adjusted for the following covariates: age, gender, median income in the ZIP code of residence (binomial for ≤ $50,000 vs. greater than $50,000), switch to a brand levothyroxine product during the follow-up period, index levothyroxine claim supply of 90 days or more, and index levothyroxine claim member cost share per 30-day supply in tertiles (≤ $5.00, $5.01-$7.99, ≥ $8.00). Of 2,632,855 eligible members aged 18 years or older, 13,427 met all study eligibility criteria. The baseline pharmacy groups were membership with 3,595 (26.8%), nonmembership with 1,919 (14.3%), and all other pharmacies with 7,913 (58.9%) members. The rates of levothyroxine claims capture persistency throughout the 4-year follow-up period were 85.4% for nonmembership (P = 0.593 vs. all other pharmacies), 77.7% for the membership group (P  less than  0.001 vs. all other pharmacies), and 85.9% for all other pharmacies. The Kaplan-Meier comparison of claims capture persistency found nearly identical claims capture loss for the nonmembership compared with all other pharmacies group, and when compared in a multivariate logistic regression model, there was no difference in the odds of levothyroxine claims capture over 4 years follow-up (OR = 1.01, 95% CI = 0.88-1.16, P = 0.900). The membership generic drug discount programs (Walgreens, CVS, Alberstons, and Savon pharmacies) had a statistically significant 61% higher odds (OR = 1.61, 95% CI = 1.45-1.79, P  less than  0.001) of levothyroxine claims capture nonpersistency. The onset of the difference between the membership group and the all other pharmacies group was temporally associated with the launch of the membership programs. In comparison to index levothyroxine member cost of ≤ $5.00 per 30-day supply, higher cost shares were associated with higher levothyroxine claims capture nonpersistency ($5.01 to $7.99 OR 1.34, 95% CI 1.19-1.52 and ≥ $8.00 OR 1.60, 95% CI 1.40-1.82). Among levothyroxine utilizers in 2006 (prior to the advent of drug discount programs), those with claims from a pharmacy that subsequently implemented a nonmembership generic drug discount program did not appear to have a different rate of levothyroxine claims capture than members from the reference group when followed through June 2010. Utilizers with claims from a pharmacy that subsequently implemented a membership program had a significantly lower levothyroxine claims capture rate. Increasing index levothyroxine member cost was associated with higher levothyroxine claims capture loss. Because the analysis could not directly measure claims capture loss associated with members who switched to a new pharmacy group without presenting their insurance information (e.g., membership discount programs), further research is needed to confirm these findings.

Universal coverage with insecticide-treated nets - applying the revised indicators for ownership and use to the Nigeria 2010 malaria indicator survey data.

PubMed

Kilian, Albert; Koenker, Hannah; Baba, Ebenezer; Onyefunafoa, Emmanuel O; Selby, Richmond A; Lokko, Kojo; Lynch, Matthew

2013-09-10

Until recently only two indicators were used to evaluate malaria prevention with insecticide-treated nets (ITN): "proportion of households with any ITN" and "proportion of the population using an ITN last night". This study explores the potential of the expanded set of indicators recommended by the Roll Back Malaria Monitoring and Evaluation Reference Group (MERG) for comprehensive analysis of universal coverage with ITN by applying them to the Nigeria 2010 Malaria Indicator Survey data. The two additional indicators of "proportion of households with at least one ITN for every two people" and "proportion of population with access to an ITN within the household" were calculated as recommended by MERG. Based on the estimates for each of the four ITN indicators three gaps were calculated: i) households with no ITN, ii) households with any but not enough ITN, iii) population with access to ITN not using it. In addition, coverage with at least one ITN at community level was explored by applying Lot Quality Assurance Sampling (LQAS) decision rules to the cluster level of the data. All outcomes were analysed by household background characteristics and whether an ITN campaign had recently been done. While the proportion of households with any ITN was only 42% overall, it was 75% in areas with a recent mass campaign and in these areas 66% of communities had coverage of 80% or better. However, the campaigns left a considerable intra-household ownership gap with 66% of households with any ITN not having enough for every family member. In contrast, the analysis comparing actual against potential use showed that ITN utilization was good overall with only 19% of people with access not using the ITN, but with a significant difference between the North, where use was excellent (use gap 11%), and the South (use gap 36%) indicating the need for enhanced behaviour change communication. The expanded ITN indicators to assess universal coverage provide strong tools for a comprehensive system effectiveness analysis that produces clear, actionable evidence of progress as well as the need for specific additional interventions clearly differentiating between gaps in ownership and use.

Improving travel information products via robust estimation techniques : final report, March 2009.

DOT National Transportation Integrated Search

2009-03-01

Traffic-monitoring systems, such as those using loop detectors, are prone to coverage gaps, arising from sensor noise, processing errors and : transmission problems. Such gaps adversely affect the accuracy of Advanced Traveler Information Systems. Th...

Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis.

PubMed

Padula, William V; Heru, Shiona; Campbell, Jonathan D

2016-04-01

Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3% (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). U.S. transgender population starting before transitional therapy. No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000-22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints--HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85% of simulations. Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.

AN APPROACH FOR DETERMINING REGIONAL LAND COVER AND SPECIES HABITAT DISTRIBUTIONS IN THE AMERICAN SOUTHWEST: THE SOUTHWEST REGIONAL GAP ANALYSIS PROJECT

EPA Science Inventory

The Southwest Regional Gap Analysis Project (SWReGAP) is developing seamless digital coverages for land cover, vertebrate animal habitat, and land management status for the 5-state region of Nevada, Arizona, Utah, New Mexico, and Colorado. The project is a second generation effor...

Potential impact of pharmacist interventions to reduce cost for Medicare Part D beneficiaries.

PubMed

Thatcher, Erin E; Vanwert, Elizabeth M; Erickson, Steven R

2013-06-01

The objective was to determine the impact of simulated pharmacist interventions on out-of-pocket cost, time to coverage gap, and cost per patient to the Medicare Part D program using actual patient cases from an adult general medicine clinic. Medication profiles of 100 randomly selected Medicare-eligible patients from a university-affiliated general internal medicine clinic were reviewed by a pharmacist to identify opportunities to cost-maximize the patients' therapies based on the plan. An online Part-D calculator, Aetna Medicare Rx Essentials, was used as the standard plan to determine medication cost and time to gap. The primary analysis was comparison of the patients' pre-review and post-review out-of-pocket cost, time to coverage gap, and cost to Medicare. A total of 65 patients had at least 1 simulated pharmacist cost intervention. The most common intervention was substituting for a less costly generic, followed by substituting a generic for a brand name. Projected patient cost savings was $476 per year. The average time to coverage gap was increased by 0.7 ±1.2 months. This study illustrates that the pharmacists may be able to reduce cost to some patients as well as to the Medicare Part D program.

A vorticity transport model to restore spatial gaps in velocity data

NASA Astrophysics Data System (ADS)

Ameli, Siavash; Shadden, Shawn

2017-11-01

Often measurements of velocity data do not have full spatial coverage in the probed domain or near boundaries. These gaps can be due to missing measurements or masked regions of corrupted data. These gaps confound interpretation, and are problematic when the data is used to compute Lagrangian or trajectory-based analyses. Various techniques have been proposed to overcome coverage limitations in velocity data such as unweighted least square fitting, empirical orthogonal function analysis, variational interpolation as well as boundary modal analysis. In this talk, we present a vorticity transport PDE to reconstruct regions of missing velocity vectors. The transport model involves both nonlinear anisotropic diffusion and advection. This approach is shown to preserve the main features of the flow even in cases of large gaps, and the reconstructed regions are continuous up to second order. We illustrate results for high-frequency radar (HFR) measurements of the ocean surface currents as this is a common application of limited coverage. We demonstrate that the error of the method is on the same order of the error of the original velocity data. In addition, we have developed a web-based gateway for data restoration, and we will demonstrate a practical application using available data. This work is supported by the NSF Grant No. 1520825.

Rising Prices of Targeted Oral Anticancer Medications and Associated Financial Burden on Medicare Beneficiaries.

PubMed

Shih, Ya-Chen Tina; Xu, Ying; Liu, Lei; Smieliauskas, Fabrice

2017-08-01

Purpose The high cost of oncology drugs threatens the affordability of cancer care. Previous research identified drivers of price growth of targeted oral anticancer medications (TOAMs) in private insurance plans and projected the impact of closing the coverage gap in Medicare Part D in 2020. This study examined trends in TOAM prices and patient out-of-pocket (OOP) payments in Medicare Part D and estimated the actual effects on patient OOP payments of partial filling of the coverage gap by 2012. Methods Using SEER linked to Medicare Part D, 2007 to 2012, we identified patients who take TOAMs via National Drug Codes in Part D claims. We calculated total drug costs (prices) and OOP payments per patient per month and compared their rates of inflation with general health care prices. Results The study cohort included 42,111 patients who received TOAMs between 2007 and 2012. Although the general prescription drug consumer price index grew at 3% per year over 2007 to 2012, mean TOAM prices increased by nearly 12% per year, reaching $7,719 per patient per month in 2012. Prices increased over time for newly and previously launched TOAMs. Mean patient OOP payments dropped by 4% per year over the study period, with a 40% drop among patients with a high financial burden in 2011, when the coverage gap began to close. Conclusion Rising TOAM prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D. Policymakers should explore methods of harnessing the surge of novel TOAMs to increase price competition for Medicare beneficiaries.

Electronic theoretical study of the influences of O adsorption on the electronic structure and optical properties of graphene

NASA Astrophysics Data System (ADS)

Shuang, Zhou; Guili, Liu; Dazhi, Fan

2017-02-01

The electronic structure and optical properties of adsorbing O atoms on graphene with different O coverage are researched using the density functional theory based upon the first-principle study to obtain further insight into properties of graphene. The adsorption energies, band structures, the density of states, light absorption coefficient and reflectivity of each system are calculated theoretically after optimizing structures of each system with different O coverage. Our calculations show that adsorption of O atoms on graphene increases the bond length of C-C which adjacent to the O atoms. When the O coverage is 9.4%, the adsorption energy (3.91 eV) is the maximum, which only increases about 1.6% higher than that of 3.1% O coverage. We find that adsorbed O atoms on pristine graphene opens up indirect gap of about 0.493-0.952 eV. Adsorbing O atoms make pristine graphene from metal into a semiconductor. When the O coverage is 9.4%, the band gap (0.952 eV) is the maximum. Comparing with pristine graphene, we find the density of states at Fermi level of O atoms adsorbing on graphene with different coverage are significantly increased. We also find that light absorption coefficient and reflectivity peaks are significantly reduced, and the larger the coverage, the smaller the absorption coefficient and reflectivity peaks are. And the blue shift phenomenon appears.

47 CFR 54.505 - Discounts.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICE Universal Service Support for Schools and Libraries § 54.505 Discounts. (a) Discount mechanism. Discounts for eligible schools and libraries shall be set as a percentage discount from the pre-discount price. (b) Discount percentages. The discounts available to eligible schools and libraries shall range...

47 CFR 54.505 - Discounts.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICE Universal Service Support for Schools and Libraries § 54.505 Discounts. (a) Discount mechanism. Discounts for eligible schools and libraries shall be set as a percentage discount from the pre-discount price. (b) Discount percentages. The discounts available to eligible schools and libraries shall range...

Design and methodology of the Geo-social Analysis of Physicians' settlement (GAP-Study) in Germany.

PubMed

Groneberg, David A; Boll, Michael; Bauer, Jan

2016-01-01

Unequally distributed disease burdens within populations are well-known and occur worldwide. They are depending on residents' social status and/or ethnic background. Country-specific health care systems - especially the coverage and distribution of health care providers - are both a potential cause as well as an important solution for health inequalities. Registers are built of all accredited physicians and psychotherapists within the outpatient care system in German metropolises by utilizing the database of the Associations of Statutory Health Insurance Physicians. The physicians' practice neighborhood will be analyzed under socioeconomic and demographic perspectives. Therefore, official city districts' statistics will be assigned to the physicians and psychotherapists according to their practice location. Averages of neighborhood indicators will be calculated for each specialty. Moreover, advanced studies will inspect differences by physicians' gender or practice type. Geo-spatial analyses of the intra-city practices distribution will complete the settlement characteristics of physicians and psychotherapists within the outpatient care system in German metropolises. The project "Geo-social Analysis of Physicians' settlement" (GAP) is designed to elucidate gaps of physician coverage within the outpatient care system, dependent on neighborhood residents' social status or ethnics in German metropolises. The methodology of the GAP-Study enables the standardized investigation of physicians' settlement behavior in German metropolises and their inter-city comparisons. The identification of potential gaps within the physicians' coverage should facilitate the delineation of approaches for solving health care inequality problems.

Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.

PubMed

Adeyinka, Daniel A; Evans, Meirion R; Ozigbu, Chamberline E; van Woerden, Hugo; Adeyinka, Esther F; Oladimeji, Olanrewaju; Aimakhu, Chris; Odoh, Deborah; Chamla, Dick

2017-03-01

Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals. Copyright© by the National Institute of Public Health, Prague 2017

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies

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

Utturkar, Sagar M.; Klingeman, Dawn M.; Hurt, Jr., Richard A.

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted.more » PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Furthermore, our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences.« less

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies

DOE PAGES

Utturkar, Sagar M.; Klingeman, Dawn M.; Hurt, Jr., Richard A.; ...

2017-07-18

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted.more » PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Furthermore, our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences.« less

A Case Study into Microbial Genome Assembly Gap Sequences and Finishing Strategies

PubMed Central

Utturkar, Sagar M.; Klingeman, Dawn M.; Hurt, Richard A.; Brown, Steven D.

2017-01-01

This study characterized regions of DNA which remained unassembled by either PacBio and Illumina sequencing technologies for seven bacterial genomes. Two genomes were manually finished using bioinformatics and PCR/Sanger sequencing approaches and regions not assembled by automated software were analyzed. Gaps present within Illumina assemblies mostly correspond to repetitive DNA regions such as multiple rRNA operon sequences. PacBio gap sequences were evaluated for several properties such as GC content, read coverage, gap length, ability to form strong secondary structures, and corresponding annotations. Our hypothesis that strong secondary DNA structures blocked DNA polymerases and contributed to gap sequences was not accepted. PacBio assemblies had few limitations overall and gaps were explained as cumulative effect of lower than average sequence coverage and repetitive sequences at contig termini. An important aspect of the present study is the compilation of biological features that interfered with assembly and included active transposons, multiple plasmid sequences, phage DNA integration, and large sequence duplication. Our targeted genome finishing approach and systematic evaluation of the unassembled DNA will be useful for others looking to close, finish, and polish microbial genome sequences. PMID:28769883

Ongoing Coverage for Ongoing Care: Access, Utilization, and Out-of-Pocket Spending Among Uninsured Working-Aged Adults with Chronic Health Care Needs

PubMed Central

Rasch, Elizabeth K.; Chan, Leighton

2011-01-01

Objectives. We sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs. Methods. We conducted multivariate analyses of the 2002–2004 Medical Expenditure Panel Survey to compare access, utilization, and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. The results are generalizable to the US community-dwelling population aged 18 to 64 years. Results. Among 92 million adults with chronic conditions, 21% experienced at least 1 month uninsured during the average year (2002–2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23% were uninsured during the average year. These gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use, and higher levels of out-of-pocket spending. Conclusions. Implementation of health care reform must focus not only on the prevention of chronic conditions and the expansion of insurance coverage but also on the long-term stability of the coverage to be offered. PMID:21164090

Equal Opportunity Laws: Topic Paper A.

ERIC Educational Resources Information Center

National Council on the Handicapped, Washington, DC.

This paper examines the status of U.S. disability-related equal opportunity laws and identifies gaps in coverage, shortcomings and inconsistencies in interpretation and application, and deficiencies in enforcement. Problems with the scope of coverage result from: (1) laws that are not enforceable in federal courts against states, not co-extensive…

Human resources for treating HIV/AIDS: needs, capacities, and gaps.

PubMed

Bärnighausen, Till; Bloom, David E; Humair, Salal

2007-11-01

Despite recent international efforts to scale-up antiretroviral treatment (ART), more than 5 million people needing ART in low- and middle-income countries (LMIC) do not receive it. Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. We estimate the HRHA gap in LMIC using recently published estimates of ART coverage, HIV incidence, health-worker emigration rates, mortality rates of people needing ART, and numbers of HRHA needed to treat 1000 ART patients (based on review studies, 2006). We project the HRHA gap in 10 years (2017) using a simple discrete-time model with a health worker pool replenished through education and depleted through emigration/death; a population needing ART replenished with a given HIV incidence rate; and higher survival rates for treated populations. We analyze the effects of varying assumptions about HRHA inflows and outflows and the evolution of the HIV pandemic in three different regional base cases (sub-Saharan Africa, non-sub-Saharan African LMIC, and South Africa). Current ART coverage for LMIC is around 28%-32% and, other things equal, will drop to 16%-19% by 2017 with constant current HRHA production rates. A naive model, ignoring the increased survival probability resulting from ART, suggests that approximately the current number of HRHA in ART services needs to be added every year for the next ten years to achieve universal coverage by 2017. In a model accounting for increased survival of treated patients, outcomes vary by region; sub-Saharan Africa requires two times, non-sub-Saharan African LMIC require 1.5 times and South Africa requires more than three times their respective current HRHA population to be added every year for the next 10 years to achieve universal coverage by 2017. Even if achieved by 2017, sustaining universal coverage requires further HRHA increases until the system reaches steady state. ART coverage is sensitive to HRHA inflow and emigration. Our model quantifies the challenge of closing the HRHA gap in LMIC. It shows that strategies to achieve universal ART coverage must account for feedback due to higher survival probabilities of people receiving ART. It suggests that universal ART coverage is unlikely to be achieved and sustained with increased HRHA inflows alone, but will require decreased HRHA outflows, substantially reduced HIV incidence, or changes in the nature or organization of care. Means to decrease HRHA emigration outflows include scholarships for healthcare education that are conditional on the recipient delivering ART in a country with high ART need for a number of years, training health workers who are not internationally mobile, or changing recruitment policies in countries receiving health workers from the developing world. Effective organizational changes include those that reduce the number of HRHA required to treat a fixed number of patients. Given the large number of health workers that even optimistic assumptions suggest will be needed in ART services in the coming decades, policymakers must ensure that the flow of workers into ART programs does not jeopardize the provision of other important health services.

Expanding health insurance for children: examining the alternatives.

PubMed

Fronstin, P; Pierron, B

1997-07-01

This Issue Brief examines the issue of uninsured children. The budget reconciliation legislation currently under congressional consideration earmarks $16 billion for new initiatives to provide health insurance coverage to approximately 5 million of the 10 million uninsured children during the next five years. Proposals to expand coverage among children include the use of tax credits, subsidies, vouchers, Medicaid program expansion, and expansion of state programs. However, these proposals do not address the decline in employment-based health insurance coverage--the underlying cause of the lack of coverage, to the extent that a cause can be identified. What is worse, some proposals to expand health insurance among children may discourage employers from offering coverage. Between 1987 and 1995, the percentage of children with employment-based health insurance declined from 66.7 percent to 58.6 percent. Despite this trend, the percentage of children without any form of health insurance coverage barely increased. In 1987, 13.1 percent were uninsured, compared with 13.8 percent in 1995. Medicaid program expansions helped to alleviate the effects of the decline in employment-based health insurance coverage among children and the potential increase in the number of uninsured children. Between 1987 and 1995, the percentage of children enrolled in the Medicaid program increased from 15.5 percent to 23.2 percent. Some questions to consider in assessing approaches to improving children's health insurance coverage include the following: If the government intervenes, should it do so through a compulsory mechanism or a voluntary system? Is the employment-based system "worth saving" for children? In other words, are the market interventions necessary to keep this system functioning for children too regulatory, too intrusive, and too cumbersome to be practical? In addition to reforming the employment-based system, what reforms are necessary in order to reach those families who have no coverage through the work place? Which approaches are both efficient and politically acceptable? Employment-based coverage of children will likely continue. The challenge for lawmakers is to find a way to cover more uninsured children without eroding employment-based coverage. Several current legislative proposals attempt to avoid this problem by excluding children who have access to employment-based coverage. Without such a requirement, the opportunity to purchase coverage at a discount would create incentives for some low-income employees to drop dependent/family coverage, which in turn could lead some employers to drop their health plans.

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20-29 in Zimbabwe.

PubMed

Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie; Njeuhmeli, Emmanuel

2016-01-01

Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20-29 was examined. Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10-19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20-29 with a corresponding increase in unit cost for these age groups. When circumcision coverage among men ages 20-29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Although increased investment in recruiting VMMC clients ages 20-29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

Impact of Cost Sharing on Therapeutic Substitution: The Story of Statins in 2006.

PubMed

Li, Pengxiang; Schwartz, J Sanford; Doshi, Jalpa A

2016-11-11

Cost sharing is widely used to encourage therapeutic substitution. This study aimed to examine the impact of increases in patient cost-sharing differentials for brand name and generic drugs on statin utilization on entry into the Medicare Part D coverage gap. Using 5% Medicare Chronic Condition Warehouse files from 2006, this quasi-experimental study examined patients with hyperlipidemia who filled prescriptions for atorvastatin or rosuvastatin between January and March 2006. Propensity score matching and difference-in-difference regressions were used to compare changes in statin utilization for the study group (patients who were not eligible for low-income subsidies [non-LIS] and had generic-only gap coverage) to those of a control group (LIS patients who faced the same cost sharing before and during the Part D coverage gap). In the final sample, 801 patients in the study group were matched to 801 patients in the control group. We found that, compared to the control group, the study group had a larger decline in any monthly brand-name statin use (-0.24 30-day fills, P<0.001). This was only partially offset by increased monthly generic statin use (+0.06 30-day fill, P<0.001), with an overall drop in any monthly statin use (-0.18 30-day fills, P<0.001). Overall adherence with statins declined (OR 0.81, P<0.001), and statin discontinuation increased (OR 1.62, P<0.001) in the study group as compared to the control group. Increases in cost-sharing differentials for brand name and generic drugs on coverage gap entry were associated with discontinuation of statins in Medicare Part D patients with hyperlipidemia. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Law and psychiatry. Doing forensic work, II: fees, billing, and collections.

PubMed

Reid, William H

2012-05-01

Forensic practice fees, billing, and collection procedures are quite different from those in general psychiatry. Most forensic practices have far fewer "clients," and individual bills are usually larger. Collections are usually better (and less frequently discounted) in forensic practice, and resolving billing disputes is far more straightforward. Medicare, Medicaid, other insurance coverage, provider networks and agreements, procedure codes, and diagnosis-related groups (DRGs) are all largely irrelevant in forensic work (although sometimes important to direct clinical services in correctional psychiatry or forensic treatment clinics). An understanding of the practicalities and ethics of charging and billing for forensic services greatly simplifies practice management.

Can history improve big bang health reform? Commentary.

PubMed

Marchildon, Gregory P

2018-07-01

At present, the professional skills of the historian are rarely relied upon when health policies are being formulated. There are numerous reasons for this, one of which is the natural desire of decision-makers to break with the past when enacting big bang policy change. This article identifies the strengths professional historians bring to bear on policy development using the establishment and subsequent reform of universal health coverage as an example. Historians provide pertinent and historically informed context; isolate the forces that have historically allowed for major reform; and separate the truly novel reforms from those attempted or implemented in the past. In addition, the historian's use of primary sources allows potentially new and highly salient facts to guide the framing of the policy problem and its solution. This paper argues that historians are critical for constructing a viable narrative of the establishment and evolution of universal health coverage policies. The lack of this narrative makes it difficult to achieve an accurate assessment of systemic gaps in coverage and access, and the design or redesign of universal health coverage that can successfully close these gaps.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

PubMed

Douglas, Elaine; Waller, Jo; Duffy, Stephen W; Wardle, Jane

2016-06-01

Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. © The Author(s) 2015.

Peierls instability as the insulating origin of the Na/Si(111)-(3 × 1) surface with a Na coverage of 2/3 monolayers

NASA Astrophysics Data System (ADS)

Kang, Myung Ho; Kwon, Se Gab; Jung, Sung Chul

2018-03-01

Density functional theory (DFT) calculations are used to investigate the insulating origin of the Na/Si(111)-(3 × 1) surface with a Na coverage of 2/3 monolayers. In the coverage definition, one monolayer refers to one Na atom per surface Si atom, so this surface contains an odd number of electrons (i.e., three Si dangling-bond electrons plus two Na electrons) per 3 × 1 unit cell. Interestingly, this odd-electron surface has been ascribed to a Mott-Hubbard insulator to account for the measured insulating band structure with a gap of about 0.8 eV. Here, we instead propose a Peierls instability as the origin of the experimental band gap. The concept of Peierls instability is fundamental in one-dimensional metal systems but has not been taken into account in previous studies of this surface. Our DFT calculations demonstrate that the linear chain structure of Si dangling bonds in this surface is energetically unstable with respect to a × 2 buckling modulation, and the buckling-induced band gap of 0.79 eV explains well the measured insulating nature.

A novel multi-item joint replenishment problem considering multiple type discounts.

PubMed

Cui, Ligang; Zhang, Yajun; Deng, Jie; Xu, Maozeng

2018-01-01

In business replenishment, discount offers of multi-item may either provide different discount schedules with a single discount type, or provide schedules with multiple discount types. The paper investigates the joint effects of multiple discount schemes on the decisions of multi-item joint replenishment. In this paper, a joint replenishment problem (JRP) model, considering three discount (all-unit discount, incremental discount, total volume discount) offers simultaneously, is constructed to determine the basic cycle time and joint replenishment frequencies of multi-item. To solve the proposed problem, a heuristic algorithm is proposed to find the optimal solutions and the corresponding total cost of the JRP model. Numerical experiment is performed to test the algorithm and the computational results of JRPs under different discount combinations show different significance in the replenishment cost reduction.

Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries123

PubMed Central

Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Myatt, Mark

2017-01-01

Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1) poverty, 2) poor dietary diversity, and 3) rural residence. Three measures of coverage were assessed: 1) consumption of the vehicle, 2) consumption of a fortifiable vehicle, and 3) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed. PMID:28404836

Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries.

PubMed

Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Neufeld, Lynnette M; Myatt, Mark

2017-05-01

Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1 ) poverty, 2 ) poor dietary diversity, and 3 ) rural residence. Three measures of coverage were assessed: 1 ) consumption of the vehicle, 2 ) consumption of a fortifiable vehicle, and 3 ) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1 ) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3 ) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed.

Concordance between monetary and sexual delay discounting in men who have sex with men.

PubMed

Jones, Jeb; Guest, Jodie L; Sullivan, Patrick S; Kramer, Michael R; Jenness, Samuel M; Sales, Jessica M

2017-12-07

Background: Delay discounting has been found to be associated with numerous health-related outcomes, including risky sexual behaviour. To date, it is unclear whether delay discounting measured in different domains is associated within individuals. The goal of this study was to assess the concordance of monetary and sexual delay discounting in men who have sex with men. Methods: Participants completed an online survey, including the Monetary Choice Questionnaire and the Sexual Discounting Task. Linear regression models were used to assess the association between monetary and sexual discount rates. Results: Sexual discount rates did not predict monetary discount rates. There was a substantial amount of clustering of sexual discount rates, requiring sexual discounting data to be categorised. Conclusions: Monetary and sexual delay discounting are distinct processes that are not necessarily associated within individuals, and monetary delay discounting is not an appropriate proxy measure for sexual impulsivity. Data from the Sexual Discounting Task are typically rank-transformed for analysis. These data suggest that this might be an invalid method of analysis. Future studies should investigate the distribution of their data to determine if it is appropriate to analyse sexual discounting data as a continuous measure.

Response of reptile and amphibian communities to canopy gaps created by wind disturbance in the Southern Appalachians

Treesearch

Cathryn H. Greenberg

2001-01-01

Reptile and amphibian communities were sampled in intact gaps created by wind disturbance, salvage-logged gaps, and closed canopy mature forest (controls). Sampling was conducted during June–October in 1997 and 1998 using drift fences with pitfall and funnel traps. Basal area of live trees, shade, leaf litter coverage, and litter depth was highest in controls and...

Measuring Impatience in Intertemporal Choice.

PubMed

Cruz Rambaud, Salvador; Muñoz Torrecillas, María José

2016-01-01

In general terms, decreasing impatience means decreasing discount rates. This property has been usually referred to as hyperbolic discounting, although there are other discount functions which also exhibit decreasing discount rates. This paper focuses on the measurement of the impatience associated with a discount function with the aim of establishing a methodology to compare this characteristic for two different discount functions. In this way, first we define the patience associated with a discount function in an interval as its corresponding discount factor and consequently we deduce that the impatience at a given moment is the corresponding instantaneous discount rate. Second we compare the degree of impatience of discount functions belonging to the same or different families, by considering the cases in which the functions do or do not intersect.

Psychophysics of time perception and intertemporal choice models

NASA Astrophysics Data System (ADS)

Takahashi, Taiki; Oono, Hidemi; Radford, Mark H. B.

2008-03-01

Intertemporal choice and psychophysics of time perception have been attracting attention in econophysics and neuroeconomics. Several models have been proposed for intertemporal choice: exponential discounting, general hyperbolic discounting (exponential discounting with logarithmic time perception of the Weber-Fechner law, a q-exponential discount model based on Tsallis's statistics), simple hyperbolic discounting, and Stevens' power law-exponential discounting (exponential discounting with Stevens' power time perception). In order to examine the fitness of the models for behavioral data, we estimated the parameters and AICc (Akaike Information Criterion with small sample correction) of the intertemporal choice models by assessing the points of subjective equality (indifference points) at seven delays. Our results have shown that the orders of the goodness-of-fit for both group and individual data were [Weber-Fechner discounting (general hyperbola) > Stevens' power law discounting > Simple hyperbolic discounting > Exponential discounting], indicating that human time perception in intertemporal choice may follow the Weber-Fechner law. Indications of the results for neuropsychopharmacological treatments of addiction and biophysical processing underlying temporal discounting and time perception are discussed.

Delay Discounting: Pigeon, Rat, Human – Does it Matter?

PubMed Central

Vanderveldt, Ariana; Oliveira, Luís; Green, Leonard

2016-01-01

Delay discounting refers to the decrease in subjective value of an outcome as the time to its receipt increases. Across species and situations, animals discount delayed rewards, and their discounting is well-described by a hyperboloid function. The current review begins with a comparison of discounting models and the procedures used to assess delay discounting in nonhuman animals. We next discuss the generality of discounting, reviewing the effects of different variables on the degree of discounting delayed reinforcers by nonhuman animals. Despite the many similarities in discounting observed between human and nonhuman animals, several differences have been proposed (e.g., the magnitude effect; nonhuman animals discount over a matter of seconds whereas humans report willing to wait months, if not years before receiving a reward), raising the possibility of fundamental species differences in intertemporal choice. After evaluating these differences, we discuss delay discounting from an adaptationist perspective. The pervasiveness of discounting across species and situations suggests it is a fundamental process underlying decision making. PMID:26881899

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition.

PubMed

Chopra, Mickey; Sharkey, Alyssa; Dalmiya, Nita; Anthony, David; Binkin, Nancy

2012-10-13

Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels--ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions-and, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Vivid Present: Visualization Abilities Are Associated with Steep Discounting of Future Rewards

PubMed Central

Parthasarathi, Trishala; McConnell, Mairead H.; Luery, Jeffrey; Kable, Joseph W.

2017-01-01

Humans and other animals discount the value of future rewards, a phenomenon known as delay discounting. Individuals vary widely in the extent to which they discount future rewards, and these tendencies have been associated with important life outcomes. Recent studies have demonstrated that imagining the future reduces subsequent discounting behavior, but no research to date has examined whether a similar principle applies at the trait level, and whether training visualization changes discounting. The current study examined if individual differences in visualization abilities are linked to individual differences in discounting and whether practicing visualization can change discounting behaviors in a lasting way. Participants (n = 48) completed the Vividness of Visual Imagery Questionnaire (VVIQ) and delay discounting task and then underwent a 4-week intervention consisting of visualization training (intervention) or relaxation training (control). Contrary to our hypotheses, participants who reported greater visualization abilities (lower scores) on the VVIQ were higher discounters. To further examine this relationship, an additional 106 participants completed the VVIQ and delay discounting task. In the total sample (n = 154), there was a significant negative correlation between VVIQ scores and discount rates, showing that individuals who are better visualizers are also higher discounters. Consistent with this relationship but again to our surprise, visualization training tended, albeit weakly, to increase discount rates, and those whose VVIQ decreased the most were those whose discount rates increased the most. These results suggest a novel association between visualization abilities and delay discounting. PMID:28321198

The Vivid Present: Visualization Abilities Are Associated with Steep Discounting of Future Rewards.

PubMed

Parthasarathi, Trishala; McConnell, Mairead H; Luery, Jeffrey; Kable, Joseph W

2017-01-01

Humans and other animals discount the value of future rewards, a phenomenon known as delay discounting. Individuals vary widely in the extent to which they discount future rewards, and these tendencies have been associated with important life outcomes. Recent studies have demonstrated that imagining the future reduces subsequent discounting behavior, but no research to date has examined whether a similar principle applies at the trait level, and whether training visualization changes discounting. The current study examined if individual differences in visualization abilities are linked to individual differences in discounting and whether practicing visualization can change discounting behaviors in a lasting way. Participants ( n = 48) completed the Vividness of Visual Imagery Questionnaire (VVIQ) and delay discounting task and then underwent a 4-week intervention consisting of visualization training (intervention) or relaxation training (control). Contrary to our hypotheses, participants who reported greater visualization abilities (lower scores) on the VVIQ were higher discounters. To further examine this relationship, an additional 106 participants completed the VVIQ and delay discounting task. In the total sample ( n = 154), there was a significant negative correlation between VVIQ scores and discount rates, showing that individuals who are better visualizers are also higher discounters. Consistent with this relationship but again to our surprise, visualization training tended, albeit weakly, to increase discount rates, and those whose VVIQ decreased the most were those whose discount rates increased the most. These results suggest a novel association between visualization abilities and delay discounting.

Notes on Discounting

ERIC Educational Resources Information Center

Rachlin, Howard

2006-01-01

In general, if a variable can be expressed as a function of its own maximum value, that function may be called a discount function. Delay discounting and probability discounting are commonly studied in psychology, but memory, matching, and economic utility also may be viewed as discounting processes. When they are so viewed, the discount function…

Measuring Impatience in Intertemporal Choice

PubMed Central

2016-01-01

In general terms, decreasing impatience means decreasing discount rates. This property has been usually referred to as hyperbolic discounting, although there are other discount functions which also exhibit decreasing discount rates. This paper focuses on the measurement of the impatience associated with a discount function with the aim of establishing a methodology to compare this characteristic for two different discount functions. In this way, first we define the patience associated with a discount function in an interval as its corresponding discount factor and consequently we deduce that the impatience at a given moment is the corresponding instantaneous discount rate. Second we compare the degree of impatience of discount functions belonging to the same or different families, by considering the cases in which the functions do or do not intersect. PMID:26890895

A 5-trial adjusting delay discounting task: Accurate discount rates in less than 60 seconds

PubMed Central

Koffarnus, Mikhail N.; Bickel, Warren K.

2014-01-01

Individuals who discount delayed rewards at a high rate are more likely to engage in substance abuse, overeating, or problem gambling. Findings such as these suggest the value of methods to obtain an accurate and fast measurement of discount rate that can be easily deployed in variety of settings. In the present study, we developed and evaluated the 5-trial adjusting delay task, a novel method of obtaining discount rate in less than one minute. We hypothesized that discount rates from the 5-trial adjusting delay task would be similar and correlated with discount rates from a lengthier task we have used previously, and that four known effects relating to delay discounting would be replicable with this novel task. To test these hypotheses, the 5-trial adjusting delay task was administered to 111 college students six times to obtain discount rates for six different commodities, along with a lengthier adjusting amount discounting task. We found that discount rates were similar and correlated between the 5-trial adjusting delay task and the adjusting amount task. Each of the four known effects relating to delay discounting was replicated with the 5-trial adjusting delay task to varying degrees. First, discount rates were inversely correlated with amount. Second, discount rates between past and future outcomes were correlated. Third, discount rates were greater for consumable rewards than with money, although we did not control for amount in this comparison. Fourth, discount rates were lower when zero amounts opposing the chosen time point were explicitly described. Results indicate that the 5-trial adjusting delay task is a viable, rapid method to assess discount rate. PMID:24708144

A 5-trial adjusting delay discounting task: accurate discount rates in less than one minute.

PubMed

Koffarnus, Mikhail N; Bickel, Warren K

2014-06-01

Individuals who discount delayed rewards at a high rate are more likely to engage in substance abuse, overeating, or problem gambling. Such findings suggest the value of methods to obtain an accurate and fast measurement of discount rate that can be easily deployed in variety of settings. In the present study, we developed and evaluated the 5-trial adjusting delay task, a novel method of obtaining a discount rate in less than 1 min. We hypothesized that discount rates from the 5-trial adjusting delay task would be similar and would correlate with discount rates from a lengthier task we have used previously, and that 4 known effects relating to delay discounting would be replicable with this novel task. To test these hypotheses, the 5-trial adjusting delay task was administered to 111 college students 6 times to obtain discount rates for 6 different commodities, along with a lengthier adjusting amount discounting task. We found that discount rates were similar and correlated between the 5-trial adjusting delay task and the adjusting amount task. Each of the 4 known effects relating to delay discounting was replicated with the 5-trial adjusting delay task to varying degrees. First, discount rates were inversely correlated with amount. Second, discount rates between past and future outcomes were correlated. Third, discount rates were greater for consumable rewards than with money, although we did not control for amount in this comparison. Fourth, discount rates were lower when $0 amounts opposing the chosen time point were explicitly described. Results indicate that the 5-trial adjusting delay task is a viable, rapid method to assess discount rate. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Delay, probability, and social discounting in a public goods game.

PubMed

Jones, Bryan A; Rachlin, Howard

2009-01-01

A human social discount function measures the value to a person of a reward to another person at a given social distance. Just as delay discounting is a hyperbolic function of delay, and probability discounting is a hyperbolic function of odds-against, social discounting is a hyperbolic function of social distance. Experiment 1 obtained individual social, delay, and probability discount functions for a hypothetical $75 reward; participants also indicated how much of an initial $100 endowment they would contribute to a common investment in a public good. Steepness of discounting correlated, across participants, among all three discount dimensions. However, only social and probability discounting were correlated with the public-good contribution; high public-good contributors were more altruistic and also less risk averse than low contributors. Experiment 2 obtained social discount functions with hypothetical $75 rewards and delay discount functions with hypothetical $1,000 rewards, as well as public-good contributions. The results replicated those of Experiment 1; steepness of the two forms of discounting correlated with each other across participants but only social discounting correlated with the public-good contribution. Most participants in Experiment 2 predicted that the average contribution would be lower than their own contribution.

Trends in insurance coverage and source of private coverage among young adults aged 19-25: United States, 2008-2012.

PubMed

Kirzinger, Whitney K; Cohen, Robin A; Gindi, Renee M

2013-12-01

Data from the National Health Interview Survey, 2008-2012. The percentage of young adults with private health insurance coverage increased from the last 6 months of 2010 through the last 6 months of 2012 (52.0% to 57.9%). Except for an increase in the first 6 months of 2011, the percentage of privately insured young adults who had a gap in coverage during the past 12 months decreased from the first 6 months of 2008 through the last 6 months of 2012 (10.5% to 7.8%). The percentage of privately insured young adults with coverage in their own name decreased from 40.8% in the last 6 months of 2010 to 27.2% in the last 6 months of 2012. The percentage of privately insured young adults with employer-sponsored health insurance increased from the last 6 months of 2010 to the last 6 months of 2012 (85.6% to 92.5%). Young adults often experience instability with regard to work, school, residential status, and financial independence. This could contribute to a lack of or gaps in insurance coverage (1,2). In September 2010, the Affordable Care Act (ACA) extended dependent health coverage to young adults up to age 26. This provision was expected to lead to increases in private coverage for young adults aged 19-25 when they became eligible for coverage through their parents' employment (3,4). This report provides estimates describing the previous insurance status and sources of coverage among privately insured young adults aged 19-25, using data from the 2008-2012 National Health Interview Survey (NHIS). Comparisons are made with adults aged 26-34, the most similar age group that was not affected by the ACA provision. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Discounting in Economic Evaluations.

PubMed

Attema, Arthur E; Brouwer, Werner B F; Claxton, Karl

2018-05-19

Appropriate discounting rules in economic evaluations have received considerable attention in the literature and in national guidelines for economic evaluations. Rightfully so, as discounting can be quite influential on the outcomes of economic evaluations. The most prominent controversies regarding discounting involve the basis for and height of the discount rate, whether costs and effects should be discounted at the same rate, and whether discount rates should decline or stay constant over time. Moreover, the choice for discount rules depends on the decision context one adopts as the most relevant. In this article, we review these issues and debates, and describe and discuss the current discounting recommendations of the countries publishing their national guidelines. We finish the article by proposing a research agenda.

Delay and probability discounting of sexual and monetary outcomes in individuals with cocaine use disorders and matched controls.

PubMed

Johnson, Matthew W; Johnson, Patrick S; Herrmann, Evan S; Sweeney, Mary M

2015-01-01

Individuals with cocaine use disorders are disproportionately affected by HIV/AIDS, partly due to higher rates of unprotected sex. Recent research suggests delay discounting of condom use is a factor in sexual HIV risk. Delay discounting is a behavioral economic concept describing how delaying an event reduces that event's value or impact on behavior. Probability discounting is a related concept describing how the uncertainty of an event decreases its impact on behavior. Individuals with cocaine use disorders (n = 23) and matched non-cocaine-using controls (n = 24) were compared in decision-making tasks involving hypothetical outcomes: delay discounting of condom-protected sex (Sexual Delay Discounting Task), delay discounting of money, the effect of sexually transmitted infection (STI) risk on likelihood of condom use (Sexual Probability Discounting Task), and probability discounting of money. The Cocaine group discounted delayed condom-protected sex (i.e., were more likely to have unprotected sex vs. wait for a condom) significantly more than controls in two of four Sexual Delay Discounting Task partner conditions. The Cocaine group also discounted delayed money (i.e., preferred smaller immediate amounts over larger delayed amounts) significantly more than controls. In the Sexual Probability Discounting Task, both groups showed sensitivity to STI risk, however the groups did not differ. The Cocaine group did not consistently discount probabilistic money more or less than controls. Steeper discounting of delayed, but not probabilistic, sexual outcomes may contribute to greater rates of sexual HIV risk among individuals with cocaine use disorders. Probability discounting of sexual outcomes may contribute to risk of unprotected sex in both groups. Correlations showed sexual and monetary results were unrelated, for both delay and probability discounting. The results highlight the importance of studying specific behavioral processes (e.g., delay and probability discounting) with respect to specific outcomes (e.g., monetary and sexual) to understand decision making in problematic behavior.

Delay and Probability Discounting of Sexual and Monetary Outcomes in Individuals with Cocaine Use Disorders and Matched Controls

PubMed Central

Johnson, Matthew W.; Johnson, Patrick S.; Herrmann, Evan S.; Sweeney, Mary M.

2015-01-01

Individuals with cocaine use disorders are disproportionately affected by HIV/AIDS, partly due to higher rates of unprotected sex. Recent research suggests delay discounting of condom use is a factor in sexual HIV risk. Delay discounting is a behavioral economic concept describing how delaying an event reduces that event’s value or impact on behavior. Probability discounting is a related concept describing how the uncertainty of an event decreases its impact on behavior. Individuals with cocaine use disorders (n = 23) and matched non-cocaine-using controls (n = 24) were compared in decision-making tasks involving hypothetical outcomes: delay discounting of condom-protected sex (Sexual Delay Discounting Task), delay discounting of money, the effect of sexually transmitted infection (STI) risk on likelihood of condom use (Sexual Probability Discounting Task), and probability discounting of money. The Cocaine group discounted delayed condom-protected sex (i.e., were more likely to have unprotected sex vs. wait for a condom) significantly more than controls in two of four Sexual Delay Discounting Task partner conditions. The Cocaine group also discounted delayed money (i.e., preferred smaller immediate amounts over larger delayed amounts) significantly more than controls. In the Sexual Probability Discounting Task, both groups showed sensitivity to STI risk, however the groups did not differ. The Cocaine group did not consistently discount probabilistic money more or less than controls. Steeper discounting of delayed, but not probabilistic, sexual outcomes may contribute to greater rates of sexual HIV risk among individuals with cocaine use disorders. Probability discounting of sexual outcomes may contribute to risk of unprotected sex in both groups. Correlations showed sexual and monetary results were unrelated, for both delay and probability discounting. The results highlight the importance of studying specific behavioral processes (e.g., delay and probability discounting) with respect to specific outcomes (e.g., monetary and sexual) to understand decision making in problematic behavior. PMID:26017273

Act No. 18 of 7 August 1989 amending Articles 1 and 4 of and adding a new article to Act No. 6 of 1987.

PubMed

1989-01-01

This Act provides the following benefits to all Panamanians and foreigners resident in Panama who have reached the age of 55, if women, and 60, if men, as well as to those who are pensioned and those retired because of disability: 1) a 50% discount on recreation and entertainment activities; 2) a public transportation discount ranging from 25 to 30%; 3) a lodging discount of 50% during the week and 30% on weekends; 4) a 25% discount on restaurants of the 1st and 2nd class; 5) a 15% discount in fast food establishments that are part of a national or international franchise; 6) a 10% discount in private hospitals and clinics when the person does not have hospital insurance; 7) a 10% discount on prescription medicines; 8) a 20% discount on general medical consultations and a 10% discount on dental, optometry, ophthalmology, cardiology, psychiatric and psychological, geriatric, and surgical services; 9) a 10% discount on technical and professional services, including legal, architectural, physiotherapy, and nursing services; 10) a 10% discount on prostheses; 11) a 50% discount on expenses and commissions related to financial, banking, and credit transactions; 12) a 15% discount on the maximum interest on personal and commercial loans; 13) a reduction of 1 percentage point in the interest on personal housing loans; 14) the freezing of the property tax on a personal home, as long as that home is the person's only property; 15) exemption from payment of the appraisal fee due on the transfer of property under the same circumstances as in 14 above; 16) a 50% discount on passports; 17) a 25% discount on electric bills under certain circumstances; and 18) a 50% discount on airport taxes or fees.

The Value of Clean Air: Comparing Discounting of Delayed Air Quality and Money Across Magnitudes.

PubMed

Berry, Meredith S; Friedel, Jonathan E; DeHart, William B; Mahamane, Salif; Jordan, Kerry E; Odum, Amy L

2017-06-01

The detrimental health effects of exposure to air pollution are well established. Fostering behavioral change concerning air quality may be challenging because the detrimental health effects of exposure to air pollution are delayed. Delay discounting, a measure of impulsive choice, encapsulates this process of choosing between the immediate conveniences of behaviors that increase pollution and the delayed consequences of prolonged exposure to poor air quality. In Experiment 1, participants completed a series of delay-discounting tasks for air quality and money. We found that participants discounted delayed air quality more than money. In Experiment 2, we investigated whether the common finding that large amounts of money are discounted less steeply than small amounts of money generalized to larger and smaller improvements in air quality. Participants discounted larger improvements in air quality less steeply than smaller improvements, indicating that the discounting of air quality shares a similar process as the discounting of money. Our results indicate that the discounting of delayed money is strongly related to the discounting of delayed air quality and that similar mechanisms may be involved in the discounting of these qualitatively different outcomes. These data are also the first to demonstrate the malleability of delay discounting of air quality, and provide important public health implications for decreasing delay discounting of air quality.

Discounting of food, sex, and money.

PubMed

Holt, Daniel D; Newquist, Matthew H; Smits, Rochelle R; Tiry, Andrew M

2014-06-01

Discounting is a useful framework for understanding choice involving a range of delayed and probabilistic outcomes (e.g., money, food, drugs), but relatively few studies have examined how people discount other commodities (e.g., entertainment, sex). Using a novel discounting task, where the length of a line represented the value of an outcome and was adjusted using a staircase procedure, we replicated previous findings showing that individuals discount delayed and probabilistic outcomes in a manner well described by a hyperbola-like function. In addition, we found strong positive correlations between discounting rates of delayed, but not probabilistic, outcomes. This suggests that discounting of delayed outcomes may be relatively predictable across outcome types but that discounting of probabilistic outcomes may depend more on specific contexts. The generality of delay discounting and potential context dependence of probability discounting may provide important information regarding factors contributing to choice behavior.

Delay Discounting of Losses in Alcohol Use Disorders and Antisocial Psychopathology: Effects of a Working Memory Load.

PubMed

Gerst, Kyle R; Gunn, Rachel L; Finn, Peter R

2017-10-01

Alcohol use disorders (AUDs) are associated with increased discounting of delayed rewards and reduced executive working memory (eWM) capacity. This association is amplified when comorbid with antisocial psychopathology (AP). Furthermore, recent studies suggest that reduced WM capacity is associated with disinhibited decisions reflected by increased impulsive decision making on the delay discounting of rewards task. While discounting of delayed rewards is well studied, the discounting of delayed losses has received significantly less experimental attention. The current study investigated (i) the rate of discounting of delayed losses in individuals with AUD only (n = 61), AUD with comorbid AP (n = 79) and healthy controls (n = 64); (ii) the relationship between eWM capacity and discounting of delayed losses; and (iii) the effect of a WM load on discounting of delayed losses. Discounting performance was assessed using a computerized discounting of delayed losses task. Results showed that the AUD-only and AUD-AP groups had higher rates of discounting of delayed losses and lower eWM capacity compared to the control groups. Lower individual eWM capacity was associated with increased discounting of delayed losses. However, WM load did not increase discounting rates overall. These results support the hypothesis that greater discounting of delayed losses is associated with AUD and comorbid AP problems and lower individual eWM capacity. Copyright © 2017 by the Research Society on Alcoholism.

Dental Use and Expenditures for Older Uninsured Americans: The Simulated Impact of Expanded Coverage

PubMed Central

Manski, Richard J; Moeller, John F; Chen, Haiyan; Schimmel, Jody; Pepper, John V; St Clair, Patricia A

2015-01-01

Objective To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans. Data Sources/Study Setting We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS). Study Design We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured. Data Collection/Extraction Methods The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ). Principal Findings We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older. Conclusions Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users. PMID:25040355

Coverage of genomic medicine: information gap between lay public and scientists.

PubMed

Sugawara, Yuya; Narimatsu, Hiroto; Fukao, Akira

2012-01-01

The sharing of information between the lay public and medical professionals is crucial to the conduct of personalized medicine using genomic information in the near future. Mass media, such as newspapers, can play an important role in disseminating scientific information. However, studies on the role of newspaper coverage of genome-related articles are highly limited. We investigated the coverage of genomic medicine in five major Japanese newspapers (Asahi, Mainichi, Yomiuri, Sankei, and Nikkei) using Nikkei Telecom and articles in scientific journals in PubMed from 1995 to 2009. The number of genome-related articles in all five newspapers temporarily increased in 2000, and began continuously decreasing thereafter from 2001 to 2009. Conversely, there was a continuous increasing trend in the number of genome-related articles in PubMed during this period. The numbers of genome-related articles among the five major newspapers from 1995 to 2009 were significantly different (P = 0.002). Commentaries, research articles, and articles about companies were the most frequent in 2001 and 2003, when the number of genome-related articles transiently increased in the five newspapers. This study highlights the significant gap between newspaper coverage and scientific articles in scientific journals.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

PubMed Central

Douglas, Elaine; Waller, Jo; Duffy, Stephen W

2015-01-01

Objective Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Methods Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. Results At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Conclusions Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. PMID:26377810

Observed and Normative Discount Functions in Addiction and other Diseases

PubMed Central

Cruz Rambaud, Salvador; Muñoz Torrecillas, María J.; Takahashi, Taiki

2017-01-01

The aim of this paper is to find a suitable discount function able to describe the progression of a certain addiction or disease under treatment as a discounting process. In effect, a certain indicator related to a disease decays over time in a manner which is mathematically similar to the way in which discounting has been modeled. We analyze the discount functions observed in experiments which study addictive and other problematic behaviors as well as some alternative hyperbola-like discount functions in order to fit the patience exhibited by the subject after receiving the treatment. Additionally, it has been experimentally found that people with addiction display high rates of discount (impatience) and preference reversals (dynamic inconsistency). This excessive discounting must be correctly modeled by a suitable discount function, otherwise, it can become a trans-disease process underlying addiction and other disorders. The (generalized) exponentiated hyperbolic discount function is proposed to describe the progression of a disease with respect to the treatment, since it maintains the property of inconsistency by exhibiting a decreasing discount rate after an initial period in which the opposite occurs. PMID:28706486

Observed and Normative Discount Functions in Addiction and other Diseases.

PubMed

Cruz Rambaud, Salvador; Muñoz Torrecillas, María J; Takahashi, Taiki

2017-01-01

The aim of this paper is to find a suitable discount function able to describe the progression of a certain addiction or disease under treatment as a discounting process. In effect, a certain indicator related to a disease decays over time in a manner which is mathematically similar to the way in which discounting has been modeled. We analyze the discount functions observed in experiments which study addictive and other problematic behaviors as well as some alternative hyperbola-like discount functions in order to fit the patience exhibited by the subject after receiving the treatment. Additionally, it has been experimentally found that people with addiction display high rates of discount (impatience) and preference reversals (dynamic inconsistency). This excessive discounting must be correctly modeled by a suitable discount function, otherwise, it can become a trans-disease process underlying addiction and other disorders. The (generalized) exponentiated hyperbolic discount function is proposed to describe the progression of a disease with respect to the treatment, since it maintains the property of inconsistency by exhibiting a decreasing discount rate after an initial period in which the opposite occurs.

The Value of Clean Air: Comparing Discounting of Delayed Air Quality and Money Across Magnitudes

PubMed Central

Friedel, Jonathan E.; DeHart, William B.; Mahamane, Salif; Jordan, Kerry E.; Odum, Amy L.

2018-01-01

The detrimental health effects of exposure to air pollution are well established. Fostering behavioral change concerning air quality may be challenging because the detrimental health effects of exposure to air pollution are delayed. Delay discounting, a measure of impulsive choice, encapsulates this process of choosing between the immediate conveniences of behaviors that increase pollution and the delayed consequences of prolonged exposure to poor air quality. In Experiment 1, participants completed a series of delay-discounting tasks for air quality and money. We found that participants discounted delayed air quality more than money. In Experiment 2, we investigated whether the common finding that large amounts of money are discounted less steeply than small amounts of money generalized to larger and smaller improvements in air quality. Participants discounted larger improvements in air quality less steeply than smaller improvements, indicating that the discounting of air quality shares a similar process as the discounting of money. Our results indicate that the discounting of delayed money is strongly related to the discounting of delayed air quality and that similar mechanisms may be involved in the discounting of these qualitatively different outcomes. These data are also the first to demonstrate the malleability of delay discounting of air quality, and provide important public health implications for decreasing delay discounting of air quality. PMID:29606776

Latin American Clinical Epidemiology Network Series - Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile.

PubMed

De la Puente, Catherine; Vallejos, Carlos; Bustos, Luis; Zaror, Carlos; Velasquez, Monica; Lanas, Fernando

2017-06-01

To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. Cost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. The ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US$). In the budget impact analysis for the baseline scenario, considering 100% of treatment, coverage, and adherence, ticagrelor represented an additional cost of CLP 5,233,854,272, for 979 QALYs gained compared with clopidogrel. Ticagrelor is cost-effective in comparison with clopidogrel for the secondary prevention of acute coronary syndrome. These findings are similar to those reported in other international cost-effectiveness studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Pharmacy patronage: identifying key factors in the decision making process using the determinant attribute approach.

PubMed

Franic, Duska M; Haddock, Sarah M; Tucker, Leslie Tootle; Wooten, Nathan

2008-01-01

To use the determinant attribute approach, a research method commonly used in marketing to identify the wants of various consumer groups, to evaluate consumer pharmacy choice when having a prescription order filled in different pharmacy settings. Cross sectional. Community independent, grocery store, community chain, and discount store pharmacies in Georgia between April 2005 and April 2006. Convenience sample of adult pharmacy consumers (n = 175). Survey measuring consumer preferences on 26 attributes encompassing general pharmacy site features (16 items), pharmacist characteristics (5 items), and pharmacy staff characteristics (5 items). 26 potential determinant attributes for pharmacy selection. 175 consumers were surveyed at community independent (n = 81), grocery store (n = 44), community chain (n = 27), or discount store (n = 23) pharmacy settings. The attributes of pharmacists and staff at all four pharmacy settings were shown to affect pharmacy patronage motives, although consumers frequenting non-community independent pharmacies were also motivated by secondary convenience factors, e.g., hours of operation, and prescription coverage. Most consumers do not perceive pharmacies as merely prescription-distribution centers that vary only by convenience. Prescriptions are not just another economic good. Pharmacy personnel influence pharmacy selection; therefore, optimal staff selection and training is likely the greatest asset and most important investment for ensuring pharmacy success.

Automated ultrasound scanning on a dual-modality breast imaging system: coverage and motion issues and solutions.

PubMed

Sinha, Sumedha P; Goodsitt, Mitchell M; Roubidoux, Marilyn A; Booi, Rebecca C; LeCarpentier, Gerald L; Lashbrook, Christine R; Thomenius, Kai E; Chalek, Carl L; Carson, Paul L

2007-05-01

We are developing an automated ultrasound imaging-mammography system wherein a digital mammography unit has been augmented with a motorized ultrasound transducer carriage above a special compression paddle. Challenges of this system are acquiring complete coverage of the breast and minimizing motion. We assessed these problems and investigated methods to increase coverage and stabilize the compressed breast. Visual tracings of the breast-to-paddle contact area and breast periphery were made for 10 patients to estimate coverage area. Various motion artifacts were evaluated in 6 patients. Nine materials were tested for coupling the paddle to the breast. Fourteen substances were tested for coupling the transducer to the paddle in lateral-to-medial and medial-to-lateral views and filling the gap between the peripheral breast and paddle. In-house image registration software was used to register adjacent ultrasound sweeps. The average breast contact area was 56%. The average percentage of the peripheral air gap filled with ultrasound gel was 61%. Shallow patient breathing proved equivalent to breath holding, whereas speech and sudden breathing caused unacceptable artifacts. An adhesive spray that preserves image quality was found to be best for coupling the breast to the paddle and minimizing motion. A highly viscous ultrasound gel proved most effective for coupling the transducer to the paddle for lateral-to-medial and medial-to-lateral views and for edge fill-in. The challenges of automated ultrasound scanning in a multimodality breast imaging system have been addressed by developing methods to fill in peripheral gaps, minimize patient motion, and register and reconstruct multisweep ultrasound image volumes.

Historical record of Landsat global coverage

USGS Publications Warehouse

Goward, Samuel; Arvidson, Terry; Williams, Darrel; Faundeen, John; Irons, James; Franks, Shannon

2006-01-01

The long-term, 34+ year record of global Landsat remote sensing data is a critical resource to study the Earth system and human impacts on this system. The National Satellite Land Remote Sensing Data Archive (NSLRSDA) is charged by public law to: “maintain a permanent, comprehensive Government archive of global Landsat and other land remote sensing data for long-term monitoring and study of the changing global environment” (U.S. Congress, 1992). The advisory committee for NSLRSDA requested a detailed analysis of observation coverage within the U.S. Landsat holdings, as well as that acquired and held by International Cooperator (IC) stations. Our analyses, to date, have found gaps of varying magnitude in U.S. holdings of Landsat global coverage data, which appear to reflect technical or administrative variations in mission operations. In many cases it may be possible to partially fill these gaps in U.S. holdings through observations that were acquired and are now being held at International Cooperator stations.

On discounting of health gains from human papillomavirus vaccination: effects of different approaches.

PubMed

Westra, Tjalke A; Parouty, Mehraj; Brouwer, Werner B; Beutels, Philippe H; Rogoza, Raina M; Rozenbaum, Mark H; Daemen, Toos; Wilschut, Jan C; Boersma, Cornelis; Postma, Maarten J

2012-05-01

Discounting has long been a matter of controversy in the field of health economic evaluations. How to weigh future health effects has resulted in ongoing discussions. These discussions are imminently relevant for health care interventions with current costs but future benefits. Different approaches to discount health effects have been proposed. In this study, we estimated the impact of different approaches for discounting health benefits of human papillomavirus (HPV) vaccination. An HPV model was used to estimate the impact of different discounting approaches on the present value of health effects. For the constant discount approaches, we varied the discount rate for health effects ranging from 0% to 4%. Next, the impact of relevant alternative discounting approaches was estimated, including hyperbolic, proportional, stepwise, and time-shifted discounting. The present value of health effects gained through HPV vaccination varied strongly when varying discount rates and approaches. The application of the current Dutch guidelines resulted in a present value of health effects that was eight or two times higher than that produced when using the proportional discounting approach or when using the internationally more common 4% discount rate for health effects, respectively. Obviously, such differences translate into large variations in corresponding incremental cost-effectiveness ratios. The exact discount rate and approach chosen in an economic evaluation importantly impact the projected value of health benefits of HPV vaccination. Investigating alternative discounting approaches in health-economic analysis is important, especially for vaccination programs yielding health effects far into the future. Our study underlines the relevance of ongoing discussions on how and at what rates to discount. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis.

PubMed

Sheng, Guangying; Chen, Suning; Dong, Chaohui; Zhang, Ri; Miao, Miao; Wu, Depei; Tan, Seng Chuen; Liu, Chao; Xiong, Tengbin

2017-04-01

Imatinib (Glivec) and nilotinib (Tasigna) have been covered by critical disease insurance in Jiangsu province of China since 2013, which changed local treatment patterns and outcomes of patients with chronic myeloid leukemia (CML). This study evaluated the long-term cost-effectiveness of insurance coverage with imatinib as the first-line treatment for patients with CML in China from a societal perspective. A decision-analytic model based on previously published and real-world evidence was applied to simulate and evaluate the lifetime clinical and economic outcomes associated with CML treatments before and after imatinib was covered by medical insurance. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs) discounted at 3% annually. Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses. In base case analysis, both cost and effectiveness of CML treatments increased after imatinib was covered by the medical insurance; on average, the incremental QALY and cost were 5.5 and ¥277,030 per patient in lifetime, respectively. The ICER of insurance coverage with imatinib was ¥50,641, which is less than the GDP per capita of China. Monte Carlo simulation resulted in the estimate of 100% probability that the insurance coverage of imatinib is cost-effective. Total cost was substantially saved at 5 years after patients initiated imatinib treatment with insurance coverage compared to no insurance coverage, the saved cost at 5 years was ¥99,565, which included the cost savings from both direct (e.g. cost of bone marrow or stem cell transplant) and indirect costs (e.g. productivity loss of patients and care-givers). The insurance coverage of imatinib is very cost-effective in China, according to the local cost and clinical data in Jiangsu province. More importantly, the insurance coverage of imatinib and nilotinib have changed the treatment patterns of CML patients, thus dramatically increasing life expectancy and quality-of-life (QoL) saving on productivity losses for both CML patients and their caregivers.

Educational Gaps in Medical Care and Health Behavior: Evidence from US Natality Data

ERIC Educational Resources Information Center

Price, Joseph; Price, Joshua; Simon, Kosali

2011-01-01

The US Natality files provide information on medical procedures and health related behavior during pregnancy and childbirth. The data set represents nearly the universe of mothers who give birth in the US, providing the most complete coverage possible of medical care and health behavior among a specific patient population. We document gaps in…

Stress hormones predict hyperbolic time-discount rates six months later in adults.

PubMed

Takahashi, Taiki; Shinada, Mizuho; Inukai, Keigo; Tanida, Shigehito; Takahashi, Chisato; Mifune, Nobuhiro; Takagishi, Haruto; Horita, Yutaka; Hashimoto, Hirofumi; Yokota, Kunihiro; Kameda, Tatsuya; Yamagishi, Toshio

2010-01-01

Stress hormones have been associated with temporal discounting. Although time-discount rate is shown to be stable over a long term, no study to date examines whether individual differences in stress hormones could predict individuals' time-discount rates in the relatively distant future (e.g., six month later), which is of interest in neuroeconomics of stress-addiction association. We assessed 87 participants' salivary stress hormone (cortisol, cortisone, and alpha-amylase) levels and hyperbolic discounting of delayed rewards consisting of three magnitudes, at the time-interval of six months. For salivary steroid assays, we employed a liquid chromatography/ mass spectroscopy (LC/MS) method. The correlations between the stress hormone levels and time-discount rates were examined. We observed that salivary alpha-amylase (sAA) levels were negatively associated with time-discount rates in never-smokers. Notably, salivary levels of stress steroids (i.e., cortisol and cortisone) negatively and positively related to time-discount rates in men and women, respectively, in never-smokers. Ever-smokers' discount rates were not predicted from these stress hormone levels. Individual differences in stress hormone levels predict impulsivity in temporal discounting in the future. There are sex differences in the effect of stress steroids on temporal discounting; while there was no sex defference in the relationship between sAA and temporal discounting.

Steeper discounting of delayed rewards in schizophrenia but not first-degree relatives.

PubMed

Yu, Linda Q; Lee, Sangil; Katchmar, Natalie; Satterthwaite, Theodore D; Kable, Joseph W; Wolf, Daniel H

2017-06-01

Excessive discounting of future rewards has been related to a variety of risky behaviors and adverse clinical conditions. Prior work examining delay discounting in schizophrenia suggests an elevated discount rate. However, it remains uncertain whether this reflects the disease process itself or an underlying genetic vulnerability, whether it is selective for delay discounting or reflects pervasive changes in decision-making, and whether it is driven by specific clinical dimensions such as cognitive impairment. Here we investigated delay discounting, as well as loss aversion and risk aversion, in three groups: schizophrenia (SZ), unaffected first-degree family members (FM), and controls without a family history of psychosis (NC). SZ had elevated discounting, without changes in loss aversion or risk aversion. Contrary to expectations, the FM group did not show an intermediate phenotype in discounting. Higher discount rates correlated with lower cognitive performance on verbal reasoning, but this did not explain elevated discount rates in SZ. Group differences were driven primarily by the non-smoking majority of the sample. This study provides further evidence for elevated discounting in schizophrenia, and demonstrates that steeper discounting is not necessarily associated with familial risk, cannot be wholly accounted for by cognitive deficits, and is not attributable to smoking-related impulsivity. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Differences in Health between Americans and Western Europeans: Effects on Longevity and Public Finance

PubMed Central

Goldman, Dana; Lakdawalla, Darius; Gailey, Adam; Zheng, Yuhui

2011-01-01

In 1975, 50 year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050. PMID:21719178

Differences in health between Americans and Western Europeans: Effects on longevity and public finance.

PubMed

Michaud, Pierre-Carl; Goldman, Dana; Lakdawalla, Darius; Gailey, Adam; Zheng, Yuhui

2011-07-01

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050. Copyright © 2011 Elsevier Ltd. All rights reserved.

Young Adults' Selection and Use of Dependent Coverage under the Affordable Care Act.

PubMed

Chen, Weiwei

2018-01-01

The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder' children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19-26 versus those aged 27-30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage.

Young Adults’ Selection and Use of Dependent Coverage under the Affordable Care Act

PubMed Central

Chen, Weiwei

2018-01-01

The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder’ children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19–26 versus those aged 27–30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage. PMID:29445721

The Roles of Technology in Primary HIV Prevention for Men Who Have Sex with Men.

PubMed

Sullivan, Patrick S; Jones, Jeb; Kishore, Nishant; Stephenson, Rob

2015-12-01

Men who have sex with men (MSM) are at disproportionate risk for HIV infection globally. The past 5 years have seen considerable advances in biomedical interventions to reduce the risk of HIV infection. To be impactful in reducing HIV incidence requires the rapid and expansive scale-up of prevention. One mechanism for achieving this is technology-based tools to improve knowledge, acceptability, and coverage of interventions and services. This review provides a summary of the current gap in coverage of primary prevention services, how technology-based interventions and services can address gaps in coverage, and the current trends in the development and availability of technology-based primary prevention tools for use by MSM. Results from agent-based models of HIV epidemics of MSM suggest that 40-50 % coverage of multiple primary HIV prevention interventions and services, including biomedical interventions like preexposure prophylaxis, will be needed to reduce HIV incidence among MSM. In the USA, current levels of coverage for all interventions, except HIV testing and condom distribution, fall well short of this target. Recent findings illustrate how technology-based HIV prevention tools can be used to provide certain kinds of services at much larger scale, with marginal incremental costs. A review of mobile apps for primary HIV prevention revealed that most are designed by nonacademic, nonpublic health developers, and only a small proportion of available mobile apps specifically address MSM populations. We are unlikely to reach the required scale of HIV prevention intervention coverage for MSM unless we can leverage technologies to bring key services to broad coverage for MSM. Despite an exciting pipeline of technology-based prevention tools, there are broader challenges with funding structures and sustainability that need to be addressed to realize the full potential of this emerging public health field.

Probability Discounting of Gains and Losses: Implications for Risk Attitudes and Impulsivity

ERIC Educational Resources Information Center

Shead, N. Will; Hodgins, David C.

2009-01-01

Sixty college students performed three discounting tasks: probability discounting of gains, probability discounting of losses, and delay discounting of gains. Each task used an adjusting-amount procedure, and participants' choices affected the amount and timing of their remuneration for participating. Both group and individual discounting…

How Many Impulsivities? A Discounting Perspective

ERIC Educational Resources Information Center

Green, Leonard; Myerson, Joel

2013-01-01

People discount the value of delayed and uncertain outcomes, and how steeply individuals discount is thought to reflect how impulsive they are. From this perspective, steep discounting of delayed outcomes (which fails to maximize long-term welfare) and shallow discounting of probabilistic outcomes (which fails to adequately take risk into account)…

7 CFR 1786.53 - Discounted present value.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Discounted present value. 1786.53 Section 1786.53... Special Discounted Prepayments on RUS Direct/Insured Loans § 1786.53 Discounted present value. The Discounted Present Value shall be calculated five business days before prepayment is made by summing the...

Individual laboratory-measured discount rates predict field behavior

PubMed Central

Chabris, Christopher F.; Laibson, David; Morris, Carrie L.; Schuldt, Jonathon P.; Taubinsky, Dmitry

2009-01-01

We estimate discount rates of 555 subjects using a laboratory task and find that these individual discount rates predict inter-individual variation in field behaviors (e.g., exercise, BMI, smoking). The correlation between the discount rate and each field behavior is small: none exceeds 0.28 and many are near 0. However, the discount rate has at least as much predictive power as any variable in our dataset (e.g., sex, age, education). The correlation between the discount rate and field behavior rises when field behaviors are aggregated: these correlations range from 0.09-0.38. We present a model that explains why specific intertemporal choice behaviors are only weakly correlated with discount rates, even though discount rates robustly predict aggregates of intertemporal decisions. PMID:19412359

Individual laboratory-measured discount rates predict field behavior.

PubMed

Chabris, Christopher F; Laibson, David; Morris, Carrie L; Schuldt, Jonathon P; Taubinsky, Dmitry

2008-12-01

We estimate discount rates of 555 subjects using a laboratory task and find that these individual discount rates predict inter-individual variation in field behaviors (e.g., exercise, BMI, smoking). The correlation between the discount rate and each field behavior is small: none exceeds 0.28 and many are near 0. However, the discount rate has at least as much predictive power as any variable in our dataset (e.g., sex, age, education). The correlation between the discount rate and field behavior rises when field behaviors are aggregated: these correlations range from 0.09-0.38. We present a model that explains why specific intertemporal choice behaviors are only weakly correlated with discount rates, even though discount rates robustly predict aggregates of intertemporal decisions.

Delay discounting as a function of intrinsic/extrinsic religiousness, religious fundamentalism, and regular church attendance.

PubMed

Weatherly, Jeffrey N; Plumm, Karyn M

2012-01-01

Delay discounting occurs when the subjective value of an outcome decreases because its delivery is delayed. Previous research has suggested that the rate at which some, but not all, outcomes are discounted varies as a function of regular church attendance. In the present study, 509 participants completed measures of intrinsic religiousness, extrinsic religiousness, religious fundamentalism, and whether they regularly attended church services. They then completed a delay-discounting task involving five outcomes. Although religiousness was not a significant predictor of discounting for all outcomes, participants scoring high in intrinsic religiousness tended to display less delay discounting than participants scoring low. Likewise, participants scoring high in religious fundamentalism tended to display more delay discounting than participants scoring low. These results partially replicate previous ones in showing that the process of discounting may vary as a function of religiousness. The results also provide some direction for those interested in altering how individuals discount.

Discounting of qualitatively different delayed health outcomes in current and never smokers

PubMed Central

Friedel, Jonathan E.; DeHart, William B.; Frye, Charles C. J.; Rung, Jillian M.; Odum, Amy L.

2016-01-01

In delay discounting, temporally remote outcomes have less value. Cigarette smoking is associated with steeper discounting of money and consumable outcomes. It is presently unclear whether smokers discount health outcomes more than non-smokers. We sought to establish the generality of steep discounting for different types of health outcomes in cigarette smokers. Seventy participants (38 smokers and 32 non-smokers) completed four hypothetical outcome delay-discounting tasks: a gain of $500, a loss of $500, a temporary boost in health, and temporary cure from a debilitating disease. Participants reported the duration of each health outcome that would be equivalent to $500; these durations were then used in the respective discounting tasks. Delays ranged from 1 week to 25 years. Smokers’ indifference points for monetary gains, boosts in health, and temporary cures were lower than indifference points from non-smokers. Indifference points of one outcome were correlated with indifference points of other outcomes. Smokers demonstrate steeper discounting across a range of delayed outcomes. How a person discounts one outcome predicts how they will discount other outcomes. These two findings support our assertion that delay discounting is in part a trait. PMID:26691848

Delay discounting and utility for money or weight loss.

PubMed

Sze, Y Y; Slaven, E M; Bickel, W K; Epstein, L H

2017-03-01

Obesity is related to a bias towards smaller immediate over larger delayed rewards. This bias is typically examined by studying single commodity discounting. However, weight loss often involves choices among multiple commodities. To our knowledge, no research has examined delay discounting of delayed weight loss compared with other commodities. We examined single commodity discounting of money and cross commodity discounting of money and weight loss in a sample of 84 adults with obesity or overweight statuses interested in weight loss. The exchange rate between money and weight loss was calculated, and participants completed two delay discounting tasks: money now versus money later and money now versus weight loss later. Participants discounted weight loss more than money ( p  < 0.001). When participants were divided into those who preferred weight loss ( n  = 61) versus money ( n  = 23), those who preferred money over weight loss discounted weight loss even more than individuals that preferred weight loss ( p  = 0.003). Greater discounting of weight loss for those who preferred money suggest that idiosyncratic preferences are related to multiple commodity discounting, and greater discounting of weight loss across all participants provide insight on important challenges for weight control.

Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data.

PubMed

Bjarnadóttir, Margrét V; Malik, Sana; Onukwugha, Eberechukwu; Gooden, Tanisha; Plaisant, Catherine

2016-02-01

Advanced computing capabilities and novel visual analytics tools now allow us to move beyond the traditional cross-sectional summaries to analyze longitudinal prescription patterns and the impact of study design decisions. For example, design decisions regarding gaps and overlaps in prescription fill data are necessary for measuring adherence using prescription claims data. However, little is known regarding the impact of these decisions on measures of medication possession (e.g., medication possession ratio). The goal of the study was to demonstrate the use of visualization tools for pattern discovery, hypothesis generation, and study design. We utilized EventFlow, a novel discrete event sequence visualization software, to investigate patterns of prescription fills, including gaps and overlaps, utilizing large-scale healthcare claims data. The study analyzes data of individuals who had at least two prescriptions for one of five hypertension medication classes: ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and diuretics. We focused on those members initiating therapy with diuretics (19.2%) who may have concurrently or subsequently take drugs in other classes as well. We identified longitudinal patterns in prescription fills for antihypertensive medications, investigated the implications of decisions regarding gap length and overlaps, and examined the impact on the average cost and adherence of the initial treatment episode. A total of 790,609 individuals are included in the study sample, 19.2% (N = 151,566) of whom started on diuretics first during the study period. The average age was 52.4 years and 53.1% of the population was female. When the allowable gap was zero, 34% of the population had continuous coverage and the average length of continuous coverage was 2 months. In contrast, when the allowable gap was 30 days, 69% of the population showed a single continuous prescription period with an average length of 5 months. The average prescription cost of the period of continuous coverage ranged from US$3.44 (when the maximum gap was 0 day) to US$9.08 (when the maximum gap was 30 days). Results were less impactful when considering overlaps. This proof-of-concept study illustrates the use of visual analytics tools in characterizing longitudinal medication possession. We find that prescription patterns and associated prescription costs are more influenced by allowable gap lengths than by definitions and treatment of overlap. Research using medication gaps and overlaps to define medication possession in prescription claims data should pay particular attention to the definition and use of gap lengths.

Women and health coverage: the affordability gap.

PubMed

Patchias, Elizabeth M; Waxman, Judy

2007-04-01

Although men and women have some similar challenges with regard to health insurance, women face unique barriers to becoming insured. More significantly, women have greater difficulty affording health care services even once they are insured. On average, women have lower incomes than men and therefore have greater difficulty paying premiums. Women also are less likely than men to have coverage through their own employer and more likely to obtain coverage through their spouses; are more likely than men to have higher out-of-pocket health care expenses; and use more healthcare services than men and consequently are in greater need of comprehensive coverage. Proposals for improving health policy need to address these disparities.

Coverage gaps for Medicaid-eligible children in the wake of federal welfare reform.

PubMed

Haley, Jennifer; Kenney, Genevieve

2003-01-01

Using data from the National Survey of America's Families, this paper examines insurance coverage changes for Medicaid-eligible citizen children between 1997 and 1999, early in the implementation of federal welfare reform. More than 20 million children qualified for Medicaid, but many were uninsured. Insurance coverage deteriorated for eligible children between 1997 and 1999, particularly for those who also qualified for cash assistance; this deterioration in coverage was largely due to dramatic declines in cash assistance participation. This paper shows that following federal welfare reform, states have faced new challenges reaching and enrolling the growing numbers of eligible children who are not connected with the welfare system.

Modeling the effect of reward amount on probability discounting.

PubMed

Myerson, Joel; Green, Leonard; Morris, Joshua

2011-03-01

The present study with college students examined the effect of amount on the discounting of probabilistic monetary rewards. A hyperboloid function accurately described the discounting of hypothetical rewards ranging in amount from $20 to $10,000,000. The degree of discounting increased continuously with amount of probabilistic reward. This effect of amount was not due to changes in the rate parameter of the discounting function, but rather was due to increases in the exponent. These results stand in contrast to those observed with the discounting of delayed monetary rewards, in which the degree of discounting decreases with reward amount due to amount-dependent decreases in the rate parameter. Taken together, this pattern of results suggests that delay and probability discounting reflect different underlying mechanisms. That is, the fact that the exponent in the delay discounting function is independent of amount is consistent with a psychophysical scaling interpretation, whereas the finding that the exponent of the probability-discounting function is amount-dependent is inconsistent with such an interpretation. Instead, the present results are consistent with the idea that the probability-discounting function is itself the product of a value function and a weighting function. This idea was first suggested by Kahneman and Tversky (1979), although their prospect theory does not predict amount effects like those observed. The effect of amount on probability discounting was parsimoniously incorporated into our hyperboloid discounting function by assuming that the exponent was proportional to the amount raised to a power. The amount-dependent exponent of the probability-discounting function may be viewed as reflecting the effect of amount on the weighting of the probability with which the reward will be received.

Count every newborn; a measurement improvement roadmap for coverage data.

PubMed

Moxon, Sarah G; Ruysen, Harriet; Kerber, Kate J; Amouzou, Agbessi; Fournier, Suzanne; Grove, John; Moran, Allisyn C; Vaz, Lara M E; Blencowe, Hannah; Conroy, Niall; Gülmezoglu, A; Vogel, Joshua P; Rawlins, Barbara; Sayed, Rubayet; Hill, Kathleen; Vivio, Donna; Qazi, Shamim A; Sitrin, Deborah; Seale, Anna C; Wall, Steve; Jacobs, Troy; Ruiz Peláez, Juan; Guenther, Tanya; Coffey, Patricia S; Dawson, Penny; Marchant, Tanya; Waiswa, Peter; Deorari, Ashok; Enweronu-Laryea, Christabel; Arifeen, Shams; Lee, Anne C C; Mathai, Matthews; Lawn, Joy E

2015-01-01

The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

26 CFR 31.3406(b)(2)-2 - Original issue discount.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Original issue discount. 31.3406(b)(2)-2... SOURCE Collection of Income Tax at Source § 31.3406(b)(2)-2 Original issue discount. (a) Original issue discount subject to backup withholding. The amount of original issue discount, treated as interest, subject...

Now for Me, Later for Us? Effects of Group Context on Temporal Discounting

PubMed Central

Charlton, Shawn R.; Yi, Richard; Porter, Caitlin; Carter, Anne E.; Bickel, Warren; Rachlin, Howard

2013-01-01

Delayed rewards are less valuable than immediate rewards. This well-established finding has focused almost entirely on individual outcomes. However, are delayed rewards similarly discounted if they are shared by a group? The current article reports on three experiments exploring the effect of group context on delay discounting. Results indicate that discount rates of individual and group rewards were highly correlated, but that respondents were more willing to wait (decreased discounting) for shared outcomes than for individual outcomes. An explanatory model is proposed suggesting that decreased discount rates in group contexts may be due to the way the effects of both delay and social discounting are combined. That is, in a group context, a person values both a future reward (discounted by delay) and a present reward to another person (discounted by the social distance between them). The results are explained by a combined discount function containing a delay factor and a factor representing the social distance between the decision maker and group members. Practical implications of the fact that shared consequences can increase individual self-control are also discussed. PMID:23641123

Discounting of reward sequences: a test of competing formal models of hyperbolic discounting

PubMed Central

Zarr, Noah; Alexander, William H.; Brown, Joshua W.

2014-01-01

Humans are known to discount future rewards hyperbolically in time. Nevertheless, a formal recursive model of hyperbolic discounting has been elusive until recently, with the introduction of the hyperbolically discounted temporal difference (HDTD) model. Prior to that, models of learning (especially reinforcement learning) have relied on exponential discounting, which generally provides poorer fits to behavioral data. Recently, it has been shown that hyperbolic discounting can also be approximated by a summed distribution of exponentially discounted values, instantiated in the μAgents model. The HDTD model and the μAgents model differ in one key respect, namely how they treat sequences of rewards. The μAgents model is a particular implementation of a Parallel discounting model, which values sequences based on the summed value of the individual rewards whereas the HDTD model contains a non-linear interaction. To discriminate among these models, we observed how subjects discounted a sequence of three rewards, and then we tested how well each candidate model fit the subject data. The results show that the Parallel model generally provides a better fit to the human data. PMID:24639662

Spin asymmetric band gap opening in graphene by Fe adsorption

NASA Astrophysics Data System (ADS)

del Castillo, E.; Cargnoni, F.; Achilli, S.; Tantardini, G. F.; Trioni, M. I.

2015-04-01

The adsorption of Fe atom on graphene is studied by first-principles Density Functional Theory. The structural, electronic, and magnetic properties are analyzed at different coverages, all preserving C6v symmetry for the Fe adatom. We observed that binding energies, magnetic moments, and adsorption distances rapidly converge as the size of the supercell increases. Among the considered supercells, those constituted by 3n graphene unit cells show a very peculiar behavior: the adsorption of a Fe atom induces the opening of a spin-dependent gap in the band structure. In particular, the gap amounts to tenths of eV in the majority spin component, while in the minority one it has a width of about 1 eV for the 3 × 3 supercell and remains significant even at very low coverages (0.25 eV for θ ≃ 2%). The charge redistribution upon Fe adsorption has also been analyzed according to state of the art formalisms indicating an appreciable charge transfer from Fe to the graphene layer.

Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder.

PubMed

Steinglass, Joanna E; Lempert, Karolina M; Choo, Tse-Hwei; Kimeldorf, Marcia B; Wall, Melanie; Walsh, B Timothy; Fyer, Abby J; Schneier, Franklin R; Simpson, H Blair

2017-05-01

Temporal discounting refers to the tendency for rewards to lose value as the expected delay to receipt increases. Individuals with anorexia nervosa (AN) have been found to show reduced temporal discounting rates, indicating a greater preference for delayed rewards compared to healthy peers. Obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) commonly co-occur with AN, and anxiety has been related to development and prognosis of AN. We examined whether reduced temporal discounting is present across these potentially related disorders, and explored the relationship between temporal discounting and anxiety transdiagnostically. One hundred ninety six individuals (75 healthy controls (HC); 50 OCD; 27 AN; 44 SAD) completed two temporal discounting tasks in which they chose between smaller-sooner and larger-later monetary rewards. Two measures of discounting-discount rate and discount factor-were compared between diagnostic groups, and associations with anxious traits were examined. Individuals with AN showed decreased temporal discounting compared to HC. OCD and SAD groups did not differ significantly from HC. Across the sample, anxiety was associated with decreased discounting; more anxious individuals showed a greater preference for delayed reward. We replicated the findings that individuals with AN show an increased preference for delayed reward relative to HC and that individuals with OCD do not differ from HC. We also showed that individuals with SAD do not differ from HC in discounting. Across this large sample, two measures of anxious temperament were associated with temporal discounting. These data raise new questions about the relationship between this dimensional trait and psychopathology. © 2016 Wiley Periodicals, Inc.

Sleep deprivation alters effort discounting but not delay discounting of monetary rewards.

PubMed

Libedinsky, Camilo; Massar, Stijn A A; Ling, Aiqing; Chee, Weiyan; Huettel, Scott A; Chee, Michael W L

2013-06-01

To determine whether sleep deprivation would affect the discounting of delayed rewards, of rewards entailing the expense of effort, or both. We measured rates of two types of reward discounting under conditions of rested wakefulness (RW) and sleep deprivation (SD). Delay discounting was defined as the willingness to accept smaller monetary rewards sooner rather than larger monetary rewards later. Effort discounting was defined as the willingness to accept smaller rewards that require less effort to obtain (e.g., typing a small number of letter strings backward) over larger but more effortful rewards (e.g., typing more letter strings to receive the reward). The first two experiments used a crossover design in which one session was conducted after a normal night of sleep (RW), and the other after a night without sleep (SD). The first experiment evaluated only temporal discounting whereas the second evaluated temporal and effort discounting. In the second experiment, the discounting tasks were repeatedly administered prior to the state comparisons to minimize the effects of order and/or repeated testing. In a third experiment, participants were studied only once in a between-subject evaluation of discounting across states. The study took place in a research laboratory. Seventy-seven healthy young adult participants: 20 in Experiment 1, 27 in Experiment 2, and 30 in Experiment 3. N/A. Sleep deprivation elicited increased effort discounting but did not affect delay discounting. The dissociable effects of sleep deprivation on two forms of discounting behavior suggest that they may have differing underlying neural mechanisms.

Time discounting and smoking behavior: evidence from a panel survey(*).

PubMed

Kang, Myong-Il; Ikeda, Shinsuke

2014-12-01

By using a panel survey of Japanese adults, we show that smoking behavior is associated with personal time discounting and its biases, such as hyperbolic discounting and the sign effect, in the way that theory predicts: smoking depends positively on the discount rate and the degree of hyperbolic discounting and negatively on the presence of the sign effect. Positive effects of hyperbolic discounting on smoking are salient for naïve people, who are not aware of their self-control problem. By estimating smoking participation and smokers' cigarette consumption in Cragg's two-part model, we find that the two smoking decisions depend on different sets of time-discounting variables. Particularly, smoking participation is affected by being a naïve hyperbolic discounter, whereas the discount rate, the presence of the sign effect, and a hyperbolic discounting proxy constructed from procrastination behavior vis-à-vis doing homework assignments affect both types of decision making. The panel data enable us to analyze the over-time instability of elicited discount rates. The instability is shown to come from measurement errors, rather than preference shocks on time preference. Several evidences indicate that the detected associations between time preferences and smoking behavior are interpersonal one, rather than within-personal one. Copyright © 2013 John Wiley & Sons, Ltd.

Drinking status but not acute alcohol consumption influences delay discounting.

PubMed

Adams, Sally; Attwood, Angela S; Munafò, Marcus R

2017-09-01

The aim of this study was to investigate the following: (a) the effects of acute alcohol on delay discounting; (b) the effects of drinking status on delayed discounting; and (c) whether these effects differ according to reward type (alcohol vs. money). Heavy and light social alcohol users (n = 96) were randomized to receive either an acute dose of alcohol at 0.4 or 0.6 g/kg or placebo in a between-subjects, double-blind design. Delay discounting of alcohol and monetary rewards was measured using a hyperbolic model, with higher scores indicative of greater delay discounting. ANOVA of discount scores indicated a main effect of reward type, where all participants had higher discount scores for alcohol versus money rewards. A main effect of drinking status was also observed, where heavier drinkers had higher discount scores compared with lighter drinkers. We did not observe a main effect of acute alcohol use on delay discounting or the hypothesized interactions between acute alcohol use and drinking status with reward type. Our data suggest that heavier drinkers discount the value of delayed rewards more steeply than lighter drinkers. Delay discounting may therefore be a promising marker of heavy alcohol consumption in social drinkers. Copyright © 2017 John Wiley & Sons, Ltd.

Delay, Probability, and Social Discounting in a Public Goods Game

ERIC Educational Resources Information Center

Jones, Bryan A.; Rachlin, Howard

2009-01-01

A human social discount function measures the value to a person of a reward to another person at a given social distance. Just as delay discounting is a hyperbolic function of delay, and probability discounting is a hyperbolic function of odds-against, social discounting is a hyperbolic function of social distance. Experiment 1 obtained individual…

Neural congruence between intertemporal and interpersonal self-control: Evidence from delay and social discounting.

PubMed

Hill, Paul F; Yi, Richard; Spreng, R Nathan; Diana, Rachel A

2017-11-15

Behavioral studies using delay and social discounting as indices of self-control and altruism, respectively, have revealed functional similarities between farsighted and social decisions. However, neural evidence for this functional link is lacking. Twenty-five young adults completed a delay and social discounting task during fMRI scanning. A spatiotemporal partial least squares analysis revealed that both forms of discounting were well characterized by a pattern of brain activity in areas comprising frontoparietal control, default, and mesolimbic reward networks. Both forms of discounting appear to draw on common neurocognitive mechanisms, regardless of whether choices involve intertemporal or interpersonal outcomes. We also observed neural profiles differentiating between high and low discounters. High discounters were well characterized by increased medial temporal lobe and limbic activity. In contrast, low discount rates were associated with activity in the medial prefrontal cortex and right temporoparietal junction. This pattern may reflect biological mechanisms underlying behavioral heterogeneity in discount rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Insurance Coverage for Rehabilitation Therapies and Association with Social Participation Outcomes among Low-Income Children.

PubMed

Mirza, Mansha; Kim, Yoonsang

2016-01-01

(1) To profile children's health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3-17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Findings support the need for comprehensive coverage of all essential services under children's health insurance programs.

Discounting future green: money versus the environment.

PubMed

Hardisty, David J; Weber, Elke U

2009-08-01

In 3 studies, participants made choices between hypothetical financial, environmental, and health gains and losses that took effect either immediately or with a delay of 1 or 10 years. In all 3 domains, choices indicated that gains were discounted more than losses. There were no significant differences in the discounting of monetary and environmental outcomes, but health gains were discounted more and health losses were discounted less than gains or losses in the other 2 domains. Correlations between implicit discount rates for these different choices suggest that discount rates are influenced more by the valence of outcomes (gains vs. losses) than by domain (money, environment, or health). Overall, results indicate that when controlling as many factors as possible, at short to medium delays, environmental outcomes are discounted in a similar way to financial outcomes, which is good news for researchers and policy makers alike.

Time-discounting and tobacco smoking: a systematic review and network analysis

PubMed Central

Barlow, Pepita; McKee, Martin; Reeves, Aaron; Galea, Gauden; Stuckler, David

2017-01-01

Abstract Background: Tobacco smoking harms health, so why do people smoke and fail to quit? An explanation originating in behavioural economics suggests a role for time-discounting, which describes how the value of a reward, such as better health, decreases with delay to its receipt. A large number of studies test the relationship of time-discounting with tobacco outcomes but the temporal pattern of this relationship and its variation according to measurement methods remain unclear. We review the association between time-discounting and smoking across (i) the life course, from initiation to cessation, and (ii) diverse discount measures. Methods: We identified 69 relevant studies in Web of Science and PubMed. We synthesized findings across methodologies and evaluated discount measures, study quality and cross-disciplinary fertilization. Results: In 44 out of 54 studies, smokers more greatly discounted the future than non-smokers and, in longitudinal studies, higher discounting predicted future smoking. Smokers with lower time-discount rates achieved higher quit rates. Findings were consistent across studies measuring discount rates using hypothetical monetary or cigarette reward scenarios. The methodological quality of the majority of studies was rated as ‘moderate’ and co-citation analysis revealed an isolation of economics journals and a dearth of studies in public health. Conclusion: There is moderate yet consistent evidence that high time-discounting is a risk factor for smoking and unsuccessful cessation. Policy scenarios assuming a flat rate of population discounting may inadequately capture smokers’ perceptions of costs and benefits. PMID:27818375

Managing prescription drug costs: a case study.

PubMed

DuBois, R W; Feinberg, P E

1994-06-01

Pharmacy costs in most private insurance companies and public concerns have risen over the past several years. To address the problem of increased expenditures in its government employee pharmacy program, the State of New York sought bids from outside vendors to help it control pharmaceutical costs. The following is a case study of the tools the state employed in that effort. Over time, both prescription drug coverage and mental health and substance abuse benefits were carved out of the medical plan and are now provided under free-standing programs. In order to participate, an independent pharmacy must accept a discount of 10% off the average wholesale price of brand name drugs and 25% off the average generic price of generic drugs.

Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State.

PubMed

Edward, Jean; Mir, Nageen; Monti, Denise; Shacham, Enbal; Politi, Mary C

2017-11-01

States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.

Tracking the Discount: Tuition Discount Rates, Net Tuition Revenue, and Efforts to Inform Institutional Practices. Professional File. Article 133, Fall 2013

ERIC Educational Resources Information Center

Davis, Natalie Pullaro; Redd, Kenneth E.

2013-01-01

This article uses findings from the 2012 Tuition Discounting Study (TDS) conducted by the National Association of College and University Business Officers (NACUBO) to provide a framework for institutional researchers to develop and adapt their own custom tuition discounting definitions and formulas. Under tuition discounting, colleges and…

77 FR 38760 - National Ambient Air Quality Standards for Particulate Matter; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-29

...% discount rate) for alternative PM 2.5 standard levels of 11/35 [mu]g/m\\3\\ (annual and 24- hour standards... rate rate 3% Discount rate 7% Discount rate 3% Discount rate \\c\\ 7% Discount rate 13/35 $2.9 $2.9 $88... deaths each year accounts for over 90% of total monetized benefits. Mortality risk valuation assumes...

Changing delay discounting in the light of the competing neurobehavioral decision systems theory: a review.

PubMed

Koffarnus, Mikhail N; Jarmolowicz, David P; Mueller, E Terry; Bickel, Warren K

2013-01-01

Excessively devaluing delayed reinforcers co-occurs with a wide variety of clinical conditions such as drug dependence, obesity, and excessive gambling. If excessive delay discounting is a trans-disease process that underlies the choice behavior leading to these and other negative health conditions, efforts to change an individual's discount rate are arguably important. Although discount rate is often regarded as a relatively stable trait, descriptions of interventions and environmental manipulations that successfully alter discount rate have begun to appear in the literature. In this review, we compare published examples of procedures that change discount rate and classify them into categories of procedures, including therapeutic interventions, direct manipulation of the executive decision-making system, framing effects, physiological state effects, and acute drug effects. These changes in discount rate are interpreted from the perspective of the competing neurobehavioral decision systems theory, which describes a combination of neurological and behavioral processes that account for delay discounting. We also suggest future directions that researchers could take to identify the mechanistic processes that allow for changes in discount rate and to test whether the competing neurobehavioral decision systems view of delay discounting is correct. © Society for the Experimental Analysis of Behavior.

Changing Delay Discounting in the Light of the Competing Neurobehavioral Decision Systems Theory: a Review

PubMed Central

Koffarnus, Mikhail N.; Jarmolowicz, David P.; Mueller, E. Terry; Bickel, Warren K.

2014-01-01

Excessively devaluing delayed reinforcers co-occurs with a wide variety of clinical conditions such as drug dependence, obesity, and excessive gambling. If excessive delay discounting is a trans-disease process that underlies the choice behavior leading to these and other negative health conditions, efforts to change an individual’s discount rate are arguably important. Although discount rate is often regarded as a relatively stable trait, descriptions of interventions and environmental manipulations that successfully alter discount rate have begun to appear in the literature. In this review, we compare published examples of procedures that change discount rate and classify them into categories of procedures, including therapeutic interventions, direct manipulation of the executive decision-making system, framing effects, physiological state effects, and acute drug effects. These changes in discount rate are interpreted from the perspective of the competing neurobehavioral decision systems theory, which describes a combination of neurological and behavioral processes that account for delay discounting. We also suggest future directions that researchers could take to identify the mechanistic processes that allow for changes in discount rate and to test whether the competing neurobehavioral decision systems view of delay discounting is correct. PMID:23344987

Domain independence and stability in young and older adults' discounting of delayed rewards

PubMed Central

Jimura, Koji; Myerson, Joel; Hilgard, Joseph; Keighley, Julia; Braver, Todd S.; Green, Leonard

2011-01-01

Individual discounting rates for different types of delayed reward are typically assumed to reflect a single, underlying trait of impulsivity. Recently, we showed that discounting rates are orders of magnitude steeper for directly consumable liquid rewards than for monetary rewards (Jimura et al. 2009), raising the question of whether discounting rates for different types of reward covary at the individual level. Accordingly, the present study examined the relation between discounting of hypothetical money and real liquid rewards in young adults (Experiment 1) and older adults (Experiment 2). At the group level, young adults discounted monetary rewards more steeply than the older adults, but the reverse pattern was observed with liquid rewards. At the individual level, the rates at which young and older participants discounted each reward type were stable over a two- to fifteen-week interval (rs >.70), but there was no significant correlation between the rates at which they discounted the two reward types. These results suggest that although similar decision-making processes may underlie the discounting of different types of rewards, the rates at which individuals discount money and directly consumable rewards may reflect separate, stable traits, rather than a single trait of impulsivity. PMID:21550384

Discounting the future: influence of the economic model.

PubMed Central

West, R R

1996-01-01

OBJECTIVE: To consider the effect of the economic discount rate on health care policy and the rationale for discounting the collective future of society generally. DESIGN: A review of the concept of discounting the future vis à vis the present from the points of view of individuals (who pass on) and of societies (that continue) and reconsideration of the application of discounting to typical public health scenarios. SETTING: A public health service, within a basically stable society, which can reasonably anticipate a nearly certain future. RESULTS: Discounting necessarily overvalues the "here and now" compared with the future. While applications of discount rates, typical of those employed in health economic studies in recent years, may seem rational in health care programmes directed at middle aged employed people, they do not for the young and the elderly, important recipients of health care. The consequences of discounting do not accord with the aims and objectives of public health. CONCLUSIONS: The "time preferences" of transient individuals within a stable society do not provide a rational basis for time preference of a stable society collectively. Discounting inevitably encourages "short termism" and hence biases public policy decision making. The neoclassical theory that gave rise to the concept of discounting requires revision. PMID:8935452

Discounting the future: influence of the economic model.

PubMed

West, R R

1996-06-01

To consider the effect of the economic discount rate on health care policy and the rationale for discounting the collective future of society generally. A review of the concept of discounting the future vis à vis the present from the points of view of individuals (who pass on) and of societies (that continue) and reconsideration of the application of discounting to typical public health scenarios. A public health service, within a basically stable society, which can reasonably anticipate a nearly certain future. Discounting necessarily overvalues the "here and now" compared with the future. While applications of discount rates, typical of those employed in health economic studies in recent years, may seem rational in health care programmes directed at middle aged employed people, they do not for the young and the elderly, important recipients of health care. The consequences of discounting do not accord with the aims and objectives of public health. The "time preferences" of transient individuals within a stable society do not provide a rational basis for time preference of a stable society collectively. Discounting inevitably encourages "short termism" and hence biases public policy decision making. The neoclassical theory that gave rise to the concept of discounting requires revision.

Experience of targeting subsidies on insecticide-treated nets: what do we know and what are the knowledge gaps?

PubMed

Worrall, Eve; Hill, Jenny; Webster, Jayne; Mortimer, Julia

2005-01-01

Widespread coverage of vulnerable populations with insecticide-treated nets (ITNs) constitutes an important component of the Roll Back Malaria (RBM) strategy to control malaria. The Abuja Targets call for 60% coverage of children under 5 years of age and pregnant women by 2005; but current coverage in Africa is unacceptably low. The RBM 'Strategic Framework for Coordinated National Action in Scaling-up Insecticide-Treated Netting Programmes in Africa' promotes coordinated national action and advocates sustained public provision of targeted subsidies to maximise public health benefits, alongside support and stimulation of the private sector. Several countries have already planned or initiated targeted subsidy schemes either on a pilot scale or on a national scale, and have valuable experience which can inform future interventions. The WHO RBM 'Workshop on mapping models for delivering ITNs through targeted subsidies' held in Zambia in 2003 provided an opportunity to share and document these country experiences. This paper brings together experiences presented at the workshop with other information on experiences of targeting subsidies on ITNs, net treatment kits and retreatment services (ITN products) in order to describe alternative approaches, highlight their similarities and differences, outline lessons learnt, and identify gaps in knowledge. We find that while there is a growing body of knowledge on different approaches to targeting ITN subsidies, there are significant gaps in knowledge in crucial areas. Key questions regarding how best to target, how much it will cost and what outcomes (levels of coverage) to expect remain unanswered. High quality, well-funded monitoring and evaluation of alternative approaches to targeting ITN subsidies is vital to develop a knowledge base so that countries can design and implement effective strategies to target ITN subsidies.

The Individual Health Discount Rate in Patients with Ulcerative Colitis

PubMed Central

Waljee, Akbar K.; Morris, Arden M.; Waljee, Jennifer F.; Higgins, Peter D.R.

2015-01-01

Background In cost-effectiveness analysis, discount rates are used in calculating the value of future costs and benefits. However, standard discount rates may not accurately describe the decision-making of patients with Ulcerative Colitis (UC). These patients often choose the long-term risks of immunosuppressive therapy over the short-term risks of colectomy, demonstrating very high discount rates for future health. In this study, we aimed to measure the discount rate in UC patients and identify variables associated with the discount rate. Methods We surveyed patients with UC and patients who were post-colectomy for UC to measure their valuations of UC and colectomy health states. We used Standard Gamble(SG) and Time-Trade-Off(TTO) methods to assess current and future health state valuations, and calculated the discount rate. Results Participants included 150 subjects with UC and 150 subjects who were post-colectomy for UC. Discount rates varied widely (20.6%–100%) with an overall median rate of 55.0%, which was significantly higher than the standard rate of 5%. Older age and male gender and predicted high discount rates (aversion to immediate risk in favor of distant future risk). For each additional decade of age, patients’ expected discount rate increased by 0.77%. Female gender was the only predictor of very low discount rates. Female patients’ discount rates averaged 8.1% less than age-matched males. Conclusions The accepted discount rate of 5% grossly underestimates UC patients’ preference for long-term over short-term risk. This might explain UC patients’ frequent choice of the long-term risks of immunosuppressive medical therapy over the short-term risks of colectomy. PMID:21560195

Insurance Discounts: Traffic Safety Tips

DOT National Transportation Integrated Search

1996-01-01

This fact sheet, NHTSA Facts: Summer 1996, discusses automobile insurance discounts. It relates how to obtain a discount, and details what factors can influence insurance premiums. It notes that discounts for safety features vary from insurance compa...

Staff-related access deficit and antenatal care coverage across the NUTS level 1 regions of Turkey.

PubMed

Yardim, Mahmut S

2010-01-01

At the heart of each health system, the workforce is central to advancing health. The World Health Organization has identified a threshold in workforce density below which high coverage of essential interventions, including those necessary to meet the health-related Millennium Development Goals (MDGs), is very unlikely. The International Labor Organization (ILO) has launched a similar indicator -staff related access deficit- using Thailand's health care professional density as a benchmark. The aim of this study is to assess the staff-related access deficit of the population across the 12 NUTS 1 level regions of Turkey. The main hypothesis is that staff-related access deficit has a correlation with and predicts the gap in antenatal care coverage (percentage of women unable to access to antenatal care) across different regions. Staff-related access deficit, as a threshold indicator, seems to have a linear relationship with the antenatal care coverage gap. The known inequalities in the distribution of the health care workforce among different regions of Turkey were put forward once more in this study using the SRA indicator. The staff-related access deficit indicator can be easily used to monitor the status of distributional inequalities of the health care workforce at different sub-national levels in the future.

DISCOUNTING OF DELAYED AND PROBABILISTIC LOSSES OVER A WIDE RANGE OF AMOUNTS

PubMed Central

Green, Leonard; Myerson, Joel; Oliveira, Luís; Chang, Seo Eun

2014-01-01

The present study examined delay and probability discounting of hypothetical monetary losses over a wide range of amounts (from $20 to $500,000) in order to determine how amount affects the parameters of the hyperboloid discounting function. In separate conditions, college students chose between immediate payments and larger, delayed payments and between certain payments and larger, probabilistic payments. The hyperboloid function accurately described both types of discounting, and amount of loss had little or no systematic effect on the degree of discounting. Importantly, the amount of loss also had little systematic effect on either the rate parameter or the exponent of the delay and probability discounting functions. The finding that the parameters of the hyperboloid function remain relatively constant across a wide range of amounts of delayed and probabilistic loss stands in contrast to the robust amount effects observed with delayed and probabilistic rewards. At the individual level, the degree to which delayed losses were discounted was uncorrelated with the degree to which probabilistic losses were discounted, and delay and probability loaded on two separate factors, similar to what is observed with delayed and probabilistic rewards. Taken together, these findings argue that although delay and probability discounting involve fundamentally different decision-making mechanisms, nevertheless the discounting of delayed and probabilistic losses share an insensitivity to amount that distinguishes it from the discounting of delayed and probabilistic gains. PMID:24745086

Cocaine dependent individuals discount future rewards more than future losses for both cocaine and monetary outcomes.

PubMed

Johnson, Matthew W; Bruner, Natalie R; Johnson, Patrick S

2015-01-01

Cocaine dependence and other forms of drug dependence are associated with steeper devaluation of future outcomes (delay discounting). Although studies in this domain have typically assessed choices between monetary gains (e.g., receive less money now versus receive more money after a delay), delay discounting is also applicable to decisions involving losses (e.g., small loss now versus larger delayed loss), with gains typically discounted more than losses (the "sign effect"). It is also known that drugs are discounted more than equivalently valued money. In the context of drug dependence, however, relatively little is known about the discounting of delayed monetary and drug losses and the presence of the sign effect. In this within-subject, laboratory study, delay discounting for gains and losses was assessed for cocaine and money outcomes in cocaine-dependent individuals (n=89). Both cocaine and monetary gains were discounted at significantly greater rates than cocaine and monetary losses, respectively (i.e., the sign effect). Cocaine gains were discounted significantly more than monetary gains, but cocaine and monetary losses were discounted similarly. Results suggest that cocaine is discounted by cocaine-dependent individuals in a systematic manner similar to other rewards. Because the sign effect was shown for both cocaine and money, delayed aversive outcomes may generally have greater impact than delayed rewards in shaping present behavior in this population. Copyright © 2014. Published by Elsevier Ltd.

Monetary delay discounting in gambling and cocaine dependence with personality comorbidities.

PubMed

Albein-Urios, Natalia; Martinez-González, José M; Lozano, Oscar; Verdejo-Garcia, Antonio

2014-11-01

Cocaine addiction and pathological gambling are commonly associated with steeper (impulsive) discounting of delayed rewards, which promotes ongoing drug and gambling behaviors. However, it is yet unclear whether impulsive delay discounting is a stable trait in cocaine and gambling disorders during abstinence, and whether it is significantly impacted by dysfunctional personality beliefs. The aim of this study was to compare the delay discounting rates of four groups: 47 cocaine users with comorbid personality disorders, 41 cocaine users without psychiatric comorbidities, 28 pathological gamblers without psychiatric comorbidities, and 36 healthy comparison individuals. We also examined the association between dysfunctional personality beliefs and delay discounting rates. Participants completed the Kirby Delay Discounting Questionnaire and the Beck Personality Belief Questionnaire as part of a larger battery. We used non-parametric tests to compare discounting rates between the groups, and bivariate correlation analyses to examine the association between beliefs and discounting rates within each of the groups. We found that discounting rates were significantly higher in individuals with disordered gambling compared to controls. Specifically in cocaine users with Cluster B personality disorders, higher discounting rates were associated with the intensity of "dependent" dysfunctional beliefs (e.g., "I am needy and weak"). Conclusion:We conclude that impulsive delay discounting is increased in gambling relative to controls and linked to personality beliefs in cocaine users with Cluster B personality disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.

Utilisation of health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal.

PubMed

Hodge, Andrew; Byrne, Abbey; Morgan, Alison; Jimenez-Soto, Eliana

2015-03-01

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.

Individual discount rates and smoking: evidence from a field experiment in Denmark.

PubMed

Harrison, Glenn W; Lau, Morten I; Rutström, E Elisabet

2010-09-01

We elicit measures of individual discount rates from a representative sample of the Danish population and test two substantive hypotheses. The first hypothesis is that smokers have higher individual discount rates than non-smokers. The second hypothesis is that smokers are more likely to have time inconsistent preferences than non-smokers, where time inconsistency is indicated by a hyperbolic discounting function. We control for the concavity of the utility function in our estimates of individual discount rates and find that male smokers have significantly higher discount rates than male non-smokers. However, smoking has no significant association with discount rates among women. This result is robust across exponential and hyperbolic discounting functions. We consider the sensitivity of our conclusions to a statistical specification that allows each observation to potentially be generated by more than one latent data-generating process. Copyright 2010 Elsevier B.V. All rights reserved.

The Effects of Financial Education on Impulsive Decision Making

PubMed Central

DeHart, William B.; Friedel, Jonathan E.; Lown, Jean M.; Odum, Amy L.

2016-01-01

Delay discounting, as a behavioral measure of impulsive choice, is strongly related to substance abuse and other risky behaviors. Therefore, effective techniques that alter delay discounting are of great interest. We explored the ability of a semester long financial education course to change delay discounting. Participants were recruited from a financial education course (n = 237) and an abnormal psychology course (n = 80). Both groups completed a delay-discounting task for $100 during the first two weeks (Time 1) of the semester as well as during the last two weeks (Time 2) of the semester. Participants also completed a personality inventory and financial risk tolerance scale both times and a delay-discounting task for $1,000 during Time 2. Delay discounting decreased in the financial education group at the end of the semester whereas there was no change in delay discounting in the abnormal psychology group. Financial education may be an effective method for reducing delay discounting. PMID:27442237

The Effects of Financial Education on Impulsive Decision Making.

PubMed

DeHart, William B; Friedel, Jonathan E; Lown, Jean M; Odum, Amy L

2016-01-01

Delay discounting, as a behavioral measure of impulsive choice, is strongly related to substance abuse and other risky behaviors. Therefore, effective techniques that alter delay discounting are of great interest. We explored the ability of a semester long financial education course to change delay discounting. Participants were recruited from a financial education course (n = 237) and an abnormal psychology course (n = 80). Both groups completed a delay-discounting task for $100 during the first two weeks (Time 1) of the semester as well as during the last two weeks (Time 2) of the semester. Participants also completed a personality inventory and financial risk tolerance scale both times and a delay-discounting task for $1,000 during Time 2. Delay discounting decreased in the financial education group at the end of the semester whereas there was no change in delay discounting in the abnormal psychology group. Financial education may be an effective method for reducing delay discounting.

Exchanging the liquidity hypothesis: Delay discounting of money and self-relevant non-money rewards

PubMed Central

Stuppy-Sullivan, Allison M.; Tormohlen, Kayla N.; Yi, Richard

2015-01-01

Evidence that primary rewards (e.g., food and drugs of abuse) are discounted more than money is frequently attributed to money's high degree of liquidity, or exchangeability for many commodities. The present study provides some evidence against this liquidity hypothesis by contrasting delay discounting of monetary rewards (liquid) and non-monetary commodities (non-liquid) that are self-relevant and utility-matched. Ninety-seven (97) undergraduate students initially completed a conventional binary-choice delay discounting of money task. Participants returned one week later and completed a self-relevant commodity delay discounting task. Both conventional hypothesis testing and more-conservative tests of statistical equivalence revealed correspondence in rate of delay discounting of money and self-relevant commodities, and in one magnitude condition, less discounting for the latter. The present results indicate that liquidity of money cannot fully account for the lower rate of delay discounting compared to non-money rewards. PMID:26556504

Probabilistic Discounting of Hypothetical Monetary Gains: University Students Differ in How They Discount "Won" and "Owed" Money

ERIC Educational Resources Information Center

Weatherly, Jeffrey N.; Derenne, Adam

2013-01-01

The present study tested whether participants would discount "won" money differently than they would "owed" money in a probability-discounting task. Participants discounted $1000 or $100,000 that they had won in a sweepstakes or that was owed to them using the multiple-choice (Experiment 1) or fill-in-the-blank (Experiment 2) method of collecting…

Women In The United States Experience High Rates Of Coverage 'Churn' In Months Before And After Childbirth.

PubMed

Daw, Jamie R; Hatfield, Laura A; Swartz, Katherine; Sommers, Benjamin D

2017-04-01

Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility. Project HOPE—The People-to-People Health Foundation, Inc.

Confronting ‘confounding by health system use’ in Medicare Part D: Comparative effectiveness of propensity score approaches to confounding adjustment

PubMed Central

Polinski, Jennifer M.; Schneeweiss, Sebastian; Glynn, Robert J.; Lii, Joyce; Rassen, Jeremy

2012-01-01

Purpose Under Medicare Part D, patient characteristics influence plan choice, which in turn influences Part D coverage gap entry. We compared pre-defined propensity score (PS) and high-dimensional propensity score (hdPS) approaches to address such ‘confounding by health system use’ in assessing whether coverage gap entry is associated with cardiovascular events or death. Methods We followed 243,079 Medicare patients aged 65+ with linked prescription, medical, and plan-specific data in 2005–2007. Patients reached the coverage gap and were followed until an event or year’s end. Exposed patients were responsible for drug costs in the gap; unexposed patients (patients with non-Part D drug insurance and Part D patients receiving a low-income subsidy (LIS)) received financial assistance. Exposed patients were 1:1 PS- or hdPS-matched to unexposed patients. The PS model included 52 predefined covariates; the hdPS model added 400 empirically identified covariates. Hazard ratios for death and any of five cardiovascular outcomes were compared. In sensitivity analyses, we explored residual confounding using only LIS patients in the unexposed group. Results In unadjusted analyses, exposed patients had no greater hazard of death (HR=1.00; 95% CI, 0.84–1.20) or other outcomes. PS- (HR=1.29;0.99–1.66) and hdPS- (HR=1.11;0.86–1.42) matched analyses showed elevated but non-significant hazards of death. In sensitivity analyses, the PS analysis showed a protective effect (HR=0.78;0.61–0.98), while the hdPS analysis (HR=1.06;0.82–1.37) confirmed the main hdPS findings. Conclusion Although the PS-matched analysis suggested elevated though non-significant hazards of death among patients with no financial assistance during the gap, the hdPS analysis produced lower estimates that were stable across sensitivity analyses. PMID:22552984

Individual health discount rate in patients with ulcerative colitis.

PubMed

Waljee, Akbar K; Morris, Arden M; Waljee, Jennifer F; Higgins, Peter D R

2011-06-01

In cost-effectiveness analysis, discount rates are used in calculating the value of future costs and benefits. However, standard discount rates may not accurately describe the decision-making of patients with ulcerative colitis (UC). These patients often choose the long-term risks of immunosuppressive therapy over the short-term risks of colectomy, demonstrating very high discount rates for future health. In this study we aimed to measure the discount rate in UC patients and identify variables associated with the discount rate. We surveyed patients with UC and patients who were postcolectomy for UC to measure their valuations of UC and colectomy health states. We used Standard Gamble (SG) and Time-Trade-Off (TTO) methods to assess current and future health state valuations and calculated the discount rate. Participants included 150 subjects with UC and 150 subjects who were postcolectomy for UC. Adjusted discount rates varied widely (0%-100%), with an overall median rate of 55.0% (interquartile range [IQR] 20.6-100), which was significantly higher than the standard rate of 5%. Within the normal range of discount rates, patients' expected discount rate increased by 0.80% for each additional year of age, and female patients had discount rates that averaged ≈ 8% less than their age-matched counterparts and approached statistical significance. The accepted discount rate of 5% grossly underestimates UC patients' preference for long-term over short-term risk. This might explain UC patients' frequent choice of the long-term risks of immunosuppressive medical therapy over the short-term risks of colectomy. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.

Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder

PubMed Central

Steinglass, Joanna E.; Lempert, Karolina M.; Choo, Tse-Hwei; Kimeldorf, Marcia B.; Wall, Melanie; Walsh, B. Timothy; Fyer, Abby J.; Schneier, Franklin R.; Simpson, H. Blair

2018-01-01

Background Temporal discounting refers to the tendency for rewards to lose value as the expected delay to receipt increases. Individuals with anorexia nervosa (AN) have been found to show reduced temporal discounting rates, indicating a greater preference for delayed rewards compared to healthy peers. Obsessive–compulsive disorder (OCD) and social anxiety disorder (SAD) commonly co-occur with AN, and anxiety has been related to development and prognosis of AN. We examined whether reduced temporal discounting is present across these potentially related disorders, and explored the relationship between temporal discounting and anxiety trans-diagnostically. Methods One hundred ninety six individuals (75 healthy controls (HC); 50 OCD; 27 AN; 44 SAD) completed two temporal discounting tasks in which they chose between smaller-sooner and larger-later monetary rewards. Two measures of discounting—discount rate and discount factor—were compared between diagnostic groups, and associations with anxious traits were examined. Results Individuals with AN showed decreased temporal discounting compared to HC. OCD and SAD groups did not differ significantly from HC. Across the sample, anxiety was associated with decreased discounting; more anxious individuals showed a greater preference for delayed reward. Conclusions We replicated the findings that individuals with AN show an increased preference for delayed reward relative to HC and that individuals with OCD do not differ from HC. We also showed that individuals with SAD do not differ from HC in discounting. Across this large sample, two measures of anxious temperament were associated with temporal discounting. These data raise new questions about the relationship between this dimensional trait and psychopathology. PMID:28009473

Time-discounting and tobacco smoking: a systematic review and network analysis.

PubMed

Barlow, Pepita; McKee, Martin; Reeves, Aaron; Galea, Gauden; Stuckler, David

2017-06-01

Tobacco smoking harms health, so why do people smoke and fail to quit? An explanation originating in behavioural economics suggests a role for time-discounting, which describes how the value of a reward, such as better health, decreases with delay to its receipt. A large number of studies test the relationship of time-discounting with tobacco outcomes but the temporal pattern of this relationship and its variation according to measurement methods remain unclear. We review the association between time-discounting and smoking across (i) the life course, from initiation to cessation, and (ii) diverse discount measures. We identified 69 relevant studies in Web of Science and PubMed. We synthesized findings across methodologies and evaluated discount measures, study quality and cross-disciplinary fertilization. In 44 out of 54 studies, smokers more greatly discounted the future than non-smokers and, in longitudinal studies, higher discounting predicted future smoking. Smokers with lower time-discount rates achieved higher quit rates. Findings were consistent across studies measuring discount rates using hypothetical monetary or cigarette reward scenarios. The methodological quality of the majority of studies was rated as 'moderate' and co-citation analysis revealed an isolation of economics journals and a dearth of studies in public health. There is moderate yet consistent evidence that high time-discounting is a risk factor for smoking and unsuccessful cessation. Policy scenarios assuming a flat rate of population discounting may inadequately capture smokers' perceptions of costs and benefits. © The Author 2016; Published by Oxford University Press on behalf of the International Epidemiological Association

The Sexual Discounting Task: HIV Risk Behavior and the Discounting of Delayed Sexual Rewards in Cocaine Dependence

PubMed Central

Johnson, Matthew W.; Bruner, Natalie R.

2011-01-01

Background Cocaine dependence is associated with high rates of sexual risk behavior and HIV infection. However, little is known about the responsible mechanism(s). Methods Cocaine-dependent individuals (N=62) completed a novel Sexual Discounting Task assessing decisions between immediate unprotected sex and delayed sex with a condom across four hypothetical partners: most (and least) likely to have a sexually transmitted infection (STI), and most (and least) sexually desirable; a real rewards money delay-discounting task, and self-reported sexual risk behavior using the HIV Risk-Taking Behavior Scale (HRBS). Results Sexual Discounting Task results were largely systematic and showed a strong effect of delay in decreasing condom use. Sexual discounting (preference for immediate unprotected sex) was significantly greater when making responses for partners judged least (compared to most) likely to have an STI, and for partners judged most (compared to least) desirable. Differences in sexual discounting were significant after controlling for differences in condom use (with no delay) between conditions. Greater discounting in 3 or the 4 Sexual Discounting Task conditions, but not in the money discounting task, was associated with greater self-reported sexual risk behavior as measured by the HRBS Conclusions Results suggest that delay is a critical variable strongly affecting HIV sexual risk behavior, and that the Sexual Discounting Task provides a clinically sensitive measure of this phenomenon that may address a variety of questions about HIV risk in future research. The wealth of behavioral and neurobiological data on delay discounting should be brought to bear on HIV education and prevention. PMID:22055012

Automatic Road Gap Detection Using Fuzzy Inference System

NASA Astrophysics Data System (ADS)

Hashemi, S.; Valadan Zoej, M. J.; Mokhtarzadeh, M.

2011-09-01

Automatic feature extraction from aerial and satellite images is a high-level data processing which is still one of the most important research topics of the field. In this area, most of the researches are focused on the early step of road detection, where road tracking methods, morphological analysis, dynamic programming and snakes, multi-scale and multi-resolution methods, stereoscopic and multi-temporal analysis, hyper spectral experiments, are some of the mature methods in this field. Although most researches are focused on detection algorithms, none of them can extract road network perfectly. On the other hand, post processing algorithms accentuated on the refining of road detection results, are not developed as well. In this article, the main is to design an intelligent method to detect and compensate road gaps remained on the early result of road detection algorithms. The proposed algorithm consists of five main steps as follow: 1) Short gap coverage: In this step, a multi-scale morphological is designed that covers short gaps in a hierarchical scheme. 2) Long gap detection: In this step, the long gaps, could not be covered in the previous stage, are detected using a fuzzy inference system. for this reason, a knowledge base consisting of some expert rules are designed which are fired on some gap candidates of the road detection results. 3) Long gap coverage: In this stage, detected long gaps are compensated by two strategies of linear and polynomials for this reason, shorter gaps are filled by line fitting while longer ones are compensated by polynomials.4) Accuracy assessment: In order to evaluate the obtained results, some accuracy assessment criteria are proposed. These criteria are obtained by comparing the obtained results with truly compensated ones produced by a human expert. The complete evaluation of the obtained results whit their technical discussions are the materials of the full paper.

Cross-commodity delay discounting of alcohol and money in alcohol users

PubMed Central

Moody, Lara N.; Tegge, Allison N.; Bickel, Warren K.

2017-01-01

Despite real-world implications, the pattern of delay discounting in alcohol users when the commodities now and later differ has not been well characterized. In this study, 60 participants on Amazon's Mechanical Turk completed the Alcohol Use Disorder Identification Test (AUDIT) to assess severity of use and completed four delay discounting tasks between hypothetical, equivalent amounts of alcohol and money available at five delays. The tasks included two cross-commodity (alcohol now-money later and money now-alcohol later) and two same-commodity (money now-money later and alcohol now-alcohol later) conditions. Delay discounting was significantly associated with clinical cutoffs of the AUDIT for both of the cross-commodity conditions but not for either of the same-commodity delay discounting tasks. The cross-commodity discounting conditions were related to severity of use wherein heavy users discounted future alcohol less and future money more. The change in direction of the discounting effect was dependent on the commodity that was distally available suggesting a distinctive pattern of discounting across commodities when comparing light and heavy alcohol users. PMID:29056767

Cross-commodity delay discounting of alcohol and money in alcohol users.

PubMed

Moody, Lara N; Tegge, Allison N; Bickel, Warren K

2017-06-01

Despite real-world implications, the pattern of delay discounting in alcohol users when the commodities now and later differ has not been well characterized. In this study, 60 participants on Amazon's Mechanical Turk completed the Alcohol Use Disorder Identification Test (AUDIT) to assess severity of use and completed four delay discounting tasks between hypothetical, equivalent amounts of alcohol and money available at five delays. The tasks included two cross-commodity (alcohol now-money later and money now-alcohol later) and two same-commodity (money now-money later and alcohol now-alcohol later) conditions. Delay discounting was significantly associated with clinical cutoffs of the AUDIT for both of the cross-commodity conditions but not for either of the same-commodity delay discounting tasks. The cross-commodity discounting conditions were related to severity of use wherein heavy users discounted future alcohol less and future money more. The change in direction of the discounting effect was dependent on the commodity that was distally available suggesting a distinctive pattern of discounting across commodities when comparing light and heavy alcohol users.

Brain Structure Linking Delay Discounting and Academic Performance.

PubMed

Wang, Song; Kong, Feng; Zhou, Ming; Chen, Taolin; Yang, Xun; Chen, Guangxiang; Gong, Qiyong

2017-08-01

As a component of self-discipline, delay discounting refers to the ability to wait longer for preferred rewards and plays a pivotal role in shaping students' academic performance. However, the neural basis of the association between delay discounting and academic performance remains largely unknown. Here, we examined the neuroanatomical substrates underlying delay discounting and academic performance in 214 adolescents via voxel-based morphometry (VBM) by performing structural magnetic resonance imaging (S-MRI). Behaviorally, we confirmed the significant correlation between delay discounting and academic performance. Neurally, whole-brain regression analyses indicated that regional gray matter volume (rGMV) of the left dorsolateral prefrontal cortex (DLPFC) was associated with both delay discounting and academic performance. Furthermore, delay discounting partly accounted for the association between academic performance and brain structure. Differences in the rGMV of the left DLPFC related to academic performance explained over one-third of the impact of delay discounting on academic performance. Overall, these results provide the first evidence for the common neural basis linking delay discounting and academic performance. Hum Brain Mapp 38:3917-3926, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

EULER-PCR: finishing experiments for repeat resolution.

PubMed

Mulyukov, Zufar; Pevzner, Pavel A

2002-01-01

Genomic sequencing typically generates a large collection of unordered contigs or scaffolds. Contig ordering (also known as gap closure) is a non-trivial algorithmic and experimental problem since even relatively simple-to-assemble bacterial genomes typically result in large set of contigs. Neighboring contigs maybe separated either by gaps in read coverage or by repeats. In the later case we say that the contigs are separated by pseudogaps, and we emphasize the important difference between gap closure and pseudogap closure. The existing gap closure approaches do not distinguish between gaps and pseudogaps and treat them in the same way. We describe a new fast strategy for closing pseudogaps (repeat resolution). Since in highly repetitive genomes, the number of pseudogaps may exceed the number of gaps by an order of magnitude, this approach provides a significant advantage over the existing gap closure methods.

Tunable and sizable band gap in silicene by surface adsorption

PubMed Central

Quhe, Ruge; Fei, Ruixiang; Liu, Qihang; Zheng, Jiaxin; Li, Hong; Xu, Chengyong; Ni, Zeyuan; Wang, Yangyang; Yu, Dapeng; Gao, Zhengxiang; Lu, Jing

2012-01-01

Opening a sizable band gap without degrading its high carrier mobility is as vital for silicene as for graphene to its application as a high-performance field effect transistor (FET). Our density functional theory calculations predict that a band gap is opened in silicene by single-side adsorption of alkali atom as a result of sublattice or bond symmetry breaking. The band gap size is controllable by changing the adsorption coverage, with an impressive maximum band gap up to 0.50 eV. The ab initio quantum transport simulation of a bottom-gated FET based on a sodium-covered silicene reveals a transport gap, which is consistent with the band gap, and the resulting on/off current ratio is up to 108. Therefore, a way is paved for silicene as the channel of a high-performance FET. PMID:23152944

Cosmetic dermatologic surgical training in US dermatology residency programs: identifying and overcoming barriers.

PubMed

Bauer, Bruce; Williams, Erin; Stratman, Erik J

2014-02-01

The public and other medical specialties expect dermatologists who offer cosmetic dermatology services to provide competent care. There are numerous barriers to achieving cosmetic dermatology competency during residency. Many dermatology residents enter the workforce planning to provide cosmetic services. If a training gap exists, this may adversely affect patient safety. To identify resources available for hands-on cosmetic dermatology training in US dermatology residency training programs and to assess program director (PD) attitudes toward cosmetic dermatology training during residency and strategies, including discounted pricing, used by training programs to overcome barriers related to resident-performed cosmetic dermatology procedures. An online survey in academic dermatology practices among PDs of US dermatology residency programs. Frequency of cosmetic dermatology devices and injectables used for dermatology resident hands-on cosmetic dermatology training, categorizing PD attitudes toward cosmetic dermatology training during residency and describing residency-related discounted pricing models. Responses from PDs were received from 53 of 114 (46%) US dermatology residency programs. All but 3 programs (94%) offered hands-on cosmetic dermatology training using botulinum toxin, and 47 of 53 (89%) provided training with hyaluronic acid fillers. Pulsed dye lasers represented the most common laser use experienced by residents (41 of 52 [79%]), followed by Q-switched Nd:YAG (30 of 52 [58%]). Discounted procedures were offered by 32 of 53 (60%) programs, with botulinum toxin (30 of 32 [94%]) and fillers (27 of 32 [84%]) most prevalent and with vascular lasers (17 of 32 [53%]) and hair removal lasers (12 of 32 [38%]) less common. Various discounting methods were used. Only 20 of 53 (38%) PDs believed that cosmetic dermatology should be a necessary aspect of residency training; 14 of 52 (27%) PDs thought that residents should not be required to perform any cosmetic dermatology procedures. Although almost every program provides hands-on cosmetic dermatology training, there are barriers to training, including patient preferences, costs of procedures and products, and PD attitudes toward cosmetic dermatology training. To promote patient safety, procedural competency is imperative.

GapFiller: a de novo assembly approach to fill the gap within paired reads

PubMed Central

2012-01-01

Background Next Generation Sequencing technologies are able to provide high genome coverages at a relatively low cost. However, due to limited reads' length (from 30 bp up to 200 bp), specific bioinformatics problems have become even more difficult to solve. De novo assembly with short reads, for example, is more complicated at least for two reasons: first, the overall amount of "noisy" data to cope with increased and, second, as the reads' length decreases the number of unsolvable repeats grows. Our work's aim is to go at the root of the problem by providing a pre-processing tool capable to produce (in-silico) longer and highly accurate sequences from a collection of Next Generation Sequencing reads. Results In this paper a seed-and-extend local assembler is presented. The kernel algorithm is a loop that, starting from a read used as seed, keeps extending it using heuristics whose main goal is to produce a collection of error-free and longer sequences. In particular, GapFiller carefully detects reliable overlaps and operates clustering similar reads in order to reconstruct the missing part between the two ends of the same insert. Our tool's output has been validated on 24 experiments using both simulated and real paired reads datasets. The output sequences are declared correct when the seed-mate is found. In the experiments performed, GapFiller was able to extend high percentages of the processed seeds and find their mates, with a false positives rate that turned out to be nearly negligible. Conclusions GapFiller, starting from a sufficiently high short reads coverage, is able to produce high coverages of accurate longer sequences (from 300 bp up to 3500 bp). The procedure to perform safe extensions, together with the mate-found check, turned out to be a powerful criterion to guarantee contigs' correctness. GapFiller has further potential, as it could be applied in a number of different scenarios, including the post-processing validation of insertions/deletions detection pipelines, pre-processing routines on datasets for de novo assembly pipelines, or in any hierarchical approach designed to assemble, analyse or validate pools of sequences. PMID:23095524

The effects of the framing of time on delay discounting.

PubMed

DeHart, William Brady; Odum, Amy L

2015-01-01

We examined the effects of the framing of time on delay discounting. Delay discounting is the process by which delayed outcomes are devalued as a function of time. Time in a titrating delay discounting task is often framed in calendar units (e.g., as 1 week, 1 month, etc.). When time is framed as a specific date, delayed outcomes are discounted less compared to the calendar format. Other forms of framing time; however, have not been explored. All participants completed a titrating calendar unit delay-discounting task for money. Participants were also assigned to one of two delay discounting tasks: time as dates (e.g., June 1st, 2015) or time in units of days (e.g., 5000 days), using the same delay distribution as the calendar delay-discounting task. Time framed as dates resulted in less discounting compared to the calendar method, whereas time framed as days resulted in greater discounting compared to the calendar method. The hyperboloid model fit best compared to the hyperbola and exponential models. How time is framed may alter how participants attend to the delays as well as how the delayed outcome is valued. Altering how time is framed may serve to improve adherence to goals with delayed outcomes. © Society for the Experimental Analysis of Behavior.

Domain independence and stability in young and older adults' discounting of delayed rewards.

PubMed

Jimura, Koji; Myerson, Joel; Hilgard, Joseph; Keighley, Julia; Braver, Todd S; Green, Leonard

2011-07-01

Individual discounting rates for different types of delayed reward are typically assumed to reflect a single, underlying trait of impulsivity. Recently, we showed that discounting rates are orders of magnitude steeper for directly consumable liquid rewards than for monetary rewards (Jimura et al., 2009), raising the question of whether discounting rates for different types of reward covary at the individual level. Accordingly, the present study examined the relation between discounting of hypothetical money and real liquid rewards in young adults (Experiment 1) and older adults (Experiment 2). At the group level, young adults discounted monetary rewards more steeply than the older adults, but there was no significant age difference with respect to liquid rewards. At the individual level, the rates at which young and older participants discounted each reward type were stable over a two- to fifteen-week interval (rs>70), but there was no significant correlation between the rates at which they discounted the two reward types. These results suggest that although similar decision-making processes may underlie the discounting of different types of rewards, the rates at which individuals discount money and directly consumable rewards may reflect separate, stable traits, rather than a single trait of impulsivity. Copyright © 2011 Elsevier B.V. All rights reserved.

OPPORTUNITY COSTS OF REWARD DELAYS AND THE DISCOUNTING OF HYPOTHETICAL MONEY AND CIGARETTES

PubMed Central

Johnson, Patrick S.; Herrmann, Evan S.; Johnson, Matthew W.

2015-01-01

Humans are reported to discount delayed rewards at lower rates than nonhumans. However, nonhumans are studied in tasks that restrict reinforcement during delays, whereas humans are typically studied in tasks that do not restrict reinforcement during delays. In nonhuman tasks, the opportunity cost of restricted reinforcement during delays may increase delay discounting rates. The present within-subjects study used online crowdsourcing (Amazon Mechanical Turk, or MTurk) to assess the discounting of hypothetical delayed money (and cigarettes in smokers) under four hypothetical framing conditions differing in the availability of reinforcement during delays. At one extreme, participants were free to leave their computer without returning, and engage in any behavior during reward delays (modeling typical human tasks). At the opposite extreme, participants were required to stay at their computer and engage in little other behavior during reward delays (modeling typical nonhuman tasks). Discounting rates increased as an orderly function of opportunity cost. Results also indicated predominantly hyperbolic discounting, the “magnitude effect,” steeper discounting of cigarettes than money, and positive correlations between discounting rates of these commodities. This is the first study to test the effects of opportunity costs on discounting, and suggests that procedural differences may partially account for observed species differences in discounting. PMID:25388973

Opportunity costs of reward delays and the discounting of hypothetical money and cigarettes.

PubMed

Johnson, Patrick S; Herrmann, Evan S; Johnson, Matthew W

2015-01-01

Humans are reported to discount delayed rewards at lower rates than nonhumans. However, nonhumans are studied in tasks that restrict reinforcement during delays, whereas humans are typically studied in tasks that do not restrict reinforcement during delays. In nonhuman tasks, the opportunity cost of restricted reinforcement during delays may increase delay discounting rates. The present within-subjects study used online crowdsourcing (Amazon Mechanical Turk, or MTurk) to assess the discounting of hypothetical delayed money (and cigarettes in smokers) under four hypothetical framing conditions differing in the availability of reinforcement during delays. At one extreme, participants were free to leave their computer without returning, and engage in any behavior during reward delays (modeling typical human tasks). At the opposite extreme, participants were required to stay at their computer and engage in little other behavior during reward delays (modeling typical nonhuman tasks). Discounting rates increased as an orderly function of opportunity cost. Results also indicated predominantly hyperbolic discounting, the "magnitude effect," steeper discounting of cigarettes than money, and positive correlations between discounting rates of these commodities. This is the first study to test the effects of opportunity costs on discounting, and suggests that procedural differences may partially account for observed species differences in discounting. © Society for the Experimental Analysis of Behavior.

--No Title--

Science.gov Websites

using mesonet visbility observations and CLARUS QC'd obs; Add ceiling height and sky cover analysis to precipitation coverage gaps near CONUS coastlines; Add significant wave height analysis to OCONUS domains

Hearing focuses on price of Norplant; Wyeth pledges discount for public sector.

PubMed

1993-11-23

In November 1993, Democratic US Representative Ron Wyden held a hearing on the cost of the contraceptive implant Norplant. Its US distributor, Wyeth-Ayerst, informed the US House Subcommittee on Regulation, Business Opportunities and Technology that it would offer the public sector a discounted price for Norplant 5 years after it had been on the US market. Public funds contributed to the development of Norplant. USAID provided $17.2 million of the $41.3 million that the Population Council spent on developing Norplant. Wyeth provided the Council levonorgestrel, the drug used in Norplant, thereby holding the right to market Norplant in the US and Canada. USAID buys Norplant from the distributor for all other countries for $23, while Wyeth sells Norplant in a package of insertion and educational materials for $365. This large gap infuriates groups providing family planning services to low-income women. Medicaid pays for Norplant and its insertion for the poorest women. Wealthier women either pay for Norplant themselves, or their health insurance pays for it. This leaves low-income women with no access to Norplant. Wyeth has formed the Norplant Foundation to provide Norplant to low-income women whom Medicaid will not cover. It also trains most providers in insertion and removal procedures. The law requires Wyeth to reimburse qualified public health clinics 15% of costs. The reason Wyeth does not yet give the public sector a discounted price is that it wants Norplant to become firmly entrenched in the private sector first. Other panelists commented on how Norplant's success may encourage other companies to return to contraception research. Liability and political controversy are still concerns, however. Another panelist expressed concern that consumers have become too dependent on pharmaceutical companies and their commercial interests.

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis.

PubMed

Shearer, Freya M; Moyes, Catherine L; Pigott, David M; Brady, Oliver J; Marinho, Fatima; Deshpande, Aniruddha; Longbottom, Joshua; Browne, Annie J; Kraemer, Moritz U G; O'Reilly, Kathleen M; Hombach, Joachim; Yactayo, Sergio; de Araújo, Valdelaine E M; da Nóbrega, Aglaêr A; Mosser, Jonathan F; Stanaway, Jeffrey D; Lim, Stephen S; Hay, Simon I; Golding, Nick; Reiner, Robert C

2017-11-01

Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Union's Horizon 2020 research and innovation programme. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

A money management-based substance use treatment increases valuation of future rewards.

PubMed

Black, Anne C; Rosen, Marc I

2011-01-01

A positive association between delay discounting and substance use has been documented; substance users tend to discount future rewards more than non-users. However, studies detailing the responsiveness of delay discounting to interventions are lacking, and few have examined how any behavioral intervention affects delay discounting and whether these effects moderate changes in substance abuse. This study assesses the effectiveness of a money management intervention, Advisor-Teller Money Manager (ATM), in reducing delay discounting over time and the relationship of these effects to changes in cocaine use. Ninety psychiatric patients with histories of cocaine and/or alcohol use were randomly assigned to 36-weeks of ATM treatment or to a minimal-attention control condition. Delay discounting and cocaine use were measured throughout the intervention with a 52-week follow up measure of cocaine use. Analyses were conducted of (a) the effect of ATM on slopes of delay discounting and cocaine abstinence and (b) the relationship between change in delay discounting and change in cocaine abstinence. The ATM intervention was associated with significantly less delay discounting and less cocaine use over time relative to controls. Increases in delay discounting were associated with decreased abstinence from cocaine. ATM treatment decreased delay discounting rates and these effects extended to cocaine use. Concrete conceptualizations of future events, as occur in financial planning, with higher perceived probability may account for higher valuation of future rewards in counseled patients. Copyright © 2010 Elsevier Ltd. All rights reserved.

Taxonomy of Tuition Discounting.

ERIC Educational Resources Information Center

Allan, Ronald Gage

1999-01-01

Reviews issues surrounding college tuition discounting, and outlines sources of confusion, defines various discount types, provides historical background prior to recent changes in fund accounting rules, describes the new rules' impact, outlines different uses of tuition discounting by three groups, and applies the accumulated definitions to an…

Decision processes in choice overload: a product of delay and probability discounting?

PubMed

Kaplan, Brent A; Reed, Derek D

2013-07-01

Recent research in the behavioral decision making literature has demonstrated that humans hyperbolically discount the subjective value of options as the number of options increases (Reed et al., 2012). These findings provide a cognitive-behavioral synthesis of the "choice overload" phenomenon, also known as the "paradox of choice." Specifically, these findings suggest that temporal discounting may serve as the underlying process contributing to this effect. As an extension, this study examined the effects of reward magnitude sizes had on rates temporal and options discounting. This manipulation was conducted to determine what role temporal discounting plays in discounting of options. The present results suggest that temporal discounting may not be the only process contributing to the choice overload effect. Copyright © 2013 Elsevier B.V. All rights reserved.

Tuition Discounting without Tears

ERIC Educational Resources Information Center

Martin, Robert E.

2004-01-01

This paper contains a policy model for tuition discounting that avoids the major financial pitfalls encountered in the administration of institutional scholarships. The dual objective of maximizing the funded scholarship discount rate and minimizing the unfunded discount rate is explained. Marginal cost pricing is the accepted criterion for…

5 CFR 1315.7 - Discounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Discounts. 1315.7 Section 1315.7 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.7 Discounts. Agencies shall follow these procedures in taking discounts and determining the payment due dates when...

Exchanging the liquidity hypothesis: Delay discounting of money and self-relevant non-money rewards.

PubMed

Stuppy-Sullivan, Allison M; Tormohlen, Kayla N; Yi, Richard

2016-01-01

Evidence that primary rewards (e.g., food and drugs of abuse) are discounted more than money is frequently attributed to money's high degree of liquidity, or exchangeability for many commodities. The present study provides some evidence against this liquidity hypothesis by contrasting delay discounting of monetary rewards (liquid) and non-monetary commodities (non-liquid) that are self-relevant and utility-matched. Ninety-seven (97) undergraduate students initially completed a conventional binary-choice delay discounting of money task. Participants returned one week later and completed a self-relevant commodity delay discounting task. Both conventional hypothesis testing and more-conservative tests of statistical equivalence revealed correspondence in rate of delay discounting of money and self-relevant commodities, and in one magnitude condition, less discounting for the latter. The present results indicate that liquidity of money cannot fully account for the lower rate of delay discounting compared to non-money rewards. Copyright © 2015 Elsevier B.V. All rights reserved.

High temporal discounters overvalue immediate rewards rather than undervalue future rewards: an event-related brain potential study.

PubMed

Cherniawsky, Avital S; Holroyd, Clay B

2013-03-01

Impulsivity is characterized in part by heightened sensitivity to immediate relative to future rewards. Although previous research has suggested that "high discounters" in intertemporal choice tasks tend to prefer immediate over future rewards because they devalue the latter, it remains possible that they instead overvalue immediate rewards. To investigate this question, we recorded the reward positivity, a component of the event-related brain potential (ERP) associated with reward processing, with participants engaged in a task in which they received both immediate and future rewards and nonrewards. The participants also completed a temporal discounting task without ERP recording. We found that immediate but not future rewards elicited the reward positivity. High discounters also produced larger reward positivities to immediate rewards than did low discounters, indicating that high discounters relatively overvalued immediate rewards. These findings suggest that high discounters may be more motivated than low discounters to work for monetary rewards, irrespective of the time of arrival of the incentives.

Humans Can Adopt Optimal Discounting Strategy under Real-Time Constraints

PubMed Central

Schweighofer, N; Shishida, K; Han, C. E; Okamoto, Y; Tanaka, S. C; Yamawaki, S; Doya, K

2006-01-01

Critical to our many daily choices between larger delayed rewards, and smaller more immediate rewards, are the shape and the steepness of the function that discounts rewards with time. Although research in artificial intelligence favors exponential discounting in uncertain environments, studies with humans and animals have consistently shown hyperbolic discounting. We investigated how humans perform in a reward decision task with temporal constraints, in which each choice affects the time remaining for later trials, and in which the delays vary at each trial. We demonstrated that most of our subjects adopted exponential discounting in this experiment. Further, we confirmed analytically that exponential discounting, with a decay rate comparable to that used by our subjects, maximized the total reward gain in our task. Our results suggest that the particular shape and steepness of temporal discounting is determined by the task that the subject is facing, and question the notion of hyperbolic reward discounting as a universal principle. PMID:17096592

Cost-effectiveness analysis of prophylactic cervical cancer vaccination in Japanese women.

PubMed

Konno, Ryo; Sasagawa, Toshiyuki; Fukuda, Takashi; Van Kriekinge, Georges; Demarteau, Nadia

2010-04-01

The incidence of cervical cancer (CC) is high in Japan and is further increasing among women younger than 30 years. This burden could be reduced by the implementation of a CC vaccine, but its cost-effectiveness is unknown. We quantified the clinical impact and assessed the cost-effectiveness of adding CC vaccination at age 12 to the current screening in place in Japan with a lifetime Markov model adapted to the Japanese setting. Transition probabilities and utility values were obtained from public databases. Direct costs for treatment and screening were estimated using Japanese medical fees. Annual costs and benefits were discounted at 3%. Sensitivity analyses were conducted on the age at vaccination, the vaccine characteristics, the discount rates, the proportion of human papillomavirus types 16/18 in cancer, and the screening coverage. Vaccinating a 12-year-old cohort was predicted to reduce CC incidence and deaths from CC by 73%. These clinical effects were associated with an incremental cost-effectiveness ratio of yen1.8 million per quality-adjusted life year gained. The incremental cost-effectiveness ratio of vaccinating all 10- to 45-year-old women was yen2.8 million per quality-adjusted life year, still below the threshold value. The implementation of a CC vaccination in Japan could reduce the CC burden in a very cost-effective manner for women up to 45 years.

48 CFR 952.251-70 - Contractor employee travel discounts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contractor employee travel... Contractor employee travel discounts. As prescribed in 951.7002, insert the following clause: Contractor Employee Travel Discounts (AUG 2009) (a) The Contractor shall take advantage of travel discounts offered to...

Moderate Effects of Same-Sex Legislation on Dependent Employer-Based Insurance Coverage among Sexual Minorities

PubMed Central

Tran, Linda Diem

2016-01-01

A difference-in-difference approach was used to compare the effects of same-sex domestic partnership, civil union, and marriage policies on same- and different-sex partners who could have benefitted from their partners’ employer-based insurance (EBI) coverage. Same-sex partners had 78% lower odds (ME=-21%) of having EBI compared to different-sex partners, adjusting for socioeconomic and health-related factors. Same-sex partners living in states that recognized same-sex marriage or domestic partnership had 89% greater odds of having EBI compared to those in states that did not recognize same-sex unions (ME=5%). The impact of same-sex legislation on increasing take-up of dependent EBI coverage among lesbians, gay men, and bisexual individuals (LGBs) was modest, and domestic partnership legislation was equally as effective as same-sex marriage in increasing same-sex partner EBI coverage. Extending dependent EBI coverage to same-sex partners can mitigate gaps in coverage for a segment of the LGB population but will not eliminate them. PMID:26762647

Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children

PubMed Central

Beattie, Allison; Yates, Robert; Noble, Douglas J

2016-01-01

Universal health coverage generates significant health and economic benefits and enables governments to reduce inequity. Where universal health coverage has been implemented well, it can contribute to nation-building. This analysis reviews evidence from Asia and Pacific drawing out determinants of successful systems and barriers to progress with a focus on women and children. Access to healthcare is important for women and children and contributes to early childhood development. Universal health coverage is a political process from the start, and public financing is critical and directly related to more equitable health systems. Closing primary healthcare gaps should be the foundation of universal health coverage reforms. Recommendations for policy for national governments to improve universal health coverage are identified, including countries spending < 3% of gross domestic product in public expenditure on health committing to increasing funding by at least 0.3%/year to reach a minimum expenditure threshold of 3%. PMID:28588989

Delay discounting of oral morphine and sweetened juice rewards in dependent and non-dependent rats.

PubMed

Harvey-Lewis, Colin; Perdrizet, Johnna; Franklin, Keith B J

2014-07-01

Opioid-dependent humans are reported to show accelerated delay discounting of opioid rewards when compared to monetary rewards. It has been suggested that this may reflect a difference in discounting of consumable and non-consumable goods not specific to dependent individuals. Here, we evaluate the discounting of similar morphine and non-morphine oral rewards in dependent and non-dependent rats We first tested the analgesic and rewarding effects of our morphine solution. In a second experiment, we assigned rats randomly to either dependent or non-dependent groups that, 30 min after daily testing, received 30 mg/kg subcutaneous dose of morphine, or saline, respectively. Delay discounting of drug-free reward was examined prior to initiation of the dosing regimen. We tested discounting of the morphine reward in half the rats and retested the discounting of the drug-free reward in the other half. All tests were run 22.5 h after the daily maintenance dose. Rats preferred the morphine cocktail to the drug-free solution and consumed enough to induce significant analgesia. The control quinine solution did not produce these effects. Dependent rats discounted morphine rewards more rapidly than before dependence and when compared to discounting drug-free rewards. In non-dependent rats both reward types were discounted similarly. These results show that morphine dependence increases impulsiveness specifically towards a drug reward while morphine experience without dependence does not.

The Effects of Condom Availability on College Women's Sexual Discounting.

PubMed

Lemley, Shea M; Jarmolowicz, David P; Parkhurst, Daniel; Celio, Mark A

2018-04-01

College students commonly engage in risky sexual behaviors, such as casual sexual encounters and inconsistent condom use. Discounting paradigms that examine how individuals devalue rewards due to their delay or uncertainty have been used to improve our understanding of behavioral problems, including sexual risk. The current study assessed relations between college women's sexual partners discounting and risky sexual behavior. In this study, college women (N = 42) completed two sexual partners delay discounting tasks that assessed how choices among hypothetical sexual partners changed across a parametric range of delays in two conditions: condom availability and condom unavailability. Participants also completed two sexual partners probability discounting tasks that assessed partner choices across a parametric range of probabilities in condom availability and unavailability conditions. Additionally, participants reported risky sexual behavior on the Sexual Risk Survey (SRS). Participants discounted delayed partners more steeply in the condom availability condition, but those differences were significant only for those women with three or fewer lifetime sexual partners. There were no consistent differences in discounting rate across condom availability conditions for probability discounting. Sexual partners discounting measures correlated with risky sexual behaviors as measured by the SRS, but a greater number of significant relations were observed with the condoms-unavailable delay discounting task. These findings suggest the importance of examining the interaction of inconsistent condom use and multiple partners in examinations of sexual decision-making.

Payers' experiences with confidential pharmaceutical price discounts: A survey of public and statutory health systems in North America, Europe, and Australasia.

PubMed

Morgan, Steven G; Vogler, Sabine; Wagner, Anita K

2017-04-01

Institutional payers for pharmaceuticals worldwide appear to be increasingly negotiating confidential discounts off of the official list price of pharmaceuticals purchased in the community setting. We conducted an anonymous survey about experiences with and attitudes toward confidential discounts on patented pharmaceuticals in a sample of high-income countries. Confidential price discounts are now common among the ten health systems that participated in our study, though some had only recently begun to use these pricing arrangements on a routine basis. Several health systems had used a wide variety of discounting schemes in the past two years. The most frequent discount received by participating health systems was between 20% and 29% of official list prices; however, six participants reported their health system received one or more discount over the past two years that was valued at 60% or more of the list prices. On average, participants reported that confidential discounts were more common, complex, and significant for specialty pharmaceuticals than for primary care pharmaceuticals. Participants had a more favorable view of the impact of confidential discount schemes on their health systems than on the global marketplace. Overall, the frequency, complexity, and scale of confidential discounts being routinely negotiated suggest that the list prices for medicines bear limited resemblance to what many institutional payers actually pay. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls.

PubMed

Kirby, K N; Petry, N M; Bickel, W K

1999-03-01

Fifty-six heroin addicts and 60 age-matched controls were offered choices between monetary rewards ($11-$80) available immediately and larger rewards ($25-$85) available after delays ranging from 1 week to 6 months. Participants had a 1-in-6 chance of winning a reward that they chose on one randomly selected trial. Delay-discounting rates were estimated from the pattern of participants' choices. The discounting model of impulsiveness (Ainslie, 1975) implies that delay-discounting rates are positively correlated with impulsiveness. On average, heroin addicts' discount rates were twice those of controls (p = .004), and discount rates were positively correlated with impulsivity as measured by self-report questionnaires (p < .05). The results lend external validity to the delay-discounting rate as a measure of impulsiveness, a characteristic associated with substance abuse.

Normative arguments from experts and peers reduce delay discounting.

PubMed

Senecal, Nicole; Wang, Teresa; Thompson, Elizabeth; Kable, Joseph W

2012-09-01

When making decisions that involve tradeoffs between the quality and timing of desirable outcomes, people consistently discount the value of future outcomes. A puzzling finding regarding such decisions is the extremely high rate at which people discount future monetary outcomes. Most economists would argue that decision-makers should only turn down rates of return that are lower than those available to them elsewhere. Yet the vast majority of studies find discount rates that are significantly higher than market interest rates (Frederick et al., 2002). Here we ask whether a lack of knowledge about the normative strategy can explain high discount rates. In an initial experiment, we find that nearly half of subjects do not spontaneously cite elements of the normative strategy when asked how people should make intertemporal monetary decisions. In two follow-up experiments, we find that after subjects read a "financial guide" detailing the normative strategy, discount rates declined by up to 85%, but were still higher than market interest rates. This decline persisted, though attenuated, for at least one month. In a final experiment, we find that peer-generated advice influences discount rates in a similar manner to "expert" advice, and that arguments focusing on normative considerations are at least as effective as others. These studies show that part of the explanation for high discount rates is a lack of knowledge regarding the normative strategy, and quantify how much discount rates are reduced in response to normative arguments. Given the high level of discounting that remains, however, there are other contributing factors to high discount rates that remain to be quantified.

Normative arguments from experts and peers reduce delay discounting

PubMed Central

Senecal, Nicole; Wang, Teresa; Thompson, Elizabeth; Kable, Joseph W

2013-01-01

When making decisions that involve tradeoffs between the quality and timing of desirable outcomes, people consistently discount the value of future outcomes. A puzzling finding regarding such decisions is the extremely high rate at which people discount future monetary outcomes. Most economists would argue that decision-makers should only turn down rates of return that are lower than those available to them elsewhere. Yet the vast majority of studies find discount rates that are significantly higher than market interest rates (Frederick et al., 2002). Here we ask whether a lack of knowledge about the normative strategy can explain high discount rates. In an initial experiment, we find that nearly half of subjects do not spontaneously cite elements of the normative strategy when asked how people should make intertemporal monetary decisions. In two follow-up experiments, we find that after subjects read a “financial guide” detailing the normative strategy, discount rates declined by up to 85%, but were still higher than market interest rates. This decline persisted, though attenuated, for at least one month. In a final experiment, we find that peer-generated advice influences discount rates in a similar manner to “expert” advice, and that arguments focusing on normative considerations are at least as effective as others. These studies show that part of the explanation for high discount rates is a lack of knowledge regarding the normative strategy, and quantify how much discount rates are reduced in response to normative arguments. Given the high level of discounting that remains, however, there are other contributing factors to high discount rates that remain to be quantified. PMID:23596504

Temporal discounting rates and their relation to exercise behavior in older adults.

PubMed

Tate, Linda M; Tsai, Pao-Feng; Landes, Reid D; Rettiganti, Mallikarjuna; Lefler, Leanne L

2015-12-01

As our nation's population ages, the rates of chronic illness and disability are expected to increase significantly. Despite the knowledge that exercise may prevent chronic disease and promote health among older adults, many still are inactive. Factors related to exercise behaviors have been explored in recent years. However, temporal discounting is a motivational concept that has not been explored in regard to exercise in older adults. Temporal discounting is a decision making process by which an individual chooses a smaller more immediate reward over a larger delayed reward. The aim of this study was to determine if temporal discounting rates vary between exercising and non-exercising older adults. This study used cross-sectional survey of 137 older adults living in the community. Older adults were recruited from 11 rural Arkansas churches. The Kirby delay-discounting Monetary Choice Questionnaire was used to collect discounting rates and then bivariate analysis was performed to compare temporal discounting rate between the exercisers and non-exercisers. Finally, multivariate analysis was used to compare discounting rate controlling for other covariates. The results indicated that exercising older adults display lower temporal discounting rates than non-exercising older adults. After controlling for education, exercisers still have lower temporal discounting rates than non-exercisers (p<0.001). These findings are important as several chronic health conditions relate to lack of exercise especially in older adults. This research suggests that if we can find appropriate incentives for discounting individuals, some type of immediate reward, then potentially we can design programs to engage and retain older adults in exercise. Copyright © 2015 Elsevier Inc. All rights reserved.

Analysis of error in TOMS total ozone as a function of orbit and attitude parameters

NASA Technical Reports Server (NTRS)

Gregg, W. W.; Ardanuy, P. E.; Braun, W. C.; Vallette, B. J.; Bhartia, P. K.; Ray, S. N.

1991-01-01

Computer simulations of orbital scenarios were performed to examine the effects of orbital altitude, equator crossing time, attitude uncertainty, and orbital eccentricity on ozone observations by future satellites. These effects were assessed by determining changes in solar and viewing geometry and earth daytime coverage loss. The importance of these changes on ozone retrieval was determined by simulating uncertainties in the TOMS ozone retrieval algorithm. The major findings are as follows: (1) Drift of equator crossing time from local noon would have the largest effect on the quality of ozone derived from TOMS. The most significant effect of this drift is the loss of earth daytime coverage in the winter hemisphere. The loss in coverage increases from 1 degree latitude for + or - 1 hour from noon, 6 degrees for + or - 3 hours from noon, to 53 degrees for + or - 6 hours from noon. An additional effect is the increase in ozone retrieval errors due to high solar zenith angles. (2) To maintain contiguous earth coverage, the maximum scan angle of the sensor must be increased with decreasing orbital altitude. The maximum scan angle required for full coverage at the equator varies from 60 degrees at 600 km altitude to 45 degrees at 1200 km. This produces an increase in spacecraft zenith angle, theta, which decreases the ozone retrieval accuracy. The range in theta was approximately 72 degrees for 600 km to approximately 57 degrees at 1200 km. (3) The effect of elliptical orbits is to create gaps in coverage along the subsatellite track. An elliptical orbit with a 200 km perigee and 1200 km apogee produced a maximum earth coverage gap of about 45 km at the perigee at nadir. (4) An attitude uncertainty of 0.1 degree in each axis (pitch, roll, yaw) produced a maximum scan angle to view the pole, and maximum solar zenith angle).

Monitoring intervention coverage in the context of universal health coverage.

PubMed

Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim

2014-09-01

Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary.

Monitoring Intervention Coverage in the Context of Universal Health Coverage

PubMed Central

Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim

2014-01-01

Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups—promotion/prevention, and treatment/care—as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary PMID:25243586

High Throughput Transcriptomics @ USEPA (Toxicology ...

EPA Pesticide Factsheets

The ideal chemical testing approach will provide complete coverage of all relevant toxicological responses. It should be sensitive and specific It should identify the mechanism/mode-of-action (with dose-dependence). It should identify responses relevant to the species of interest. Responses should ideally be translated into tissue-, organ-, and organism-level effects. It must be economical and scalable. Using a High Throughput Transcriptomics platform within US EPA provides broader coverage of biological activity space and toxicological MOAs and helps fill the toxicological data gap. Slide presentation at the 2016 ToxForum on using High Throughput Transcriptomics at US EPA for broader coverage biological activity space and toxicological MOAs.

Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured.

PubMed

DeVoe, Jennifer; Angier, Heather; Likumahuwa, Sonja; Hall, Jennifer; Nelson, Christine; Dickerson, Kay; Keller, Sara; Burdick, Tim; Cohen, Deborah

2014-01-01

Lack of health insurance negatively impacts children's health. Despite federal initiatives to expand children's coverage and accelerate state outreach efforts, millions of US children remain uninsured or experience frequent gaps in coverage. Most current efforts to enroll and retain eligible children in public insurance programs take place outside of the health care system. This study is a partnership between patients' families, medical informaticists, federally qualified health center (FQHC) staff, and researchers to build and test information technology tools to help FQHCs reach uninsured children and those at risk for losing coverage.

Count every newborn; a measurement improvement roadmap for coverage data

PubMed Central

2015-01-01

Background The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks. PMID:26391444

Delay Discounting and Social Policy Issues

ERIC Educational Resources Information Center

Weatherly, Jeffrey N.; Plumm, Karyn M.; Derenne, Adam

2011-01-01

The present study used a delay discounting framework to study decisions about six social policy issues and one monetary outcome. For outcomes that nearly all participants discounted, social policies were discounted significantly more than money. A similar result was observed when analyzing all outcomes using data only from participants who…

Modeling the Effect of Reward Amount on Probability Discounting

ERIC Educational Resources Information Center

Myerson, Joel; Green, Leonard; Morris, Joshua

2011-01-01

The present study with college students examined the effect of amount on the discounting of probabilistic monetary rewards. A hyperboloid function accurately described the discounting of hypothetical rewards ranging in amount from $20 to $10,000,000. The degree of discounting increased continuously with amount of probabilistic reward. This effect…

78 FR 67393 - Change in Discount Rate for Water Resources Planning

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-12

... Discount Rate for Water Resources Planning AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of change. SUMMARY: The Water Resources Planning Act of 1965 and the Water Resources Development Act of 1974 require an annual determination of a discount rate for Federal water resources planning. The discount rate...

7 CFR 1786.98 - Discounted present value.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Discounted present value. 1786.98 Section 1786.98... Discounted present value. (a) The Discounted Present Value shall be calculated by RUS before prepayment is made by summing the present values of all remaining payments on all outstanding notes according to the...

Tuition Discounting through Unfunded Institutional Aid at Private Baccalaureate Colleges

ERIC Educational Resources Information Center

Martin, Jeremy Paul

2012-01-01

Colleges and universities discount tuition by providing institutional aid to reduce the actual amount paid by a student. Discount rates are substantial and continue to increase, particularly at private institutions. Funded institutional discounts are linked to gifts or endowment income restricted to financial aid. Unfunded institutional discounts…

Influenza Vaccination Coverage and Its Associated Factors among North Korean Defectors Living in the Republic of Korea.

PubMed

Song, In Gyu; Lee, Haewon; Yi, Jinseon; Kim, Min Sun; Park, Sang Min

2015-09-01

This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.

Maintained Physical Activity Induced Changes in Delay Discounting.

PubMed

Sofis, Michael J; Carrillo, Ale; Jarmolowicz, David P

2017-07-01

Those who discount the subjective value of delayed rewards less steeply are more likely to engage in physical activity. There is limited research, however, showing whether physical activity can change rates of delay discounting. In a two-experiment series, treatment and maintenance effects of a novel, effort-paced physical activity intervention on delay discounting were evaluated with multiple baseline designs. Using a lap-based method, participants were instructed to exercise at individualized high and low effort levels and to track their own perceived effort. The results suggest that treatment-induced changes in discounting were maintained at follow-up for 13 of 16 participants. In Experiment 2, there were statistically significant group-level improvements in physical activity and delay discounting when comparing baseline with both treatment and maintenance phases. Percentage change in delay discounting was significantly correlated with session attendance and relative pace (min/mile) improvement over the course of the 7-week treatment. Implications for future research are discussed.

Life cycle costing with a discount rate

NASA Technical Reports Server (NTRS)

Posner, E. C.

1978-01-01

This article studies life cycle costing for a capability needed for the indefinite future, and specifically investigates the dependence of optimal policies on the discount rate chosen. The two costs considered are reprocurement cost and maintenance and operations (M and O) cost. The procurement price is assumed known, and the M and O costs are assumed to be a known function, in fact, a non-decreasing function, of the time since last reprocurement. The problem is to choose the optimum reprocurement time so as to minimize the quotient of the total cost over a reprocurement period divided by the period. Or one could assume a discount rate and try to minimize the total discounted costs into the indefinite future. It is shown that the optimum policy in the presence of a small discount rate hardly depends on the discount rate at all, and leads to essentially the same policy as in the case in which discounting is not considered.

A Mechanism for Reducing Delay Discounting by Altering Temporal Attention

ERIC Educational Resources Information Center

Radu, Peter T.; Yi, Richard; Bickel, Warren K.; Gross, James J.; McClure, Samuel M.

2011-01-01

Rewards that are not immediately available are discounted compared to rewards that are immediately available. The more a person discounts a delayed reward, the more likely that person is to have a range of behavioral problems, including clinical disorders. This latter observation has motivated the search for ions that reduce discounting. One…

Contexts and Individual Differences as Influences on Consumers' Delay Discounting

ERIC Educational Resources Information Center

Foxall, Gordon R.; Doyle, John R.; Yani-de-Soriano, Mirella; Wells, Victoria K.

2011-01-01

Delay discounting is often considered a universal feature of human choice behavior, but there is controversy over whether it is an individual difference that reflects an underlying psychological trait or a domain-specific behavior. Trait influence on discounting would manifest in (a) highly correlated discount rates for all decisions, regardless…

Attention-deficit/hyperactivity disorder, delay discounting, and risky financial behaviors: A preliminary analysis of self-report data.

PubMed

Beauchaine, Theodore P; Ben-David, Itzhak; Sela, Aner

2017-01-01

Delay discounting-often referred to as hyperbolic discounting in the financial literature-is defined by a consistent preference for smaller, immediate rewards over larger, delayed rewards, and by failure of future consequences to curtail current consummatory behaviors. Previous research demonstrates (1) excessive delay discounting among individuals with attention-deficit/hyperactivity disorder (ADHD), (2) common neural substrates of delay discounting and hyperactive-impulsive symptoms of ADHD, and (3) associations between delay discounting and both debt burden and high interest rate borrowing. This study extends prior research by examining associations between ADHD symptoms, delay discounting, and an array of previously unevaluated financial outcomes among 544 individuals (mean age 35 years). Controlling for age, income, sex, education, and substance use, ADHD symptoms were associated with delay discounting, late credit card payments, credit card balances, use of pawn services, personal debt, and employment histories (less time spent at more jobs). Consistent with neural models of reward processing and associative learning, more of these relations were attributable to hyperactive-impulsive symptoms than inattentive symptoms. Implications for financial decision-making and directions for future research are discussed.

Using Crowdsourcing to Examine Relations Between Delay and Probability Discounting

PubMed Central

Jarmolowicz, David P.; Bickel, Warren K.; Carter, Anne E.; Franck, Christopher T.; Mueller, E. Terry

2016-01-01

Although the extensive lines of research on delay and/or probability discounting have greatly expanded our understanding of human decision-making processes, the relation between these two phenomena remains unclear. For example, some studies have reported robust associations between delay and probability discounting, whereas others have failed to demonstrate a consistent relation between the two. The current study sought to clarify this relation by examining the relation between delay and probability discounting in a large sample of internet users (n= 904) using the Amazon Mechanical Turk (AMT) crowdsourcing service. Because AMT is a novel data collection platform, the findings were validated through the replication of a number of previously established relations (e.g., relations between delay discounting and cigarette smoking status). A small but highly significant positive correlation between delay and probability discounting rates was obtained, and principal component analysis suggested that two (rather than one) components were preferable to account for the variance in both delay and probability discounting. Taken together, these findings suggest that delay and probability discounting may be related, but are not manifestations of a single component (e.g., impulsivity). PMID:22982370

Alternative to the traditional discount method of wholesaler purchasing.

PubMed

Lee, G F; Bair, J N; Piz, J W

1982-07-01

A program of purchasing drugs from wholesalers at the wholesaler's exact invoice cost plus a percentage is described and compared with the traditional method of average wholesale price (AWP) less a discount. The comparison was conducted by the pharmacy department of a 310-bed, teaching hospital that awarded a one-year contract to a wholesaler offering its items at the exact cost plus a pre-established percentage. Data collected from monthly wholesaler computer printouts gave the following information on each product: (1) list price per item, (2) actual cost to pharmacy per item, (3) percentage discount from AWP, and (4) quantity ordered. The net percentage discount from AWP for 12 months was calculated and compared to the former (traditional) discount rate. The net discount from AWP was 15.6% for purchases made by the hospital during the first 12 months of the program. When compared with the smaller discount the hospital traditionally received, the new program saved the hospital $5758 on annual purchases of $136,419. The actual dollar savings to an institution that changes from a traditional discount program to a cost-plus-percentage program depends on: (1) the negotiated percentage added to wholesaler cost, (2) the discount from AWP that the institution was previously receiving, and (3) the volume of wholesale purchases.

Retailer Stackelberg game in a supply chain with pricing and service decisions and simple price discount contract.

PubMed

Sadjadi, Seyed Jafar; Asadi, Hashem; Sadeghian, Ramin; Sahebi, Hadi

2018-01-01

This paper studies the Retailer Stackelberg game in a supply chain consisting of two manufacturers and one retailer where they compete simultaneously under three factors including price, service and simple price discount contract. It is assumed that the second manufacturer provides service directly to his customers, and the retailer provides service for the first product's customers, while the retailer buys the first product under price discount from the first manufacturer. The analysis of the optimal equilibrium solutions and the results of the numerical examples show that if a manufacturer chooses the appropriate range of discount rate, he will gain more profit than when there is no discount given to the retailer. This situation can be considered as an effective tool for the coordination of the first manufacturer and the retailer to offer discount by manufacturer and to provide the service by the retailer. We obtain equilibrium solution of Retailer Stackelberg game and analyze the numerical examples under two cases: a) the manufacturers sell their products to the retailer without price discount contract. b) The first manufacturer sells his products to the retailer with the simple price discount contract. The preliminary results show that the service and the price discount contract can improve the performance of supply chain.

Mild opioid deprivation increases the degree that opioid-dependent outpatients discount delayed heroin and money.

PubMed

Giordano, Louis A; Bickel, Warren K; Loewenstein, George; Jacobs, Eric A; Marsch, Lisa; Badger, Gary J

2002-09-01

A growing literature suggests that excessive temporal discounting of delayed rewards may be a contributing factor in the etiology of substance abuse problems. Little is known, however, about how drug deprivation may affect temporal discounting of delayed rewards by drug-dependent individuals. To examine the extent to which opioid deprivation affects how opioid-dependent individuals discount small, medium and large quantities of delayed heroin and money. Thirteen opioid-dependent individuals maintained on buprenorphine completed a hypothetical choice task in which they choose between a constant delayed reward amount and an immediate reward amount that was adjusted until they expressed indifference between both outcomes. The task was completed for three values of heroin and money rewards during eight sessions under conditions of opioid deprivation (four sessions) and satiation (four sessions). Across conditions, hyperbolic functions provided a good fit for the discounting data. Degree of discounting was significantly higher when subjects were opioid deprived. Consistent with previous findings, degree of discounting was higher for heroin than money and inversely related to the magnitude of the reward. Opioid deprivation increased the degree to which dependent individuals discounted delayed heroin and money. Understanding the conditions that affect how drug-dependent individuals discount delayed rewards might help us understand the myopic choices made by such individuals and help improve treatment outcomes.

Discounting of money and sex: effects of commodity and temporal position in stimulant-dependent men and women.

PubMed

Jarmolowicz, David P; Landes, Reid D; Christensen, Darren R; Jones, Bryan A; Jackson, Lisa; Yi, Richard; Bickel, Warren K

2014-11-01

Research on delay discounting has contributed to the understanding of numerous addiction-related phenomena. For example, studies have shown that substance dependent individuals discount their addictive substances (e.g., cocaine) more rapidly than they do other commodities (e.g., money). Recent research has shown that substance dependent individuals discount delayed sex more rapidly than delayed money, and their discounting rates for delayed sex were higher than those of non-addicted individuals. The particular reason that delay discounting rates for sex are higher than those for money, however, are unclear. Do individuals discount delayed sex rapidly because immediate sex is particularly appealing or because delayed sex does not retain its value? Moreover, do the same factors influence men and women's choices? The current study examined delay discounting in four conditions (money now versus money later; sex now versus sex later; money now, versus sex later; sex now versus money later) in cocaine dependent men and women. The procedures used isolated the role of the immediate versus delayed commodity. For men, the higher rates of delay discounting for sex were because delayed sex did not retain its value, whereas both the immediate and delayed commodity influenced the female participants' decisions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cross-promotional alcohol discounting in Australia's grocery sector: a barrier to initiatives to curb excessive alcohol consumption?

PubMed

Wardle, Jonathan L; Chang, Sungwon

2015-04-01

Excessive alcohol consumption is an increasing issue internationally. Pricing strategies, including discount restrictions, have been identified as one of the most effective policy means by which to reduce heavy alcohol consumption. In Australia, cross-promotional alcohol discounts are increasingly used by supermarket chains as a marketing tool. The purpose of the present study is to provide preliminary data on the nature and extent of cross-promotional alcohol discounting in the Australian grocery sector. A purposive sample of 34 supermarkets in Australia's three largest cities was selected and minor grocery purchases made to uncover the prevalence and level of cross-promotional alcohol discounting. Cross-promotional 'bundled' discounts were very common with 33 of the 34 supermarkets offering a 'two for one' discount on bottles of wine. Even with minor purchases (mean purchase $1.35), the mean value of discounts received was substantial ($16.23). These results appear to be consistent with claims that major supermarket chains are using alcohol discounts as loss leaders to entice new consumers. These strategies are antithetical to public health strategies aimed at reducing excessive alcohol consumption. Further examination of the impact of major retailers on public health initiatives is warranted, particularly in light of increasing retailer concentration. © 2014 Public Health Association of Australia.

Retailer Stackelberg game in a supply chain with pricing and service decisions and simple price discount contract

PubMed Central

Sadjadi, Seyed Jafar; Sadeghian, Ramin; Sahebi, Hadi

2018-01-01

This paper studies the Retailer Stackelberg game in a supply chain consisting of two manufacturers and one retailer where they compete simultaneously under three factors including price, service and simple price discount contract. It is assumed that the second manufacturer provides service directly to his customers, and the retailer provides service for the first product’s customers, while the retailer buys the first product under price discount from the first manufacturer. The analysis of the optimal equilibrium solutions and the results of the numerical examples show that if a manufacturer chooses the appropriate range of discount rate, he will gain more profit than when there is no discount given to the retailer. This situation can be considered as an effective tool for the coordination of the first manufacturer and the retailer to offer discount by manufacturer and to provide the service by the retailer. We obtain equilibrium solution of Retailer Stackelberg game and analyze the numerical examples under two cases: a) the manufacturers sell their products to the retailer without price discount contract. b) The first manufacturer sells his products to the retailer with the simple price discount contract. The preliminary results show that the service and the price discount contract can improve the performance of supply chain. PMID:29649315

Does temporal discounting explain unhealthy behavior? A systematic review and reinforcement learning perspective

PubMed Central

Story, Giles W.; Vlaev, Ivo; Seymour, Ben; Darzi, Ara; Dolan, Raymond J.

2014-01-01

The tendency to make unhealthy choices is hypothesized to be related to an individual's temporal discount rate, the theoretical rate at which they devalue delayed rewards. Furthermore, a particular form of temporal discounting, hyperbolic discounting, has been proposed to explain why unhealthy behavior can occur despite healthy intentions. We examine these two hypotheses in turn. We first systematically review studies which investigate whether discount rates can predict unhealthy behavior. These studies reveal that high discount rates for money (and in some instances food or drug rewards) are associated with several unhealthy behaviors and markers of health status, establishing discounting as a promising predictive measure. We secondly examine whether intention-incongruent unhealthy actions are consistent with hyperbolic discounting. We conclude that intention-incongruent actions are often triggered by environmental cues or changes in motivational state, whose effects are not parameterized by hyperbolic discounting. We propose a framework for understanding these state-based effects in terms of the interplay of two distinct reinforcement learning mechanisms: a “model-based” (or goal-directed) system and a “model-free” (or habitual) system. Under this framework, while discounting of delayed health may contribute to the initiation of unhealthy behavior, with repetition, many unhealthy behaviors become habitual; if health goals then change, habitual behavior can still arise in response to environmental cues. We propose that the burgeoning development of computational models of these processes will permit further identification of health decision-making phenotypes. PMID:24659960

Does temporal discounting explain unhealthy behavior? A systematic review and reinforcement learning perspective.

PubMed

Story, Giles W; Vlaev, Ivo; Seymour, Ben; Darzi, Ara; Dolan, Raymond J

2014-01-01

The tendency to make unhealthy choices is hypothesized to be related to an individual's temporal discount rate, the theoretical rate at which they devalue delayed rewards. Furthermore, a particular form of temporal discounting, hyperbolic discounting, has been proposed to explain why unhealthy behavior can occur despite healthy intentions. We examine these two hypotheses in turn. We first systematically review studies which investigate whether discount rates can predict unhealthy behavior. These studies reveal that high discount rates for money (and in some instances food or drug rewards) are associated with several unhealthy behaviors and markers of health status, establishing discounting as a promising predictive measure. We secondly examine whether intention-incongruent unhealthy actions are consistent with hyperbolic discounting. We conclude that intention-incongruent actions are often triggered by environmental cues or changes in motivational state, whose effects are not parameterized by hyperbolic discounting. We propose a framework for understanding these state-based effects in terms of the interplay of two distinct reinforcement learning mechanisms: a "model-based" (or goal-directed) system and a "model-free" (or habitual) system. Under this framework, while discounting of delayed health may contribute to the initiation of unhealthy behavior, with repetition, many unhealthy behaviors become habitual; if health goals then change, habitual behavior can still arise in response to environmental cues. We propose that the burgeoning development of computational models of these processes will permit further identification of health decision-making phenotypes.

Supermarket discounts of low-energy density foods: effects on purchasing, food intake, and body weight.

PubMed

Geliebter, Allan; Ang, Ian Yi Han; Bernales-Korins, Maria; Hernandez, Dominica; Ochner, Christopher N; Ungredda, Tatiana; Miller, Rachel; Kolbe, Laura

2013-12-01

To assess the effects of a 50% discount on low-energy density (ED) fruits and vegetables (F&V), bottled water, and diet sodas on shoppers' purchasing, food intake, and body weight. A randomized, controlled trial was conducted at two Manhattan supermarkets, in which a 4-week baseline period (no discounts) preceded an 8-week intervention period (50% discount), and a 4-week follow-up period (no discounts). Twenty-four hour dietary recall, as well as body weight and body composition measures were obtained every 4 weeks. Participants (n = 47, 33f; 14m) were overweight and obese (BMI ≥ 25) shoppers. Purchasing of F&V during intervention was greater in the discount group than in the control group (P < 0.0001). Purchasing of these items by the discount group relative to the control group during follow-up was reduced from intervention (P = 0.002), but still remained higher than during baseline (P = 0.01), indicating a partially sustained effect. Intake of F&V increased from baseline to intervention in the discount group relative to the control group (P = 0.037) and was sustained during follow-up. Body weight change did not differ significantly between groups, although post hoc analysis indicated a change within the discount group (-1.1 kg, P = 0.006) but not within the control group. Discounts of low-ED F&V led to increased purchasing and intake of those foods. Copyright © 2013 The Obesity Society.

Measurement and validation of measures for impulsive food choice across obese and healthy-weight individuals.

PubMed

Hendrickson, Kelsie L; Rasmussen, Erin B; Lawyer, Steven R

2015-07-01

The present study established a brief measure of delay discounting for food, the Food Choice Questionnaire (FCQ), and compared it to another more established measure of food discounting that uses the adjusting amount (AA) procedure. One hundred forty-four undergraduate participants completed either two measures of hypothetical food discounting (a computerized food AA procedure or the FCQ) or two measures of hypothetical money discounting [a computerized monetary AA procedure or the Monetary Choice questionnaire (MCQ)]. The money condition was used as a replication of previous work. Results indicated that the FCQ yielded consistent data that strongly correlated with the AA food discounting task. Moreover, a magnitude effect was found with the FCQ, such that smaller amounts of food were discounted more steeply than larger amounts. In addition, individuals with higher percent body fat (PBF) discounted food more steeply than individuals with lower PBF. The MCQ, which also produced a magnitude effect, and the monetary adjusting amount procedure yielded data that were orderly, consistent, and correlated strongly with one another, replicating previous literature. This study is the first to show that a novel measure of food discounting (the FCQ) yields consistent data strongly correlated with an established measure of food discounting and is sensitive to PBF. Moreover, the FCQ is easier and quicker to administer than the AA procedure, which may interest researchers who use discounting tasks in food-related research. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cocaine administration dose-dependently increases sexual desire and decreases condom use likelihood: The role of delay and probability discounting in connecting cocaine with HIV.

PubMed

Johnson, Matthew W; Herrmann, Evan S; Sweeney, Mary M; LeComte, Robert S; Johnson, Patrick S

2017-02-01

Although cocaine use has been linked to sexual HIV risk behavior for decades, the direct effects of cocaine on sexual desire and sexual decision-making are unexamined. Research suggests delay discounting (devaluation of future outcomes) and probability discounting (devaluation of uncertain outcomes) play roles in condom use decisions. This study examined the effect of cocaine administration on sexual desire, hypothetical condom use, and discounting tasks. This double-blind, within-subjects study compared the effects of 0, 125, and 250 mg/70 kg oral cocaine HCl in 12 cocaine users. Measures included sexual desire and other subjective ratings, the Sexual Delay Discounting Task, the Sexual Probability Discounting Task, and monetary delay and probability discounting tasks. Cocaine caused dose-related increases in sexual desire and prototypical stimulant abuse-liability ratings. Relative to placebo, cocaine did not significantly alter condom use likelihood when condoms were immediately available or when sex was associated with 100% certainty of sexually transmitted infection (STI). In contrast, cocaine dose-dependently strengthened the effect of delay (sexual delay discounting) and STI uncertainty (sexual probability discounting) in decreasing condom use likelihood. Cocaine caused no significant change in monetary delay and probability discounting. This is the first study showing that cocaine administration increases sexual desire. Detrimental effects of cocaine on sexual risk were only observed when safer sex required delay, or STI risk was uncertain (representative of many real-world scenarios), suggesting a critical role of discounting processes. Lack of monetary effects highlights the importance of studying clinically relevant outcomes when examining drug effects on behavioral processes.

Time discounting and the body mass index. Evidence from the Netherlands.

PubMed

Borghans, Lex; Golsteyn, Bart H H

2006-01-01

In many Western countries, the relative weight of people -- measured by the body mass index (BMI) -- has increased substantially in recent years, leading to an increasing incidence of overweight and related health problems. As with many forms of risky behavior, it is plausible that overweight is related to the individual discount rate. Increases in credit card debts, the rise in gambling and the development of a more hedonic life style, suggest that the average discount rate has increased over time. An increase in time discounting may be a contributing factor in the rise in BMI. Applying a large set of indicators for the individual discount rate from a Dutch survey, this paper analyzes whether changes in time discounting can account for differences in body mass between individuals at a given point in time and whether changes in the average individual discount rate can explain the remarkable increase in BMI experienced in recent years in the Netherlands. We find some evidence for a link between time discounting and differences in BMI between people, but this relationship depends strongly on the choice of the proxy for the discount rate. Giving our hypothesis the best chance, we analyze the development of the time discounting proxies that are most strongly related to BMI. We find no evidence for a change of these proxies over time. Our main conclusion therefore is that overweight might be related to the way people discount future health benefits, but the increase in BMI is more likely explained by shifts in other parameters that determine the intertemporal decisions regarding the trade-off of current and future health and satisfaction.

The choice of discount brand cigarettes: a comparative analysis of International Tobacco Control surveys in Canada and the USA (2002-2005).

PubMed

Nargis, Nigar; Fong, Geoffrey T; Chaloupka, Frank J; Li, Qiang

2014-03-01

Increasing tobacco taxes to increase price is a proven tobacco control measure. This article investigates how smokers respond to tax and price increases in their choice of discount brand cigarettes versus premium brands. To estimate how increase in the tax rate can affect smokers' choice of discount brands versus premium brands. Using data from International Tobacco Control surveys in Canada and the USA, a logit model was constructed to estimate the probability of choosing discount brand cigarettes in response to its price changes relative to premium brands, controlling for individual-specific demographic and socioeconomic characteristics and regional effects. The self-reported price of an individual smoker is used in a random-effects regression model to impute price and to construct the price ratio for discount and premium brands for each smoker, which is used in the logit model. An increase in the ratio of price of discount brand cigarettes to the price of premium brands by 0.1 is associated with a decrease in the probability of choosing discount brands by 0.08 in Canada. No significant effect is observed in case of the USA. The results of the model explain two phenomena: (1) the widened price differential between premium and discount brand cigarettes contributed to the increased share of discount brand cigarettes in Canada in contrast to a relatively steady share in the USA during 2002-2005 and (2) increasing the price ratio of discount brands to premium brands-which occurs with an increase in specific excise tax-may lead to upward shifting from discount to premium brands rather than to downward shifting. These results underscore the significance of studying the effectiveness of tax increases in reducing overall tobacco consumption, particularly for specific excise taxes.

Delay Discounting as an Index of Sustainable Behavior: Devaluation of Future Air Quality and Implications for Public Health.

PubMed

Berry, Meredith S; Nickerson, Norma P; Odum, Amy L

2017-09-01

Poor air quality and resulting annual deaths represent significant public health concerns. Recently, rapid delay discounting (the devaluation of future outcomes) of air quality has been considered a potential barrier for engaging in long term, sustainable behaviors that might help to reduce emissions (e.g., reducing private car use, societal support for clean air initiatives). Delay discounting has been shown to be predictive of real world behavior outside of laboratory settings, and therefore may offer an important framework beyond traditional variables thought to measure sustainable behavior such as importance of an environmental issue, or environmental attitudes/values, although more research is needed in this area. We examined relations between discounting of air quality, respiratory health, and monetary gains and losses. We also examined, relations between discounting and self-reported importance of air quality and respiratory health, and nature relatedness. Results showed rapid delay discounting of all outcomes across the time frames assessed, and significant positive correlations between delay discounting of air quality, respiratory health, and monetary outcomes. Steeper discounting of monetary outcomes relative to air quality and respiratory health outcomes was observed in the context of gains; however, no differences in discounting were observed across losses of monetary, air quality, and respiratory health. Replicating the sign effect, monetary outcomes were discounted more steeply than monetary losses. Importance of air quality, respiratory health and nature relatedness were significantly and positively correlated with one another, but not with degree of delay discounting of any outcome, demonstrating the need for more comprehensive measures that predict pro-environmental behaviors that might benefit individuals and public health over time. These results add to our understanding of decision-making, and demonstrate alarming rates of delay discounting of air quality and health. These results implicate a major public health concern and potential barriers to individual and societal behavior that reduce pollution and emissions for conservation of clean air.

Delay Discounting as an Index of Sustainable Behavior: Devaluation of Future Air Quality and Implications for Public Health

PubMed Central

Berry, Meredith S.; Nickerson, Norma P.; Odum, Amy L.

2017-01-01

Poor air quality and resulting annual deaths represent significant public health concerns. Recently, rapid delay discounting (the devaluation of future outcomes) of air quality has been considered a potential barrier for engaging in long term, sustainable behaviors that might help to reduce emissions (e.g., reducing private car use, societal support for clean air initiatives). Delay discounting has been shown to be predictive of real world behavior outside of laboratory settings, and therefore may offer an important framework beyond traditional variables thought to measure sustainable behavior such as importance of an environmental issue, or environmental attitudes/values, although more research is needed in this area. We examined relations between discounting of air quality, respiratory health, and monetary gains and losses. We also examined, relations between discounting and self-reported importance of air quality and respiratory health, and nature relatedness. Results showed rapid delay discounting of all outcomes across the time frames assessed, and significant positive correlations between delay discounting of air quality, respiratory health, and monetary outcomes. Steeper discounting of monetary outcomes relative to air quality and respiratory health outcomes was observed in the context of gains; however, no differences in discounting were observed across losses of monetary, air quality, and respiratory health. Replicating the sign effect, monetary outcomes were discounted more steeply than monetary losses. Importance of air quality, respiratory health and nature relatedness were significantly and positively correlated with one another, but not with degree of delay discounting of any outcome, demonstrating the need for more comprehensive measures that predict pro-environmental behaviors that might benefit individuals and public health over time. These results add to our understanding of decision-making, and demonstrate alarming rates of delay discounting of air quality and health. These results implicate a major public health concern and potential barriers to individual and societal behavior that reduce pollution and emissions for conservation of clean air. PMID:28862671

Estimating the coverage of mental health programmes: a systematic review.

PubMed

De Silva, Mary J; Lee, Lucy; Fuhr, Daniela C; Rathod, Sujit; Chisholm, Dan; Schellenberg, Joanna; Patel, Vikram

2014-04-01

The large treatment gap for people suffering from mental disorders has led to initiatives to scale up mental health services. In order to track progress, estimates of programme coverage, and changes in coverage over time, are needed. Systematic review of mental health programme evaluations that assess coverage, measured either as the proportion of the target population in contact with services (contact coverage) or as the proportion of the target population who receive appropriate and effective care (effective coverage). We performed a search of electronic databases and grey literature up to March 2013 and contacted experts in the field. Methods to estimate the numerator (service utilization) and the denominator (target population) were reviewed to explore methods which could be used in programme evaluations. We identified 15 735 unique records of which only seven met the inclusion criteria. All studies reported contact coverage. No study explicitly measured effective coverage, but it was possible to estimate this for one study. In six studies the numerator of coverage, service utilization, was estimated using routine clinical information, whereas one study used a national community survey. The methods for estimating the denominator, the population in need of services, were more varied and included national prevalence surveys case registers, and estimates from the literature. Very few coverage estimates are available. Coverage could be estimated at low cost by combining routine programme data with population prevalence estimates from national surveys.

A Job with a Future? Delay Discounting, Magnitude Effects, and Domain Independence of Utility for Career Decisions.

ERIC Educational Resources Information Center

Schoenfelder, Thomas E.; Hantula, Donald A.

2003-01-01

Seniors (n=20) assessed two job offers with differences in domain (salary/tasks), delay (career-long earnings), and magnitude (initial salary offer). Contrary to discounted utility theory, choices reflected nonconstant discount rates for future salary/tasks (delay effect), lower discount rates for salary/preferred tasks (magnitude effect), and a…

Delay Discounting of Different Outcomes in a Sample of American Indian and Non-Indian College Students

ERIC Educational Resources Information Center

Weatherly, Jeffrey N.; McDonald, J. Douglas

2011-01-01

Delay discounting occurs when an individual prefers a lesser amount of an outcome that is available immediately, rather than waiting for the full amount. The present study was a preliminary investigation into delay discounting in a yet unstudied population, American Indians (AIs). AI college students completed a delay-discounting task that…

Demand, Funding, and Prestige: Driving the Use of Undergraduate Tuition Discounting in Research 1 Institutions

ERIC Educational Resources Information Center

Gunderson, Greg R.

2009-01-01

The purpose of the study was to determine (a) if high school enrollment demand, governmental funding capacity, or institutional prestige were predictors of the use of tuition discounts, (b) if increases in tuition discounts stimulated institutional spending capacity, and (c) if tuition discounts trends were notably different if examined from a…

A Discounting Framework for Choice With Delayed and Probabilistic Rewards

PubMed Central

Green, Leonard; Myerson, Joel

2005-01-01

When choosing between delayed or uncertain outcomes, individuals discount the value of such outcomes on the basis of the expected time to or the likelihood of their occurrence. In an integrative review of the expanding experimental literature on discounting, the authors show that although the same form of hyperbola-like function describes discounting of both delayed and probabilistic outcomes, a variety of recent findings are inconsistent with a single-process account. The authors also review studies that compare discounting in different populations and discuss the theoretical and practical implications of the findings. The present effort illustrates the value of studying choice involving both delayed and probabilistic outcomes within a general discounting framework that uses similar experimental procedures and a common analytical approach. PMID:15367080

Integrating Behavioral Economics and Behavioral Genetics: Delayed Reward Discounting as an Endophenotype for Addictive Disorders

PubMed Central

MacKillop, James

2013-01-01

Delayed reward discounting is a behavioral economic index of impulsivity, referring to how much an individual devalues a reward based on its delay in time. As a behavioral process that varies considerably across individuals, delay discounting has been studied extensively as a model for self-control, both in the general population and in clinical samples. There is growing interest in genetic influences on discounting and, in particular, the prospect of discounting as an endophenotype for addictive disorders (i.e., a heritable mechanism partially responsible for conferring genetic risk). This review assembles and critiques the evidence supporting this hypothesis. Via numerous cross-sectional studies and a small number of longitudinal studies, there is considerable evidence that impulsive discounting is associated with addictive behavior and appears to play an etiological role. Moreover, there is increasing evidence from diverse methodologies that impulsive delay discounting is temporally stable, heritable, and that elevated levels are present in nonaffected family members. These findings suggest that impulsive discounting meets the criteria for being considered an endophenotype. In addition, recent findings suggest that genetic variation related to dopamine neurotransmission is significantly associated with variability in discounting preferences. A significant caveat, however, is that the literature is modest in some domains and, in others, not all the findings have been supportive or consistent. In addition, important methodological considerations are necessary in future studies. Taken together, although not definitive, there is accumulating support for the hypothesis of impulsive discounting as an endophenotype for addictive behavior and a need for further systematic investigation. PMID:23344986

Estimating Drug Costs: How do Manufacturer Net Prices Compare with Other Common US Price References?

PubMed

Mattingly, T Joseph; Levy, Joseph F; Slejko, Julia F; Onwudiwe, Nneka C; Perfetto, Eleanor M

2018-05-12

Drug costs are frequently estimated in economic analyses using wholesale acquisition cost (WAC), but what is the best approach to develop these estimates? Pharmaceutical manufacturers recently released transparency reports disclosing net price increases after accounting for rebates and other discounts. Our objective was to determine whether manufacturer net prices (MNPs) could approximate the discounted prices observed by the U.S. Department of Veterans Affairs (VA). We compared the annual, average price discounts voluntarily reported by three pharmaceutical manufacturers with the VA price for specific products from each company. The top 10 drugs by total sales reported from company tax filings for 2016 were included. The discount observed by the VA was determined from each drug's list price, reported as WAC, in 2016. Descriptive statistics were calculated for the VA discount observed and a weighted price index was calculated using the lowest price to the VA (Weighted VA Index), which was compared with the manufacturer index. The discounted price as a percentage of the WAC ranged from 9 to 74%. All three indexes estimated by the average discount to the VA were at or below the manufacturer indexes (42 vs. 50% for Eli Lilly, 56 vs. 65% for Johnson & Johnson, and 59 vs. 59% for Merck). Manufacturer-reported average net prices may provide a close approximation of the average discounted price granted to the VA, suggesting they may be a useful proxy for the true pharmacy benefits manager (PBM) or payer cost. However, individual discounts for products have wide variation, making a standard discount adjustment across multiple products less acceptable.

Delay discounting of food by rhesus monkeys: Cocaine and food choice in isomorphic and allomorphic situations.

PubMed

Huskinson, Sally L; Woolverton, William L; Green, Leonard; Myerson, Joel; Freeman, Kevin B

2015-06-01

Research on delay discounting has focused largely on nondrug reinforcers in an isomorphic context in which choice is between alternatives that involve the same type of reinforcer. Less often, delay discounting has been studied with drug reinforcers in a more ecologically valid allomorphic context where choice is between alternatives involving different types of reinforcers. The present experiment is the first to examine discounting of drug and nondrug reinforcers in both isomorphic and allomorphic situations using a theoretical model (i.e., the hyperbolic discounting function) that allows for comparisons of discounting rates between reinforcer types and amounts. The goal of the current experiment was to examine discounting of a delayed, nondrug reinforcer (food) by male rhesus monkeys when the immediate alternative was either food (isomorphic situation) or cocaine (allomorphic situation). In addition, we sought to determine whether there was a magnitude effect with delayed food in the allomorphic situation. Choice of immediate food and immediate cocaine increased with amount and dose, respectively. Choice functions for immediate food and cocaine generally shifted leftward as delay increased. Compared to isomorphic situations in which food was the immediate alternative, delayed food was discounted more steeply in allomorphic situations where cocaine was the immediate alternative. Notably, discounting was not affected by the magnitude of the delayed reinforcer. These data indicate that how steeply a delayed nondrug reinforcer is discounted may depend more on the qualitative characteristics of the immediate reinforcer and less on the magnitude of the delayed one. (c) 2015 APA, all rights reserved).

Measuring Progress Toward Universal Health Coverage: Does the Monitoring Framework of Bangladesh Need Further Improvement?

PubMed

Gupta, Rajat Das; Shahabuddin, Asm

2018-01-08

This review aimed to compare Bangladesh's Universal Health Coverage (UHC) monitoring framework with the global-level recommendations and to find out the existing gaps of Bangladesh's UHC monitoring framework compared to the global recommendations. In order to reach the aims of the review, we systematically searched two electronic databases - PubMed and Google Scholar - by using appropriate keywords to select articles that describe issues related to UHC and the monitoring framework of UHC applied globally and particularly in Bangladesh. Four relevant documents were found and synthesized. The review found that Bangladesh incorporated all of the recommendations suggested by the global monitoring framework regarding mentoring the financial risk protection and equity perspective. However, a significant gap in the monitoring framework related to service coverage was observed. Although Bangladesh has a significant burden of mental illnesses, cataract, and neglected tropical diseases, indicators related to these issues were absent in Bangladesh's UHC framework. Moreover, palliative-care-related indicators were completely missing in the framework. The results of this review suggest that Bangladesh should incorporate these indicators in their UHC monitoring framework in order to track the progress of the country toward UHC more efficiently and in a robust way.

Altering impulsive decision making with an acceptance-based procedure.

PubMed

Morrison, Kate L; Madden, Gregory J; Odum, Amy L; Friedel, Jonathan E; Twohig, Michael P

2014-09-01

Delay discounting is one facet of impulsive decision making and involves subjectively devaluing a delayed outcome. Steeply discounting delayed rewards is correlated with substance abuse and other problematic behaviors. To the extent that steep delay discounting underlies these clinical disorders, it would be advantageous to find psychosocial avenues for reducing delay discounting. Acceptance-based interventions may prove useful as they may help to decrease the distress that arises while waiting for a delayed outcome. The current study was conducted to determine if a 60-90 minute acceptance-based training would change delay discounting rates among 30 undergraduate university students in comparison to a waitlist control. Measures given at pre- and posttraining included a hypothetical monetary delay discounting task, the Acceptance and Action Questionnaire-II (AAQ-II), and the Distress Tolerance Scale. Those assigned to the treatment group decreased their discounting of delayed money, but not distress intolerance or psychological inflexibility when compared to the waitlist control group. After the waiting period, the control group received the intervention. Combining all participants' pre- to posttreatment data, the acceptance-based treatment significantly decreased discounting of monetary rewards and increased distress tolerance. The difference in AAQ-II approached significance. Acceptance-based treatments may be a worthwhile option for decreasing delay discounting rates and, consequently, affecting the choices that underlie addiction and other problematic behaviors. Copyright © 2014. Published by Elsevier Ltd.

Transactional problem content in cost discounting: parallel effects for probability and delay.

PubMed

Jones, Stephen; Oaksford, Mike

2011-05-01

Four experiments investigated the effects of transactional content on temporal and probabilistic discounting of costs. Kusev, van Schaik, Ayton, Dent, and Chater (2009) have shown that content other than gambles can alter decision-making behavior even when associated value and probabilities are held constant. Transactions were hypothesized to lead to similar effects because the cost to a purchaser always has a linked gain, the purchased commodity. Gain amount has opposite effects on delay and probabilistic discounting (e.g., Benzion, Rapoport, & Yagil, 1989; Green, Myerson, & Ostaszewski, 1999), a finding that is not consistent with descriptive decision theory (Kahneman & Tversky, 1979; Loewenstein & Prelec, 1992). However, little or no effect on discounting has been observed for losses or costs. Experiment 1, using transactions, showed parallel effects for temporal and probabilistic discounting: Smaller amounts were discounted more than large amounts. As the cost rises, people value the commodity more, and they consequently discount less. Experiment 2 ruled out a possible methodological cause for this effect. Experiment 3 replicated Experiment 1. Experiment 4, using gambles, showed no effect for temporal discounting, because of the absence of the linked gain, but the same effect for probabilistic discounting, because prospects implicitly introduce a linked gain (Green et al., 1999; Prelec & Loewenstein, 1991). As found by Kusev et al. (2009), these findings are not consistent with decision theory and suggest closer attention should be paid to the effects of content on decision making.

Discounting medical malpractice claim reserves for self-insured hospitals.

PubMed

Frese, Richard; Kitchen, Patrick

2011-01-01

The hospital CFO often works with the hospital's actuary and external auditor to calculate the reserves recorded in financial statements. Hospital management, usually the CFO, needs to decide the discount rate that is most appropriate. A formal policy addressing the rationale for discounting and the rationale for selecting the discount rate can be helpful to the CFO, actuary, and external auditor.

31 CFR 356.21 - How are awards at the high yield or discount rate calculated?

Code of Federal Regulations, 2010 CFR

2010-07-01

... discount rate calculated? 356.21 Section 356.21 Money and Finance: Treasury Regulations Relating to Money... high yield or discount rate calculated? (a) Awards to submitters. We generally prorate bids at the highest accepted yield or discount rate under § 356.20(a)(2) of this part. For example, if 80.15% is the...

26 CFR 1.1272-3 - Election by a holder to treat all interest on a debt instrument as OID.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., OID, de minimis OID, market discount, de minimis market discount, and unstated interest, as adjusted... the rules provided by this section. (ii) Debt instrument with market discount. (A) A holder may make the election under this section for a debt instrument with market discount only if the holder is...

26 CFR 1.1272-3 - Election by a holder to treat all interest on a debt instrument as OID.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., OID, de minimis OID, market discount, de minimis market discount, and unstated interest, as adjusted... the rules provided by this section. (ii) Debt instrument with market discount. (A) A holder may make the election under this section for a debt instrument with market discount only if the holder is...

26 CFR 1.1272-3 - Election by a holder to treat all interest on a debt instrument as OID.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., market discount, de minimis market discount, and unstated interest, as adjusted by any amortizable bond... provided by this section. (ii) Debt instrument with market discount. (A) A holder may make the election under this section for a debt instrument with market discount only if the holder is eligible to make an...

26 CFR 1.1272-3 - Election by a holder to treat all interest on a debt instrument as OID.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., OID, de minimis OID, market discount, de minimis market discount, and unstated interest, as adjusted... the rules provided by this section. (ii) Debt instrument with market discount. (A) A holder may make the election under this section for a debt instrument with market discount only if the holder is...

Values in Time Discounting.

PubMed

Heilmann, Conrad

2017-10-01

Controversies about time discounting loom large in decisions about climate change. Prominently, a particularly controversial debate about time discounting in climate change decision-making has been conducted within climate economics, between the authors of Stern et al. (Stern review on the economics of climate change, 2006) and their critics (most prominently Dasgupta in Comments on the Stern review's economics of climate change, 2006; Tol in Energy Environ 17(6):977-981, 2006; Weitzman in J Econ Lit XLV:703-724, 2007; Nordhaus in J Econ Lit XLV:686-702, 2007). The article examines the role of values in this debate. Firstly, it is shown that time discounting is a case in which values are key because it is at heart an ethical problem. Secondly, it is argued that time discounting in climate economics is a case of economists making frequent and routine references to ethical values and indeed conduct ethical debates with each other. Thirdly, it is argued that there is evidence for deep and pervasive entanglement between facts and values in the prevalent methodologies for time discounting. Finally, it is argued that this means that economists have given up the 'value-free ideal' concerning time discounting, and discussed how the current methodology of time discounting in economics can be improved.

A low tension between individual and societal time aspects in health improved outcomes.

PubMed

Ortendahl, Monica; Fries, James F

2006-11-01

To review intertemporal choices, involving decisions with a trade-off between something now and something later. These choices are common in health both at an individual and societal level. The present value of an outcome, for example, the amount of money or the health outcomes in various aspects, is equivalent to the value of a future outcome discounted with the delay of time. The concept of diminishing value over time is positive discounting. Economic forecasts generally use discount rates in which the value of a future dollar is less than the value of a present dollar, and where the discount rates are similar for the individual investor and society. The value of future health is commonly thought of as similar to the value of future money. Yet, the individual may rationally choose a discount rate that is exceedingly low or even negative. This paradox is particularly relevant when considering primary and secondary prevention, where initial and continuing costs may precede beneficent outcomes by decades, making discount rate selections the dominant factor in determining decisions. We suggest that the societal perspective should also recognize that discount rates for health outcomes are largely irrelevant and that even negative discount rates have crucial relevance.

Acute ethanol does not always affect delay discounting in rats selected to prefer or avoid ethanol.

PubMed

Wilhelm, Clare J; Mitchell, Suzanne H

2012-01-01

The purpose of this study was to determine whether animals predisposed to prefer alcohol possess an altered acute response to alcohol on a delay discounting task relative to animals predisposed to avoid alcohol. We used rats selected to prefer or avoid alcohol to assess whether genotype moderates changes in delay discounting induced by acute ethanol exposure. Selectively bred rat lines of Sardinian alcohol-preferring (sP; n = 8) and non-preferring (sNP; n = 8) rats, and alko alcohol (AA, n = 8) and alko non-alcohol (ANA, n = 8) rats were trained in an adjusting amount task to assess delay discounting. There were no significant effects of line on baseline discounting; however, both lines of alcohol-preferring rats exhibit slowed reaction times. Acute ethanol (0, 0.25, 0.5 g/kg) treatment also had no effect on delay discounting in any of the selectively bred rat lines. Our data indicate that in these lines of animals, alcohol preference or avoidance has no impact on delay discounting following acute ethanol exposure. It is possible that other genetic models or lines may be differentially affected by alcohol and exhibit qualitatively and quantitatively different responses in delay discounting tasks.

Harnessing the uncertainty monster: Putting quantitative constraints on the intergenerational social discount rate

NASA Astrophysics Data System (ADS)

Lewandowsky, Stephan; Freeman, Mark C.; Mann, Michael E.

2017-09-01

There is broad consensus among economists that unmitigated climate change will ultimately have adverse global economic consequences, that the costs of inaction will likely outweigh the cost of taking action, and that social planners should therefore put a price on carbon. However, there is considerable debate and uncertainty about the appropriate value of the social discount rate, that is the extent to which future damages should be discounted relative to mitigation costs incurred now. We briefly review the ethical issues surrounding the social discount rate and then report a simulation experiment that constrains the value of the discount rate by considering 4 sources of uncertainty and ambiguity: Scientific uncertainty about the extent of future warming, social uncertainty about future population and future economic development, political uncertainty about future mitigation trajectories, and ethical ambiguity about how much the welfare of future generations should be valued today. We compute a certainty-equivalent declining discount rate that accommodates all those sources of uncertainty and ambiguity. The forward (instantaneous) discount rate converges to a value near 0% by century's end and the spot (horizon) discount rate drops below 2% by 2100 and drops below previous estimates by 2070.

Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting.

PubMed

Negash, Sesen; Sheppard, Nicole Van Ness; Lambert, Nathaniel M; Fincham, Frank D

2016-01-01

Internet pornography is a multi-billion-dollar industry that has grown increasingly accessible. Delay discounting involves devaluing larger, later rewards in favor of smaller, more immediate rewards. The constant novelty and primacy of sexual stimuli as particularly strong natural rewards make Internet pornography a unique activator of the brain's reward system, thereby having implications for decision-making processes. Based on theoretical studies of evolutionary psychology and neuroeconomics, two studies tested the hypothesis that consuming Internet pornography would relate to higher rates of delay discounting. Study 1 used a longitudinal design. Participants completed a pornography use questionnaire and a delay discounting task at Time 1 and then again four weeks later. Participants reporting higher initial pornography use demonstrated a higher delay discounting rate at Time 2, controlling for initial delay discounting. Study 2 tested for causality with an experimental design. Participants were randomly assigned to abstain from either their favorite food or pornography for three weeks. Participants who abstained from pornography use demonstrated lower delay discounting than participants who abstained from their favorite food. The finding suggests that Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards. Theoretical and clinical implications of these studies are highlighted.

The neural basis of cultural differences in delay discounting

PubMed Central

Kim, Bokyung; Sung, Young Shin; McClure, Samuel M.

2012-01-01

People generally prefer to receive rewarding outcomes sooner rather than later. Such preferences result from delay discounting, or the process by which outcomes are devalued for the expected delay until their receipt. We investigated cultural differences in delay discounting by contrasting behaviour and brain activity in separate cohorts of Western (American) and Eastern (Korean) subjects. Consistent with previous reports, we find a dramatic difference in discounting behaviour, with Americans displaying much greater present bias and elevated discount rates. Recent neuroimaging findings suggest that differences in discounting may arise from differential involvement of either brain reward areas or regions in the prefrontal and parietal cortices associated with cognitive control. We find that the ventral striatum is more greatly recruited in Americans relative to Koreans when discounting future rewards, but there is no difference in prefrontal or parietal activity. This suggests that a cultural difference in emotional responsivity underlies the observed behavioural effect. We discuss the implications of this research for strategic interrelations between Easterners and Westerners. PMID:22271781

Brain activity in valuation regions while thinking about the future predicts individual discount rates.

PubMed

Cooper, Nicole; Kable, Joseph W; Kim, B Kyu; Zauberman, Gal

2013-08-07

People vary widely in how much they discount delayed rewards, yet little is known about the sources of these differences. Here we demonstrate that neural activity in ventromedial prefrontal cortex (VMPFC) and ventral striatum (VS) when human subjects are asked to merely think about the future--specifically, to judge the subjective length of future time intervals--predicts delay discounting. High discounters showed lower activity for longer time delays, while low discounters showed the opposite pattern. Our results demonstrate that the correlation between VMPFC and VS activity and discounting occurs even in the absence of choices about future rewards, and does not depend on a person explicitly evaluating future outcomes or judging their self-relevance. This suggests a link between discounting and basic processes involved in thinking about the future, such as temporal perception. Our results also suggest that reducing impatience requires not suppression of VMPFC and VS activity altogether, but rather modulation of how these regions respond to the present versus the future.

Discounting of Condom-Protected Sex as a Measure of High Risk for Sexually Transmitted Infection Among College Students.

PubMed

Collado, Anahí; Johnson, Patrick S; Loya, Jennifer M; Johnson, Matthew W; Yi, Richard

2017-10-01

The study examined sexual delay discounting, or the devaluation of condom-protected sex in the face of delay, as a risk factor for sexually transmitted infection (STI) among college students. Participants (143 females, 117 males) completed the sexual delay discounting task (Johnson & Bruner, 2012) and questionnaires of risky sexual behavior, risk perception, and knowledge. Participants exhibited steeper sexual delay discounting (above and beyond general likelihood of having unprotected sex) when partners were viewed as more desirable or less likely to have a STI, with males demonstrating greater sexual delay discounting than females across most conditions. Importantly, greater self-reported risky sexual behaviors were associated with higher rates of sexual delay discounting, but not with likelihood of using a condom in the absence of delay. These results provide support for considering sexual delay discounting, with particular emphasis on potential delays to condom use, as a risk factor for STI among college students.

Brain Activity in Valuation Regions while Thinking about the Future Predicts Individual Discount Rates

PubMed Central

Cooper, Nicole; Kim, B. Kyu; Zauberman, Gal

2013-01-01

People vary widely in how much they discount delayed rewards, yet little is known about the sources of these differences. Here we demonstrate that neural activity in ventromedial prefrontal cortex (VMPFC) and ventral striatum (VS) when human subjects are asked to merely think about the future—specifically, to judge the subjective length of future time intervals—predicts delay discounting. High discounters showed lower activity for longer time delays, while low discounters showed the opposite pattern. Our results demonstrate that the correlation between VMPFC and VS activity and discounting occurs even in the absence of choices about future rewards, and does not depend on a person explicitly evaluating future outcomes or judging their self-relevance. This suggests a link between discounting and basic processes involved in thinking about the future, such as temporal perception. Our results also suggest that reducing impatience requires not suppression of VMPFC and VS activity altogether, but rather modulation of how these regions respond to the present versus the future. PMID:23926268

Cigarette smokers show steeper discounting of both food and cigarettes than money.

PubMed

Odum, Amy L; Baumann, Ana A L

2007-12-01

People with drug addiction show steeper discounting of drugs of abuse than money. One suggestion is that this effect is related to withdrawal processes in drug dependence. We investigated whether it could be related to the fact that drugs are directly consumable, whereas money is not. We determined whether regular cigarette smokers discount food (another consumable outcome) less steeply than cigarettes, both of which were predicted to be discounted more steeply than money. Cigarette smokers (N=20) indicated preferences for immediate and delayed outcomes in a titration procedure that determined indifference points at various delays. In three separate conditions, the choices involved food, cigarettes, or money. The value of the delayed option was always US$ 10 or US$ 10 worth of the outcome. Cigarette smokers discounted both cigarettes and food more steeply than money. Most importantly, cigarettes and food were discounted to a similar degree. Cigarettes may be steeply discounted in part due to their consumable nature, rather than solely due to withdrawal-related processes.

"Prince Charming Syndrome?" Gender gap in preferences for defined contribution pensions in Japan.

PubMed

Watanabe, Satoshi P

2017-01-01

Using survey data collected by the Japan Institute of Life Insurance in 2002, this study finds that a significant gender gap existed in defined contribution (DC) pension knowledge among workers employed at small- to medium-sized private firms in Japan. Even with similar DC knowledge, however, men and women reveal different preferences for DC pensions, indicating that their perceptional responses may widely differ from actual behaviors. Apart from the knowledge gap, the result shows evidence of the Prince Charming Syndrome among female employees as a significant source of the gender gap in DC participation rates. Among corporate pension-covered employees, the gender difference in the efficacy of DC portability is a more significant gap-generating factor. DC tax advantage is particularly favored by pension-covered female employees over male counterparts, reducing the DC preference gap. No similar evidence is found for employees with no corporate pension coverage.

Cost-effectiveness of different human papillomavirus vaccines in Singapore.

PubMed

Lee, Vernon J; Tay, Sun Kuie; Teoh, Yee Leong; Tok, Mei Yin

2011-03-31

Human papillomavirus (HPV) vaccines are widely available and there have been studies exploring their potential clinical impact and cost-effectiveness. However, few studies have compared the cost-effectiveness among the 2 main vaccines available - a bivalent vaccine against HPV 16/18, and a quadrivalent vaccine against 6/11/16/18. We explore the cost-effectiveness of these two HPV vaccines in tropical Singapore. We developed a Markov state-transition model to represent the natural history of cervical cancer to predict HPV infection, cancer incidence, mortality, and costs. Cytologic screening and treatment of different outcomes of HPV infection were incorporated. Vaccination was provided to a cohort of 12-year old females in Singapore, followed up until death. Based on available vaccines on the market, the bivalent vaccine had increased effectiveness against a wider range of HPV types, while the quadrivalent vaccine had effectiveness against genital warts. Incremental cost-effectiveness ratios (ICER) compared vaccination to no-vaccination, and between the two vaccines. Sensitivity analyses explored differences in vaccine effectiveness and uptake, and other key input parameters. For the no vaccination scenario, 229 cervical cancer cases occurred over the cohort's lifetime. The total discounted cost per individual due to HPV infection was SGD$275 with 28.54 discounted life-years. With 100% vaccine coverage, the quadrivalent vaccine reduced cancers by 176, and had an ICER of SGD$12,866 per life-year saved. For the bivalent vaccine, 197 cancers were prevented with an ICER of $12,827 per life-year saved. Comparing the bivalent to the quadrivalent vaccine, the ICER was $12,488 per life-year saved. However, the cost per QALY saved for the quadrivalent vaccine compared to no vaccine was $9,071, while it was $10,392 for the bivalent vaccine, with the quadrivalent vaccine dominating the bivalent vaccine due to the additional QALY effect from reduction in genital warts. The overall outcomes were most sensitive to vaccine cost and coverage. HPV vaccination is a cost-effective strategy, and should be considered a possible strategy to reduce the impact of HPV infection.

Error Discounting in Probabilistic Category Learning

PubMed Central

Craig, Stewart; Lewandowsky, Stephan; Little, Daniel R.

2011-01-01

Some current theories of probabilistic categorization assume that people gradually attenuate their learning in response to unavoidable error. However, existing evidence for this error discounting is sparse and open to alternative interpretations. We report two probabilistic-categorization experiments that investigated error discounting by shifting feedback probabilities to new values after different amounts of training. In both experiments, responding gradually became less responsive to errors, and learning was slowed for some time after the feedback shift. Both results are indicative of error discounting. Quantitative modeling of the data revealed that adding a mechanism for error discounting significantly improved the fits of an exemplar-based and a rule-based associative learning model, as well as of a recency-based model of categorization. We conclude that error discounting is an important component of probabilistic learning. PMID:21355666

The date-delay framing effect in temporal discounting depends on substance abuse.

PubMed

Klapproth, Florian

2012-07-01

In the present study, individuals with substance use disorders (n=30) and non-addicted controls (n=30) were presented with a delay-discounting task with time being described either as dates or as temporal intervals. Three main results were obtained. First, in both groups reward size had a large impact on discounting future rewards, with discount rates becoming larger with smaller reward sizes. Second, participants discounted future rewards less strongly when their time of delivery was presented as a date instead of a temporal distance. Third, whereas discount rates of individuals with substance use disorders varied substantially with regard to the presentation of time in the task, the controls changed their choices depending on time presentation only slightly. Copyright © 2012 Elsevier B.V. All rights reserved.

Do the Powerful Discount the Future Less? The Effects of Power on Temporal Discounting

PubMed Central

Duan, Jinyun; Wu, Sherry J.; Sun, Luying

2017-01-01

Individuals have the tendency to discount rewards in the future, known as temporal discounting, and we find that sense of power (the felt capacity to influence the thinking and behavior of others) reduces such tendency. In Studies 1 and 2, we used both an experiment and a survey with organizational employees to demonstrate that power reduced temporal discounting. In Study 3, we replicated study 1 while exploring a unique cultural trait of Danbo, or indifference to fame and wealth, across two ethnic groups (Han and Tibetan groups) in China. While power reduces temporal discounting, the relationship between the two may be leveraged by individual differences of optimism, frustration, and Danbo. The results imply a more nuanced interpretation of how individual and situational factors can affect intertemporal choice. PMID:28680410

Value of the future: Discounting in random environments

NASA Astrophysics Data System (ADS)

Farmer, J. Doyne; Geanakoplos, John; Masoliver, Jaume; Montero, Miquel; Perelló, Josep

2015-05-01

We analyze how to value future costs and benefits when they must be discounted relative to the present. We introduce the subject for the nonspecialist and take into account the randomness of the economic evolution by studying the discount function of three widely used processes for the dynamics of interest rates: Ornstein-Uhlenbeck, Feller, and log-normal. Besides obtaining exact expressions for the discount function and simple asymptotic approximations, we show that historical average interest rates overestimate long-run discount rates and that this effect can be large. In other words, long-run discount rates should be substantially less than the average rate observed in the past, otherwise any cost-benefit calculation would be biased in favor of the present and against interventions that may protect the future.

Value of the future: Discounting in random environments.

PubMed

Farmer, J Doyne; Geanakoplos, John; Masoliver, Jaume; Montero, Miquel; Perelló, Josep

2015-05-01

We analyze how to value future costs and benefits when they must be discounted relative to the present. We introduce the subject for the nonspecialist and take into account the randomness of the economic evolution by studying the discount function of three widely used processes for the dynamics of interest rates: Ornstein-Uhlenbeck, Feller, and log-normal. Besides obtaining exact expressions for the discount function and simple asymptotic approximations, we show that historical average interest rates overestimate long-run discount rates and that this effect can be large. In other words, long-run discount rates should be substantially less than the average rate observed in the past, otherwise any cost-benefit calculation would be biased in favor of the present and against interventions that may protect the future.

Do the Powerful Discount the Future Less? The Effects of Power on Temporal Discounting.

PubMed

Duan, Jinyun; Wu, Sherry J; Sun, Luying

2017-01-01

Individuals have the tendency to discount rewards in the future, known as temporal discounting, and we find that sense of power (the felt capacity to influence the thinking and behavior of others) reduces such tendency. In Studies 1 and 2, we used both an experiment and a survey with organizational employees to demonstrate that power reduced temporal discounting. In Study 3, we replicated study 1 while exploring a unique cultural trait of Danbo , or indifference to fame and wealth, across two ethnic groups (Han and Tibetan groups) in China. While power reduces temporal discounting, the relationship between the two may be leveraged by individual differences of optimism, frustration, and Danbo . The results imply a more nuanced interpretation of how individual and situational factors can affect intertemporal choice.

Reconstruction of Arctic surface temperature in past 100 years using DINEOF

NASA Astrophysics Data System (ADS)

Zhang, Qiyi; Huang, Jianbin; Luo, Yong

2015-04-01

Global annual mean surface temperature has not risen apparently since 1998, which is described as global warming hiatus in recent years. However, measuring of temperature variability in Arctic is difficult because of large gaps in coverage of Arctic region in most observed gridded datasets. Since Arctic has experienced a rapid temperature change in recent years that called polar amplification, and temperature risen in Arctic is faster than global mean, the unobserved temperature in central Arctic will result in cold bias in both global and Arctic temperature measurement compared with model simulations and reanalysis datasets. Moreover, some datasets that have complete coverage in Arctic but short temporal scale cannot show Arctic temperature variability for long time. Data Interpolating Empirical Orthogonal Function (DINEOF) were applied to fill the coverage gap of NASA's Goddard Institute for Space Studies Surface Temperature Analysis (GISTEMP 250km smooth) product in Arctic with IABP dataset which covers entire Arctic region between 1979 and 1998, and to reconstruct Arctic temperature in 1900-2012. This method provided temperature reconstruction in central Arctic and precise estimation of both global and Arctic temperature variability with a long temporal scale. Results have been verified by extra independent station records in Arctic by statistical analysis, such as variance and standard deviation. The result of reconstruction shows significant warming trend in Arctic in recent 30 years, as the temperature trend in Arctic since 1997 is 0.76°C per decade, compared with 0.48°C and 0.67°C per decade from 250km smooth and 1200km smooth of GISTEMP. And global temperature trend is two times greater after using DINEOF. The discrepancies above stress the importance of fully consideration of temperature variance in Arctic because gaps of coverage in Arctic cause apparent cold bias in temperature estimation. The result of global surface temperature also proves that global warming in recent years is not as slow as thought.

Rhea North Polar Maps - January 2011

NASA Image and Video Library

2011-05-02

The northern and southern hemispheres of Rhea are seen in these polar stereographic maps, mosaicked from the best-available NASA Cassini and Voyager images. Six Voyager images fill in gaps in Cassini coverage of the moon north pole.

Rhea South Polar Map - January 2011

NASA Image and Video Library

2011-05-02

The northern and southern hemispheres of Rhea are seen in these polar stereographic maps, mosaicked from the best-available NASA Cassini and Voyager images. Six Voyager images fill in gaps in Cassini coverage of the moon north pole.

Discounting the distant future-Data on Australian discount rates estimated by a stochastic interest rate model.

PubMed

Truong, Chi; Trück, Stefan

2017-04-01

Data on certainty equivalent discount factors and discount rates for stochastic interest rates in Australia are provided in this paper. The data has been used for the analysis of investments into climate adaptation projects in ׳It׳s not now or never: Implications of investment timing and risk aversion on climate adaptation to extreme events ׳ (Truong and Trück, 2016) [3] and can be used for other cost-benefit analysis studies in Australia. The data is of particular interest for the discounting of projects that create monetary costs and benefits in the distant future.

Further observations on comparison of immunization coverage by lot quality assurance sampling and 30 cluster sampling.

PubMed

Singh, J; Jain, D C; Sharma, R S; Verghese, T

1996-06-01

Lot Quality Assurance Sampling (LQAS) and standard EPI methodology (30 cluster sampling) were used to evaluate immunization coverage in a Primary Health Center (PHC) where coverage levels were reported to be more than 85%. Of 27 sub-centers (lots) evaluated by LQAS, only 2 were accepted for child coverage, whereas none was accepted for tetanus toxoid (TT) coverage in mothers. LQAS data were combined to obtain an estimate of coverage in the entire population; 41% (95% CI 36-46) infants were immunized appropriately for their ages, while 42% (95% CI 37-47) of their mothers had received a second/ booster dose of TT. TT coverage in 149 contemporary mothers sampled in EPI survey was also 42% (95% CI 31-52). Although results by the two sampling methods were consistent with each other, a big gap was evident between reported coverage (in children as well as mothers) and survey results. LQAS was found to be operationally feasible, but it cost 40% more and required 2.5 times more time than the EPI survey. LQAS therefore, is not a good substitute for current EPI methodology to evaluate immunization coverage in a large administrative area. However, LQAS has potential as method to monitor health programs on a routine basis in small population sub-units, especially in areas with high and heterogeneously distributed immunization coverage.

Framing Reinforcement Learning from Human Reward: Reward Positivity, Temporal Discounting, Episodicity, and Performance

DTIC Science & Technology

2014-09-29

Framing Reinforcement Learning from Human Reward: Reward Positivity, Temporal Discounting, Episodicity , and Performance W. Bradley Knox...positive a trainer’s reward values are; temporal discounting, the extent to which future reward is discounted in value; episodicity , whether task...learning occurs in discrete learning episodes instead of one continuing session; and task performance, the agent’s performance on the task the trainer

Discounting toward Disaster: Tuition Discounting, College Finances, and Enrollments of Low-Income Undergraduates. New Agenda Series[TM], Volume 3, Number 2.

ERIC Educational Resources Information Center

Redd, Kenneth E.

To study the effects of college tuition discounting, data from annual Institutional Student Aid Surveys of private colleges and universities were compared to enrollment and Pell Grant data from the U.S. Department of Education. Findings indicated that: (1) at least one quarter of the colleges and universities used discounting strategies that…

Can we use human judgments to determine the discount rate?

PubMed

Baron, J

2000-12-01

It has been suggested that the long-term discount rate for environmental goods should decrease at longer delays. One justification for this suggestion is that human judgments support it. This article presents an experiment showing that judgments concerning discount rates are internally inconsistent. These results point to potential problems with the use of judgments referenda for determining discount rates in cost-benefit analyses.

26 CFR 1.6049-7T - Market discount fraction reported with other financial information with respect to REMICs and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 13 2010-04-01 2010-04-01 false Market discount fraction reported with other... TAX (CONTINUED) INCOME TAXES Information Returns § 1.6049-7T Market discount fraction reported with... purposes of § 1.6049-7(f)(2)(i)(G)(1) relating to the market discount fraction to be reported with other...

Moderate Effects of Same-Sex Legislation on Dependent Employer-Based Insurance Coverage Among Sexual Minorities.

PubMed

Tran, Linda Diem

2016-12-01

A difference-in-difference approach was used to compare the effects of same-sex domestic partnership, civil union, and marriage policies on same- and different-sex partners who could have benefitted from their partners' employer-based insurance (EBI) coverage. Same-sex partners had 78% lower odds (Marginal Effect = -21%) of having EBI compared with different-sex partners, adjusting for socioeconomic and health-related factors. Same-sex partners living in states that recognized same-sex marriage or domestic partnership had 89% greater odds of having EBI compared with those in states that did not recognize same-sex unions (ME = 5%). The impact of same-sex legislation on increasing take-up of dependent EBI coverage among lesbians, gay men, and bisexual individuals was modest, and domestic partnership legislation was equally as effective as same-sex marriage in increasing same-sex partner EBI coverage. Extending dependent EBI coverage to same-sex partners can mitigate gaps in coverage for a segment of the lesbians, gay men, and bisexual population but will not eliminate them. © The Author(s) 2016.

The choice of discount brand cigarettes: A comparative analysis of International Tobacco Control (ITC) Surveys in Canada and the United States (2002–2005)

PubMed Central

Nargis, Nigar; Fong, Geoffrey T.; Chaloupka, Frank J.; Li, Qiang

2014-01-01

Background Increasing tobacco taxes to increase price is a proven tobacco control measure. This paper investigates how smokers respond to tax and price increases in their choice of discount brand cigarettes vs. premium brands. Objective To estimate how increase in the tax rate can affect smokers’ choice of discount brands versus premium brands. Methods Using data from ITC Surveys in Canada and the United States, a logit model was constructed to estimate the probability of choosing discount brand cigarettes in response to its price changes relative to premium brands, controlling for individual-specific demographic and socio-economic characteristics and regional effects. The self-reported price of an individual smoker is used in a random-effects regression model to impute price and to construct the price ratio for discount and premium brands for each smoker, which is used in the logit model. Findings An increase in the ratio of price of discount brand cigarettes to the price of premium brands by 0.1 is associated with a decrease in the probability of choosing discount brands by 0.08 in Canada. No significant effect is observed in case of the United States. Conclusion The results of the model explain two phenomena: (1) the widened price differential between premium and discount brand cigarettes contributed to the increased share of discount brand cigarettes in Canada in contrast to a relatively steady share in the United States during 2002–2005, and (2) increasing the price ratio of discount brands to premium brands—which occurs with an increase in specific excise tax—may lead to upward shifting from discount to premium brands rather than to downward shifting. These results underscore the significance of studying the effectiveness of tax increases in reducing overall tobacco consumption, particularly for specific excise taxes. PMID:23986408

Enhanced Neural Responses to Imagined Primary Rewards Predict Reduced Monetary Temporal Discounting.

PubMed

Hakimi, Shabnam; Hare, Todd A

2015-09-23

The pervasive tendency to discount the value of future rewards varies considerably across individuals and has important implications for health and well-being. Here, we used fMRI with human participants to examine whether an individual's neural representation of an imagined primary reward predicts the degree to which the value of delayed monetary payments is discounted. Because future rewards can never be experienced at the time of choice, imagining or simulating the benefits of a future reward may play a critical role in decisions between alternatives with either immediate or delayed benefits. We found that enhanced ventromedial prefrontal cortex response during imagined primary reward receipt was correlated with reduced discounting in a separate monetary intertemporal choice task. Furthermore, activity in enhanced ventromedial prefrontal cortex during reward imagination predicted temporal discounting behavior both between- and within-individual decision makers with 62% and 73% mean balanced accuracy, respectively. These results suggest that the quality of reward imagination may impact the degree to which future outcomes are discounted. Significance statement: We report a novel test of the hypothesis that an important factor influencing the discount rate for future rewards is the quality with which they are imagined or estimated in the present. Previous work has shown that temporal discounting is linked to individual characteristics ranging from general intelligence to the propensity for addiction. We demonstrate that individual differences in a neurobiological measure of primary reward imagination are significantly correlated with discounting rates for future monetary payments. Moreover, our neurobiological measure of imagination can be used to accurately predict choice behavior both between and within individuals. These results suggest that improving reward imagination may be a useful therapeutic target for individuals whose high discount rates promote detrimental behaviors. Copyright © 2015 the authors 0270-6474/15/3513103-07$15.00/0.

Is Every Smoker Interested in Price Promotions? An Evaluation of Price-Related Discounts by Cigarette Brands

PubMed Central

Xu, Xin; Wang, Xu; Caraballo, Ralph S.

2015-01-01

Context Raising unit price is one of the most effective ways of reducing cigarette consumption. A large proportion of US adult smokers use generic brands or price discounts in response to higher prices, which may mitigate the public health impacts of raising unit price. Objective The main purpose of this study was to evaluate the retail price impact and the determinants of price-related discount use among US adult smokers by their most commonly used cigarette brand types. Methods Data from the 2009–2010 National Adult Tobacco Survey, a telephone survey of US adults 18 years or older, was used to assess price-related discount use by cigarette brands. Price-related discounts included coupons, rebates, buy 1 get 1 free, 2 for 1, or any other special promotions. Multivariate logistic regression was used to assess sociodemographic and tobacco use determinants of discount use by cigarette brands. Results Discount use was most common among premium brand users (22.1%), followed by generic (13.3%) and other brand (10.8%) users. Among premium brand users, those who smoked 10 to 20 cigarettes per day were more likely to use discounts, whereas elderly smokers, non-Hispanic blacks, those with greater annual household income, dual users of cigarettes and other combustible tobacco products, and those who had no quit intentions were less likely to do so. Among generic brand users, those who had no quit intentions and those who smoked first cigarette within 60 minutes after waking were more likely to use discounts. Conclusions Frequent use of discounts varies between smokers of premium and generic cigarette brands. Setting a high minimum price, together with limiting the use of coupons and promotions, may uphold the effect of cigarette excise taxes to reduce smoking prevalence. PMID:26598952

Is Every Smoker Interested in Price Promotions? An Evaluation of Price-Related Discounts by Cigarette Brands.

PubMed

Xu, Xin; Wang, Xu; Caraballo, Ralph S

2016-01-01

Raising unit price is one of the most effective ways of reducing cigarette consumption. A large proportion of US adult smokers use generic brands or price discounts in response to higher prices, which may mitigate the public health impacts of raising unit price. The main purpose of this study was to evaluate the retail price impact and the determinants of price-related discount use among US adult smokers by their most commonly used cigarette brand types. Data from the 2009-2010 National Adult Tobacco Survey, a telephone survey of US adults 18 years or older, was used to assess price-related discount use by cigarette brands. Price-related discounts included coupons, rebates, buy 1 get 1 free, 2 for 1, or any other special promotions. Multivariate logistic regression was used to assess sociodemographic and tobacco use determinants of discount use by cigarette brands. Discount use was most common among premium brand users (22.1%), followed by generic (13.3%) and other brand (10.8%) users. Among premium brand users, those who smoked 10 to 20 cigarettes per day were more likely to use discounts, whereas elderly smokers, non-Hispanic blacks, those with greater annual household income, dual users of cigarettes and other combustible tobacco products, and those who had no quit intentions were less likely to do so. Among generic brand users, those who had no quit intentions and those who smoked first cigarette within 60 minutes after waking were more likely to use discounts. Frequent use of discounts varies between smokers of premium and generic cigarette brands. Setting a high minimum price, together with limiting the use of coupons and promotions, may uphold the effect of cigarette excise taxes to reduce smoking prevalence.

Toward a more reliable federal survey for tracking health insurance coverage and access.

PubMed

Kenney, Genevieve; Holahan, John; Nichols, Len

2006-06-01

Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument and related survey documentation and the methodological literature. Identification of the data needed to address key policy questions on insurance coverage, assessment of how well existing surveys meet this need, definition of the critical elements of an ideal survey, and examination of the potential for building on existing surveys. Collection and critical assessment of pertinent survey documentation and methodological studies. While all the federal surveys examined provide valuable information, the information available to guide key policy decisions still has major gaps. Issues include measurement of insurance coverage and critical content gaps, inadequate sample sizes to support precise state and substate estimates, considerable delays between data collection and availability, and concerns about response rates and item nonresponse. Our assessment is that the Current Population Survey (CPS) and the National Health Interview Survey could be most readily modified to address these issues. The vast resources devoted to health care and the magnitude of the uninsurance problem make it critical that we have a reliable source for tracking health care and coverage at the national and state levels and for major local areas. It is plausible that this could be more cost effectively done by building on existing surveys than by designing and fielding a new one, but further research is needed to make a definitive judgment. At a minimum, the health insurance information collected on the CPS should be revised to address existing measurement problems.

Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines.

PubMed

Hodge, Andrew; Firth, Sonja; Bermejo, Raoul; Zeck, Willibald; Jimenez-Soto, Eliana

2016-07-06

Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving the wealth-based utilisation gap. Using national representative data from the 2013 Philippines Demographic and Health Survey, we examine the extent overall differences in the utilisation of maternal health services can be explained by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by differences in observed characteristics. After controlling for factors characterising the socioeconomic status of the household (i.e. the mothers' and her partners' education and occupation), the birth order of the child was the major factor contributing to the disparity. Mothers' religion and the subjective distance to the health facility were also noteworthy. This study has found moderate wealth-based disparities in the utilisation of institutional delivery in the Philippines. The results confirm the importance of recent efforts made by the Philippine government to implement equitable, pro-poor focused health programs in the most deprived geographic areas of the country. The importance of addressing the social determinants of health, particularly education, as well as developing and implementing effective strategies to encourage institutional delivery for higher order births, should be prioritised.

National red listing beyond the 2010 target.

PubMed

Zamin, Tara J; Baillie, Jonathan E M; Miller, Rebecca M; Rodríguez, Jon Paul; Ardid, Ana; Collen, Ben

2010-08-01

Following creation of the 2010 Biodiversity Target under the Convention on Biological Diversity and adoption of the United Nations Millennium Development Goals, information on status and trends of biodiversity at the national level has become increasingly important to both science and policy. National red lists (NRLs) of threatened species may provide suitable data for reporting on progress toward these goals and for informing national conservation priority setting. This information will also become increasingly important for developing species- and ecosystem-based strategies for climate change adaptation. We conducted a thorough global review of NRLs in 109 countries and analyzed gaps in NRL coverage in terms of geography and taxonomy to determine priority regions and taxonomic groups for further investment. We then examined correlations between the NRL data set and gross domestic product (GDP) and vertebrate species richness. The largest geographic gap was in Oceania, followed by middle Africa, the Caribbean, and western Africa, whereas the largest taxonomic gaps were for invertebrates, fungi, and lichens. The comprehensiveness of NRL coverage within a given country was positively correlated with GDP and negatively correlated with total vertebrate richness and threatened vertebrate richness. This supports the assertion that regions with the greatest and most vulnerable biodiversity receive the least conservation attention and indicates that financial resources may be an integral limitation. To improve coverage of NRLs, we propose a combination of projects that target underrepresented taxa or regions and projects that provide the means for countries to create or update NRLs on their own. We recommend improvements in knowledge transfer within and across regions as a priority for future investment.

Delay discounting of qualitatively different reinforcers in rats.

PubMed

Calvert, Amanda L; Green, Leonard; Myerson, Joel

2010-03-01

Humans discount larger delayed rewards less steeply than smaller rewards, whereas no such magnitude effect has been observed in rats (and pigeons). It remains possible that rats' discounting is sensitive to differences in the quality of the delayed reinforcer even though it is not sensitive to amount. To evaluate this possibility, Experiment 1 examined discounting of qualitatively different food reinforcers: highly preferred versus nonpreferred food pellets. Similarly, Experiment 2 examined discounting of highly preferred versus nonpreferred liquid reinforcers. In both experiments, an adjusting-amount procedure was used to determine the amount of immediate reinforcer that was judged to be of equal subjective value to the delayed reinforcer. The amount and quality of the delayed reinforcer were varied across conditions. Discounting was well described by a hyperbolic function, but no systematic effects of the quantity or the quality of the delayed reinforcer were observed.

Psychosocial Influences on Fruit and Vegetable Intake Following a NYC Supermarket Discount.

PubMed

Bernales-Korins, Maria; Ang, Ian Yi Han; Khan, Shamima; Geliebter, Allan

2017-08-01

To assess the effect of a 50% discount on fruits and vegetables (F&V) on the purchase and intake of F&V and on psychosocial determinants of F&V intake: self-efficacy (SE), stages of change (SOC), and perceived barriers (PB). This randomized controlled trial was conducted in local supermarkets over 16 weeks, including a 4-week baseline, 8-week discount intervention, and 4-week follow-up. Shoppers with overweight or obesity (BMI > 25) were randomized to receive a discount or no discount via their reward scan card after the baseline. Twenty-four-hour recalls and psychosocial measures were obtained for each study period. Purchases (P < 0.0005) and intakes (P = 0.019) of F&V increased significantly during the intervention, while only F&V intake was sustained at follow-up. The discount intervention increased SE (P < 0.01) and SOC (P < 0.05) and did not decrease PB (P = 0.057) during the intervention. SOC mediated the discount intervention effect on F&V intake (P < 0.05) during the intervention, explaining 43% of variance. A supermarket discount intervention led to increases in purchases and intakes of F&V and increases in the psychosocial factors SE and SOC and did not decrease PB. The discount intervention prompted participants to move from the preparation to action stage of SOC, which acted as a mediator for increased F&V intake. © 2017 The Obesity Society.

Hospital charge exemptions for the poor in Shandong, China.

PubMed

Meng, Qingyue; Sun, Qiang; Hearst, Norman

2002-12-01

Rapid economic changes in China have produced soaring hospital charges, a breakdown of the old social health insurance system, a resulting crisis in hospital affordability and renewed interest in mechanisms for discounts or exemptions from hospital charges for the poor. Little is known, however, about how effective such systems are in practice. We studied nine public hospitals in Shandong Province that offer discount or exemption mechanisms for the poor. Methods included document review, key informant interviews, detailed review of financial records and focus group discussions. These hospitals receive little government subsidy and must support themselves almost entirely through user fees. Hospital managers saw discount mechanisms primarily as marketing tools and designed them to limit their cost. Only a small fraction of hospital services were eligible for discount, and these were usually low cost or low utilization items. Discounts were generally 10-50% for selected items with very few services exempted from charge. The total value of discounts granted was 1% or less of total hospital operating budgets. Correct identification of indigents was a major difficulty for hospitals. Only a minority of indigents received discounts, the process was sometimes arbitrary and some who received discounts were not really poor. Government policies requiring discounts for the poor were vague and not enforced. The exemption programmes studied do not provide effective protection from hospital charges for the poor. To be effective, exemption mechanisms would likely require both financing and regulation by the government as well as an accurate way to identify the poor.

Map of Rhea - January 2011

NASA Image and Video Library

2011-05-02

This global digital map of Rhea was created using data taken during NASA Cassini and Voyager spacecraft flybys. This map contains data from Cassini Jan. 11, 2011, flyby of Rhea. Six Voyager images fill gaps in Cassini coverage of the north pole.

Low-coverage surface diffusion in complex periodic energy landscapes: Analytical solution for systems with symmetric hops and application to intercalation in topological insulators

NASA Astrophysics Data System (ADS)

Gosálvez, Miguel A.; Otrokov, Mikhail M.; Ferrando, Nestor; Ryabishchenkova, Anastasia G.; Ayuela, Andres; Echenique, Pedro M.; Chulkov, Evgueni V.

2016-02-01

This is the first of two papers that introduce a general expression for the tracer diffusivity in complex, periodic energy landscapes with M distinct hop rates in one-, two-, and three-dimensional diluted systems (low-coverage, single-tracer limit). The present report focuses on the analysis of diffusion in systems where the end sites of the hops are located symmetrically with respect to the hop origins (symmetric hops), as encountered in many ideal surfaces and bulk materials. For diffusion in two dimensions, a number of formulas are presented for complex combinations of the different hops in systems with triangular, rectangular, and square symmetry. The formulas provide values in excellent agreement with kinetic Monte Carlo simulations, concluding that the diffusion coefficient can be directly determined from the proposed expressions without performing the simulations. Based on the diffusion barriers obtained from first-principles calculations and a physically meaningful estimate of the attempt frequencies, the proposed formulas are used to analyze the diffusion of Cu, Ag, and Rb adatoms on the surface and within the van der Waals (vdW) gap of a model topological insulator, Bi2Se3 . Considering the possibility of adsorbate intercalation from the terraces to the vdW gaps at morphological steps, we infer that, at low coverage and room temperature, (i) a majority of the Rb atoms bounce back at the steps and remain on the terraces, (ii) Cu atoms mostly intercalate into the vdW gap, the remaining fraction staying at the steps, and (iii) Ag atoms essentially accumulate at the steps and gradually intercalate into the vdW gap. These conclusions are in good qualitative agreement with previous experiments. The companion report (M. A. Gosálvez et al., Phys. Rev. B, submitted] extends the present study to the description of systems that contain asymmetric hops.

Delay or probability discounting in a model of impulsive behavior: effect of alcohol.

PubMed Central

Richards, J B; Zhang, L; Mitchell, S H; de Wit, H

1999-01-01

Little is known about the acute effects of drugs of abuse on impulsivity and self-control. In this study, impulsivity was assessed in humans using a computer task that measured delay and probability discounting. Discounting describes how much the value of a reward (or punisher) is decreased when its occurrence is either delayed or uncertain. Twenty-four healthy adult volunteers ingested a moderate dose of ethanol (0.5 or 0.8 g/kg ethanol: n = 12 at each dose) or placebo before completing the discounting task. In the task the participants were given a series of choices between a small, immediate, certain amount of money and $10 that was either delayed (0, 2, 30, 180, or 365 days) or probabilistic (i.e., certainty of receipt was 1.0, .9, .75, .5, or .25). The point at which each individual was indifferent between the smaller immediate or certain reward and the $10 delayed or probabilistic reward was identified using an adjusting-amount procedure. The results indicated that (a) delay and probability discounting were well described by a hyperbolic function; (b) delay and probability discounting were positively correlated within subjects; (c) delay and probability discounting were moderately correlated with personality measures of impulsivity; and (d) alcohol had no effect on discounting. PMID:10220927

The impact of price discounts and calorie messaging on beverage consumption: a multi-site field study.

PubMed

Jue, J Jane S; Press, Matthew J; McDonald, Daniel; Volpp, Kevin G; Asch, David A; Mitra, Nandita; Stanowski, Anthony C; Loewenstein, George

2012-12-01

To examine the efficacy of alternative approaches for shifting consumers toward zero calorie beverages. We examined the effect of price discounts and novel presentations of calorie information on sales of beverages. This prospective interrupted time-series quasi-experiment included three sites in Philadelphia, PA, Evanston, IL, and Detroit, MI. Each site received five interventions: (1) a 10% price discount on zero-calorie beverages; (2) the 10% discount plus discount messaging; (3) messaging comparing calorie information of sugared beverages with zero-calorie beverages; (4) messaging comparing exercise equivalent information; and (5) messaging comparing both calorie and exercise equivalent information. The main outcome was daily sales of bottled zero-calorie and sugared beverages. Data was collected from October 2009 until May 2010 and analyzed from May 2010 until May 2011. The overall analysis failed to demonstrate a consistent effect across all interventions. Two treatments had statistically significant effects: the discount plus discount messaging, with an increase in purchases of zero calorie beverages; and the calorie messaging intervention, with an increase in purchases of sugar-sweetened beverages. Individual site analysis results were similar. The effects of price discounts and calorie messaging in different forms on beverage purchases were inconsistent and frequently small. Copyright © 2012 Elsevier Inc. All rights reserved.

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

Yuan, Chris, E-mail: cyuan@uwm.edu; Wang, Endong; Zhai, Qiang

Temporal homogeneity of inventory data is one of the major problems in life cycle assessment (LCA). Addressing temporal homogeneity of life cycle inventory data is important in reducing the uncertainties and improving the reliability of LCA results. This paper attempts to present a critical review and discussion on the fundamental issues of temporal homogeneity in conventional LCA and propose a theoretical framework for temporal discounting in LCA. Theoretical perspectives for temporal discounting in life cycle inventory analysis are discussed first based on the key elements of a scientific mechanism for temporal discounting. Then generic procedures for performing temporal discounting inmore » LCA is derived and proposed based on the nature of the LCA method and the identified key elements of a scientific temporal discounting method. A five-step framework is proposed and reported in details based on the technical methods and procedures needed to perform a temporal discounting in life cycle inventory analysis. Challenges and possible solutions are also identified and discussed for the technical procedure and scientific accomplishment of each step within the framework. - Highlights: • A critical review for temporal homogeneity problem of life cycle inventory data • A theoretical framework for performing temporal discounting on inventory data • Methods provided to accomplish each step of the temporal discounting framework.« less

Estimating the coverage of mental health programmes: a systematic review

PubMed Central

De Silva, Mary J; Lee, Lucy; Fuhr, Daniela C; Rathod, Sujit; Chisholm, Dan; Schellenberg, Joanna; Patel, Vikram

2014-01-01

Background The large treatment gap for people suffering from mental disorders has led to initiatives to scale up mental health services. In order to track progress, estimates of programme coverage, and changes in coverage over time, are needed. Methods Systematic review of mental health programme evaluations that assess coverage, measured either as the proportion of the target population in contact with services (contact coverage) or as the proportion of the target population who receive appropriate and effective care (effective coverage). We performed a search of electronic databases and grey literature up to March 2013 and contacted experts in the field. Methods to estimate the numerator (service utilization) and the denominator (target population) were reviewed to explore methods which could be used in programme evaluations. Results We identified 15 735 unique records of which only seven met the inclusion criteria. All studies reported contact coverage. No study explicitly measured effective coverage, but it was possible to estimate this for one study. In six studies the numerator of coverage, service utilization, was estimated using routine clinical information, whereas one study used a national community survey. The methods for estimating the denominator, the population in need of services, were more varied and included national prevalence surveys case registers, and estimates from the literature. Conclusions Very few coverage estimates are available. Coverage could be estimated at low cost by combining routine programme data with population prevalence estimates from national surveys. PMID:24760874

Proposed regulations could limit access to affordable health coverage for workers' children and family members.

PubMed

Jacobs, Ken; Graham-Squire, Dave; Roby, Dylan H; Kominski, Gerald F; Kinane, Christina M; Needleman, Jack; Watson, Greg; Gans, Daphna

2011-12-01

Key Findings. The Patient Protection and Affordable Care Act (ACA) is designed to offer premium subsidies to help eligible individuals and their families purchase insurance coverage when affordable job-based coverage is not available. However, the law is unclear on how this affordability protection is applied in those instances where self-only coverage offered by an employer is affordable but family coverage is not. Regulations recently proposed by the Department of the Treasury would make family members ineligible for subsidized coverage in the exchange if an employee is offered affordable self-only coverage by an employer, even if family coverage is unaffordable. This could have significant financial consequences for low- and moderate-income families that fall in this gap. Using an alternative interpretation of the law could allow the entire family to enter the exchange when family coverage is unaffordable, which would broaden access to coverage. However, this option has been cited as cost prohibitive. In this brief we consider a middle ground alternative that would base eligibility for the individual worker on the cost of self-only coverage, but would use the additional cost to the employee for family coverage as the basis for determining affordability and eligibility for subsidies for the remaining family members. We find that: Under the middle ground alternative scenario an additional 144,000 Californians would qualify for and use premium subsidies in the California Health Benefit Exchange, half of whom are children. Less than 1 percent of those with employer-based coverage would move to subsidized coverage in the California Health Benefit Exchange as a result of having unaffordable coverage on the job.

Brain damage treated with non proven intensive training 2003-2011: a Norwegian cost analysis.

PubMed

Norum, Jan; Ramsvik, Arnborg; Tjeldnes, Knut

2012-10-10

There has been an increased request for intensive training and rehabilitation of patients with brain damage in Norway. These programs are demanding with regard to personnel, travelling, time and economic resources. We aimed to indicate cost and gain to make these programs cost-effective. A retrospective study included all patients referred to the Northern Norway Regional Health Authority (NNRHA) trust during the nine years period 2003-2011. All referrals to the NNRHA trust for the economic coverage of foreign based rehabilitation or habilitation programs (The Advanced Bio-Mechanical Rehabilitation (ABR), Institutes of Achievement of Human Potential program (IAHP) (Doman Method), Family Hope Center (FHC) program and the Kozijavkin Method) were included. 17 patients were detected and 15 fulfilled the inclusion criteria for funding. Median age was 8 years (1-31 years). Cost from the specialist health care point of view was calculated. A cut-off limit of €57,000/quality adjusted life year (QALY) and a 4% discount rate was employed. The undiscounted cost per patient enrolled was calculated €133,210 (discounted €121,348). To make these therapies cost effective, a total of at least 2.13 QALYs (2.34 undiscounted QALYs) must be gained per patient enrolled. Such a gain could not be indicated and we doubt it is achievable. Non-proven intensive training programs for patients with brain damage are costly. As long as their effect has not been documented, health care services should not spend resources on these programs outside clinical trials.

Influenza Vaccination Coverage among Adults in Korea: 2008–2009 to 2011–2012 Seasons

PubMed Central

Yang, Hye Jung; Cho, Sung-il

2014-01-01

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008–2009 season to the 2011–2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates. PMID:25429683

Influenza vaccination coverage among adults in Korea: 2008-2009 to 2011-2012 seasons.

PubMed

Yang, Hye Jung; Cho, Sung-Il

2014-11-25

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008-2009 season to the 2011-2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates.

Money earlier or later? Simple heuristics explain intertemporal choices better than delay discounting does.

PubMed

Ericson, Keith M Marzilli; White, John Myles; Laibson, David; Cohen, Jonathan D

2015-06-01

Heuristic models have been proposed for many domains involving choice. We conducted an out-of-sample, cross-validated comparison of heuristic models of intertemporal choice (which can account for many of the known intertemporal choice anomalies) and discounting models. Heuristic models outperformed traditional utility-discounting models, including models of exponential and hyperbolic discounting. The best-performing models predicted choices by using a weighted average of absolute differences and relative percentage differences of the attributes of the goods in a choice set. We concluded that heuristic models explain time-money trade-off choices in experiments better than do utility-discounting models. © The Author(s) 2015.

Money Earlier or Later? Simple Heuristics Explain Intertemporal Choices Better than Delay Discounting1

PubMed Central

Marzilli Ericson, Keith M.; White, John Myles; Laibson, David; Cohen, Jonathan D.

2015-01-01

Heuristic models have been proposed for many domains of choice. We compare heuristic models of intertemporal choice, which can account for many of the known intertemporal choice anomalies, to discounting models. We conduct an out-of-sample, cross-validated comparison of intertemporal choice models. Heuristic models outperform traditional utility discounting models, including models of exponential and hyperbolic discounting. The best performing models predict choices by using a weighted average of absolute differences and relative (percentage) differences of the attributes of the goods in a choice set. We conclude that heuristic models explain time-money tradeoff choices in experiments better than utility discounting models. PMID:25911124

17 CFR 210.4-07 - Discount on shares.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 1940, AND ENERGY POLICY AND CONSERVATION ACT OF 1975 Rules of General Application § 210.4-07 Discount on shares. Discount on shares, or any unamortized balance thereof, shall be shown separately as a...

Individual and social discounting in a viscous population.

PubMed

Sozou, Peter D

2009-08-22

Social discounting in economics involves applying a diminishing weight to community-wide benefits or costs into the future. It impacts on public policy decisions involving future positive or negative effects, but there is no consensus on the correct basis for determining the social discount rate. This study presents an evolutionary biological framework for social discounting. How an organism should value future benefits to its local community is governed by the extent to which members of the community in the future are likely to be its kin. Trade-offs between immediate and delayed benefits to an individual or to its community are analysed for a modelled patch-structured iteroparous population with limited dispersal. It is shown that the social discount rate is generally lower than the individual (private) discount rate. The difference in the two rates is most pronounced, in ratio terms, when the dispersal level is low and the hazard rate for patch destruction is much smaller than the individual mortality rate. When decisions involve enforced collective action rather than individuals acting independently, social investment increases but the social discount rate remains the same.

Reinforcer pathologies: Predicting alcohol related problems in college drinking men and women.

PubMed

Lemley, Shea M; Kaplan, Brent A; Reed, Derek D; Darden, Alexandria C; Jarmolowicz, David P

2016-10-01

Alcohol use in college is common, and problematic consequences of alcohol may affect college men and women differently. Approaches within behavioral economics have been used to improve our understanding of alcohol use in college students. The current study assessed relations between college students' delay discounting, demand for alcohol, and alcohol problems as measured by the Young Adult Alcohol Consequences Questionnaire (YAACQ). In this study, 80 college drinkers completed a monetary choice questionnaire that assessed delay discounting of money, a novel beer choice questionnaire that evaluated delay discounting of beer, and an alcohol purchase task that measured demand for alcohol. Behavioral economic measures associated with the reinforcer pathologies model (i.e., demand and discounting) predicted alcohol consequences as measured by the YAACQ. For men, these significant predictor variables included money discounting, beer discounting, and intensity of alcohol demand, whereas for women money discounting and essential value were significant predictors. These findings highlight the utility of the reinforcer pathologies approach for the study of alcohol use and the importance of considering gender differences in examining college drinking. Copyright © 2016. Published by Elsevier Ireland Ltd.

Marital status, spousal coverage, and the gender gap in employer-sponsored health insurance.

PubMed

Buchmueller, T C

Not only do men who work full time earn more than women, but they are more likely to receive employer-sponsored health benefits. This paper provides evidence on the gender gap in employer-sponsored health insurance. The results indicate that the gap is driven largely by the tendency of married women to decline employer-sponsored insurance in favor of being covered through their husbands. Indeed, among single workers, women are more likely than men to be offered insurance. These findings call into question the conclusion made by previous researchers that employers discriminate against women in the provision of health insurance.

New estimates of gaps and transitions in health insurance.

PubMed

Short, Pamela Farley; Graefe, Deborah R; Swartz, Katherine; Uberoi, Namrata

2012-12-01

Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004-2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of nonelderly Americans) were uninsured for at least 1 month during those 4 years. Approximately 23 million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms' effects on coverage stability.

75 FR 5322 - Formations of, Acquisitions by, and Mergers of Bank Holding Companies

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-02

....5 percent of the outstanding voting shares of Israel Discount Bank, Ltd., Tel Aviv, Israel, and thereby indirectly acquire additional voting shares of Discount Bancorp Inc., and Israel Discount Bank of...

Parabolic discounting of monetary rewards by physical effort.

PubMed

Hartmann, Matthias N; Hager, Oliver M; Tobler, Philippe N; Kaiser, Stefan

2013-11-01

When humans and other animals make decisions in their natural environments prospective rewards have to be weighed against costs. It is well established that increasing costs lead to devaluation or discounting of reward. While our knowledge about discount functions for time and probability costs is quite advanced, little is known about how physical effort discounts reward. In the present study we compared three different models in a binary choice task in which human participants had to squeeze a handgrip to earn monetary rewards: a linear, a hyperbolic, and a parabolic model. On the group as well as the individual level, the concave parabolic model explained most variance of the choice data, thus contrasting with the typical hyperbolic discounting of reward value by delay. Research on effort discounting is not only important to basic science but also holds the potential to quantify aberrant motivational states in neuropsychiatric disorders. Copyright © 2013 Elsevier B.V. All rights reserved.

Delay and probability discounting among payday and title loan recipients.

PubMed

Mahoney, Colin T; Lawyer, Steven R

2016-04-01

Payday and title loans are short-term loans associated with significant economic impact. Behavioral theories of impulsive choice may provide insight into behavioral processes that underlie the propensity to take out payday and title loans. Adults between the ages of 18 and 30 recruited from the community completed delay and probability discounting tasks for hypothetical money as well as measures of substance use. Patterns of discounting were characterized using a hyperbolic decay model and area under the curve. Participants who took out a payday and/or title loan in the past (n=41) exhibited more impulsive choice patterns on the delay discounting task than did those who did not (n=255). Substance use mediated this relationship between payday and title loan retention and delay discounting. These findings suggest potentially important relationships between payday/title loan borrowing, substance use, and delay discounting. Copyright © 2016 Elsevier B.V. All rights reserved.

Estimating implied rates of discount in healthcare decision-making.

PubMed

West, R R; McNabb, R; Thompson, A G H; Sheldon, T A; Grimley Evans, J

2003-01-01

To consider whether implied rates of discounting from the perspectives of individual and society differ, and whether implied rates of discounting in health differ from those implied in choices involving finance or "goods". The study comprised first a review of economics, health economics and social science literature and then an empirical estimate of implied rates of discounting in four fields: personal financial, personal health, public financial and public health, in representative samples of the public and of healthcare professionals. Samples were drawn in the former county and health authority district of South Glamorgan, Wales. The public sample was a representative random sample of men and women, aged over 18 years and drawn from electoral registers. The health professional sample was drawn at random with the cooperation of professional leads to include doctors, nurses, professions allied to medicine, public health, planners and administrators. The literature review revealed few empirical studies in representative samples of the population, few direct comparisons of public with private decision-making and few direct comparisons of health with financial discounting. Implied rates of discounting varied widely and studies suggested that discount rates are higher the smaller the value of the outcome and the shorter the period considered. The relationship between implied discount rates and personal attributes was mixed, possibly reflecting the limited nature of the samples. Although there were few direct comparisons, some studies found that individuals apply different rates of discount to social compared with private comparisons and health compared with financial. The present study also found a wide range of implied discount rates, with little systematic effect of age, gender, educational level or long-term illness. There was evidence, in both samples, that people chose a lower rate of discount in comparisons made on behalf of society than in comparisons made for themselves. Both public and health professional samples tended to choose lower discount rates in health-related comparisons than in finance-related comparisons. It was also suggested that implied rates of discount, derived from responses to hypothetical questions, can be influenced by detail of question framing. The study suggested that both the lay public and healthcare professionals consider that the discount rate appropriate for public decisions is lower than that for private decisions. This finding suggests that lay people as well as healthcare professionals, used to making decisions on behalf of others, recognise that society is not simply an aggregate of individuals. It also implies a general appreciation that society is more stable and has a more predictable future than does the individual. There is fairly general support for this view in the theoretical literature and limited support in the few previous direct comparisons. Further research is indicated, possibly involving more in-depth interviewing and drawing inference on real, rather than hypothetical choices.

Can investments in health systems strategies lead to changes in immunization coverage?

PubMed

Brenzel, Logan

2014-04-01

National immunization programs in developing countries have made major strides to immunize the world's children, increasing full coverage to 83% of children. However, the World Health Organization estimates that 22 million children less than five years of age are left unvaccinated, and coverage levels have been plateauing for nearly a decade. This paper describes the evidence on factors contributing to low vaccination uptake, and describes the connection between these factors and the documented strategies and interventions that can lead to changes in immunization outcomes. The author suggests that investments in these areas may contribute more effectively to immunization coverage and also have positive spill-over benefits for health systems. The paper concludes that while some good quality evidence exists of what works and may contribute to immunization outcomes, the quality of evidence needs to improve and major gaps need to be addressed.

To close the childhood immunization gap, we need a richer understanding of parents' decision-making.

PubMed

Corben, Paul; Leask, Julie

2016-12-01

Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.

Covered today, sick tomorrow? Trends and correlates of children's health insurance instability.

PubMed

Hill, Heather D; Shaefer, H Luke

2011-10-01

Many children with health insurance will experience gaps in coverage over time, potentially reducing their access to and use of preventive health care services. This article uses the Survey of Income and Program Participation to examine how the stability of children's health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children's health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there being no clear policy explanation for such a relationship.

Uterotonic use immediately following birth: using a novel methodology to estimate population coverage in four countries.

PubMed

Ricca, Jim; Dwivedi, Vikas; Varallo, John; Singh, Gajendra; Pallipamula, Suranjeen Prasad; Amade, Nazir; de Luz Vaz, Maria; Bishanga, Dustan; Plotkin, Marya; Al-Makaleh, Bushra; Suhowatsky, Stephanie; Smith, Jeffrey Michael

2015-01-22

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth (UUIFB) in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings. The rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen. Available data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen. This methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.

Spatio-Temporal Gap Analysis of OBIS-SEAMAP Project Data: Assessment and Way Forward

PubMed Central

Kot, Connie Y.; Fujioka, Ei; Hazen, Lucie J.; Best, Benjamin D.; Read, Andrew J.; Halpin, Patrick N.

2010-01-01

The OBIS-SEAMAP project has acquired and served high-quality marine mammal, seabird, and sea turtle data to the public since its inception in 2002. As data accumulated, spatial and temporal biases resulted and a comprehensive gap analysis was needed in order to assess coverage to direct data acquisition for the OBIS-SEAMAP project and for taxa researchers should true gaps in knowledge exist. All datasets published on OBIS-SEAMAP up to February 2009 were summarized spatially and temporally. Seabirds comprised the greatest number of records, compared to the other two taxa, and most records were from shipboard surveys, compared to the other three platforms. Many of the point observations and polyline tracklines were located in northern and central Atlantic and the northeastern and central-eastern Pacific. The Southern Hemisphere generally had the lowest representation of data, with the least number of records in the southern Atlantic and western Pacific regions. Temporally, records of observations for all taxa were the lowest in fall although the number of animals sighted was lowest in the winter. Oceanographic coverage of observations varied by platform for each taxa, which showed that using two or more platforms represented habitat ranges better than using only one alone. Accessible and published datasets not already incorporated do exist within spatial and temporal gaps identified. Other related open-source data portals also contain data that fill gaps, emphasizing the importance of dedicated data exchange. Temporal and spatial gaps were mostly a result of data acquisition effort, development of regional partnerships and collaborations, and ease of field data collection. Future directions should include fostering partnerships with researchers in the Southern Hemisphere while targeting datasets containing species with limited representation. These results can facilitate prioritizing datasets needed to be represented and for planning research for true gaps in space and time. PMID:20886047

Spatio-temporal gap analysis of OBIS-SEAMAP project data: assessment and way forward.

PubMed

Kot, Connie Y; Fujioka, Ei; Hazen, Lucie J; Best, Benjamin D; Read, Andrew J; Halpin, Patrick N

2010-09-24

The OBIS-SEAMAP project has acquired and served high-quality marine mammal, seabird, and sea turtle data to the public since its inception in 2002. As data accumulated, spatial and temporal biases resulted and a comprehensive gap analysis was needed in order to assess coverage to direct data acquisition for the OBIS-SEAMAP project and for taxa researchers should true gaps in knowledge exist. All datasets published on OBIS-SEAMAP up to February 2009 were summarized spatially and temporally. Seabirds comprised the greatest number of records, compared to the other two taxa, and most records were from shipboard surveys, compared to the other three platforms. Many of the point observations and polyline tracklines were located in northern and central Atlantic and the northeastern and central-eastern Pacific. The Southern Hemisphere generally had the lowest representation of data, with the least number of records in the southern Atlantic and western Pacific regions. Temporally, records of observations for all taxa were the lowest in fall although the number of animals sighted was lowest in the winter. Oceanographic coverage of observations varied by platform for each taxa, which showed that using two or more platforms represented habitat ranges better than using only one alone. Accessible and published datasets not already incorporated do exist within spatial and temporal gaps identified. Other related open-source data portals also contain data that fill gaps, emphasizing the importance of dedicated data exchange. Temporal and spatial gaps were mostly a result of data acquisition effort, development of regional partnerships and collaborations, and ease of field data collection. Future directions should include fostering partnerships with researchers in the Southern Hemisphere while targeting datasets containing species with limited representation. These results can facilitate prioritizing datasets needed to be represented and for planning research for true gaps in space and time.

Pramipexole-induced increased probabilistic discounting: comparison between a rodent model of Parkinson's disease and controls.

PubMed

Rokosik, Sandra L; Napier, T Celeste

2012-05-01

The dopamine agonist pramipexole (PPX) can increase impulsiveness, and PPX therapy for neurological diseases (Parkinson's disease (PD) and restless leg syndrome) is associated with impulse control disorders (ICDs) in subpopulations of treated patients. A commonly reported ICD is pathological gambling of which risk taking is a prominent feature. Probability discounting is a measurable aspect of risk taking. We recently developed a probability discounting paradigm wherein intracranial self-stimulation (ICSS) serves as the positive reinforcer. Here we used this paradigm to determine the effects of PPX on discounting. We included assessments of a rodent model of PD, wherein 6-OHDA was injected into the dorsolateral striatum of both hemispheres, which produced persistent PD-like deficits in posture adjustment. Rats were trained to perform ICSS-mediated probability discounting, in which PD-like and control groups exhibited similar profiles. Rats were treated twice daily for 2 weeks with 2 mg/kg (±)PPX (ie, 1 mg/kg of the active form), a dose that improved lesion-induced motor deficits. In both groups, (±)PPX increased discounting; preference for the large reinforcer was enhanced 30-45% at the most uncertain probabilities. Tolerance did not develop with repeated treatments. Increased discounting subsided within 2 weeks of (±)PPX cessation, and re-exposure to (±)PPX reinstated heightened discounting. Such findings emulate the clinical scenario; therefore, ICSS for discounting assessments in rats exhibited high face validity. This model should prove useful in medication development where assessment of the propensity of a putative therapy to induce risk-taking behaviors is of interest.

How we value the future affects our desire to learn.

PubMed

Moore, Alana L; Hauser, Cindy E; McCarthy, Michael A

2008-06-01

Active adaptive management is increasingly advocated in natural resource management and conservation biology. Active adaptive management looks at the benefit of employing strategies that may be suboptimal in the near term but which may provide additional information that will facilitate better management in future years. However, when comparing management policies it is traditional to weigh future rewards geometrically (at a constant discount rate) which results in far-distant rewards making a negligible contribution to the total benefit. Under such a discounting scheme active adaptive management is rarely of much benefit, especially if learning is slow. A growing number of authors advocate the use of alternative forms of discounting when evaluating optimal strategies for long-term decisions which have a social component. We consider a theoretical harvested population for which the recovery rate from an unharvestably small population size is unknown and look at the effects on the benefit of experimental management when three different forms of discounting are employed. Under geometric discounting, with a discount rate of 5% per annum, managing to learn actively had little benefit. This study demonstrates that discount functions which weigh future rewards more heavily result in more conservative harvesting strategies, but do not necessarily encourage active learning. Furthermore, the optimal management strategy is not equivalent to employing geometric discounting at a lower rate. If alternative discount functions are made mandatory in calculating optimal management strategies for environmental management then this will affect the structure of optimal management regimes and change when and how much we are willing to invest in learning.

Investigating the Impact of Cognitive Load and Motivation on Response Control in Relation to Delay Discounting in Children with ADHD.

PubMed

Martinelli, Mary K; Mostofsky, Stewart H; Rosch, Keri S

2017-10-01

Attention-deficit/hyperactivity disorder (ADHD) is characterized by deficits in impulse control across a range of behaviors, from simple actions to those involving complex decision-making (e.g., preference for smaller-sooner versus larger later rewards). This study investigated whether changes in motor response control with increased cognitive load and motivational contingencies are associated with decision-making in the form of delay discounting among 8-12 year old children with and without ADHD. Children with ADHD (n = 26; 8 girls) and typically developing controls (n = 40; 11 girls) completed a standard go/no-go (GNG) task, a GNG task with motivational contingencies, a GNG task with increased cognitive load, and two measures of delay discounting: a real-time task in which the delays and immediately consumable rewards are experienced in real-time, and a classic task involving choices about money at longer delays. Children with ADHD, particularly girls, exhibited greater delay discounting than controls during the real-time discounting task, whereas diagnostic groups did not significantly differ on the classic discounting task. The effect of cognitive load on response control was uniquely associated with greater discounting on the real-time task for children with ADHD, but not for control children. The effect of motivational contingencies on response control was not significantly associated with delay discounting for either diagnostic group. The findings from this study help to inform our understanding of the factors that influence deficient self-control in ADHD, suggesting that impairments in cognitive control may contribute to greater delay discounting in ADHD.

Neural activation during delay discounting is associated with 6-month change in risky sexual behavior in adolescents.

PubMed

Gardiner, Casey K; Karoly, Hollis C; Thayer, Rachel E; Gillman, Arielle S; Sabbineni, Amithrupa; Bryan, Angela D

2018-04-19

Identifying cognitive and neural mechanisms of decision making in adolescence can enhance understanding of, and interventions to reduce, risky health behaviors in adolescence. Delay discounting, or the propensity to discount the magnitude of temporally distal rewards, has been associated with diverse health risk behaviors, including risky sex. This cognitive process involves recruitment of reward and cognitive control brain regions, which develop on different trajectories in adolescence and are also implicated in real-world risky decision making. However, no extant research has examined how neural activation during delay discounting is associated with adolescents' risky sexual behavior. To determine whether a relationship exists between adolescents' risky sexual behavior and neural activation during delay discounting. Adolescent participants completed a delay discounting paradigm during functional magnetic resonance imaging (fMRI) scanning, and they reported risky sexual behavior at baseline, 3-, 6-, 9-, and 12-month follow-up time points. Latent growth curve models were employed to determine relationships between brain activation during delay discounting and change in risky sexual behavior over time. Greater activation in brain regions associated with reward and cognitive control (caudate, putamen, nucleus accumbens, anterior cingulate, insula, orbitofrontal cortex, inferior frontal gyrus, dorsolateral prefrontal cortex) during delay discounting was associated with lower mean levels of risky sexual behavior but greater growth over the period from baseline to 6 months. Neural activation during delay discounting is cross-sectionally and prospectively associated with risky sexual behavior in adolescence, highlighting a neural basis of risky decision-making as well as opportunities for early identification and intervention.

A random utility model of delay discounting and its application to people with externalizing psychopathology.

PubMed

Dai, Junyi; Gunn, Rachel L; Gerst, Kyle R; Busemeyer, Jerome R; Finn, Peter R

2016-10-01

Previous studies have demonstrated that working memory capacity plays a central role in delay discounting in people with externalizing psychopathology. These studies used a hyperbolic discounting model, and its single parameter-a measure of delay discounting-was estimated using the standard method of searching for indifference points between intertemporal options. However, there are several problems with this approach. First, the deterministic perspective on delay discounting underlying the indifference point method might be inappropriate. Second, the estimation procedure using the R2 measure often leads to poor model fit. Third, when parameters are estimated using indifference points only, much of the information collected in a delay discounting decision task is wasted. To overcome these problems, this article proposes a random utility model of delay discounting. The proposed model has 2 parameters, 1 for delay discounting and 1 for choice variability. It was fit to choice data obtained from a recently published data set using both maximum-likelihood and Bayesian parameter estimation. As in previous studies, the delay discounting parameter was significantly associated with both externalizing problems and working memory capacity. Furthermore, choice variability was also found to be significantly associated with both variables. This finding suggests that randomness in decisions may be a mechanism by which externalizing problems and low working memory capacity are associated with poor decision making. The random utility model thus has the advantage of disclosing the role of choice variability, which had been masked by the traditional deterministic model. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

A flexible benefits tax credit for health insurance and more.

PubMed

Etheredge, Lynn

2001-01-01

This essay outlines a concept for a "flexible benefits" tax credit for expanding health insurance coverage and other purposes such as retirement savings plans (with potential withdrawals for higher education, first-home ownership, and catastrophic medical expenses). Two examples are presented. The advantages of a flexible benefits tax credit are considered in terms of efficient use of the budget surplus to help meet the varied (and changing) needs of American families, to eliminate major national gaps in health insurance and pension coverage, and to advance other objectives. If the budget surplus is used wisely, political decisionmakers could achieve health insurance coverage for most uninsured workers and children and assure a future with real economic security for American families.

Wisdom Needed.

ERIC Educational Resources Information Center

Lapovsky, Lucie

1998-01-01

Results of the National Association of College and University Business Officers' annual survey (n=340 institutions) of institutional aid to students (tuition discounting) are summarized. Data include an analysis of tuition patterns, freshman tuition discount rates, undergraduate discount rates, class differences, and relationships among variables…

Implementation Experience with Deep Discount Fares

DOT National Transportation Integrated Search

1994-09-01

This report reviews the experiences of transit agencies across the country with Deep Discount fares, a new public transit pricing strategy, between 1988 and 1993. Based on new market research findings, Deep Discounting has shown that it is possible t...

A social discounting model based on Tsallis’ statistics

NASA Astrophysics Data System (ADS)

Takahashi, Taiki

2010-09-01

Social decision making (e.g. social discounting and social preferences) has been attracting attention in economics, econophysics, social physics, behavioral psychology, and neuroeconomics. This paper proposes a novel social discounting model based on the deformed algebra developed in the Tsallis’ non-extensive thermostatistics. Furthermore, it is suggested that this model can be utilized to quantify the degree of consistency in social discounting in humans and analyze the relationships between behavioral tendencies in social discounting and other-regarding economic decision making under game-theoretic conditions. Future directions in the application of the model to studies in econophysics, neuroeconomics, and social physics, as well as real-world problems such as the supply of live organ donations, are discussed.

Philosophical origins of the social rate of discount in cost-benefit analysis.

PubMed

Robinson, J C

1990-01-01

The social rate of discount--that is, the way decision makers today evaluate future consequences of collective activity--raises difficult issues of intergenerational justice. When benefits are discounted at the present rate the United States government requires, serious efforts to promote public health over the long term will fail cost-benefit tests. No consensus exists among theorists to establish fair rates; philosophers support discounting with economic arguments that economists reject, while economists no less paradoxically support the concept using philosophical arguments that philosophers disavow. A new emphasis on the role of consumers' and citizens' time preferences, however, will keep open rather than close debates on the social discount rate.

Benchmarking Discount Rate in Natural Resource Damage Assessment with Risk Aversion.

PubMed

Wu, Desheng; Chen, Shuzhen

2017-08-01

Benchmarking a credible discount rate is of crucial importance in natural resource damage assessment (NRDA) and restoration evaluation. This article integrates a holistic framework of NRDA with prevailing low discount rate theory, and proposes a discount rate benchmarking decision support system based on service-specific risk aversion. The proposed approach has the flexibility of choosing appropriate discount rates for gauging long-term services, as opposed to decisions based simply on duration. It improves injury identification in NRDA since potential damages and side-effects to ecosystem services are revealed within the service-specific framework. A real embankment case study demonstrates valid implementation of the method. © 2017 Society for Risk Analysis.

Separate and overlapping brain areas encode subjective value during delay and effort discounting.

PubMed

Massar, Stijn A A; Libedinsky, Camilo; Weiyan, Chee; Huettel, Scott A; Chee, Michael W L

2015-10-15

Making decisions about rewards that involve delay or effort requires the integration of value and cost information. The brain areas recruited in this integration have been well characterized for delay discounting. However only a few studies have investigated how effort costs are integrated into value signals to eventually determine choice. In contrast to previous studies that have evaluated fMRI signals related to physical effort, we used a task that focused on cognitive effort. Participants discounted the value of delayed and effortful rewards. The value of cognitively effortful rewards was represented in the anterior portion of the inferior frontal gyrus and dorsolateral prefrontal cortex. Additionally, the value of the chosen option was encoded in the anterior cingulate cortex, caudate, and cerebellum. While most brain regions showed no significant dissociation between effort discounting and delay discounting, the ACC was significantly more activated in effort compared to delay discounting tasks. Finally, overlapping regions within the right orbitofrontal cortex and lateral temporal and parietal cortices encoded the value of the chosen option during both delay and effort discounting tasks. These results indicate that encoding of rewards discounted by cognitive effort and delay involves partially dissociable brain areas, but a common representation of chosen value is present in the orbitofrontal, temporal and parietal cortices. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Impact of episodic thinking on altruism

PubMed Central

Yi, Richard; Pickover, Alison; Stuppy-Sullivan, Allison M.; Baker, Sydney; Landes, Reid D.

2016-01-01

Episodic future thinking, which refers to the use of prospective imagery to concretely imagine oneself in future scenarios, has been shown to reduce delay discounting (enhance self-control). A parallel approach, in which prospective imagery is used to concretely imagine other’s scenarios, may similarly reduce social discounting (i.e., enhance altruism). In study 1, participants engaged in episodic thinking about the self or others, in a repeated-measures design, while completing a social discounting task. Reductions in social discounting were observed as a function of episodic thinking about others, though an interaction with order was also observed. Using an independent-measures design in study 2, the effect of episodic thinking about others was replicated. Study 3 addressed a limitation of studies 1 and 2, the possibility that simply thinking about others decreased social discounting. Capitalizing on Construal Level Theory, which specifies that social distance and time in the future are both dimensions of a common psychological distance, we hypothesized that episodic future thinking should also decrease social discounting. Participants engaged in episodic future thinking or episodic present thinking, in a repeated-measures design, while completing a social discounting task. The pattern of results was similar to study 1, providing support for the notion that episodic thinking about psychologically distant outcomes (for others or in the future) reduces social discounting. Application of similar episodic thinking approaches may enhance altruism. PMID:27821875

Future Discounting in Congo Basin Hunter-Gatherers Declines with Socio-Economic Transitions.

PubMed

Salali, Gul Deniz; Migliano, Andrea Bamberg

2015-01-01

Humans have a tendency to discount the future; that is we value small, short-term rewards over larger, long-term rewards. The degree of future discounting, however, changes in response to socio-ecological factors. Here, we study Mbendjele BaYaka hunter-gatherers of northern Congo and their farmer neighbours to investigate adaptations in inter-temporal preferences in humans. We argue that in immediate-return systems, where food storage is absent and egalitarianism is enforced through levelling mechanisms, future discounting is an adaptive strategy to prevent wealth accumulation and the emergence of hierarchies. This ensures food sharing and allows for survival in unpredictable environments where there is risk of an energy shortfall. On the other hand, when food storage is made possible by the emergence of agriculture or as seen in some delayed-return hunter-gatherer populations, wealth accumulation, hierarchies and lower discount rates become the adaptive strategy. Therefore, individuals in immediate-return, egalitarian societies will discount the future more than those in non-egalitarian, delayed-return societies. Consistent with the predictions we found that market integration and socio-economic transitions decrease the future discounting in Mbendjele hunter-gatherers. Our measures of socio-economic differences marked this transition in hunter-gatherers living in a logging town. The degree of future-discounting was the same between more market-integrated hunter-gatherers and their farmer neighbours.

Evaluation of Deep Discount Fare Strategies

DOT National Transportation Integrated Search

1995-08-01

This report evaluates the success of a fare pricing strategy known as deep discounting, that entails the bulk sale of transit tickets or tokens to customers at a significant discount compared to the full fare single ticket price. This market-driven s...

15 CFR 990.63 - Discounting and compounding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... NATURAL RESOURCE DAMAGE ASSESSMENTS Restoration Implementation Phase § 990.63 Discounting and compounding. (a) Estimated future restoration costs. When determining estimated future costs of implementing a Final Restoration Plan, trustees must discount such future costs back to the date the demand is...

Investigating the Equatorial Gaps in Snowball Earth Sea Glaciers

NASA Astrophysics Data System (ADS)

Spaulding-Astudillo, F.; Ashkenazy, Y.; Tziperman, E.; Abbot, D. S.

2017-12-01

The way photosynthetic life survived the Neoproterozoic Snowball Earth events is still a matter of debate that has deep implications for planetary habitability. One option is that gaps in thick, semi-global ice coverage (sea glaciers) could be maintained at the equator by ocean-ice-atmosphere dynamics. We investigate this idea by modifying a global ocean-thick-marine-ice model developed for modeling Neoproterozoic Snowball Events to account for gaps in thick ice and interactions with atmospheric dynamics. Our hypothesis is that in the parameter regime that allows for sea glacier flow, ice flow will make gaps in the thick ice, and therefore an open ocean solution, less likely. This would suggest that oases in thick ice are a more viable survival mechanism for photosynthetic life during a Snowball Earth event.

Superconducting Vacuum-Gap Crossovers for High Performance Microwave Applications

NASA Technical Reports Server (NTRS)

Denis, Kevin L.; Brown, Ari D.; Chang, Meng-Ping; Hu, Ron; U-Yen, Kongpop; Wollack, Edward J.

2016-01-01

The design and fabrication of low-loss wide-bandwidth superconducting vacuum-gap crossovers for high performance millimeter wave applications are described. In order to reduce ohmic and parasitic losses at millimeter wavelengths a vacuum gap is preferred relative to dielectric spacer. Here, vacuum-gap crossovers were realized by using a sacrificial polymer layer followed by niobium sputter deposition optimized for coating coverage over an underlying niobium signal layer. Both coplanar waveguide and microstrip crossover topologies have been explored in detail. The resulting fabrication process is compatible with a bulk micro-machining process for realizing waveguide coupled detectors, which includes sacrificial wax bonding, and wafer backside deep reactive ion etching for creation of leg isolated silicon membrane structures. Release of the vacuum gap structures along with the wax bonded wafer after DRIE is implemented in the same process step used to complete the detector fabrication. ?

Pharmacy Benefit Management Companies: Do They Create Value in the US Healthcare System?

PubMed

Lyles, Alan

2017-05-01

Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing. Whether these potential outcomes are realized within the relevant budget is a function of the healthcare system and the interaction of benefit design and clinical processes-not just individually vetted components. Efficiencies and values achieved in price discounts and cost sharing can be nullified if there is irrational prescribing (over-utilization, under-utilization and mis-utilization), variable patient adherence to medication regimens, ineffective formulary processes, or fraud, waste and abuse. Rising prescription drug costs and the increasing prevalence of 'high deductible health plans', which require much greater patient out-of-pocket costs, is creating a crisis for PBM efforts towards an affordable pharmacy benefit. Since PBM rebate and incentive contracts are opaque to the public, whether they add value by restraining higher drug prices or benefit from them is debatable.

"What time is my next meal?" delay-discounting individuals choose smaller portions under conditions of uncertainty.

PubMed

Zimmerman, Annie R; Ferriday, Danielle; Davies, Sarah R; Martin, Ashley A; Rogers, Peter J; Mason, Alice; Brunstrom, Jeffrey M

2017-09-01

'Dietary' delay discounting is typically framed as a trade-off between immediate rewards and long-term health concerns. Our contention is that prospective thinking also occurs over shorter periods, and is engaged to select portion sizes based on the interval between meals (inter-meal interval; IMI). We sought to assess the extent to which the length of an IMI influences portion-size selection. We predicted that delay discounters would show 'IMI insensitivity' (relative lack of concern about hunger or fullness between meals). In particular, we were interested in participants' sensitivity to an uncertain IMI. We hypothesized that when meal times were uncertain, delay discounters would be less responsive and select smaller portion sizes. Participants (N = 90) selected portion sizes for lunch. In different trials, they were told to expect dinner at 5pm, 9pm, and either 5pm or 9pm (uncertain IMI). Individual differences in future-orientation were measured using a monetary delay-discounting task. Participants chose larger portions when the IMI was longer (p < 0.001). When the IMI was uncertain, delay-discounting participants chose smaller portions than the average portion chosen in the certain IMIs (p < 0.05). Furthermore, monetary discounting mediated a relationship between BMI and smaller portion selection in uncertainty (p < 0.05). This is the first study to report an association between delay discounting and IMI insensitivity. We reason that delay discounters selected smaller portions because they were less sensitive to the uncertain IMI, and overlooked concerns about potential future hunger. These findings are important because they illustrate that differences in discounting are expressed in short-term portion-size decisions and suggest that IMI insensitivity increases when meal timings are uncertain. Further research is needed to confirm whether these findings generalise to other populations. Copyright © 2017. Published by Elsevier Ltd.

Pharmacy discounts on generic medicines in France: is there room for further efficiency savings?

PubMed

Kanavos, Panos; Taylor, David

2007-10-01

In France control of pharmaceutical expenditure has been a policy priority for many years and generic policies have featured prominently on the policy agenda. Measures including reference pricing, generic substitution and international non-proprietary name (INN) prescribing have been introduced in recent years. Generic manufacturers and wholesalers may offer discounts, rebates or promotions to pharmacies in order to gain an edge over their competitors, but their true extent is unknown. To identify the amplitude of discounts on generic medicines, and whether wholesalers or generic manufacturers offer these beyond officially negotiated margins and allowable discounts, by conducting a pilot study. Data on net prices were acquired for all available presentations of 11 generic molecules selected across different therapeutic categories included in the 40 most selling generic products in 2005. Data were obtained via a questionnaire survey followed by interview with selected pharmacies (n = 4) and whole-salers (n = 2). Pharmacies and wholesalers participated in this study subject to confidentiality and anonymity. Pharmacies usually prefer to buy generic products directly from manufacturers rather than from wholesalers in order to avoid paying additional margins imposed by wholesalers. Discounts are mostly price-related and generally vary from 20 to 70% off the wholesaler selling price (WSP), on top of the officially allowed 10.74%. Discounts on the ex-factory price (EFP) are much lower, typically around 7.5%. Discounts are prohibited for branded products, beyond the officially allowed ceiling of 2.5%. While horizontal integration among pharmacies is disallowed, pharmacies may form purchasing groups allowing them to realise greater discounts from suppliers. Overall, the evidence suggests that discounts occur in France beyond what may be allowable and their extent can be significant. If general discount levels for generic medicines are as high as this pilot study suggests, then this may imply that health insurance in France may be overpaying for commodity generic medicines.

Price-based promotions of alcohol: legislative consistencies and inconsistencies across the Australian retail, entertainment and media sectors.

PubMed

Wardle, Jon

2015-05-01

Excessive alcohol consumption is a major public health issue internationally, with alcohol consumption being recognised as a leading cause of preventable illness and major social burden. To help ameliorate the risks and harms associated with alcohol consumption, all levels of governments have explored various legislative and regulatory provisions to support responsible alcohol consumption, service and promotion. In this article, using Australia as a case study, the legislative environment around responsible alcohol promotion and consumption across the Australian retail, entertainment and media sectors will be explored, with a focus on pricing and volume-based discounts. Whilst the potential harm and effect of both the licensed and non-licensed sectors appears to be widely acknowledged as similar in both scope and size of effect, legislative protections overwhelmingly focus solely on reducing the risks associated with alcohol consumption in licensed premises. This article explores the legislative provisions around preventing excessive alcohol consumption through promotional and marketing activities, and notes that whilst the licensed premises sector is facing increasing legislative restrictions, the off-premises sector remains unregulated and in some cases has even had existing restrictions removed, despite forming an increasing part of the alcohol chain in Australia. There appear to be inconsistencies and regulatory gaps in relation to price-based and volume-based discount alcohol promotions. Regulatory loopholes allow the retail sector in particular to use discounted alcohol as a promotional tool, in a way that is inconsistent with the goals of public health alcohol legislation, and in a way which would be illegal in any other sector. There appears to be a compelling case for introducing new restrictions, or extending existing restrictions, on these forms of promotion across all sectors involved in alcohol promotion, and there is considerable evidence that there would be considerable public health benefit from doing so. Copyright © 2015 Elsevier B.V. All rights reserved.

The Effects of Methylphenidate on Discounting of Delayed Rewards in ADHD

PubMed Central

Shiels, Keri; Hawk, Larry W.; Reynolds, Brady; Mazzullo, Rebecca; Rhodes, Jessica; Pelham, William E.; Waxmonsky, James G.; Gangloff, Brian P.

2010-01-01

Impulsivity is a central component of attention-deficit/hyperactivity disorder (ADHD). Delay discounting, or a preference for smaller, immediate rewards over larger, delayed rewards is considered an important aspect of impulsivity, and delay-related impulsivity has been emphasized in etiological models of ADHD. The current study examined whether stimulant medication, an effective treatment for ADHD, reduces discounting of delayed experiential and hypothetical rewards among 49 children (age 9–12 years) with ADHD. Following a practice day, participants completed a 3-day double-blind placebo-controlled acute medication assessment. Active doses were long-acting methylphenidate (Concerta), with the nearest equivalents of 0.3 and 0.6 mg/kg TID immediate-release methylphenidate. On each testing day, participants completed experiential (real-world money in real time) and hypothetical discounting tasks. Relative to placebo, methylphenidate reduced discounting of delayed experiential rewards, but not hypothetical rewards. Broadly consistent with etiological models that emphasize delay-related impulsivity among children with ADHD, these findings provide initial evidence that stimulant medication reduces delay discounting among those with the disorder. The present results also draw attention to task parameters that may influence the sensitivity of various delay discounting measures to medication effects. PMID:19803628

Attention-deficit/hyperactivity disorder, delay discounting, and risky financial behaviors: A preliminary analysis of self-report data

PubMed Central

2017-01-01

Delay discounting—often referred to as hyperbolic discounting in the financial literature—is defined by a consistent preference for smaller, immediate rewards over larger, delayed rewards, and by failure of future consequences to curtail current consummatory behaviors. Previous research demonstrates (1) excessive delay discounting among individuals with attention-deficit/hyperactivity disorder (ADHD), (2) common neural substrates of delay discounting and hyperactive-impulsive symptoms of ADHD, and (3) associations between delay discounting and both debt burden and high interest rate borrowing. This study extends prior research by examining associations between ADHD symptoms, delay discounting, and an array of previously unevaluated financial outcomes among 544 individuals (mean age 35 years). Controlling for age, income, sex, education, and substance use, ADHD symptoms were associated with delay discounting, late credit card payments, credit card balances, use of pawn services, personal debt, and employment histories (less time spent at more jobs). Consistent with neural models of reward processing and associative learning, more of these relations were attributable to hyperactive-impulsive symptoms than inattentive symptoms. Implications for financial decision-making and directions for future research are discussed. PMID:28481903

A Mechanism for Reducing Delay Discounting by Altering Temporal Attention

PubMed Central

Radu, Peter T; Yi, Richard; Bickel, Warren K; Gross, James J; McClure, Samuel M

2011-01-01

Rewards that are not immediately available are discounted compared to rewards that are immediately available. The more a person discounts a delayed reward, the more likely that person is to have a range of behavioral problems, including clinical disorders. This latter observation has motivated the search for interventions that reduce discounting. One surprisingly simple method to reduce discounting is an “explicit-zero” reframing that states default or null outcomes. Reframing a classical discounting choice as “something now but nothing later” versus “nothing now but more later” decreases discount rates. However, it is not clear how this “explicit-zero” framing intervention works. The present studies delineate and test two possible mechanisms to explain the phenomenon. One mechanism proposes that the explicit-zero framing creates the impression of an improving sequence, thereby enhancing the present value of the delayed reward. A second possible mechanism posits an increase in attention allocation to temporally distant reward representations. In four experiments, we distinguish between these two hypothesized mechanisms and conclude that the temporal attention hypothesis is superior for explaining our results. We propose a model of temporal attention whereby framing affects intertemporal preferences by modifying present bias. PMID:22084496

Social Discounting and the Prisoner’s Dilemma Game

PubMed Central

Locey, Matthew L.; Safin, Vasiliy; Rachlin, Howard

2014-01-01

Altruistic behavior has been defined in economic terms as “…costly acts that confer economic benefits on other individuals” (Fehr & Fischbacher, 2003). In a prisoner’s dilemma game, cooperation benefits the group but is costly to the individual (relative to defection), yet a significant number of players choose to cooperate. We propose that people do value rewards to others, albeit at a discounted rate (social discounting), in a manner similar to discounting of delayed rewards (delay discounting). Two experiments opposed the personal benefit from defection to the socially discounted benefit to others from cooperation. The benefit to others was determined from a social discount function relating the individual’s subjective value of a reward to another person and the social distance between that individual and the other person. In Experiment 1, the cost of cooperating was held constant while its social benefit was varied in terms of the number of other players, each gaining a fixed, hypothetical amount of money. In Experiment 2, the cost of cooperating was again held constant while the social benefit of cooperating was varied by the hypothetical amount of money earned by a single other player. In both experiments, significantly more participants cooperated when the social benefit was higher. PMID:23344990

Delay and probability discounting of multiple commodities in smokers and never-smokers using multiple-choice tasks.

PubMed

Poltavski, Dmitri V; Weatherly, Jeffrey N

2013-12-01

The purpose of the present study was to investigate temporal and probabilistic discounting in smokers and never-smokers, across a number of commodities, using a multiple-choice method. One hundred and eighty-two undergraduate university students, of whom 90 had never smoked, 73 were self-reported light smokers (<10 cigarettes/day), and 17 were heavy smokers (10+cigarettes/day), completed computerized batteries of delay and probability discounting questions pertaining to a total of eight commodities and administered in a multiple-choice format. In addition to cigarettes, monetary rewards, and health outcomes, the tasks included novel commodities such as ideal dating partner and retirement income. The results showed that heavy smokers probability discounted commodities at a significantly shallower rate than never-smokers, suggesting greater risk-taking. No effect of smoking status was observed for delay discounting questions. The only commodity that was probability discounted significantly less than others was 'finding an ideal dating partner'. The results suggest that probability discounting tasks using the multiple-choice format can discriminate between non-abstaining smokers and never-smokers and could be further explored in the context of behavioral and drug addictions.

Measuring Progress Toward Universal Health Coverage: Does the Monitoring Framework of Bangladesh Need Further Improvement?

PubMed Central

Shahabuddin, ASM

2018-01-01

This review aimed to compare Bangladesh’s Universal Health Coverage (UHC) monitoring framework with the global-level recommendations and to find out the existing gaps of Bangladesh’s UHC monitoring framework compared to the global recommendations. In order to reach the aims of the review, we systematically searched two electronic databases - PubMed and Google Scholar - by using appropriate keywords to select articles that describe issues related to UHC and the monitoring framework of UHC applied globally and particularly in Bangladesh. Four relevant documents were found and synthesized. The review found that Bangladesh incorporated all of the recommendations suggested by the global monitoring framework regarding mentoring the financial risk protection and equity perspective. However, a significant gap in the monitoring framework related to service coverage was observed. Although Bangladesh has a significant burden of mental illnesses, cataract, and neglected tropical diseases, indicators related to these issues were absent in Bangladesh’s UHC framework. Moreover, palliative-care-related indicators were completely missing in the framework. The results of this review suggest that Bangladesh should incorporate these indicators in their UHC monitoring framework in order to track the progress of the country toward UHC more efficiently and in a robust way. PMID:29541562

77 FR 59456 - Proposed Collection; Comment Request for Form 8281

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-27

... 8281, Information Return for Publicity Offered Original Issue Discount Instructions. DATES: Written... Offered Original Issue Discount Instruments. OMB Number: 1545-0887. Form Number: 8281. Abstract: Internal... publicity offered debt instruments having original issue discount. Regulations section 1.1275- 3 prescribes...

The Students Decision Making in Solving Discount Problem

ERIC Educational Resources Information Center

Abdillah; Nusantara, Toto; Subanji; Susanto, Hery; Abadyo

2016-01-01

This research is reviewing students' process of decision making intuitively, analytically, and interactively. The research done by using discount problem which specially created to explore student's intuition, analytically, and interactively. In solving discount problems, researcher exploring student's decision in determining their attitude which…

Alcohol Increases Delay and Probability Discounting of Condom-Protected Sex: A Novel Vector for Alcohol-Related HIV Transmission.

PubMed

Johnson, Patrick S; Sweeney, Mary M; Herrmann, Evan S; Johnson, Matthew W

2016-06-01

Alcohol use, especially at binge levels, is associated with sexual HIV risk behavior, but the mechanisms through which alcohol increases sexual risk taking are not well-examined. Delay discounting, that is, devaluation of future consequences as a function of delay to their occurrence, has been implicated in a variety of problem behaviors, including risky sexual behavior. Probability discounting is studied with a similar framework as delay discounting, but is a distinct process in which a consequence is devalued because it is uncertain or probabilistic. Twenty-three, nondependent alcohol users (13 male, 10 female; mean age = 25.3 years old) orally consumed alcohol (1 g/kg) or placebo in 2 separate experimental sessions. During sessions, participants completed tasks examining delay and probability discounting of hypothetical condom-protected sex (Sexual Delay Discounting Task, Sexual Probability Discounting Task) and of hypothetical and real money. Alcohol decreased the likelihood that participants would wait to have condom-protected sex versus having immediate, unprotected sex. Alcohol also decreased the likelihood that participants would use an immediately available condom given a specified level of sexually transmitted infection (STI) risk. Alcohol did not affect delay discounting of money, but it did increase participants' preferences for larger, probabilistic monetary rewards over smaller, certain rewards. Acute, binge-level alcohol intoxication may increase sexual HIV risk by decreasing willingness to delay sex in order to acquire a condom in situations where one is not immediately available, and by decreasing sensitivity to perceived risk of STI contraction. These findings suggest that delay and probability discounting are critical, but heretofore unrecognized, processes that may mediate the relations between alcohol use and HIV risk. Copyright © 2016 by the Research Society on Alcoholism.

Optimal harvesting of fish stocks under a time-varying discount rate.

PubMed

Duncan, Stephen; Hepburn, Cameron; Papachristodoulou, Antonis

2011-01-21

Optimal control theory has been extensively used to determine the optimal harvesting policy for renewable resources such as fish stocks. In such optimisations, it is common to maximise the discounted utility of harvesting over time, employing a constant time discount rate. However, evidence from human and animal behaviour suggests that we have evolved to employ discount rates which fall over time, often referred to as "hyperbolic discounting". This increases the weight on benefits in the distant future, which may appear to provide greater protection of resources for future generations, but also creates challenges of time-inconsistent plans. This paper examines harvesting plans when the discount rate declines over time. With a declining discount rate, the planner reduces stock levels in the early stages (when the discount rate is high) and intends to compensate by allowing the stock level to recover later (when the discount rate will be lower). Such a plan may be feasible and optimal, provided that the planner remains committed throughout. However, in practice there is a danger that such plans will be re-optimized and adjusted in the future. It is shown that repeatedly restarting the optimization can drive the stock level down to the point where the optimal policy is to harvest the stock to extinction. In short, a key contribution of this paper is to identify the surprising severity of the consequences flowing from incorporating a rather trivial, and widely prevalent, "non-rational" aspect of human behaviour into renewable resource management models. These ideas are related to the collapse of the Peruvian anchovy fishery in the 1970's. Copyright © 2010 Elsevier Ltd. All rights reserved.

Susceptibility to price discounting of soda by neighbourhood educational status: an ecological analysis of disparities in soda consumption using point-of-purchase transaction data in Montreal, Canada.

PubMed

Mamiya, Hiroshi; Moodie, Erica E M; Ma, Yu; Buckeridge, David L

2018-06-22

Price discounting is a marketing tactic used frequently by food industries and retailers, but the extent to which education modifies the effect of discounting on the purchasing of unhealthy foods has received little attention. We investigated whether there was a differential association of price discounting of soda with store-level soda purchasing records between 2008 and 2013 by store-neighbourhood education in Montreal, Canada. Using data on grocery purchase transactions from a sample of supermarkets, pharmacies, supercentres and convenience stores, we performed an ecological time-series analysis, modelling weekly store-level sales of soda as a function of store-level price discounting, store- and neighbourhood-level confounders and an interaction term between discounting and categorical education in the neighbourhood of each store. Analysis by store type (n = 18 743, 12 437, 3965 and 49 533 store-weeks for superstores, pharmacies, supercentres and convenience stores, respectively) revealed that the effect measure modification of discounting by neighbourhood education on soda purchasing was lower in stores in the more educated neighbourhoods, most notably in pharmacies: -0.020 [95% confidence interval (CI): -0.028, -0.012] and -0.038 (95% CI: -0.051, -0.025), for middle- and high-education categories, respectively). Weaker effect modification was observed in convenience stores. There was no evidence of effect modification in supercentres or superstores. Price discounting is an important environmental risk factor for soda purchasing and can widen education inequalities in excess sugar intake across levels of education. Interventions to regulate price discounting warrant further investigation as a public health strategy to improve population nutrition, particularly in lower-education neighbourhoods.

Genetic basis of delay discounting in frequent gamblers: examination of a priori candidates and exploration of a panel of dopamine-related loci

PubMed Central

Gray, Joshua C; MacKillop, James

2014-01-01

Introduction Delay discounting is a behavioral economic index of impulsivity that reflects preferences for small immediate rewards relative to larger delayed rewards. It has been consistently linked to pathological gambling and other forms of addictive behavior, and has been proposed to be a behavioral characteristic that may link genetic variation and risk of developing addictive disorders (i.e., an endophenotype). Studies to date have revealed significant associations with polymorphisms associated with dopamine neurotransmission. The current study examined associations between delay discounting and both previously linked variants and a novel panel of dopamine-related variants in a sample of frequent gamblers. Methods Participants were 175 weekly gamblers of European ancestry who completed the Monetary Choice Questionnaire to assess delay discounting preferences and provided a DNA via saliva. Results In a priori tests, two loci previously associated with delayed reward discounting (rs1800497 and rs4680) were not replicated, however, the long form of DRD4 VNTR was significantly associated with lower discounting of delayed rewards. Exploratory analysis of the dopamine-related panel revealed 11 additional significant associations in genes associated with dopamine synthesis, breakdown, reuptake, and receptor function (DRD3, SLC6A3, DDC, DBH, and SLC18A2). An aggregate genetic risk score from the nominally significant loci accounted for 17% of the variance in discounting. Mediational analyses largely supported the presence of indirect effects between the associated loci, delay discounting, and pathological gambling severity. Conclusions These findings do not replicate previously reported associations but identify several novel candidates and provide preliminary support for a systems biology approach to understand the genetic basis of delay discounting. PMID:25365808

Discounts and rebates granted to public payers for medicines in European countries

PubMed Central

Vogler, Sabine; Zimmermann, Nina; Habl, Claudia; Piessnegger, Jutta; Bucsics, Anna

2012-01-01

Objective: The objective of this study was to provide an overview about the existence and types of discounts and rebates granted to public payers by the pharmaceutical industry in European countries. Methods: Data were collected via a questionnaire in spring 2011. Officials from public authorities for pharmaceutical pricing and reimbursement represented in the PPRI (Pharmaceutical Pricing and Reimbursement Information) network provided the information and reviewed the compilation. Results: Information is available from 31 European countries. Discounts and rebates granted to public payers by pharmaceutical industry were reported for 25 European countries. Such discounts exist both in the in- and out-patient sectors in 21 countries and in the in-patient sector only in four countries. Six countries reported not having any regulations or agreements regarding the discounts and rebates granted by industry. The most common discounts and rebates are price reductions and refunds linked to sales volume but types such as in-kind support, price-volume and risk-sharing agreements are also in place. A mix of various types of discounts and rebates is common. Many of these arrangements are confidential. Differences regarding types, the organizational and legal framework, validity and frequency of updates and the amount of the discounts and rebates granted exist among the surveyed countries. Conclusions: In Europe, discounts and rebates on medicines granted by pharmaceutical industry to public payers are common tools to contain public pharmaceutical expenditure. They appear to be used as a complimentary measure when price regulation does not achieve the desired results and in the few European countries with no or limited price regulation. The confidential character of many of these arrangements impedes transparency and may lead to a distortion of medicines prices. An analysis of the impact on these measures is recommended. PMID:23093898

Hydrocarbon deposition in gaps of tungsten and graphite tiles in Experimental Advanced Superconducting Tokamak edge plasma parameters

NASA Astrophysics Data System (ADS)

Xu, Qian; Yang, Zhongshi; Luo, Guang-Nan

2015-09-01

The three-dimensional (3D) Monte Carlo code PIC-EDDY has been utilized to investigate the mechanism of hydrocarbon deposition in gaps of tungsten tiles in the Experimental Advanced Superconducting Tokamak (EAST), where the sheath potential is calculated by the 2D in space and 3D in velocity particle-in-cell method. The calculated results for graphite tiles using the same method are also presented for comparison. Calculation results show that the amount of carbon deposited in the gaps of carbon tiles is three times larger than that in the gaps of tungsten tiles when the carbon particles from re-erosion on the top surface of monoblocks are taken into account. However, the deposition amount is found to be larger in the gaps of tungsten tiles at the same CH4 flux. When chemical sputtering becomes significant as carbon coverage on tungsten increases with exposure time, the deposition inside the gaps of tungsten tiles would be considerable.

Pension coverage among the baby boomers: initial findings from a 1993 survey.

PubMed

Woods, J R

1994-01-01

Using data from a series of supplements to the Current Population Survey, this article presents findings on workers' coverage under employer-sponsored retirement plans in 1993, and recent trends in coverage. The analysis focuses on workers 25-54, a group that includes the baby boom generation. Among all wage and salary workers in this age range (including government employees and part-time workers), 55 percent reported participating in a retirement plan on their current primary jobs, and an additional 3 percent were covered from other jobs. After a modest decline in the early 1980's, the coverage rate has remained essentially unchanged over the past 10 years, and limited data suggest that the baby boomers are doing about as well on pension coverage as older workers at similar points in their careers. Beneath this relative stability in overall coverage, however, at least two important changes have occurred: a significant narrowing of the gender gap in coverage and a shift in types of retirement plans. Increasing numbers of workers are being covered solely by 401(k)-type plans, a development that raises new uncertainties about the form and amount of future benefits. On the other hand, limited data in this study suggest that 401(k) plans may be serving their intended purpose for the majority of workers who have them.

Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems.

PubMed

Rosen, David L; Grodensky, Catherine A; Holley, Tara K

2016-01-01

Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18-64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827) had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the "coverage gap" and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.

Tuning the tunneling magnetoresistance by using fluorinated graphene in graphene based magnetic junctions

NASA Astrophysics Data System (ADS)

Meena, Shweta; Choudhary, Sudhanshu

2017-12-01

Spin polarized properties of fluorinated graphene as tunnel barrier with CrO2 as two HMF electrodes are studied using first principle methods based on density functional theory. Fluorinated graphene with different fluorine coverages is explored as tunnel barriers in magnetic tunnel junctions. Density functional computation for different fluorine coverages imply that with increase in fluorine coverages, there is increase in band gap (Eg) of graphene, Eg ˜ 3.466 e V was observed when graphene sheet is fluorine adsorbed on both-side with 100% coverage (CF). The results of CF graphene are compared with C4F (fluorination on one-side of graphene sheet with 25% coverage) and out-of-plane graphene based magnetic tunnel junctions. On comparison of the results it is observed that CF graphene based structure offers high TMR ˜100%, and the transport of carrier is through tunneling as there are no transmission states near Fermi level. This suggests that graphene sheet with both-side fluorination with 100% coverages acts as a perfect insulator and hence a better barrier to the carriers which is due to negligible spin down current (I ↓ ) in both Parallel Configuration (PC) and Antiparallel Configuration (APC).

The Impact of Medicare Part D on the Proportion of Out-of-Pocket Prescription Drug Costs Among Older Adults With Diabetes.

PubMed

Choi, Yoon Jeong; Jia, Haomiao; Gross, Tal; Weinger, Katie; Stone, Patricia W; Smaldone, Arlene M

2017-04-01

The purpose of this study was to evaluate the impact of Medicare Part D on reducing the financial burden of prescription drugs in older adults with diabetes. Using Medical Expenditure Panel Survey data (2000-2011), interrupted time series and difference-in-difference analyses were used to examine out-of-pocket costs for prescription drugs in 4,664 Medicare beneficiaries (≥65 years of age) compared with 2,938 younger, non-Medicare adults (50-60 years) with diabetes and to estimate the causal effects of Medicare Part D. Part D enrollment of Medicare beneficiaries with diabetes gradually increased from 45.7% (2006) to 52.4% (2011). Compared with years 2000-2005, out-of-pocket pharmacy costs decreased by 13.5% (SE 2.1) for all Medicare beneficiaries with diabetes following Part D implementation; on average, Part D beneficiaries had 5.3% (0.8) lower costs compared with those without Part D. Compared with a younger group with diabetes, out-of-pocket pharmacy costs decreased by 19.4% (1.7) for Medicare beneficiaries after Part D. Part D beneficiaries with diabetes who experienced the coverage gap decreased from 60.1% (2006) to 40.9% (2011) over this period. These findings demonstrate that although Medicare Part D has been effective in reducing the out-of-pocket cost burden of prescription drugs, approximately two out of five Part D beneficiaries with diabetes experienced the coverage gap in 2011. Future research is needed to examine the impact of Affordable Care Act provisions to close the coverage gap on the cost burden of prescription drugs for Medicare beneficiaries with diabetes. © 2017 by the American Diabetes Association.

Predictors, help-seeking behaviour and treatment coverage for depression in adults in Sehore district, India

PubMed Central

Lyngdoh, Tanica; Murhar, Vaibhav; Samudre, Sandesh; Krafft, Thomas

2017-01-01

Background National Mental Health Survey found that in India, the point prevalence of major depressive disorder (MDD) was 2.7% and the treatment gap was 85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and the treatment gap was 80%. Aims To describe the baseline prevalence of depression among adults, association of various demographic and socioeconomic variables with depression and estimation of contact coverage for the same. Method Population-based cross-sectional survey of 3220 adults in Sehore district of Madhya Pradesh, India. The outcome of interest was a probable diagnosis of depression that was measured using the Patient Health Questionnaire (PHQ-9) and the proportion of individuals with depression (PHQ-9>9) who sought care for the same. The data were analysed using simple and multiple log-linear regression. Results Low educational attainment, unemployment and indebtedness were associated with both moderate/severe depression (PHQ-9 score >9) and severe depression only (PHQ-9 score >14), whereas age, caste and marital status were associated with only moderate or severe depression. Religion, type of house, land ownership and amount of loan taken were not associated with either moderate/severe or only severe depression. The contact coverage for moderate/severe depression was 13.08% (95% CI 10.2–16.63). Conclusions There is an urgent need to bridge the treatment gap by targeting individuals with social vulnerabilities and integrating evidence-based interventions in primary care. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28904815

A systematic review and meta-analysis of community and facility-based approaches to address gaps in HIV testing and linkage in sub-Saharan Africa

PubMed Central

Sharma, Monisha; Ying, Roger; Tarr, Gillian; Barnabas, Ruanne

2016-01-01

HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention. PMID:26633769

Is there still an immunity gap in high-level national immunization coverage, Iran?

PubMed

Zahraei, Seyed Mohsen; Eshrati, Babak; Gouya, Mohammad Mehdi; Mohammadbeigi, Abolfazl; Kamran, Aziz

2014-10-01

As there is a significant number of Iranian immigrant and illegal refugees living in marginal areas of large cities that might induce immunization gap in these areas.  The aim of this study was to provide reliable information on vaccination status of these people. A cross sectional study was conducted on children 24-47 month old who lived in the suburb areas of five large cities of Iran in 2013. Proportional cluster sampling method was used in each city and standard questionnaire of the World Health Organization applied for the purpose of data collection. The survey counts immunizations based on immunization card plus the history of vaccination according to the mother's memory. All gathered data were analyzed using SPSS software (version 16). Overall, 4502 children (49.2% female) aged 24-47 month participated in this survey among which 88.1% were Iranian and 11.9% were Afghan or other nationalities. Totally, 4479 (99.4%, CI 95%: 99.2%-99.6%) of the children had a vaccination card while 828 (18.5%, CI 95%; 15.8%-21.1%) could not present it to the interviewers. 96.8% of children were fully immunized, 3.2% were partially immunized and 0.1% were not immunized. There was no significant difference in terms of vaccine coverage among males and females. The prevalence of partially immunization in non-Iranian children was six fold of Iranian children (11.9% vs. 2%). Immunization program is implemented appropriately with high coverage rates in suburb areas of the country. However, there is still an immunity gap in non-Iranian immigrants, which should be a health system considered as a high-risk group by the health system.

Tuition Discounting and Socioeconomic Diversity at Larger Private Universities

ERIC Educational Resources Information Center

Reinoehl, Jason K.; Kowalski, Theodore J.

2015-01-01

Tuition discounting is a tactic deployed by many private four-year institutions as a means for enhancing either tuition revenue or institutional image. This study examines associations between "socioeconomic diversity" and two aspects of institutional grants--"freshman discount rate" and "freshman grant recipient discount…

Tuition Discounting in Challenging Times.

ERIC Educational Resources Information Center

Hubbell, Loren Loomis; Lapovsky, Lucie

2002-01-01

The twelfth annual tuition discounting survey by the National Association of College and University Business Officers (NACUBO) revealed that tuition discounts are up slightly; it also provided data on participation rates, grant levels, distribution changes, correlation with endowments, shifts on the horizon, and other significant changes. (EV)

Towards a General Model of Temporal Discounting

ERIC Educational Resources Information Center

van den Bos, Wouter; McClure, Samuel M.

2013-01-01

Psychological models of temporal discounting have now successfully displaced classical economic theory due to the simple fact that many common behavior patterns, such as impulsivity, were unexplainable with classic models. However, the now dominant hyperbolic model of discounting is itself becoming increasingly strained. Numerous factors have…

Towards a healthier discount procedure.

PubMed

Klock, Rogier M; Brouwer, Werner Bf; Annemans, Lieven Jp; Bos, Jasper M; Postma, Maarten J

2005-02-01

Most national guidelines for pharmacoeconomic research prescribe discounting, mostly of money and health against the same rate. There is much debate on whether this is adequate. Two theoretical arguments, the consistency argument of Weinstein and Stason, and the paralyzing paradox of Keeler and Cretin, are mostly responsible for the current standards. However, more recently, several authors have indicated that the basis to claim the necessity of using similar discount rates is rather weak, both practically and theoretically. In terms of finding a new theoretical basis on which to base discount rates for money and, in particular, health, Van Hout has made an important suggestion arguing that the discount rate for health could be based on the expected growth in life expectancy and the diminishing marginal utility related to such additional health. Similarly, Gravelle and Smith argue that if the value of health grows over time, discount rates that are used for costs cannot directly be applied to effects, but should be adjusted downwards.

Effects of episodic future thinking on discounting: Personalized age-progressed pictures improve risky long-term health decisions.

PubMed

Kaplan, Brent A; Reed, Derek D; Jarmolowicz, David P

2016-03-01

Many everyday choices are associated with both delayed and probabilistic outcomes. The temporal attention hypothesis suggests that individuals' decision making can be improved by focusing attention on temporally distal events and implies that environmental manipulations that bring temporally distal outcomes into focus may alter an individual's degree of discounting. One such manipulation, episodic future thinking, has shown to lower discount rates; however, several questions remain about the applicability of episodic future thinking to domains other than delay discounting. The present experiments examine the effects of a modified episodic-future-thinking procedure in which participants viewed age-progressed computer-generated images of themselves and answered questions related to their future, on probability discounting in the context of both a delayed health gain and loss. Results indicate that modified episodic future thinking effectively altered individuals' degree of discounting in the predicted directions and demonstrate the applicability of episodic future thinking to decision making of socially significant outcomes. © 2015 Society for the Experimental Analysis of Behavior.

A two-level discount model for coordinating a decentralized supply chain considering stochastic price-sensitive demand

NASA Astrophysics Data System (ADS)

Heydari, Jafar; Norouzinasab, Yousef

2015-12-01

In this paper, a discount model is proposed to coordinate pricing and ordering decisions in a two-echelon supply chain (SC). Demand is stochastic and price sensitive while lead times are fixed. Decentralized decision making where downstream decides on selling price and order size is investigated. Then, joint pricing and ordering decisions are extracted where both members act as a single entity aim to maximize whole SC profit. Finally, a coordination mechanism based on quantity discount is proposed to coordinate both pricing and ordering decisions simultaneously. The proposed two-level discount policy can be characterized from two aspects: (1) marketing viewpoint: a retail price discount to increase the demand, and (2) operations management viewpoint: a wholesale price discount to induce the retailer to adjust its order quantity and selling price jointly. Results of numerical experiments demonstrate that the proposed policy is suitable to coordinate SC and improve the profitability of SC as well as all SC members in comparison with decentralized decision making.

Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011.

PubMed

Walker, Allison T; Smith, Philip J; Kolasa, Maureen

2014-04-18

The Presidential Childhood Immunization Initiative was developed in 1993 to address major gaps in childhood vaccination coverage in the United States. Eliminating the cost of vaccines as a barrier to vaccination was one strategy of the Childhood Immunization Initiative; it led to Congressional legislation that authorized creation of the Vaccines for Children program (VFC) in 1994. CDC analyzed National Immunization Survey data for 1995-2011 to evaluate trends in disparities in vaccination coverage rates between non-Hispanic white children and children of other racial/ethnic groups. VFC has been effective in ireducing disparities in vaccination coverage among U.S. children. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that has been effective in reducing childhood vaccination coverage-related disparities in the United States. At its inception in 1994, VFC was implemented in 78 Immunization Action Plan areas that covered the entire United States; within each area, concerted efforts were made to improve childhood vaccination coverage. The findings in this report demonstrate that there have been no racial/ethnic disparities in vaccine coverage for measles-mumps-rubella and poliovirus in the United States since 2005. Disparities in coverage for the diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine were absent, declining, or inconsistent during this period, depending on the racial/ethnic group examined. The results in this report highlight the effectiveness of VFC.

Biphasic Effects of Alcohol on Delay and Probability Discounting

PubMed Central

Bidwell, L. Cinnamon; MacKillop, James; Murphy, James G.; Grenga, Andrea; Swift, Robert M.; McGeary, John E.

2014-01-01

Delay discounting and probability discounting are behavioral economic indices of impulsive and risky decision making that have been associated with addictive behavior, but the acute biphasic effects of alcohol on these decision-making processes are not well understood. This study sought to investigate the biphasic effects of alcohol on delay and probability discounting across the ascending and descending limbs of the breath alcohol concentration (BAC) curve, which are respectively characterized by the stimulant and sedative effects of alcohol. Delay and probability discounting were measured at four time points (Baseline, Ascending, Descending, and Endpoint) across the BAC curve at two target alcohol doses (40 mg/dl and 80 mg/dl) in healthy adults (N = 23 and 27, for both doses, respectively). There was no significant effect of alcohol on delay discounting at either dose. Alcohol significantly affected probability discounting, such that reduced discounting for uncertain rewards was evident during the descending limb of the BAC curve at the lower dose (p<.05) and during both the ascending and descending limb of the BAC curve at the higher dose (p<.05). Thus, alcohol resulted in increased risky decision making, particularly during the descending limb which is primarily characterized by the sedative effects of alcohol. These findings suggest that the biphasic effects of alcohol across the ascending and descending limbs of the BAC have differential effects on behavior related to decision-making for probabilistic, but not delayed, rewards. Parallels to and distinctions from previous findings are discussed. PMID:23750692

Stated time preferences for health: a systematic review and meta analysis of private and social discount rates.

PubMed

Mahboub-Ahari, Alireza; Pourreza, Abolghasem; Sari, Ali Akbari; Rahimi Foroushani, Abbas; Heydari, Hassan

2014-01-01

The present study aimed to provide better insight on methodological issues related to time preference studies, and to estimate private and social discount rates, using a rigorous systematic review and meta-analysis. We searched PubMed, EMBASE and Proquest databases in June 2013. All studies had estimated private and social time preference rates for health outcomes through stated preference approach, recognized eligible for inclusion. We conducted both fixed and random effect meta-analyses using mean discount rate and standard deviation of the included studies. I-square statistics was used for testing heterogeneity of the studies. Private and social discount rates were estimated separately via Stata11 software. Out of 44 screened full texts, 8 population-based empirical studies were included in qualitative synthesis. Reported time preference rates for own health were from 0.036 to 0.07 and for social health from 0.04 to 0.2. Private and social discount rates were estimated at 0.056 (95% CI: 0.038, 0.074) and 0.066 (95% CI: 0.064, 0.068), respectively. Considering the impact of time preference on healthy behaviors and because of timing issues, individual's time preference as a key determinant of policy making should be taken into account. Direct translation of elicited discount rates to the official discount rates has been remained questionable. Decisions about the proper discount rate for health context, may need a cross-party consensus among health economists and policy makers.

Probability Weighting Functions Derived from Hyperbolic Time Discounting: Psychophysical Models and Their Individual Level Testing.

PubMed

Takemura, Kazuhisa; Murakami, Hajime

2016-01-01

A probability weighting function (w(p)) is considered to be a nonlinear function of probability (p) in behavioral decision theory. This study proposes a psychophysical model of probability weighting functions derived from a hyperbolic time discounting model and a geometric distribution. The aim of the study is to show probability weighting functions from the point of view of waiting time for a decision maker. Since the expected value of a geometrically distributed random variable X is 1/p, we formulized the probability weighting function of the expected value model for hyperbolic time discounting as w(p) = (1 - k log p)(-1). Moreover, the probability weighting function is derived from Loewenstein and Prelec's (1992) generalized hyperbolic time discounting model. The latter model is proved to be equivalent to the hyperbolic-logarithmic weighting function considered by Prelec (1998) and Luce (2001). In this study, we derive a model from the generalized hyperbolic time discounting model assuming Fechner's (1860) psychophysical law of time and a geometric distribution of trials. In addition, we develop median models of hyperbolic time discounting and generalized hyperbolic time discounting. To illustrate the fitness of each model, a psychological experiment was conducted to assess the probability weighting and value functions at the level of the individual participant. The participants were 50 university students. The results of individual analysis indicated that the expected value model of generalized hyperbolic discounting fitted better than previous probability weighting decision-making models. The theoretical implications of this finding are discussed.

Unhealthy diets, obesity and time discounting: a systematic literature review and network analysis

PubMed Central

Reeves, Aaron; McKee, Martin; Galea, Gauden; Stuckler, David

2016-01-01

Summary There is an increasing policy commitment to address the avoidable burdens of unhealthy diet, overweight and obesity. However, to design effective policies, it is important to understand why people make unhealthy dietary choices. Research from behavioural economics suggests a critical role for time discounting, which describes how people's value of a reward, such as better health, decreases with delay to its receipt. We systematically reviewed the literature on the relationship of time discounting with unhealthy diets, overweight and obesity in Web of Science and PubMed. We identified 41 studies that met our inclusion criteria as they examined the association between time discount rates and (i) unhealthy food consumption; (ii) overweight and (iii) response to dietary and weight loss interventions. Nineteen out of 25 cross‐sectional studies found time discount rates positively associated with overweight, obesity and unhealthy diets. Experimental studies indicated that lower time discounting was associated with greater weight loss. Findings varied by how time discount rates were measured; stronger results were observed for food than monetary‐based measurements. Network co‐citation analysis revealed a concentration of research in nutrition journals. Overall, there is moderate evidence that high time discounting is a significant risk factor for unhealthy diets, overweight and obesity and may serve as an important target for intervention. © 2016 The Authors Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO) PMID:27256685

The use of integer programming to select bulls across breeding companies with volume price discounts.

PubMed

McConnel, M B; Galligan, D T

2004-10-01

Optimization programs are currently used to aid in the selection of bulls to be used in herd breeding programs. While these programs offer a systematic approach to the problem of semen selection, they ignore the impact of volume discounts. Volume discounts are discounts that vary depending on the number of straws purchased. The dynamic nature of volume discounts means that, in order to be adequately accounted for, they must be considered in the optimization routine. Failing to do this creates a missed economic opportunity because the potential benefits of optimally selecting and combining breeding company discount opportunities are not captured. To address these issues, an integer program was created which used binary decision variables to incorporate the effects of quantity discounts into the optimization program. A consistent set of trait criteria was used to select a group of bulls from 3 sample breeding companies. Three different selection programs were used to select the bulls, 2 traditional methods and the integer method. After the discounts were applied using each method, the integer program resulted in the lowest cost portfolio of bulls. A sensitivity analysis showed that the integer program also resulted in a low cost portfolio when the genetic trait goals were changed to be more or less stringent. In the sample application, a net benefit of the new approach over the traditional approaches was a 12.3 to 20.0% savings in semen cost.

Impact of a Pharmacy Benefit Change on New Use of Mail Order Pharmacy among Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)

PubMed Central

Karter, Andrew J; Parker, Melissa M; Duru, O Kenrik; Schillinger, Dean; Adler, Nancy E; Moffet, Howard H; Adams, Alyce S; Chan, James; Herman, Willam H; Schmittdiel, Julie A

2015-01-01

Objective To assess the impact of a pharmacy benefit change on mail order pharmacy (MOP) uptake. Data Sources/Study Setting Race-stratified, random sample of diabetes patients in an integrated health care delivery system. Study Design In this natural experiment, we studied the impact of a pharmacy benefit change that conditionally discounted medications if patients used MOP and prepaid two copayments. We compared MOP uptake among those exposed to the benefit change (n = 2,442) and the reference group with no benefit change (n = 8,148), and estimated differential MOP uptake across social strata using a difference-in-differences framework. Data Collection/Extraction Methods Ascertained MOP uptake (initiation among previous nonusers). Principal Findings Thirty percent of patients started using MOP after receiving the benefit change versus 9 percent uptake among the reference group (p < .0001). After adjustment, there was a 26 percentage point greater MOP uptake (benefit change effect). This benefit change effect was significantly smaller among patients with inadequate health literacy (15 percent less), limited English proficiency (14 percent less), and among Latinos and Asians (24 and 16 percent less compared to Caucasians). Conclusions Conditionally discounting medications delivered by MOP effectively stimulated MOP uptake overall, but it unintentionally widened previously existing social gaps in MOP use because it stimulated less MOP uptake in vulnerable populations. PMID:25131156

New Estimates of Gaps and Transitions in Health Insurance

PubMed Central

Short, Pamela Farley; Graefe, Deborah R.; Swartz, Katherine; Uberoi, Namrata

2014-01-01

Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004–2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of non-elderly Americans) were uninsured for at least one month during those four years. Approximately twenty-three million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms’ effects on coverage stability. PMID:22833452

The magnitude of and health system responses to the mental health treatment gap in adults in India and China.

PubMed

Patel, Vikram; Xiao, Shuiyuan; Chen, Hanhui; Hanna, Fahmy; Jotheeswaran, A T; Luo, Dan; Parikh, Rachana; Sharma, Eesha; Usmani, Shamaila; Yu, Yu; Druss, Benjamin G; Saxena, Shekhar

2016-12-17

This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate. Copyright © 2016 Elsevier Ltd. All rights reserved.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries.

PubMed

Leyvraz, Magali; Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark; Neufeld, Lynnette M

2017-05-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries123

PubMed Central

Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark

2017-01-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap. PMID:28404839

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

PubMed Central

Ogbuanu, Ikechukwu U.; Adegoke, Oluwasegun J.; Scobie, Heather M.; Uba, Belinda V.; Wannemuehler, Kathleen A.; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J.; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F.

2016-01-01

Background Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Methods Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods. Results Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Conclusions Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria. PMID:27936077

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015.

PubMed

Gunnala, Rajni; Ogbuanu, Ikechukwu U; Adegoke, Oluwasegun J; Scobie, Heather M; Uba, Belinda V; Wannemuehler, Kathleen A; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F

2016-01-01

Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014-2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12-23 months was documented based on vaccination card or caretaker's recall. District-level coverage estimates were calculated using survey methods. Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1-63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%-139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.

78 FR 48606 - Guidance Regarding Deferred Discharge of Indebtedness Income of Corporations and Deferred...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

... Regarding Deferred Discharge of Indebtedness Income of Corporations and Deferred Original Issue Discount... deduction of deferred original issue discount (OID) (deferred OID deductions) under section 108(i)(5)(D... original issue discount deductions of C corporations. * * * * * (b) * * * (2) * * * (iii) * * * (D...

49 CFR 377.203 - Extension of credit to shippers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment of the full, nondiscounted rate instead of the discounted rate otherwise applicable. The difference between the discount and the full rate constitutes a carrier's liquidated damages for its collection effort. Under this method the tariff shall identify the discount rates that are subject to the...

Tobacco use and health insurance literacy among vulnerable populations: implications for health reform.

PubMed

Braun, Robert T; Hanoch, Yaniv; Barnes, Andrew J

2017-11-15

Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy - a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces given their expected health care needs and are able to access health care services effectively is fundamentally related to understanding health insurance. However, no studies to date have examined this important relationship. Data were collected from 631 lower-income, minority, rural residents of Virginia. Health insurance literacy was assessed by asking four factual questions about the coverage options presented to them. Adjusted associations between tobacco use and health insurance literacy were tested using multivariate linear regression, controlling for numeracy, risk-taking, discount rates, health status, experiences with the health care system, and demographics. Nearly one third (31%) of participants were current tobacco users, 80% were African American and 27% were uninsured. Average health insurance literacy across all participants was 2.0 (SD 1.1) out of a total possible score of 4. Current tobacco users had significantly lower HIL compared to non-users (-0.22, p < 0.05) after adjustment. Participants who were less educated, African American, and less numerate reported more difficulty understanding health insurance (p < 0.05 each.) CONCLUSIONS: Tobacco users face higher premiums for health coverage than non-users in the individual insurance marketplace. Our results suggest they may be less equipped to shop for plans that provide them with adequate out-of-pocket risk protection, thus placing greater financial burdens on them and potentially limiting access to tobacco cessation and treatment programs and other needed health services.

Addressing Medicaid/marketplace churn through multimarket plans: assessing the current state of play.

PubMed

Rosenbaum, Sara

2015-02-01

Both before and after the Affordable Care Act (ACA), the US health insurance system is characterized by fragmentation. Pre-ACA, this fragmentation included major coverage gaps, causing significant periods of coverage interruption, especially for lower-income people. The ACA does not end the problem of churning among sources of public financing, but it does hold the potential for enabling people to move among sources of coverage rather than go without insurance. Several strategies for reducing coverage churn exist, but none is foolproof and all are in their early stages. Thus the ability of issuers to participate across multiple public financing arrangements and to offer stable provider networks becomes crucial to achieving continuity of care. Interviews with nine companies involved in developing or operating multimarket strategies confirm the feasibility of this approach while revealing major challenges, especially the challenge of finding providers willing to treat members regardless of the source of coverage. Strategies for increasing multimarket plans and networks represent one of the great areas of future policy and operational focus. Copyright © 2015 by Duke University Press.

Realizing Universal Health Coverage in East Africa: the relevance of human rights.

PubMed

Yamin, Alicia Ely; Maleche, Allan

2017-08-03

Applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women's, children's, and adolescents' health in East Africa, which is a priority under the Sustainable Development Agenda. Nevertheless, there is a gap between global rhetoric of human rights and ongoing health reform efforts. This debate article seeks to fill part of that gap by setting out principles of human rights-based approaches (HRBAs), and then applying those principles to questions that countries undertaking efforts toward UHC and promoting women's, children's and adolescents' health, will need to face, focusing in particular on ensuring enabling legal and policy frameworks, establishing fair financing; priority-setting processes, and meaningful oversight and accountability mechanisms. In a region where democratic institutions are notoriously weak, we argue that the explicit application of a meaningful human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of health reform initiatives being undertaken in the region.

ScanIndel: a hybrid framework for indel detection via gapped alignment, split reads and de novo assembly.

PubMed

Yang, Rendong; Nelson, Andrew C; Henzler, Christine; Thyagarajan, Bharat; Silverstein, Kevin A T

2015-12-07

Comprehensive identification of insertions/deletions (indels) across the full size spectrum from second generation sequencing is challenging due to the relatively short read length inherent in the technology. Different indel calling methods exist but are limited in detection to specific sizes with varying accuracy and resolution. We present ScanIndel, an integrated framework for detecting indels with multiple heuristics including gapped alignment, split reads and de novo assembly. Using simulation data, we demonstrate ScanIndel's superior sensitivity and specificity relative to several state-of-the-art indel callers across various coverage levels and indel sizes. ScanIndel yields higher predictive accuracy with lower computational cost compared with existing tools for both targeted resequencing data from tumor specimens and high coverage whole-genome sequencing data from the human NIST standard NA12878. Thus, we anticipate ScanIndel will improve indel analysis in both clinical and research settings. ScanIndel is implemented in Python, and is freely available for academic use at https://github.com/cauyrd/ScanIndel.

A method for the estimate of the wall diffusion for non-axisymmetric fields using rotating external fields

NASA Astrophysics Data System (ADS)

Frassinetti, L.; Olofsson, K. E. J.; Fridström, R.; Setiadi, A. C.; Brunsell, P. R.; Volpe, F. A.; Drake, J.

2013-08-01

A new method for the estimate of the wall diffusion time of non-axisymmetric fields is developed. The method based on rotating external fields and on the measurement of the wall frequency response is developed and tested in EXTRAP T2R. The method allows the experimental estimate of the wall diffusion time for each Fourier harmonic and the estimate of the wall diffusion toroidal asymmetries. The method intrinsically considers the effects of three-dimensional structures and of the shell gaps. Far from the gaps, experimental results are in good agreement with the diffusion time estimated with a simple cylindrical model that assumes a homogeneous wall. The method is also applied with non-standard configurations of the coil array, in order to mimic tokamak-relevant settings with a partial wall coverage and active coils of large toroidal extent. The comparison with the full coverage results shows good agreement if the effects of the relevant sidebands are considered.

Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

PubMed

Palli, Swetha R; Rizzo, John A; Heidrich, Natalie

2018-06-01

The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.

Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru.

PubMed

Goldie, Sue J; Levin, Carol; Mosqueira-Lovón, N Rocio; Ortendahl, Jesse; Kim, Jane; O'Shea, Meredith; Diaz Sanchez, Mireia; Mendoza Araujo, Maria Ana

2012-12-01

To estimate the benefits, cost-effectiveness (i.e., value for money), and required financial costs (e.g., affordability) of adding human papillomavirus (HPV) vaccination to Peru's cervical cancer screening program. Evidence (e.g., coverage, delivery costs) from an HPV vaccination demonstration project conducted in Peru was combined with epidemiological data in an empirically calibrated mathematical model to assess screening (HPV DNA testing three to five times per lifetime) and HPV vaccination under different cost, coverage, and efficacy assumptions. Model outcomes included lifetime risk of cancer reduction, cancer cases averted, lives saved, average life expectancy gains, short-term financial costs, and discounted long-term economic costs. Status quo low levels of screening (e.g., cytologic screening at 10.0% coverage) reduced lifetime risk of cervical cancer by 11.9%, compared to not screening. Adding vaccination of preadolescent girls at a coverage achieved in the demonstration program (82.0%) produced an additional 46.1% reduction, and would cost less than US$ 500 per year of life saved (YLS) at ~US$ 7/dose or ~US$ 1 300 at ~US$ 20/dose. One year of vaccination was estimated to cost ~US$ 5 million at ~US$ 5/dose or ~US$ 16 million at ~US$ 20/dose, including programmatic costs. Enhanced screening in adult women combined with preadolescent vaccination had incremental cost-effectiveness ratios lower than Peru's 2005 per capita gross domestic product (GDP; US$ 2 852, in 2009 US$), and would be considered cost-effective. Preadolescent HPV vaccination, followed by enhanced HPV DNA screening in adult women, could prevent two out of three cervical cancer deaths. Several strategies would be considered "good value" for resources invested, provided vaccine prices are low. While financial costs imply substantial immediate investments, the high-value payoff should motivate creative mechanisms for financing and scale-up of delivery programs.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act.

PubMed

Novak, Priscilla; Anderson, Andrew C; Chen, Jie

2018-05-12

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014-2016, but gaps remain.

75 FR 55677 - Guidance Regarding Deferred Discharge of Indebtedness Income of Corporations and Deferred...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

... Regarding Deferred Discharge of Indebtedness Income of Corporations and Deferred Original Issue Discount... deferred discharge of indebtedness (COD) income (deferred COD income) and deferred original issue discount...)-1T Deferred discharge of indebtedness income and deferred original issue discount deductions of C...

Time Horizons, Discounting, and Intertemporal Choice

ERIC Educational Resources Information Center

Streich, Philip; Levy, Jack S.

2007-01-01

Although many decisions involve a stream of payoffs over time, political scientists have given little attention to how actors make the required tradeoffs between present and future payoffs, other than applying the standard exponential discounting model from economics. After summarizing the basic discounting model, we identify some of its leading…

Who Benefits from Tuition Discounts at Public Universities?

ERIC Educational Resources Information Center

Hillman, Nicholas W.

2010-01-01

This article uses data from the 2004 National Postsecondary Student Aid Study to provide insight about the range of tuition discounting practices at public institutions. Specifically, it examines the characteristics of students who receive tuition discounts from public four-year colleges and universities. A binary logistic regression is applied to…

Smoking, Discount Rates, and Returns to Education

ERIC Educational Resources Information Center

Fersterer, Josef; Winter-Ebmer, Rudolf

2003-01-01

Individual time preference determines schooling enrolment. Moreover, smoking behavior in early ages has been shown to be highly related to time preference rates. Insofar as discount rates are uncorrelated to ability, predicting school enrolment by discount rates can get rid of the ability bias in an earnings regression. Accordingly, we use smoking…

Tuition Discounting to Optimize Enrollment and Revenue

ERIC Educational Resources Information Center

Parrott, Sarah A.

2008-01-01

As the borders between higher education systems continue to erode and competition for qualified students increases, many institutions are exploring variable pricing options, known in the USA as "tuition discounting." The goal of tuition discounting is to use institutional funds to attract and retain desired students while maximizing net…

47 CFR 54.523 - Payment for the non-discount portion of supported services.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.523 Payment for the non-discount portion of supported services. An eligible school, library, or... discounts. An eligible school, library, or consortium may not receive rebates for services or products...

47 CFR 54.523 - Payment for the non-discount portion of supported services.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.523 Payment for the non-discount portion of supported services. An eligible school, library, or... discounts. An eligible school, library, or consortium may not receive rebates for services or products...

Literature Searching Services--Choosing the Contract with the Best Discount Plan.

ERIC Educational Resources Information Center

Buckel, William L. (Bill)

1982-01-01

Focuses on the cost-saving technique--selecting the contract that offers the best discount--available when using the Lockheed DIALOG system. Examples of savings, password/contract options, and discount plans are given and a microcomputer program written in BASIC II to aid in calculating savings is described. (EJS)

47 CFR 54.523 - Payment for the non-discount portion of supported services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... discounts. An eligible school, library, or consortium may not receive rebates for services or products...) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.523 Payment for the non-discount portion of supported services. An eligible school, library, or...

Rats bred for high alcohol drinking are more sensitive to delayed and probabilistic outcomes.

PubMed

Wilhelm, C J; Mitchell, S H

2008-10-01

Alcoholics and heavy drinkers score higher on measures of impulsivity than nonalcoholics and light drinkers. This may be because of factors that predate drug exposure (e.g. genetics). This study examined the role of genetics by comparing impulsivity measures in ethanol-naive rats selectively bred based on their high [high alcohol drinking (HAD)] or low [low alcohol drinking (LAD)] consumption of ethanol. Replicates 1 and 2 of the HAD and LAD rats, developed by the University of Indiana Alcohol Research Center, completed two different discounting tasks. Delay discounting examines sensitivity to rewards that are delayed in time and is commonly used to assess 'choice' impulsivity. Probability discounting examines sensitivity to the uncertain delivery of rewards and has been used to assess risk taking and risk assessment. High alcohol drinking rats discounted delayed and probabilistic rewards more steeply than LAD rats. Discount rates associated with probabilistic and delayed rewards were weakly correlated, while bias was strongly correlated with discount rate in both delay and probability discounting. The results suggest that selective breeding for high alcohol consumption selects for animals that are more sensitive to delayed and probabilistic outcomes. Sensitivity to delayed or probabilistic outcomes may be predictive of future drinking in genetically predisposed individuals.

Food and beverage price discounts to improve health in remote Aboriginal communities: mixed method evaluation of a natural experiment.

PubMed

Ferguson, Megan; O'Dea, Kerin; Holden, Stacey; Miles, Eddie; Brimblecombe, Julie

2017-02-01

Retrospectively evaluate food price discounts in remote Aboriginal community stores. Four price discount strategies of 10% were designed in 2010, aiming to influence grocery, fruit, vegetables and diet soft-drink sales. This natural experiment across a group of stores was evaluated using an explanatory, sequential mixed method design through analysis of store point-of-sale, document, observation and interview data. The outcome was measured by change in: 1) percentage of grocery sales to total food and beverage; 2) fruit and vegetable sales; and 3) diet soft-drink sales. Qualitative data enabled the interpretation of outcomes through understanding perceived success and benefits, and enablers and barriers to implementation. Eighteen community stores and 54 informants participated. While targeted price discounts were considered important to improving health, no discernible effect was evident, due to inadequate design and communication of discount promotion, and probably inadequate magnitude of discount. Strategy impact on food and beverage sales was limited by promotion and magnitude of discount. Implication for Public Health: This study demonstrates key factors and commitment required to design, communicate, implement and monitor strategies to improve health in this challenging remote retail context. Evaluation of natural experiments can contribute evidence to policy-making. © 2016 The Authors.

Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls.

PubMed

Kirby, Kris N; Petry, Nancy M

2004-04-01

To test a prediction of the discounting model of impulsiveness that discount rates would be positively associated with addiction. The delay-discount rate refers to the rate of reduction in the present value of a future reward as the delay to that reward increases. We estimated participants' discount rates on the basis of their pattern of choices between smaller immediate rewards ($11-80) and larger, delayed rewards ($25-85; at delays from 1 week to 6 months) in a questionnaire format. Participants had a one-in-six chance of winning a reward that they chose on one randomly selected trial. Heroin (n = 27), cocaine (n = 41) and alcohol (n = 33) abusers and non-drug-using controls (n = 44) were recruited from advertisements. They were tested in a drug abuse research clinic at a medical school. On average, the cocaine and heroin groups had higher rates than controls (both P < 0.001), but alcoholics did not (P = 0.44). Abstinence was associated with lower rates for heroin abusers (P = 0.03), but not for cocaine or alcohol abusers (both P > 0.50). These data suggest that discount rates vary with the preferred drug of abuse, and that high discount rates should be considered in the development of substance abuse prevention and treatment efforts.

The discounting model selector: Statistical software for delay discounting applications.

PubMed

Gilroy, Shawn P; Franck, Christopher T; Hantula, Donald A

2017-05-01

Original, open-source computer software was developed and validated against established delay discounting methods in the literature. The software executed approximate Bayesian model selection methods from user-supplied temporal discounting data and computed the effective delay 50 (ED50) from the best performing model. Software was custom-designed to enable behavior analysts to conveniently apply recent statistical methods to temporal discounting data with the aid of a graphical user interface (GUI). The results of independent validation of the approximate Bayesian model selection methods indicated that the program provided results identical to that of the original source paper and its methods. Monte Carlo simulation (n = 50,000) confirmed that true model was selected most often in each setting. Simulation code and data for this study were posted to an online repository for use by other researchers. The model selection approach was applied to three existing delay discounting data sets from the literature in addition to the data from the source paper. Comparisons of model selected ED50 were consistent with traditional indices of discounting. Conceptual issues related to the development and use of computer software by behavior analysts and the opportunities afforded by free and open-sourced software are discussed and a review of possible expansions of this software are provided. © 2017 Society for the Experimental Analysis of Behavior.

Delay Discounting and the use of Mindful Attention versus Distraction in the Treatment of Drug Addiction: A Conceptual Review

PubMed Central

Ashe, Melinda L.; Newman, Michelle G.; Wilson, Stephen J.

2015-01-01

In recent decades, researchers have integrated measurements of delay discounting, how the subjective valuation of a reward changes as a function of time, into their study of addiction. Research has begun to explore the idea that delay discounting may serve as both a marker for the effectiveness of existing treatments for addiction and a potential target for novel intervention strategies. As this work is in its infancy, many potentially significant connections between the construct of delay discounting and the treatment of addiction have yet to be explored. Here, we present a conceptual review highlighting novel points of intersection between delay discounting and two approaches to treating addiction that have become increasingly popular in recent years: those that focus on the development of mindfulness skills and those that emphasize the use of distraction techniques. Viewing these two techniques through the lens of delay discounting is particularly intriguing because of the very different way that they address the experience of drug cravings in the present moment (nonjudgmentally attending to versus shifting attention away from subjective cravings, respectively). We propose that these opposing strategies for dealing with cravings may interact with delay discounting in ways that have important implications for treatment effectiveness. PMID:25545725

Effects of blood glucose on delay discounting, food intake and counterregulation in lean and obese men.

PubMed

Klement, Johanna; Kubera, Britta; Eggeling, Jonas; Rädel, Christin; Wagner, Christin; Park, Soyoung Q; Peters, Achim

2018-03-01

Delay discounting as a measure of impulsivity has been shown to be higher in obesity with an association of increased food intake. Moreover, obese humans showed a higher wanting for high-calorie food than lean men when blood glucose concentrations were low. First studies linking blood glucose levels to delay discounting yielded mixed results. We hypothesized that obese people - in comparison to lean men - have a relative lack of energy, especially when blood glucose levels are low, that results in higher levels of delay discounting, food intake and hormonal counterregulation. We investigated 20 lean and 20 obese healthy young men in a single-blind balanced cross-over design. With a standardized glucose clamp technique, subjects underwent a hypoglycemic state in one condition and a euglycemic state in the control condition. Regularly, blood was sampled for assessment of hormonal status, and questionnaires were filled out to assess delay discounting and symptom awareness. After normalizing blood glucose concentrations, subjects were free to eat from a standardized test buffet, followed by a snack test. Delay discounting was higher in obese than in lean men throughout experiments (p < 0.03). However, we did not observe significant discounting differences between glucose conditions (p > 0.1). Furthermore, the discounting performance did not correlate with food intake from the test buffet or snack test (p > 0.3). As a response to hypoglycemia, hormonal counterregulation was pronounced in both weight groups (p < 0.03), but responses of ACTH, norepinephrine and glucagon were stronger in obese compared to lean men (p < 0.03). Also, intake from the high-calorie buffet after hypoglycemia compared to euglycemia was higher in obese subjects (p < 0.02) but comparable in lean men (p > 0.5). Our data suggest that augmented delay discounting is a robust feature in obesity that is not linked to glucose levels or actual food intake. With our systematically controlled approach, combining performance in delay discounting with regard to distinct blood glucose levels, different weight groups, counterregulatory behavior and food intake, our results imply that delay discounting is not susceptible to fluctuations of blood glucose and do not support the assumption that a low body's energy content leads to increased impulsivity. Further replications including women and larger sample sizes are needed to corroborate our data. Copyright © 2018 Elsevier Ltd. All rights reserved.

Anomalous Elasticity of 4He Films at the Quantum Phase Transition

NASA Astrophysics Data System (ADS)

Shirahama, Keiya; Takahashi, Daisuke; Kogure, Takayuki; Yoshimura, Hitomi; Higashino, Rama

4 He films on solid substrates exhibit a quantum phase transition between localized (nonsuperfluid) and superfluid states by changing coverage n. We have made torsional oscillator (TO) studies for 4He films adsorbed on nanoporous glasses. A TO with localized films showed an apparent ''supersolid'' behavior, an increase in TO frequency f with broad peak in Q-1. Combining with FEM analyses for TO's with different designs, we conclude that the behavior results from the softening of adsorbed 4He films at high temperatures. The features in f and Q-1 are fitted well to a Debye-like activation with a distributed energy gap Δ, so the elasticity is accounted by thermal excitation of localized atoms to an ''extended'' state. As the critical coverage nc approaches the gap decreases to zero with a powerlaw Δ ~(n -nc) 1 . 2 . Assuming that the 4He chemical potential μ (n) is located in the middle of the gap, we can estimate the elastic constant κ-1 =n2 ∂μ / ∂n . The elasticity agrees with shear moduli of 4He films obtained from the FEM analysis within factor of three. The energetics proposed from the elastic behavior naturally explains other properties of He films adsorbed on disordered substrates.

Changes in health insurance for US children and their parents: comparing 2003 to 2008.

PubMed

Angier, Heather; DeVoe, Jennifer E; Tillotson, Carrie; Wallace, Lorraine

2013-01-01

Recent policy changes have affected access to health insurance for families in the United States. Private health insurance premiums have increased, and state Medicaid programs have cut back coverage for adults. Concurrently, the Children's Health Insurance Program has made public insurance available to more children. We aimed to better understand how child and parent health insurance coverage patterns may have changed as a result of these policies. We analyzed data from the nationally representative Medical Expenditure Panel Survey, comparing cohorts from 2003 and 2008. We assessed cross-sectional and full-year coverage patterns for child/parent pairs, stratified by income. We conducted chi-square tests to assess significant differences in coverage over time. Middle-income child/parent pairs had the most significant changes in their coverage patterns. For example, those with full-year health insurance coverage significantly decreased from 85.4% in 2003 to 80.6% in 2008. There was also an increase in uninsured middle-income child/parent pairs for the full year (5.6% in 2003 to 8.3% in 2008) and an increase in pairs who had a gap in coverage (9.7% in 2003 to 13.0% in 2008). The percentage of middle-income child/parent pairs who were lacking insurance, for part or all of the year, has risen, suggesting that these families may be caught between affording private coverage and being eligible for public coverage. Unless private coverage becomes more affordable, insurance instability among middle-income families may persist despite the passage of the Patient Protection and Affordable Care Act.

Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn and child health services in rural areas of India

PubMed Central

Modi, Dhiren; Gopalan, Ravi; Shah, Shobha; Venkatraman, Sethuraman; Desai, Gayatri; Desai, Shrey; Shah, Pankaj

2015-01-01

Background A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. Objective This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. Design The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Results Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff. Conclusions The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial. PMID:25697233

A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries.

PubMed

Rantanen, Jorma; Lehtinen, Suvi; Valenti, Antonio; Iavicoli, Sergio

2017-10-05

The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents. A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries. A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents. The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).

Full-Coverage High-Resolution Daily PM(sub 2.5) Estimation using MAIAC AOD in the Yangtze River Delta of China

NASA Technical Reports Server (NTRS)

Xiao, Qingyang; Wang, Yujie; Chang, Howard H.; Meng, Xia; Geng, Guannan; Lyapustin, Alexei Ivanovich; Liu, Yang

2017-01-01

Satellite aerosol optical depth (AOD) has been used to assess population exposure to fine particulate matter (PM (sub 2.5)). The emerging high-resolution satellite aerosol product, Multi-Angle Implementation of Atmospheric Correction(MAIAC), provides a valuable opportunity to characterize local-scale PM(sub 2.5) at 1-km resolution. However, non-random missing AOD due to cloud snow cover or high surface reflectance makes this task challenging. Previous studies filled the data gap by spatially interpolating neighboring PM(sub 2.5) measurements or predictions. This strategy ignored the effect of cloud cover on aerosol loadings and has been shown to exhibit poor performance when monitoring stations are sparse or when there is seasonal large-scale missngness. Using the Yangtze River Delta of China as an example, we present a Multiple Imputation (MI) method that combines the MAIAC high-resolution satellite retrievals with chemical transport model (CTM) simulations to fill missing AOD. A two-stage statistical model driven by gap-filled AOD, meteorology and land use information was then fitted to estimate daily ground PM(sub 2.5) concentrations in 2013 and 2014 at 1 km resolution with complete coverage in space and time. The daily MI models have an average R(exp 2) of 0.77, with an inter-quartile range of 0.71 to 0.82 across days. The overall Ml model 10-fold cross-validation R(exp 2) (root mean square error) were 0.81 (25 gm(exp 3)) and 0.73 (18 gm(exp 3)) for year 2013 and 2014, respectively. Predictions with only observational AOD or only imputed AOD showed similar accuracy.Comparing with previous gap-filling methods, our MI method presented in this study performed bette rwith higher coverage, higher accuracy, and the ability to fill missing PM(sub 2.5) predictions without ground PM(sub 2.5) measurements. This method can provide reliable PM(sub 2.5)predictions with complete coverage that can reduce biasin exposure assessment in air pollution and health studies.

Gaps and opportunities for the World Heritage Convention to contribute to global wilderness conservation.

PubMed

Allan, James R; Kormos, Cyril; Jaeger, Tilman; Venter, Oscar; Bertzky, Bastian; Shi, Yichuan; Mackey, Brendan; van Merm, Remco; Osipova, Elena; Watson, James E M

2018-02-01

Wilderness areas are ecologically intact landscapes predominantly free of human uses, especially industrial-scale activities that result in substantial biophysical disturbance. This definition does not exclude land and resource use by local communities who depend on such areas for subsistence and bio-cultural connections. Wilderness areas are important for biodiversity conservation and sustain key ecological processes and ecosystem services that underpin planetary life-support systems. Despite these widely recognized benefits and values of wilderness, they are insufficiently protected and are consequently being rapidly eroded. There are increasing calls for multilateral environmental agreements to make a greater and more systematic contribution to wilderness conservation before it is too late. We created a global map of remaining terrestrial wilderness following the established last-of-the-wild method, which identifies the 10% of areas with the lowest human pressure within each of Earth's 62 biogeographic realms and identifies the 10 largest contiguous areas and all contiguous areas >10,000 km 2 . We used our map to assess wilderness coverage by the World Heritage Convention and to identify gaps in coverage. We then identified large nationally designated protected areas with good wilderness coverage within these gaps. One-quarter of natural and mixed (i.e., sites of both natural and cultural value) World Heritage Sites (WHS) contained wilderness (total of 545,307 km 2 ), which is approximately 1.8% of the world's wilderness extent. Many WHS had excellent wilderness coverage, for example, the Okavango Delta in Botswana (11,914 km 2 ) and the Central Suriname Nature Reserve (16,029 km 2 ). However, 22 (35%) of the world's terrestrial biorealms had no wilderness representation within WHS. We identified 840 protected areas of >500 km 2 that were predominantly wilderness (>50% of their area) and represented 18 of the 22 missing biorealms. These areas offer a starting point for assessing the potential for the designation of new WHSs that could help increase wilderness representation on the World Heritage list. We urge the World Heritage Convention to ensure that the ecological integrity and outstanding universal value of existing WHS with wilderness values are preserved. © 2017 Society for Conservation Biology.

Cigarette brand preference as a function of price among smoking youths in Canada: are they smoking premium, discount or native brands?

PubMed

Leatherdale, S T; Ahmed, R; Barisic, A; Murnaghan, D; Manske, S

2009-12-01

Given that little is known about the price-related cigarette brand preferences of youths, the current study seeks to characterise cigarette brand preferences and examine factors associated with smoking discount or native cigarette brands among Canadian youths who are current smokers. This study used nationally representative data collected from 71,003 grade 5-12 students as part of the 2006-7 Canadian Youth Smoking Survey (YSS). Using data from current smokers, logistic regression models were used to examine factors associated with smoking discount or native cigarette brands relative to premium cigarette brands. In 2006, premium cigarettes were the most prevalent brand of cigarette youths report usually smoking (49.4%); a substantial number of youths do report usually smoking either discount (12.9%) or native (9.3%) cigarette brands. Occasional smokers were more likely to report usually smoking premium cigarettes whereas daily smokers were more likely to report smoking either discount or native cigarettes. In particular, discount and native brands appear to be appealing among smoking youths with less spending money or those who are heavier smokers compared to youths smoking premium brands. Discount and native cigarette brands are commonly used by a substantial number of smoking youths in Canada. Additional research is required to better understand the reasons behind different cigarette brand preferences and how youths are able to access premium, discount and illicit native cigarettes. Moreover, ongoing surveillance of the cigarette brand preferences of youths is required for guiding future tobacco control policy and programming activities.

Delay discounting rates: a strong prognostic indicator of smoking relapse.

PubMed

Sheffer, Christine E; Christensen, Darren R; Landes, Reid; Carter, Larry P; Jackson, Lisa; Bickel, Warren K

2014-11-01

Recent evidence suggests that several dimensions of impulsivity and locus of control are likely to be significant prognostic indicators of relapse. One-hundred and thirty-one treatment seeking smokers were enrolled in six weeks of multi-component cognitive-behavioral therapy with eight weeks of nicotine replacement therapy. Cox proportional hazard regressions were used to model days to relapse with each of the following: delay discounting of $100, delay discounting of $1000, six subscales of the Barratt Impulsiveness Scale (BIS), Rotter's Locus of Control (RLOC), Fagerstrom's Test for Nicotine Dependence (FTND), and the Perceived Stress Scale (PSS). Hazard ratios for a one standard deviation increase were estimated with 95% confidence intervals for each explanatory variable. Likelihood ratios were used to examine the level of association with days to relapse for different combinations of the explanatory variables while accounting for nicotine dependence and stress level. These analyses found that the $100 delay discounting rate had the strongest association with days to relapse. Further, when discounting rates were combined with the FTND and PSS, the associations remained significant. When the other measures were combined with the FTND and PSS, their associations with relapse non-significant. These findings indicate that delay discounting is independently associated with relapse and adds to what is already accounted for by nicotine dependence and stress level. They also signify that delay discounting is a productive new target for enhancing treatment for tobacco dependence. Consequently, adding an intervention designed to decrease discounting rates to a comprehensive treatment for tobacco dependence has the potential to decrease relapse rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

No food for thought: moderating effects of delay discounting and future time perspective on the relation between income and food insecurity.

PubMed

Epstein, Leonard H; Jankowiak, Noelle; Lin, Henry; Paluch, Rocco; Koffarnus, Mikhail N; Bickel, Warren K

2014-09-01

Low income is related to food insecurity, and research has suggested that a scarcity of resources associated with low income can shift attention to the present, thereby discounting the future. We tested whether attending to the present and discounting the future may moderate the influence of income on food insecurity. Delay discounting and measures of future time perspective (Zimbardo Time Perspective Inventory, Consideration of Future Consequences Scale, time period of financial planning, and subjective probability of living to age 75 y) were studied as moderators of the relation between income and food insecurity in a diverse sample of 975 adults, 31.8% of whom experienced some degree of food insecurity. Income, financial planning, subjective probability of living to age 75 y, and delay discounting predicted food insecurity as well as individuals who were high in food insecurity. Three-way interactions showed that delay discounting interacted with financial planning and income to predict food insecurity (P = 0.003). At lower levels of income, food insecurity was lowest for subjects who had good financial planning skills and did not discount the future, whereas having good financial skills and discounting the future had minimal influence on food insecurity. The same 3-way interaction was observed when high food insecurity was predicted (P = 0.008). Because of the role of scarce resources on narrowing attention and reducing prospective thinking, research should address whether modifying future orientation may reduce food insecurity even in the face of diminishing financial resources. © 2014 American Society for Nutrition.

Unhealthy diets, obesity and time discounting: a systematic literature review and network analysis.

PubMed

Barlow, Pepita; Reeves, Aaron; McKee, Martin; Galea, Gauden; Stuckler, David

2016-09-01

There is an increasing policy commitment to address the avoidable burdens of unhealthy diet, overweight and obesity. However, to design effective policies, it is important to understand why people make unhealthy dietary choices. Research from behavioural economics suggests a critical role for time discounting, which describes how people's value of a reward, such as better health, decreases with delay to its receipt. We systematically reviewed the literature on the relationship of time discounting with unhealthy diets, overweight and obesity in Web of Science and PubMed. We identified 41 studies that met our inclusion criteria as they examined the association between time discount rates and (i) unhealthy food consumption; (ii) overweight and (iii) response to dietary and weight loss interventions. Nineteen out of 25 cross-sectional studies found time discount rates positively associated with overweight, obesity and unhealthy diets. Experimental studies indicated that lower time discounting was associated with greater weight loss. Findings varied by how time discount rates were measured; stronger results were observed for food than monetary-based measurements. Network co-citation analysis revealed a concentration of research in nutrition journals. Overall, there is moderate evidence that high time discounting is a significant risk factor for unhealthy diets, overweight and obesity and may serve as an important target for intervention. © 2016 The Authors Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO). © 2016 The Authors Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).

Trends in the use and advertising of discount versus premium snuff.

PubMed

Timberlake, David S; Pechmann, Cornelia

2013-02-01

The Conwood Company, a major producer of discount moist snuff, was awarded a $1 billion antitrust settlement in the year 2000 against its leading competitor, the U.S. Smokeless Tobacco Company. The objective of this study was to examine the trends in use and advertising of discount versus premium snuff since the Conwood settlement, a topic seldom addressed in the tobacco control literature. 2 sources of data were analyzed in 2011: (a) male snuff users from the 2002-2009 National Surveys on Drug Use and Health (N = 13,172) and (b) total advertisements of moist snuff identified from over 350 consumer magazines dated 2005-2009 (N = 861). For the survey data, demographic and tobacco-related measures were assessed as predictors of use of discount versus premium snuff in logistic regression models. For the advertising data, associations were examined between the snuff category and nicotine content, magazine youth readership, and year of magazine publication. The prevalence of discount and premium snuff use among males increased and decreased, respectively, from 2002 to 2009. Significant predictors of using discount versus premium snuff were being an adolescent, being an African-American, being a current or former smoker, living in a less populated region of the country, and using snuff frequently. Discount snuff advertising was associated with publication in magazines with a high youth readership. Discount snuff has grown in popularity among male adolescents who have been a target of advertising. The tobacco's cheap price and high nicotine content pose a public health problem because of the potential for long-term tobacco use and dependence.

Me, Myself, and Money II: Relative Deprivation Predicts Disordered Gambling Severity via Delay Discounting, Especially Among Gamblers Who Have a Financially Focused Self-Concept.

PubMed

Tabri, Nassim; Will Shead, N; Wohl, Michael J A

2017-12-01

In the current research, we examined whether the known link between relative deprivation and disordered gambling (via delay discounting; i.e., preferences for immediate smaller rewards relative to delayed larger rewards) is moderated by the extent to which gamblers have a financially focused self-concept. Specifically, we hypothesized that delay discounting would be a strong predictor of disordered gambling among those who base their self-worth on their financial success. To test this moderated-mediation model, a community sample of gamblers (N = 239) completed measures that assessed relative deprivation, delay discounting, financially focused self-concept, and disordered gambling severity. As predicted, people who felt more relative deprivation reported more severe symptoms of disordered gambling and this association was mediated by delay discounting. Importantly, this mediated relationship was moderated by the extent to which participants' self-concept was focused on financial success. Among participants whose self-concept was high in financial focus, greater delay discounting (stemming from relative deprivation) was a strong predictor of disordered gambling. Among people whose self-concept was low in financial focus, delay discounting (stemming from relative deprivation) was a weak predictor of disordered gambling. Thus, the magnitude of the indirect effect of relative deprivation on disordered gambling severity was larger among people with a more financially focused self-concept-an effect mediated by delay discounting. These findings suggest that targeting gamblers' financial focus in prevention and treatment interventions may be instrumental in curtailing the development and maintenance of disordered gambling.

Towards the 75th Anniversary

ERIC Educational Resources Information Center

Slingsby, David

2016-01-01

The "Journal of Biological Education" is firmly established as the authoritative voice in the world of biological education. The journal aims to bridge the gap between research and practice, providing information, ideas and opinion, in addition to critical examinations of advances in biology research and teaching. Through the coverage of…

Conceptual Gaps in Circuits Textbooks: A Comparative Study

ERIC Educational Resources Information Center

Sangam, Deepika; Jesiek, Brent K.

2015-01-01

Many university-level electrical engineering courses continue to use textbooks as curriculum scaffolds, prescribed texts, and/or reference volumes. Textbook reliance is even more pronounced in courses that teach foundational principles of the discipline, such as introductory circuit theory. This paper reports on the conceptual coverage of…

The cost-effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario: in the past year, several court cases have been brought against provincial governments to increase funding for Intensive Behavioural Intervention (IBI). This economic evaluation examines the costs and consequences of expanding an IBI program.

PubMed

Motiwala, Sanober S; Gupta, Shamali; Lilly, Meredith B; Ungar, Wendy J; Coyte, Peter C

2006-01-01

Intensive Behavioural Intervention (IBI) describes behavioural therapies provided to autistic children to overcome intellectual and functional disabilities. The high cost of IBI has caused concern regarding access, and recently, several court cases have been brought against provincial governments to increase funding for this intervention. This economic evaluation assessed the costs and consequences of expanding an IBI program from current coverage for one-third of children to all autistic children aged two to five in Ontario, Canada. Data on the hours and costs of IBI, and costs of educational and respite services, were obtained from the government. Data on program efficacy were obtained from the literature. These data were modelled to determine the incremental cost savings and gains in dependency-free life years. Total savings from expansion of the current program were $45,133,011 in 2003 Canadian dollars. Under our model parameters, expansion of IBI to all eligible children represents a cost-saving policy whereby total costs of care for autistic individuals are lower and gains in dependency-free life years are higher. Sensitivity analyses carried out to address uncertainty and lack of good evidence for IBI efficacy and appropriate discount rates yielded mixed results: expansion was not cost saving with discount rates of 5% or higher and with lower IBI efficacy beyond a certain threshold. Further research on the efficacy of IBI is recommended.

Brain Damage Treated with Non Proven Intensive Training 2003-2011: A Norwegian Cost Analysis

PubMed Central

Norum, Jan; Ramsvik, Arnborg; Tjeldnes, Knut

2012-01-01

Objectives: There has been an increased request for intensive training and rehabilitation of patients with brain damage in Norway. These programs are demanding with regard to personnel, travelling, time and economic resources. We aimed to indicate cost and gain to make these programs cost-effective. Methods: A retrospective study included all patients referred to the Northern Norway Regional Health Authority (NNRHA) trust during the nine years period 2003-2011. All referrals to the NNRHA trust for the economic coverage of foreign based rehabilitation or habilitation programs (The Advanced Bio-Mechanical Rehabilitation (ABR), Institutes of Achievement of Human Potential program (IAHP) (Doman method), Family Hope Center (FHC) program and the Kozijavkin method) were included. 17 patients were detected and 15 fulfilled the inclusion criteria for funding. Median age was 8 years (1-31 years). Cost from the specialist health care point of view was calculated. A cut-off limit of €57,000/quality adjusted life year (QALY) and a 4% discount rate was employed. Results: The undiscounted cost per patient enrolled was calculated €133,210 (discounted €121,348). To make these therapies cost effective, a total of at least 2.13 QALYs (2.34 undiscounted QALYs) must be gained per patient enrolled. Such a gain could not be indicated and we doubt it is achievable. Conclusion: Non-proven intensive training programs for patients with brain damage are costly. As long as their effect has not been documented, health care services should not spend resources on these programs outside clinical trials. PMID:23121754

Quality defects in market beef and dairy cows and bulls sold through livestock auction markets in the Western United States: II. Relative effects on selling price.

PubMed

Ahola, J K; Foster, H A; Vanoverbeke, D L; Jensen, K S; Wilson, R L; Glaze, J B; Fife, T E; Gray, C W; Nash, S A; Panting, R R; Rimbey, N R

2011-05-01

Relative effects of Beef Quality Assurance (BQA)-related defects in market beef and dairy cows and bulls on selling price at auction was evaluated during 2008. The presence and severity of 23 BQA-related traits were determined during sales in Idaho, California, and Utah. Overall, 18,949 unique lots consisting of 23,479 animals were assessed during 125 dairy sales and 79 beef sales. Mean sale price ± SD (per 45.5 kg) for market beef cows, beef bulls, dairy cows, and dairy bulls was $45.15 ± 9.42, $56.30 ± 9.21, $42.23 ± 12.26, and $55.10 ± 9.07, respectively. When combined, all recorded traits explained 36% of the variation in selling price in beef cows, 35% in beef bulls, 61% in dairy cows, and 56% in dairy bulls. Premiums and discounts were determined in comparison with a "par" or "base" animal. Compared with a base BCS 5 beef cow (on a 9-point beef scale), BCS 1 to 4 cows were discounted (P < 0.0001), whereas premiums (P < 0.05) were estimated for BCS 6 to 8. Compared with a base BCS 3.0 dairy cow (on a 5-point dairy scale), more body condition resulted in a premium (P ≤ 0.001), whereas a less-than-desirable BCS of 2.0 or 2.5 was discounted (P < 0.0001). Emaciated or near-emaciated cows (beef BCS 1 or 2; dairy BCS 1.0 or 1.5) were discounted (P < 0.0001). Compared with base cows weighing 545 to 635 kg, lighter BW beef cows were discounted (P < 0.0001), whereas heavier beef cows received (P < 0.05) a premium. Compared with a base dairy cow weighing 636 to 727 kg, lighter BW cows were discounted (P < 0.0001), whereas heavier cows (727 to 909 kg) received a premium (P < 0.01). Beef and dairy cows with any evidence of lameness were discounted (P < 0.0001). Presence of ocular neoplasia in the precancerous stage discounted (P = 0.05) beef cows and discounted (P < 0.01) dairy cows, whereas at the cancerous stage, it discounted (P < 0.0001) all cows. Hide color influenced (P < 0.0001) selling price in beef cattle but had no effect (P = 0.17) in dairy cows. Animals that were visibly sick were discounted (P < 0.0001). Results suggest that improving BCS and BW, which producers can do at the farm or ranch level, positively affects sale price. Furthermore, animals that are visibly sick or have a defect associated with a possible antibiotic risk will be discounted. Ultimately, animals with minor quality defects should be sold in a timely manner before the defect advances and the discount increases.

Riding the rollercoaster: the ups and downs in out-of-pocket spending under the standard Medicare drug benefit.

PubMed

Stuart, Bruce; Briesacher, Becky A; Shea, Dennis G; Cooper, Barbara; Baysac, Fatima S; Limcangco, M Rhona

2005-01-01

This study projects how much Medicare beneficiaries who sign up for the standard Part D drug benefit in 2006 will pay in quarterly out-of-pocket payments through 2008. In the first year we estimate that about 38 percent of enrollees will hit the benefit's no-coverage zone, known as the "doughnut hole," and that 14 percent will exceed the catastrophic threshold. Because drug spending is highly persistent over time, beneficiaries who experience the biggest gaps in coverage are likely to do so year after year, with potentially serious financial consequences.

78 FR 8226 - Proposed Collection; Comment Request for Form 1099-OID

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... Form 1099-OID, Original Issue Discount. DATES: Written comments should be received on or before April 8... . SUPPLEMENTARY INFORMATION: Title: Original Issue Discount. OMB Number: 1545-0117. Form Number: 1099-OID. Abstract: Form 1099-OID is used for reporting original issue discount as required by section 6049 of the...

Delay Discounting of Self-Determined and Experimenter-Determined Commodities

ERIC Educational Resources Information Center

Weatherly, Jeffrey N.; Gudding, Jennifer; Derenne, Adam

2010-01-01

Research suggests that individuals prefer self-determined reinforcers over experimenter-determined ones. The present study had 518 college students complete a delay-discounting task in which the commodity was cigarettes, a grocery store gift card, casino tokens, cash, or the choice of the four. The least amount of delay discounting was observed…

75 FR 61747 - Discount Energy Group, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... proceeding of Discount Energy Group, LLC's application for market-based rate authority, with an accompanying... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. ER10-2803-000] Discount Energy Group, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for Blanket...

Tuition Discounting Is on the Rise: Results of a NACUBO Study of Independent Institutions.

ERIC Educational Resources Information Center

Hubbell, Loren Loomis

1995-01-01

A study by the National Association of College and University Business Officers (NACUBO) analyzed tuition discount ratios for small colleges with lower tuition, small colleges with higher tuition, and large colleges/universities. It examined average tuition discount percentages, average tuition rates and enrollments, percent of students aided, and…

Internet Addiction and Delay Discounting in College Students

ERIC Educational Resources Information Center

Saville, Bryan K.; Gisbert, Amanda; Kopp, Jason; Telesco, Carolyn

2010-01-01

To examine the relation between Internet addiction and delay discounting, we gave 276 college students a survey designed to measure Internet addiction and a paper-based delay-discounting task. In our larger sample, we identified 14 students who met the criteria for Internet addiction; we also identified 14 matched controls who were similar to the…

The Impact of Delays on Parents' Perceptions of Treatments for Problem Behavior

ERIC Educational Resources Information Center

Call, Nathan A.; Reavis, Andrea R.; McCracken, Courtney E.; Gillespie, Scott E.; Scheithauer, Mindy C.

2015-01-01

Parent engagement in behavioral interventions is critical for treatments to succeed. Parental decision-making regarding treatments can be impacted by systematic biases, such as the tendency to discount the value of delayed benefits, or "delay discounting". This study examined the impact of delay discounting on parents' perceptions of…

Future Rice Is Discounted Less Steeply than Future Money in Thailand

ERIC Educational Resources Information Center

Takahashi, Masaharu; Masataka, Nobuo; Malaivijitnond, Suchinda; Wongsiri, Siriwat

2008-01-01

There is evidence that people discount food more steeply than money, suggesting that primary or consumable reinforcers lose value quickly, whereas conditioned or nonconsumable reinforcers lose value slowly. In the present study, discounting rates of baht (unstable currency) and rice (preservable food) were compared during a period of unstable…

Determining a Relationship between Higher Education Financial Position and Tuition Discount Rates

ERIC Educational Resources Information Center

Browning, Julianna

2013-01-01

Institutions have increased the practice of tuition discounting, that is, the strategic use of price discrimination. During the past 30 years, both the average percent discount given to students and the proportion of students receiving tuition breaks have increased. As this practice has increased, there are financial determinants and implications…

Delay Discounting of Qualitatively Different Reinforcers in Rats

ERIC Educational Resources Information Center

Calvert, Amanda L.; Green, Leonard; Myerson, Joel

2010-01-01

Humans discount larger delayed rewards less steeply than smaller rewards, whereas no such magnitude effect has been observed in rats (and pigeons). It remains possible that rats' discounting is sensitive to differences in the quality of the delayed reinforcer even though it is not sensitive to amount. To evaluate this possibility, Experiment 1…

Discounting Future Green: Money versus the Environment

ERIC Educational Resources Information Center

Hardisty, David J.; Weber, Elke U.

2009-01-01

In 3 studies, participants made choices between hypothetical financial, environmental, and health gains and losses that took effect either immediately or with a delay of 1 or 10 years. In all 3 domains, choices indicated that gains were discounted more than losses. There were no significant differences in the discounting of monetary and…

Discounting of Monetary Rewards that are Both Delayed and Probabilistic: Delay and Probability Combine Multiplicatively, not Additively

PubMed Central

Vanderveldt, Ariana; Green, Leonard; Myerson, Joel

2014-01-01

The value of an outcome is affected both by the delay until its receipt (delay discounting) and by the likelihood of its receipt (probability discounting). Despite being well-described by the same hyperboloid function, delay and probability discounting involve fundamentally different processes, as revealed, for example, by the differential effects of reward amount. Previous research has focused on the discounting of delayed and probabilistic rewards separately, with little research examining more complex situations in which rewards are both delayed and probabilistic. In two experiments, participants made choices between smaller rewards that were both immediate and certain and larger rewards that were both delayed and probabilistic. Analyses revealed significant interactions between delay and probability factors inconsistent with an additive model. In contrast, a hyperboloid discounting model in which delay and probability were combined multiplicatively provided an excellent fit to the data. These results suggest that the hyperboloid is a good descriptor of decision making in complicated monetary choice situations like those people encounter in everyday life. PMID:24933696

THE DISCOUNTED REPRODUCTIVE NUMBER FOR EPIDEMIOLOGY

PubMed Central

Reluga, Timothy C.; Medlock, Jan; Galvani, Alison

2013-01-01

The basic reproductive number, , and the effective reproductive number, , are commonly used in mathematical epidemiology as summary statistics for the size and controllability of epidemics. However, these commonly used reproductive numbers can be misleading when applied to predict pathogen evolution because they do not incorporate the impact of the timing of events in the life-history cycle of the pathogen. To study evolution problems where the host population size is changing, measures like the ultimate proliferation rate must be used. A third measure of reproductive success, which combines properties of both the basic reproductive number and the ultimate proliferation rate, is the discounted reproductive number . The discounted reproductive number is a measure of reproductive success that is an individual’s expected lifetime offspring production discounted by the background population growth rate. Here, we draw attention to the discounted reproductive number by providing an explicit definition and a systematic application framework. We describe how the discounted reproductive number overcomes the limitations of both the standard reproductive numbers and proliferation rates, and show that is closely connected to Fisher’s reproductive values for different life-history stages PMID:19364158

Temporal discounting and heart rate reactivity to stress.

PubMed

Diller, James W; Patros, Connor H G; Prentice, Paula R

2011-07-01

Temporal discounting is the reduction of the value of a reinforcer as a function of increasing delay to its presentation. Impulsive individuals discount delayed consequences more rapidly than self-controlled individuals, and impulsivity has been related to substance abuse, gambling, and other problem behaviors. A growing body of literature has identified biological correlates of impulsivity, though little research to date has examined relations between delay discounting and markers of poor health (e.g., cardiovascular reactivity to stress). We evaluated the relation between one aspect of impulsivity, measured using a computerized temporal discounting task, and heart rate reactivity, measured as a change in heart rate from rest during a serial subtraction task. A linear regression showed that individuals who were more reactive to stress responded more impulsively (i.e., discounted delayed reinforcers more rapidly). When results were stratified by gender, the effect was observed for females, but not for males. This finding supports previous research on gender differences in cardiovascular reactivity and suggests that this type of reactivity may be an important correlate of impulsive behavior. Copyright © 2011 Elsevier B.V. All rights reserved.

Agreeing to disagree on climate policy.

PubMed

Heal, Geoffrey M; Millner, Antony

2014-03-11

Disagreements about the value of the utility discount rate--the rate at which our concern for the welfare of future people declines with their distance from us in time--are at the heart of the debate about the appropriate intensity of climate policy. Seemingly small differences in the discount rate yield very different policy prescriptions, and no consensus "correct" value has been identified. We argue that the choice of discount rate is an ethical primitive: there are many different legitimate opinions as to its value, and none should receive a privileged place in economic analysis of climate policy. Rather, we advocate a social choice-based approach in which a diverse set of individual discount rates is aggregated into a "representative" rate. We show that performing this aggregation efficiently leads to a time-dependent discount rate that declines monotonically to the lowest rate in the population. We apply this discounting scheme to calculations of the social cost of carbon recently performed by the US government and show that it provides an attractive compromise between competing ethical positions, and thus provides a possible resolution to the ethical impasse in climate change economics.

Cross-cultural comparisons of delay discounting of gain and loss.

PubMed

Ishii, Keiko; Gang, Lili; Takahashi, Taiki

2016-11-01

People generally tend to discount future outcomes in favor of smaller but immediate gains (i.e., delay discounting). The present research examined cultural similarities and differences in delay discounting of gain and loss between Chinese and Japanese, based on a q-exponential model of intertemporal choice. Using a hypothetical situation, we asked 65 Japanese participants and 51 Chinese participants to choose between receiving (or paying) a different amount of money immediately or with a specified delay (1 week, 2 weeks, 1 month, 6 months, 1 year, 5 years, and 25 years). For each delay, participants completed a series of 40 binary choices for gain or loss. Regardless of cultures, the q-exponential model was the optimal model. Both impulsivity and time-inconsistency were higher for future gains than for future losses. In addition to the cultural similarities, Chinese participants discounted future gains and losses more steeply than did Japanese. In contrast, Japanese participants were more time-inconsistent in delay discounting than were Chinese, suggesting that the reduction in their subjective value depended relatively on delay.

Food reinforcement and delay discounting in zBMI-discordant siblings.

PubMed

Feda, Denise M; Roemmich, James N; Roberts, April; Epstein, Leonard H

2015-02-01

The interaction of food reinforcement and the inability to delay gratification are related to adult energy intake and obesity. This study was designed to test the association of sibling pair differences in relative reinforcing efficacy of food and delay discounting on sibling pair differences in zBMI scores of same-gender zBMI-discordant siblings. We tested main and interactive relationships between delay discounting and relative reinforcing efficacy of food on zBMI discordance in 14 zBMI-discordant biological sibling pairs (6 female pairs) using a discordant sibling study design. Sibling pair differences in relative reinforcing efficacy of food were associated with sibling pair differences in zBMI (p= 0.046); this effect was moderated by delay discounting (p <0.002). Sibling pairs with greater differences in relative reinforcing efficacy and delay discounting had greater differences in zBMI. The combination of greater sibling pair differences in delay discounting and relative reinforcing efficacy is associated with greater discordance in zBMI in adolescent sibling pairs. Copyright © 2014 Elsevier Ltd. All rights reserved.

What Makes You Generous? The Influence of Rural and Urban Rearing on Social Discounting in China

PubMed Central

2015-01-01

An individual’s willingness to share resources declines as the social distance between the decision maker and the recipient increases, which is known as social discounting. This social-distance-dependent prosocial behavior is likely to be influenced by the region in which individuals were raised. Based on previous studies on social discounting, this research focuses on the differing social distance-dependent prosocial behaviors between rural- and urban-reared participants in China. Our data showed that both groups’ behaviors conform to the social discounting function and fit the hyperbolic model, as reported in previous studies about social discounting. Interestingly, individuals who were raised in rural areas yielded a smaller discount rate than those who were raised in urban areas, which indicated that a rural upbringing produced people who were more generous than those with an urban upbringing. Furthermore, this distinct type of generosity occurred notably among individuals with greater social distance, such as strangers or distant acquaintances. The reason may be due to the difference in dominant culture, production mode and lifestyle between rural and urban people. PMID:26172452

An alternative approach to calculating Area-Under-the-Curve (AUC) in delay discounting research.

PubMed

Borges, Allison M; Kuang, Jinyi; Milhorn, Hannah; Yi, Richard

2016-09-01

Applied to delay discounting data, Area-Under-the-Curve (AUC) provides an atheoretical index of the rate of delay discounting. The conventional method of calculating AUC, by summing the areas of the trapezoids formed by successive delay-indifference point pairings, does not account for the fact that most delay discounting tasks scale delay pseudoexponentially, that is, time intervals between delays typically get larger as delays get longer. This results in a disproportionate contribution of indifference points at long delays to the total AUC, with minimal contribution from indifference points at short delays. We propose two modifications that correct for this imbalance via a base-10 logarithmic transformation and an ordinal scaling transformation of delays. These newly proposed indices of discounting, AUClog d and AUCor d, address the limitation of AUC while preserving a primary strength (remaining atheoretical). Re-examination of previously published data provides empirical support for both AUClog d and AUCor d . Thus, we believe theoretical and empirical arguments favor these methods as the preferred atheoretical indices of delay discounting. © 2016 Society for the Experimental Analysis of Behavior.

Social Discounting under Risk.

PubMed

Jin, Jia; Pei, Guanxiong; Ma, Qingguo

2017-01-01

As a measure of how prosocial behavior depends on social distance, social discounting is defined as the decrease in generosity between the decision maker and the recipient as the social distance increases. While risk is a ubiquitous part of modern life, there is limited research on the relationship between risk and prosocial behavior. In the present experiment, we empirically test whether risk has an influence on social discounting. We use the choice titration procedure to examine this effect. Our data show that independent of risk, participants are less eager to forego money and exhibit more selfishness toward a specific person when the social distance increases; these findings are reflected in the hyperbolic model. Interestingly, risk influences the shape of the social discounting function, which is reflected in the notable different discount rates. Individuals who make decisions under risk yield a smaller discount rate than those who make decisions without risk, i.e., under risk subjects reduce less their generosity as a function of the social distance. Furthermore, this distinct type of generosity occurs typically among individuals with 10-distance recipients but not with the closest- and furthest-social-distance recipients.

Food reinforcement and delay discounting in zBMI-discordant siblings ☆

PubMed Central

Feda, Denise M.; Roemmich, James N.; Roberts, April; Epstein, Leonard H.

2014-01-01

Objective The interaction of food reinforcement and the inability to delay gratification are related to adult energy intake and obesity. This study was designed to test the association of sibling pair differences in relative reinforcing efficacy of food and delay discounting on sibling pair differences in zBMI scores of same-gender zBMI-discordant siblings. Design and methods We tested main and interactive relationships between delay discounting and relative reinforcing efficacy of food on zBMI discordance in 14 zBMI-discordant biological sibling pairs (6 female pairs) using a discordant sibling study design. Results Sibling pair differences in relative reinforcing efficacy of food were associated with sibling pair differences in zBMI (p = 0.046); this effect was moderated by delay discounting (p < 0.002). Sibling pairs with greater differences in relative reinforcing efficacy and delay discounting had greater differences in zBMI. Conclusions The combination of greater sibling pair differences in delay discounting and relative reinforcing efficacy is associated with greater discordance in zBMI in adolescent sibling pairs. PMID:25464024

Bleak Present, Bright Future: Online Episodic Future Thinking, Scarcity, Delay Discounting, and Food Demand.

PubMed

Sze, Yan Yan; Stein, Jeffrey S; Bickel, Warren K; Paluch, Rocco A; Epstein, Leonard H

2017-07-01

Obesity is associated with steep discounting of the future and increased food reinforcement. Episodic future thinking (EFT), a type of prospective thinking, has been observed to reduce delay discounting (DD) and improve dietary decision making. In contrast, negative income shock (i.e., abrupt transitions to poverty) has been shown to increase discounting and may worsen dietary decision-making. Scalability of EFT training and protective effects of EFT against simulated negative income shock on DD and demand for food were assessed. In two experiments we showed online-administered EFT reliably reduced DD. Furthermore, EFT reduced DD and demand for fast foods even when challenged by negative income shock. Our findings suggest EFT is a scalable intervention that has implications for improving public health by reducing discounting of the future and demand for high energy dense food.

State of inequality in malaria intervention coverage in sub-Saharan African countries.

PubMed

Galactionova, Katya; Smith, Thomas A; de Savigny, Don; Penny, Melissa A

2017-10-18

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries. Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015. There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions. Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.

Filling in the GAPS: evaluating completeness and coverage of open-access biodiversity databases in the United States

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

Troia, Matthew J.; McManamay, Ryan A.

Primary biodiversity data constitute observations of particular species at given points in time and space. Open-access electronic databases provide unprecedented access to these data, but their usefulness in characterizing species distributions and patterns in biodiversity depend on how complete species inventories are at a given survey location and how uniformly distributed survey locations are along dimensions of time, space, and environment. Our aim was to compare completeness and coverage among three open-access databases representing ten taxonomic groups (amphibians, birds, freshwater bivalves, crayfish, freshwater fish, fungi, insects, mammals, plants, and reptiles) in the contiguous United States. We compiled occurrence records frommore » the Global Biodiversity Information Facility (GBIF), the North American Breeding Bird Survey (BBS), and federally administered fish surveys (FFS). In this study, we aggregated occurrence records by 0.1° × 0.1° grid cells and computed three completeness metrics to classify each grid cell as well-surveyed or not. Next, we compared frequency distributions of surveyed grid cells to background environmental conditions in a GIS and performed Kolmogorov–Smirnov tests to quantify coverage through time, along two spatial gradients, and along eight environmental gradients. The three databases contributed >13.6 million reliable occurrence records distributed among >190,000 grid cells. The percent of well-surveyed grid cells was substantially lower for GBIF (5.2%) than for systematic surveys (BBS and FFS; 82.5%). Still, the large number of GBIF occurrence records produced at least 250 well-surveyed grid cells for six of nine taxonomic groups. Coverages of systematic surveys were less biased across spatial and environmental dimensions but were more biased in temporal coverage compared to GBIF data. GBIF coverages also varied among taxonomic groups, consistent with commonly recognized geographic, environmental, and institutional sampling biases. Lastly, this comprehensive assessment of biodiversity data across the contiguous United States provides a prioritization scheme to fill in the gaps by contributing existing occurrence records to the public domain and planning future surveys.« less

Filling in the GAPS: evaluating completeness and coverage of open-access biodiversity databases in the United States

DOE PAGES

Troia, Matthew J.; McManamay, Ryan A.

2016-06-12

Primary biodiversity data constitute observations of particular species at given points in time and space. Open-access electronic databases provide unprecedented access to these data, but their usefulness in characterizing species distributions and patterns in biodiversity depend on how complete species inventories are at a given survey location and how uniformly distributed survey locations are along dimensions of time, space, and environment. Our aim was to compare completeness and coverage among three open-access databases representing ten taxonomic groups (amphibians, birds, freshwater bivalves, crayfish, freshwater fish, fungi, insects, mammals, plants, and reptiles) in the contiguous United States. We compiled occurrence records frommore » the Global Biodiversity Information Facility (GBIF), the North American Breeding Bird Survey (BBS), and federally administered fish surveys (FFS). In this study, we aggregated occurrence records by 0.1° × 0.1° grid cells and computed three completeness metrics to classify each grid cell as well-surveyed or not. Next, we compared frequency distributions of surveyed grid cells to background environmental conditions in a GIS and performed Kolmogorov–Smirnov tests to quantify coverage through time, along two spatial gradients, and along eight environmental gradients. The three databases contributed >13.6 million reliable occurrence records distributed among >190,000 grid cells. The percent of well-surveyed grid cells was substantially lower for GBIF (5.2%) than for systematic surveys (BBS and FFS; 82.5%). Still, the large number of GBIF occurrence records produced at least 250 well-surveyed grid cells for six of nine taxonomic groups. Coverages of systematic surveys were less biased across spatial and environmental dimensions but were more biased in temporal coverage compared to GBIF data. GBIF coverages also varied among taxonomic groups, consistent with commonly recognized geographic, environmental, and institutional sampling biases. Lastly, this comprehensive assessment of biodiversity data across the contiguous United States provides a prioritization scheme to fill in the gaps by contributing existing occurrence records to the public domain and planning future surveys.« less

Can you refuse these discounts? An evaluation of the use and price discount impact of price-related promotions among US adult smokers by cigarette manufacturers

PubMed Central

Caraballo, Ralph S; Wang, Xu; Xu, Xin

2014-01-01

Objectives The raising unit price of cigarette has been shown to be one of the most effective ways of reducing cigarette consumption and increasing rates of successful quitting. However, researchers have shown that price-sensitive smokers have used a variety of strategies to mitigate the effect of the rising price of cigarettes on their smoking habits. In particular, 23–34% of adult smokers in the US use cheaper brands, and 18–55% use coupons or promotions. Little is known about the discount use by type of brands. As such, the main purpose of this analysis is to evaluate the uses and price discount effects of these price-related discounts by manufacturers and major brands. Setting An analysis based on the cross-sectional 2009–2010 National Adult Tobacco Survey (NATS). Participants 11 766 current smokers aged 18 or above in the USA. Primary outcome measures Price-related discount was defined as smokers who used coupons, rebates, buy-one-get-one-free, two-for-one or any other special promotions for their last cigarettes purchase. Results The use of price-related discounts and associated price impact vary widely by cigarette manufacturer and brand. Approximately one of three Camel, one of four Marlboro and one of eight Newport smokers used price-related discounts on their latest cigarette purchases. The average price reductions of discounts offered by Philip Morris (PM) or R.J. Reynolds (RJR) were around 29 cents per pack while that of Lorillard (Newport only) was 24 cents per pack. Cigarette brands that provided significant per pack price reductions include: PM Marlboro (28 cents), RJR brand Camel (41 cents), Doral (50 cents), Kool (73 cents) and Salem (80 cents), and Lorillard Newport (24 cents). Conclusions Policies that decrease price-minimisation strategies will benefit public health. PMID:24898086

Can you refuse these discounts? An evaluation of the use and price discount impact of price-related promotions among US adult smokers by cigarette manufacturers.

PubMed

Caraballo, Ralph S; Wang, Xu; Xu, Xin

2014-06-04

The raising unit price of cigarette has been shown to be one of the most effective ways of reducing cigarette consumption and increasing rates of successful quitting. However, researchers have shown that price-sensitive smokers have used a variety of strategies to mitigate the effect of the rising price of cigarettes on their smoking habits. In particular, 23-34% of adult smokers in the US use cheaper brands, and 18-55% use coupons or promotions. Little is known about the discount use by type of brands. As such, the main purpose of this analysis is to evaluate the uses and price discount effects of these price-related discounts by manufacturers and major brands. An analysis based on the cross-sectional 2009-2010 National Adult Tobacco Survey (NATS). 11 766 current smokers aged 18 or above in the USA. Price-related discount was defined as smokers who used coupons, rebates, buy-one-get-one-free, two-for-one or any other special promotions for their last cigarettes purchase. The use of price-related discounts and associated price impact vary widely by cigarette manufacturer and brand. Approximately one of three Camel, one of four Marlboro and one of eight Newport smokers used price-related discounts on their latest cigarette purchases. The average price reductions of discounts offered by Philip Morris (PM) or R.J. Reynolds (RJR) were around 29 cents per pack while that of Lorillard (Newport only) was 24 cents per pack. Cigarette brands that provided significant per pack price reductions include: PM Marlboro (28 cents), RJR brand Camel (41 cents), Doral (50 cents), Kool (73 cents) and Salem (80 cents), and Lorillard Newport (24 cents). Policies that decrease price-minimisation strategies will benefit public health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Insulin, Central Dopamine D2 Receptors, and Monetary Reward Discounting in Obesity

PubMed Central

Eisenstein, Sarah A.; Gredysa, Danuta M.; Antenor–Dorsey, Jo Ann; Green, Leonard; Arbeláez, Ana Maria; Koller, Jonathan M.; Black, Kevin J.; Perlmutter, Joel S.; Moerlein, Stephen M.; Hershey, Tamara

2015-01-01

Animal research finds that insulin regulates dopamine signaling and reward behavior, but similar research in humans is lacking. We investigated whether individual differences in body mass index, percent body fat, pancreatic β-cell function, and dopamine D2 receptor binding were related to reward discounting in obese and non-obese adult men and women. Obese (n = 27; body mass index>30) and non-obese (n = 20; body mass index<30) adults were assessed for percent body fat with dual-energy X-ray absorptiometry and for β-cell function using disposition index. Choice of larger, but delayed or less certain, monetary rewards relative to immediate, certain smaller monetary rewards was measured using delayed and probabilistic reward discounting tasks. Positron emission tomography using a non-displaceable D2-specific radioligand, [11C](N-methyl)benperidol quantified striatal D2 receptor binding. Groups differed in body mass index, percent body fat, and disposition index, but not in striatal D2 receptor specific binding or reward discounting. Higher percent body fat in non-obese women related to preference for a smaller, certain reward over a larger, less likely one (greater probabilistic discounting). Lower β-cell function in the total sample and lower insulin sensitivity in obese related to stronger preference for an immediate and smaller monetary reward over delayed receipt of a larger one (greater delay discounting). In obese adults, higher striatal D2 receptor binding related to greater delay discounting. Interestingly, striatal D2 receptor binding was not significantly related to body mass index, percent body fat, or β-cell function in either group. Our findings indicate that individual differences in percent body fat, β-cell function, and striatal D2 receptor binding may each contribute to altered reward discounting behavior in non-obese and obese individuals. These results raise interesting questions about whether and how striatal D2 receptor binding and metabolic factors, including β-cell function, interact to affect reward discounting in humans. PMID:26192187

Insulin, Central Dopamine D2 Receptors, and Monetary Reward Discounting in Obesity.

PubMed

Eisenstein, Sarah A; Gredysa, Danuta M; Antenor-Dorsey, Jo Ann; Green, Leonard; Arbeláez, Ana Maria; Koller, Jonathan M; Black, Kevin J; Perlmutter, Joel S; Moerlein, Stephen M; Hershey, Tamara

2015-01-01

Animal research finds that insulin regulates dopamine signaling and reward behavior, but similar research in humans is lacking. We investigated whether individual differences in body mass index, percent body fat, pancreatic β-cell function, and dopamine D2 receptor binding were related to reward discounting in obese and non-obese adult men and women. Obese (n = 27; body mass index>30) and non-obese (n = 20; body mass index<30) adults were assessed for percent body fat with dual-energy X-ray absorptiometry and for β-cell function using disposition index. Choice of larger, but delayed or less certain, monetary rewards relative to immediate, certain smaller monetary rewards was measured using delayed and probabilistic reward discounting tasks. Positron emission tomography using a non-displaceable D2-specific radioligand, [11C](N-methyl)benperidol quantified striatal D2 receptor binding. Groups differed in body mass index, percent body fat, and disposition index, but not in striatal D2 receptor specific binding or reward discounting. Higher percent body fat in non-obese women related to preference for a smaller, certain reward over a larger, less likely one (greater probabilistic discounting). Lower β-cell function in the total sample and lower insulin sensitivity in obese related to stronger preference for an immediate and smaller monetary reward over delayed receipt of a larger one (greater delay discounting). In obese adults, higher striatal D2 receptor binding related to greater delay discounting. Interestingly, striatal D2 receptor binding was not significantly related to body mass index, percent body fat, or β-cell function in either group. Our findings indicate that individual differences in percent body fat, β-cell function, and striatal D2 receptor binding may each contribute to altered reward discounting behavior in non-obese and obese individuals. These results raise interesting questions about whether and how striatal D2 receptor binding and metabolic factors, including β-cell function, interact to affect reward discounting in humans.

A tutorial on the use of Excel 2010 and Excel for Mac 2011 for conducting delay-discounting analyses.

PubMed

Reed, Derek D; Kaplan, Brent A; Brewer, Adam T

2012-01-01

In recent years, researchers and practitioners in the behavioral sciences have profited from a growing literature on delay discounting. The purpose of this article is to provide readers with a brief tutorial on how to use Microsoft Office Excel 2010 and Excel for Mac 2011 to analyze discounting data to yield parameters for both the hyperbolic discounting model and area under the curve. This tutorial is intended to encourage the quantitative analysis of behavior in both research and applied settings by readers with relatively little formal training in nonlinear regression.

A TUTORIAL ON THE USE OF EXCEL 2010 AND EXCEL FOR MAC 2011 FOR CONDUCTING DELAY-DISCOUNTING ANALYSES

PubMed Central

Reed, Derek D; Kaplan, Brent A; Brewer, Adam T

2012-01-01

In recent years, researchers and practitioners in the behavioral sciences have profited from a growing literature on delay discounting. The purpose of this article is to provide readers with a brief tutorial on how to use Microsoft Office Excel 2010 and Excel for Mac 2011 to analyze discounting data to yield parameters for both the hyperbolic discounting model and area under the curve. This tutorial is intended to encourage the quantitative analysis of behavior in both research and applied settings by readers with relatively little formal training in nonlinear regression. PMID:22844143

Discount rates in risk versus money and money versus money tradeoffs.

PubMed

Alberini, Anna; Chiabai, Aline

2007-04-01

We use data from a survey of residents of five Italian cities conducted in late spring 2004 to estimate the discount rates implicit in (1) money versus future risk reductions and (2) money versus money tradeoffs. We find that the mean personal discount rate is 0.3-1.7% in (1) and 8.7% in (2). The latter is lower than the discount rates estimated in comparable situations in many recent studies, greater than market interest rates in Italy at the time, and exhibits modest variation with age and gender. The discount rate implicit in money versus risk tradeoffs is within the range of estimates from studies in the United States and Europe, and does not depend on observable individual characteristics. We use split samples to investigate whether a completely abstract risk reduction - one where the risk reduction delivery has been stripped of all specifics, so that respondents should focus on the risks without being distracted by details - results in WTP and discount figures comparable to those from an identified delivery mechanism (a medical test). We find that while WTP for an immediate risk reduction is 42-73% higher with the abstract risk reduction, the discount rate in the money versus risk tradeoffs and the variance of the error term in the WTP equation are the same across the two variants of the questionnaire.

Apathy but not diminished expression in schizophrenia is associated with discounting of monetary rewards by physical effort.

PubMed

Hartmann, Matthias N; Hager, Oliver M; Reimann, Anna V; Chumbley, Justin R; Kirschner, Matthias; Seifritz, Erich; Tobler, Philippe N; Kaiser, Stefan

2015-03-01

Negative symptoms in schizophrenia have been grouped into the 2 factors of apathy and diminished expression, which might be caused by separable pathophysiological mechanisms. Recently, it has been proposed that apathy could be due to dysfunctional integration of reward and effort during decision making. We asked whether apathy in particular is associated with stronger devaluation ("discounting") of monetary rewards that require physical effort. Thirty-one patients with schizophrenia and 20 healthy control participants performed a computerized effort discounting task in which they could choose to exert physical effort on a handgrip to obtain monetary rewards. This procedure yields an individual measure for the strength of effort discounting. The degree of effort discounting was strongly correlated with apathy, but not with diminished expression. Importantly, the association between apathy and effort discounting was not driven by cognitive ability, antipsychotic medication, or other clinical and demographic variables. This study provides the first evidence for a highly specific association of apathy with effort-based decision making in patients with schizophrenia. Within a translational framework, the present effort discounting task could provide a bridge between apathy as a psychopathological phenomenon and established behavioral tasks to address similar states in animals. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Physical and cognitive effort discounting across different reward magnitudes: Tests of discounting models

PubMed Central

Ostaszewski, Paweł

2017-01-01

The effort required to obtain a rewarding outcome is an important factor in decision-making. Describing the reward devaluation by increasing effort intensity is substantial to understanding human preferences, because every action and choice that we make is in itself effortful. To investigate how reward valuation is affected by physical and cognitive effort, we compared mathematical discounting functions derived from research on discounting. Seven discounting models were tested across three different reward magnitudes. To test the models, data were collected from a total of 114 participants recruited from the general population. For one-parameter models (hyperbolic, exponential, and parabolic), the data were explained best by the exponential model as given by a percentage of explained variance. However, after introducing an additional parameter, data obtained in the cognitive and physical effort conditions were best described by the power function model. Further analysis, using the second order Akaike and Bayesian Information Criteria, which account for model complexity, allowed us to identify the best model among all tested. We found that the power function best described the data, which corresponds to conventional analyses based on the R2 measure. This supports the conclusion that the function best describing reward devaluation by physical and cognitive effort is a concave one and is different from those that describe delay or probability discounting. In addition, consistent magnitude effects were observed that correspond to those in delay discounting research. PMID:28759631

Delay Discounting in Lewis and Fischer 344 Rats: Steady-state and Rapid-determination Adjusting-amount Procedures

PubMed Central

Stein, Jeffrey S; Pinkston, Jonathan W; Brewer, Adam T; Francisco, Monica T; Madden, Gregory J

2012-01-01

Lewis rats have been shown to make more impulsive choices than Fischer 344 rats in discrete-trial choice procedures that arrange fixed (i.e., nontitrating) reinforcement parameters. However, nontitrating procedures yield only gross estimates of preference, as choice measures in animal subjects are rarely graded at the level of the individual subject. The present study was designed to examine potential strain differences in delay discounting using an adjusting-amount procedure, in which distributed (rather than exclusive) choice is observed due to dynamic titration of reinforcer magnitude across trials. Using a steady-state version of the adjusting-amount procedure in which delay was manipulated between experimental conditions, steeper delay discounting was observed in Lewis rats compared to Fischer 344 rats; further, delay discounting in both strains was well described by the traditional hyperbolic discounting model. However, upon partial completion of the present study, a study published elsewhere (Wilhelm & Mitchell, 2009) demonstrated no difference in delay discounting between these strains with the use of a more rapid version of the adjusting-amount procedure (i.e., in which delay is manipulated daily). Thus, following completion of the steady-state assessment in the present study, all surviving Lewis and Fischer 344 rats completed an approximation of this rapid-determination procedure in which no strain difference in delay discounting was observed. PMID:22693360

Delay discounting in Lewis and Fischer 344 rats: steady-state and rapid-determination adjusting-amount procedures.

PubMed

Stein, Jeffrey S; Pinkston, Jonathan W; Brewer, Adam T; Francisco, Monica T; Madden, Gregory J

2012-05-01

Lewis rats have been shown to make more impulsive choices than Fischer 344 rats in discrete-trial choice procedures that arrange fixed (i.e., nontitrating) reinforcement parameters. However, nontitrating procedures yield only gross estimates of preference, as choice measures in animal subjects are rarely graded at the level of the individual subject. The present study was designed to examine potential strain differences in delay discounting using an adjusting-amount procedure, in which distributed (rather than exclusive) choice is observed due to dynamic titration of reinforcer magnitude across trials. Using a steady-state version of the adjusting-amount procedure in which delay was manipulated between experimental conditions, steeper delay discounting was observed in Lewis rats compared to Fischer 344 rats; further, delay discounting in both strains was well described by the traditional hyperbolic discounting model. However, upon partial completion of the present study, a study published elsewhere (Wilhelm & Mitchell, 2009) demonstrated no difference in delay discounting between these strains with the use of a more rapid version of the adjusting-amount procedure (i.e., in which delay is manipulated daily). Thus, following completion of the steady-state assessment in the present study, all surviving Lewis and Fischer 344 rats completed an approximation of this rapid-determination procedure in which no strain difference in delay discounting was observed.

Predictive Validity of Delay Discounting Behavior in Adolescence: A Longitudinal Twin Study

PubMed Central

Isen, Joshua D.; Sparks, Jordan C.; Iacono, William G.

2014-01-01

A standard assumption in the delay discounting literature is that individuals who exhibit steeper discounting of hypothetical rewards also experience greater difficulty deferring gratification to real-world rewards. There is ample cross-sectional evidence that delay discounting paradigms reflect a variety of maladaptive psychosocial outcomes, including substance use pathology. We sought to determine whether a computerized assessment of hypothetical delay discounting (HDD) taps into behavioral impulsivity in a community sample of adolescent twins (N = 675). Using a longitudinal design, we hypothesized that greater HDD at age 14–15 predicts real-world impulsive choices and risk for substance use disorders in late adolescence. We also examined the genetic and environmental structure of HDD performance. Individual differences in HDD behavior showed moderate heritability, and were prospectively associated with real-world temporal discounting at age 17–18. Contrary to expectations, HDD was not consistently related to substance use or trait impulsivity. Although a significant association between HDD behavior and past substance use emerged in males, this effect was mediated by cognitive ability. In both sexes, HDD failed to predict a comprehensive index of substance use problems and behavioral disinhibition in late adolescence. In sum, we present some of the first evidence that HDD performance is heritable and predictive of real-world temporal discounting of rewards. Nevertheless, HDD might not serve as a valid marker of substance use disorder risk in younger adolescents, particularly females. PMID:24999868

Delay and Probability Discounting in Humans: An Overview

ERIC Educational Resources Information Center

McKerchar, Todd L.; Renda, C. Renee

2012-01-01

The purpose of this review is to introduce the reader to the concepts of delay and probability discounting as well as the major empirical findings to emerge from research with humans on these concepts. First, we review a seminal discounting study by Rachlin, Raineri, and Cross (1991) as well as an influential extension of this study by Madden,…

Changing Delay Discounting in the Light of the Competing Neurobehavioral Decision Systems Theory: A Review

ERIC Educational Resources Information Center

Koffarnus, Mikhail N.; Jarmolowicz, David P.; Mueller, E. Terry; Bickel, Warren K.

2013-01-01

Excessively devaluing delayed reinforcers co-occurs with a wide variety of clinical conditions such as drug dependence, obesity, and excessive gambling. If excessive delay discounting is a trans-disease process that underlies the choice behavior leading to these and other negative health conditions, efforts to change an individual's discount rate…

Valuing the Future: Should Educational Benefits Be Discounted?

ERIC Educational Resources Information Center

Gilead, Tal

2015-01-01

The practice of assigning a lesser value to benefits the further they are into the future, or, in economic terms, discounting, has long played a significant role in shaping public policy. Recently, due to the growing influence of economic modes of thinking on the educational realm, the concept of discounting is also starting to have an influence…

Beyond the Shadow of a Trait: Understanding Discounting through Item-Level Analysis of Personality Scales

ERIC Educational Resources Information Center

Charlton, Shawn R.; Gossett, Bradley D.; Charlton, Veda A.

2011-01-01

Temporal discounting, the loss in perceived value associated with delayed outcomes, correlates with a number of personality measures, suggesting that an item-level analysis of trait measures might provide a more detailed understanding of discounting. The current report details two studies that investigate the utility of such an item-level…

Unintended Consequences of Tuition Discounting. New Agenda Series[TM].

ERIC Educational Resources Information Center

Davis, Jerry Sheehan

Tuition discounting, the use of institutionally funded grants to help defray students' college costs, came into vogue in the late 1970s and has since become standard practice at U.S. four-year colleges and universities. Institutions use the discounts for a variety of purposes, but generally their use is to manage or tailor enrollment in some…