Sample records for development nhi work
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NASA Astrophysics Data System (ADS)
de Lange, Wim; Prinsen, Geert.; Hoogewoud, Jacco; Veldhuizen, Ab; Ruijgh, Erik; Kroon, Timo
2013-04-01
Nationwide modeling aims to produce a balanced distribution of climate change effects (e.g. harm on crops) and possible compensation (e.g. volume fresh water) based on consistent calculation. The present work is based on the Netherlands Hydrological Instrument (NHI, www.nhi.nu), which is a national, integrated, hydrological model that simulates distribution, flow and storage of all water in the surface water and groundwater systems. The instrument is developed to assess the impact on water use on land-surface (sprinkling crops, drinking water) and in surface water (navigation, cooling). The regional expertise involved in the development of NHI come from all parties involved in the use, production and management of water, such as waterboards, drinking water supply companies, provinces, ngo's, and so on. Adequate prediction implies that the model computes changes in the order of magnitude that is relevant to the effects. In scenarios related to drought, adequate prediction applies to the water demand and the hydrological effects during average, dry, very dry and extremely dry periods. The NHI acts as a part of the so-called Deltamodel (www.deltamodel.nl), which aims to predict effects and compensating measures of climate change both on safety against flooding and on water shortage during drought. To assess the effects, a limited number of well-defined scenarios is used within the Deltamodel. The effects on demand of fresh water consist of an increase of the demand e.g. for surface water level control to prevent dike burst, for flushing salt in ditches, for sprinkling of crops, for preserving wet nature and so on. Many of the effects are dealt with? by regional and local parties. Therefore, these parties have large interest in the outcome of the scenario analyses. They are participating in the assessment of the NHI previous to the start of the analyses. Regional expertise is welcomed in the calibration phase of NHI. It aims to reduce uncertainties by improving the rules for manmade re-direction of surface water, schematizations & parameters included in the model. This is carried out in workshops and in one-to-one expert meetings on regional models & the NHI. All results of NHI are presented on the internet and any expert may suggest improvements to the model. The final goal of the involvement of regional parties is the acceptation by decision impact receiving authorities
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Abuya, Timothy; Maina, Thomas; Chuma, Jane
2015-02-12
Many Low-and-Middle-Income countries are considering reviewing their health financing systems to meet the principles of Universal Health Coverage (UHC). One financing mechanism, which has dominated UHC reforms, is the development of health insurance schemes. We trace the historical development of the National Health Insurance (NHI) policy, illuminate stakeholders' perceptions on the design to inform future development of health financing policies in Kenya. We conducted a retrospective policy analysis of the development of a NHI policy in Kenya using data from document reviews and seven in depth interviews with key stakeholders involved in the NHI design. Analysis was conducted using a thematic framework. The design of a NHI scheme was marked by complex interaction of the actor's understanding of the design, proposed implementation strategies and the covert opposition of the reform due to several reasons. First, actor's perception of the cost of the NHI design and its implication to the economy generated opposition. This was due to inadequate communication strategies to articulate the policy, leading to a vacuum of factual information flow to various players. Secondly, perceived fear of implications of the changes among private sector players threatened support and success gained. Thirdly, underlying mistrust associated with perceived lack of government's commitment towards transparency and good governance affected active engagement of all key players dampening the spirit of collective bargain breeding opposition. Finally, some international actors perceived a clash of their role and that of international programs based on vertical approaches that were inherent in the health system. The thrust towards UHC using NHI schemes should not only focus on the design of a viable NHI package but should also involve stakeholder engagements, devise ways of improving the health care system, enhance transparency and develop adequate governance structures to institutions mandated to provide leadership in the reform process to overcome covert opposition.
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NASA Astrophysics Data System (ADS)
de Lange, W. J.
2014-05-01
Wim J. de Lange, Geert F. Prinsen, Jacco H. Hoogewoud, Ab A Veldhuizen, Joachim Hunink, Erik F.W. Ruijgh, Timo Kroon Nationwide modeling aims to produce a balanced distribution of climate change effects (e.g. harm on crops) and possible compensation (e.g. volume fresh water) based on consistent calculation. The present work is based on the Netherlands Hydrological Instrument (NHI, www.nhi.nu), which is a national, integrated, hydrological model that simulates distribution, flow and storage of all water in the surface water and groundwater systems. The instrument is developed to assess the impact on water use on land-surface (sprinkling crops, drinking water) and in surface water (navigation, cooling). The regional expertise involved in the development of NHI come from all parties involved in the use, production and management of water, such as waterboards, drinking water supply companies, provinces, ngo's, and so on. Adequate prediction implies that the model computes changes in the order of magnitude that is relevant to the effects. In scenarios related to drought, adequate prediction applies to the water demand and the hydrological effects during average, dry, very dry and extremely dry periods. The NHI acts as a part of the so-called Deltamodel (www.deltamodel.nl), which aims to predict effects and compensating measures of climate change both on safety against flooding and on water shortage during drought. To assess the effects, a limited number of well-defined scenarios is used within the Deltamodel. The effects on demand of fresh water consist of an increase of the demand e.g. for surface water level control to prevent dike burst, for flushing salt in ditches, for sprinkling of crops, for preserving wet nature and so on. Many of the effects are dealt with by regional and local parties. Therefore, these parties have large interest in the outcome of the scenario analyses. They are participating in the assessment of the NHI previous to the start of the analyses. Regional expertise is welcomed in the calibration phase of NHI. It aims to reduce uncertainties by improving the rules for manmade re-direction of surface water, schematizations & parameters included in the model. This is carried out in workshops and in one-to-one expert meetings on regional models & the NHI. All results of NHI are presented on the internet and any expert may suggest improvements to the model. The final goal of the involvement of regional parties is the acceptation by decision impact receiving authorities. The presentation will give an overview of the experiences and results of the participation process both technically and in the national policy making context.
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Chiu, Yu-Chan; Smith, Katherine Clegg; Morlock, Laura; Wissow, Lawrence
2007-02-01
The Taiwanese practice of patients giving informal payments to physicians to secure services is deeply rooted in social and cultural factors. This study examines the portrayal of informal payments by Taiwanese print news media over a period of 12 years-from prior to until after the implementation of national health insurance (NHI) in Taiwan in 1995. The goal of the study was to examine how the advent of NHI changed the rationale for and use of informal payments. Both before and after the introduction of NHI, Taiwanese newspapers portrayed informal payments as appropriate means to secure access to better health care. Newspaper accounts established that, although NHI reduced patients' financial barriers to care, it did not change deeply held cultural beliefs that good care depended on the development of a reciprocal sense of obligation between patients and physicians. Physicians may have also encouraged the ongoing use of informal payments to make up revenue lost when NHI standardized fees and limited income from dispensing medications. In 2002, seven years after the implementation of NHI, the use of informal payments, though illegal, was still being justified in the print media through allusions to its role in traditional Taiwanese culture.
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Feasible economic strategies to improve screening compliance for colorectal cancer in Korea
Park, Sang Min; Yun, Young Ho; Kwon, Soonman
2005-01-01
AIM: While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea. METHODS: The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model. RESULTS: When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses. CONCLUSION: Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea. PMID:15786532
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Reform towards National Health Insurance in Malaysia: the equity implications.
Yu, Chai Ping; Whynes, David K; Sach, Tracey H
2011-05-01
This paper assesses the potential equity impact of Malaysia's projected reform of its current tax financed system towards National Health Insurance (NHI). The Kakwani's progressivity index was used to assess the equity consequences of the new NHI system (with flat rate NHI scheme) compared to the current tax financed system. It was also used to model a proposed system (with a progressive NHI scheme) that can generate the same amount of funding more equitably. The new NHI system would be less equitable than the current tax financed system, as evident from the reduction of Kakwani's index to 0.168 from 0.217. The new flat rate NHI scheme, if implemented, would reduce the progressivity of the health finance system because it is a less progressive finance source than that of general government revenue. We proposed a system with a progressive NHI scheme that generates the same amount of funding whilst preserving the equity at the Kakwani's progressivity index of 0.213. A NHI system with a progressive NHI scheme is proposed to be implemented to raise health funding whilst preserving the equity in health care financing. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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The effect of Taiwan's national health insurance on mortality of the elderly: revisited.
Chang, Simon
2012-11-01
A recent paper estimates the effects of Taiwan's National Health Insurance (NHI) on the elderly and concludes that NHI greatly increased the medical care utilization of the elderly but did not reduce their mortality. Using more recent and more accurate mortality data of the same group of elderly, this note re-estimates the NHI effect on mortality and finds that the mortality hazard of the previously uninsured elderly in the post-NHI period was on average 24% lower than it would have been in the absence of NHI. However, the NHI effect on the mortality hazard is only evident in the first 6 years following the enactment of NHI, suggesting that it may be difficult to undo the damage caused by the lack of insurance in early life. Copyright © 2011 John Wiley & Sons, Ltd.
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Lee, Yen-Han; Ang, Ting Fang Alvin; Chiang, Timothy C; Kaplan, Warren A
2018-01-01
It has been over 20 years since Taiwan's implementation of its National Health Insurance (NHI) program. Under this program, the health insurance coverage rate has reached approximately 99% of the population. Despite guaranteeing the residents of Taiwan equal access regardless of socioeconomic status and background, critical problems and controversies persist, and they continue to challenge the NHI. We analyze the primary issues facing the NHI program with emphasis on financial and consumer behavioral aspects. Furthermore, we apply models from mainland China, South Korea and Singapore to discuss what Taiwan could learn from the systems employed by these countries to modify the NHI. Targeting the needs of the NHI, we have three policy recommendations: separating the NHI scheme into different target populations, strengthening the NHI referral system and regulating the access of overseas citizens to health services while in Taiwan. After two decades in existence, problems persist and there is a continuing need to improve Taiwan's NHI. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
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The Taiwan National Health Insurance program and full infant immunization coverage.
Chen, Chin-Shyan; Liu, Tsai-Ching
2005-02-01
We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization.
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Kao, Wei-Heng; Hong, Ji-Hong; See, Lai-Chu; Yu, Huang-Ping; Hsu, Jun-Te; Chou, I-Jun; Chou, Wen-Chi; Chiou, Meng-Jiun; Wang, Chun-Chieh; Kuo, Chang-Fu
2017-08-16
We aimed to evaluate the validity of cancer diagnosis in the National Health Insurance (NHI) database, which has routinely collected the health information of almost the entire Taiwanese population since 1995, compared with the Taiwan National Cancer Registry (NCR). There were 26,542,445 active participants registered in the NHI database between 2001 and 2012. National Cancer Registry and NHI database records were compared for cancer diagnosis; date of cancer diagnosis; and 1, 2, and 5 year survival. In addition, the 10 leading causes of cancer deaths in Taiwan were analyzed. There were 908,986 cancer diagnoses in NCR and NHI database and 782,775 (86.1%) in both, with 53,192 (5.9%) in the NHI database only and 73,019 (8.0%) in the NCR only. The positive predictive value of the NHI database cancer diagnoses was 94% for all cancers; the positive predictive value of the 10 specific cancers ranged from 95% (lung cancer) to 82% (cervical cancer). The date of diagnosis in the NHI database was generally delayed by a median of 15 days (interquartile range 8-18) compared with the NCR. The 1, 2, and 5 year survival rates were 71.21%, 60.85%, and 47.44% using the NHI database and were 71.18%, 60.17%, and 46.09% using NCR data. Recording of cancer diagnoses and survival estimates based on these diagnosis codes in the NHI database are generally consistent with the NCR. Studies using NHI database data must pay careful attention to eligibility and record linkage; use of both sources is recommended. Copyright © 2017 John Wiley & Sons, Ltd.
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The Taiwan National Health Insurance Program and Full Infant Immunization Coverage
Chen, Chin-Shyan; Liu, Tsai-Ching
2005-01-01
Objectives. We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). Methods. We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. Results. Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. Conclusions. The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization. PMID:15671469
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Adams, Rosmond; Chou, Yiing-Jenq; Pu, Christy
2015-04-09
Numerous Caribbean countries are considering implementing National Health Insurance (NHI) and pooling resources to finance their health sectors. Based on this increased interest in health insurance, we investigated the willingness to participate and to pay for NHI in St. Vincent and the Grenadines, an upper-middle-income Caribbean country. Four hundred heads of household in St. Vincent and the Grenadines were interviewed in August 2012 and September 2012. The samples were selected through simple random sampling, including the stratification of rural, semiurban, and urban communities to ensure the representativeness of the sample. A contingent valuation method with a pretested interviewer-led questionnaire was used. Respondents were presented with a hypothetical NHI plan. Chi-squared analysis was performed to identify factors that are associated with the willingness to participate. Multiple logistic regression was used to explore the factors that influence respondents' willingness to pay. In total, 69.5% (n = 278) of the respondents indicated that they were willing to participate in the proposed NHI plan, of whom 72.3% were willing to pay for the first bid (EC$50). When the bid was reduced to EC$25, all of the remaining respondents who indicated they were willing to participate were willing to pay this lowered bid. Overall, the respondents were willing to pay EC$77.83 (US$28.83) per month for each person to enroll in the NHI plan. Age, income, and having some form of health insurance were significantly associated with a willingness to participate in the plan. A higher socioeconomic status was the principal determinant factor for the willingness to participate. This is similar to studies on developing economies. The government can use these findings to guide the successful implementation of the proposed NHI program. People with a lower socioeconomic status must be engaged from the start of and throughout the development process to enhance their understanding of and participation in the plan.
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User’s Manual for Strategic Satellite System Terminal Segment Life Cycle Cost Model. Volume 1
1981-03-01
the depot pipeline, given by: NFD(I) = EFAIL (I,NS)*TNB(NS) NS *1 [LRU(I) + RTS(NHI(1))]*NRTS(I)*DRCT(LO(NS)) + NRTS(NHI(i))*(l - COND(I))*DADI where... EFAIL (I,NS)*TNB(NS)* [(LRU(I) + RTS(NHI(I)))*NRTS(I) NS + NRTS(NHI(I))*(l-COND(I))] *DMH(I)*DMF where DMH(I) = averaRP marnours to perform depot...XJC - RSCA(I) + 12*PIUP* EFAIL (I,NS)*TNB(NS)* NS {(LRUCI)+RTS(NHI(I)))* (CR(I)*BIIH(I)*BMF*BLR + CN(I)*(DMH(I)*DMF*DLR + 2*CPPD(LOCNS))*WT(I)) + CC
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Kim, Kye-Hyun; Park, Eun-Cheol
2012-01-01
The Korean National Health Insurance (NHI) system was an unprecedented accomplishment that was achieved in a short period of time. In this study, we sought to identify gaps between physicians and the public with respect to attitudes toward the NHI system in Korea. The study population was derived from the 2008 Korean Medical Association Survey, which was conducted to investigate satisfaction with and perceptions of the NHI system among physicians (n = 961) and the public (n = 935). Only 6.5% of the physicians were satisfied with NHI system, and 71.5% were dissatisfied with it. In contrast, 28.3% of the public were satisfied with the NHI system, and 21.4% were dissatisfied. The level of dissatisfaction expressed by physicians (2.03 ± 0.91 on a five-point scale) was also higher than that expressed by the public (3.06 ± 0.84). Despite rapid growth of NHI system, a large gap in satisfaction exists between physicians and the public. PMID:22690087
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Lee, Sang-Soo; Salole, Eugene
2014-06-01
The development of health funding policy in Korea has followed the country's rapid economic development, with a comprehensive National Health Insurance (NHI) system in place by 1989. The funding of medical devices has followed this progression, with incorporation into the NHI reimbursement system in 2000 (several years later than pharmaceuticals), but important issues affecting patient access remain. Although the effect of devices on the NHI budget is relatively modest (only about 4%), because of concerns about NHI sustainability, attention has increasingly been paid to their management and funding. Unlike pharmaceuticals, however, it has been quite challenging to develop clear and fair criteria for reimbursement coverage and pricing of medical devices. The two key and longstanding issues around the reimbursement of medical devices in Korea are how to expedite market entry of improved or innovative medical devices at appropriate prices, and how to satisfactorily lower the reimbursement levels of older devices, thereby making headroom for new technologies to be reimbursed. Despite protracted discussions over the last decade, industry and government have been unable to reach full agreement. There has been some progress (e.g., introduction of the Value Appraisal and the Revaluation Systems), but there remains urgent need for productive discussion and consensus between government and industry regarding reasonable funding rules, transparency, and clarity in the reimbursement pricing process for medical devices. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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Kim, Min Kyoung; Lee, Seung Mi; Bae, Sung-Hee; Kim, Hyun Joo; Lim, Nam Gu; Yoon, Seok-Jun; Lee, Jin Yong; Jo, Min-Woo
2018-01-05
Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.
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Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.
Woolhandler, Steffie; Himmelstein, David U; Angell, Marcia; Young, Quentin D
2003-08-13
The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage.
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Lee, Sang-Yi; Chun, Chang-Bae; Lee, Yong-Gab; Seo, Nam Kyu
2008-01-01
A typology is the useful way of understanding the key frameworks of health care system. With many different criteria of health care system, several typologies have been introduced and applied to each country's health care system. Among those, National Health Service (NHS), Social Health Insurance (SHI), and Private Health Insurance (PHI) are three most well-known types of health care system in the 3-model typology. Differentiated from the existing 3-model typology of health care system, South Korea and Taiwan implemented new concept of National Health Insurance (NHI) system. Since none of previous typologies can be applied to these countries' NHI to explain its unique features in a proper manner, a new typology needs to be introduced. Therefore, this paper introduces a new typology with two crucial variables that are 'state administration for health care financing' and 'main body for health care provision'. With these two variables, the world's national health care systems can be divided into four types of model: NHS, SHI, NHI, and PHI (Liberal model). This research outlines the rationale of developing new typology and introduces main features and frameworks of the NHI that South Korea and Taiwan implemented in the 1990 s.
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Chu, Tu-Bin; Liu, Tsai-Ching; Chen, Chin-Shyan; Tsai, Yi-Wen; Chiu, Wen-Ta
2005-01-01
Background Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. Methods Data used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995. Results An individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan. Conclusion Although NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved. PMID:16137336
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Silver, George A.
1978-01-01
For many years, a sharp distinction was made between NHS and NHI on the basis of payment and program focus. First, NHS was defined as a program essentially based on Congressional appropriations (general revenues); while NHI would be based on premiums largely derived from the insured. Second, NHS guaranteed service while NHI guaranteed only payment for services rendered. The distinctions were later extended from these definitions to include differences in response to resource needs, changing task descriptions and personnel assignments, more equitable redistribution of manpower, centralized administration and consumer participation. In general, if the goal were equity, NHS seemed more responsive than NHI. However, in recent years, the approach to NHI has been modified in response to criticism as well as increasing recognition of changed needs, and proposals for NHI like the Kennedy-Corman bill have become more like proposals for a NHS. In short, the difference today is largely one of immediate as against eventual transformation of the medical care system into a social instrument aiming to achieve equity. The major disagreement is whether the present medical care system lends itself to modification so as to achieve that end. PMID:685298
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Chang, Li
2011-01-01
This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.
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NASA Astrophysics Data System (ADS)
Verkaik, J.
2013-12-01
The Netherlands Hydrological Instrument (NHI) model predicts water demands in periods of drought, supporting the Dutch decision makers in taking operational as well as long-term decisions with respect to the water supply. Other applications of NHI are predicting fresh-salt interaction, nutrient loadings, and agriculture change. The NHI model consists of several coupled models: a saturated groundwater model (MODFLOW), an unsaturated groundwater model (MetaSWAP), a sub-catchment surface water model (MOZART), and a distribution network of surface waters model (DM/SOBEK). Each of these models requires specific, usually large, input data that may be the result of sophisticated schematization workflows. Input data can also be dependent on each other, for example, the precipitation data is input for the unsaturated zone model (cells) as well as for the surface water models (polygons). For efficient data management, we developed several Python tools such that the modeler or stakeholder can use the model in a user-friendly manner, and data is managed in a consistent, transparent and reproducible way. Two open source Python tools are presented here: the data version control module for the workflow manager VisTrails called FileSync, and the NHI model control script that uses FileSync. VisTrails is an open-source scientific workflow and provenance management system that provides support for simulations, data exploration and visualization. Since VisTrails does not directly support version control we developed a version control module called FileSync. With this generic module, the user can synchronize data from and to his workflow through a dialog window. The FileSync dialog calls the FileSync script that is command-line based and performs the actual data synchronization. This script allows the user to easily create a model repository, upload and download data, create releases and define scenarios. The data synchronization approach applied here differs from systems as Subversion or Git, since these systems do not perform well for large (binary) model data files. For this reason, a new concept of parameterization and data splitting has been implemented. Each file, or set of files, is uniquely labeled as a parameter, and for this parameter metadata is maintained by Subversion. The metadata data contains file hashes to identify data content and the location where the actual bulk data are stored that can be reached by FTP. The NHI model control script is a command-line driven Python script for pre-processing, running, and post-processing the NHI model and uses one single configuration file for all computational kernels. This configuration file is an easy-to-use, keyword-driven, Windows INI-file, having separate sections for all the kernels. It also includes a FileSync data section where the user can specify version controlled model data to be used as input. The NHI control script keeps all the data consistent during the pre-processing. Furthermore, this script is able to do model state handling when the NHI model is used for ensemble forecasting.
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Cost trend analysis of initial cancer treatment in Taiwan.
Li, Tsai-Yun; Hsieh, Jan-Sing; Lee, King-Teh; Hou, Ming-Feng; Wu, Chia-Ling; Kao, Hao-Yun; Shi, Hon-Yi
2014-01-01
Despite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment. The analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996-2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share. In addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments.
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Okorafor, Okore Apia
2012-05-01
A recent health reform proposal in South Africa proposes universal access to a comprehensive package of healthcare services in the public sector, through the implementation of a national health insurance (NHI) scheme. Implementation of the scheme is likely to involve the introduction of a payroll tax. It is implied that the introduction of the payroll tax will significantly reduce the size of the private health insurance market. The objective of this study was to estimate the impact of an NHI payroll tax on the demand for private health insurance in South Africa, and to explore the broader implications for health policy. The study applies probit regression analysis on household survey data to estimate the change in demand for private health insurance as a result of income shocks arising from the proposed NHI. The introduction of payroll taxes for the proposed NHI was estimated to result in a reduction to private health insurance membership of 0.73%. This suggests inelasticity in the demand for private health insurance. In the literature on the subject, this inelasticity is usually due to quality differences between alternatives. In the South African context, there may be other factors at play. An NHI tax may have a very small impact on the demand for private health insurance. Although additional financial resources will be raised through a payroll tax under the proposed NHI reform, systemic problems within the South African health system can adversely affect the ability of the NHI to translate additional finances into better quality healthcare. If these systemic challenges are not adequately addressed, the introduction of a payroll tax could introduce inefficiencies within the South African health system.
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First Applications of the New Parallel Krylov Solver for MODFLOW on a National and Global Scale
NASA Astrophysics Data System (ADS)
Verkaik, J.; Hughes, J. D.; Sutanudjaja, E.; van Walsum, P.
2016-12-01
Integrated high-resolution hydrologic models are increasingly being used for evaluating water management measures at field scale. Their drawbacks are large memory requirements and long run times. Examples of such models are The Netherlands Hydrological Instrument (NHI) model and the PCRaster Global Water Balance (PCR-GLOBWB) model. Typical simulation periods are 30-100 years with daily timesteps. The NHI model predicts water demands in periods of drought, supporting operational and long-term water-supply decisions. The NHI is a state-of-the-art coupling of several models: a 7-layer MODFLOW groundwater model ( 6.5M 250m cells), a MetaSWAP model for the unsaturated zone (Richards emulator of 0.5M cells), and a surface water model (MOZART-DM). The PCR-GLOBWB model provides a grid-based representation of global terrestrial hydrology and this work uses the version that includes a 2-layer MODFLOW groundwater model ( 4.5M 10km cells). The Parallel Krylov Solver (PKS) speeds up computation by both distributed memory parallelization (Message Passing Interface) and shared memory parallelization (Open Multi-Processing). PKS includes conjugate gradient, bi-conjugate gradient stabilized, and generalized minimal residual linear accelerators that use an overlapping additive Schwarz domain decomposition preconditioner. PKS can be used for both structured and unstructured grids and has been fully integrated in MODFLOW-USG using METIS partitioning and in iMODFLOW using RCB partitioning. iMODFLOW is an accelerated version of MODFLOW-2005 that is implicitly and online coupled to MetaSWAP. Results for benchmarks carried out on the Cartesius Dutch supercomputer (https://userinfo.surfsara.nl/systems/cartesius) for the PCRGLOB-WB model and on a 2x16 core Windows machine for the NHI model show speedups up to 10-20 and 5-10, respectively.
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Marshall, Roger J; Zhang, Zhongqian; Broad, Joanna B; Wells, Sue
2007-06-01
To assess agreement between ethnicity as recorded by two independent databases in New Zealand, PREDICT and the National Health Index (NHI), and to assess sensitivity of ethnic-specific measures of health outcomes to either ethnicity record. Patients assessed using PREDICT form the study cohort. Ethnicity was recorded for PREDICT and an associated NHI ethnicity code was identified by merge-match linking on an encrypted NHI number. Agreement between ethnicity measures was assessed by kappa scores and scaled rectangle diagrams. A cohort of 18,239 individuals was linked in both PREDICT and NHI databases. The agreement between ethnicity classifications was reasonably good, with overall kappa coefficient of 0.82. There was better agreement for women than men and agreement improved with age and with time since the PREDICT system has been operational. Ethnic-specific cardiovascular (CVD) hospital admission rates were sensitive to ethnicity coding by NHI or PREDICT; rate ratios for ethnic groups, relative to European, based on PREDICT were attenuated towards the null relative to the NHI classification. Agreement between ethnicity was moderately good. Discordances that do exist do not have a substantial effect on prevalence-based measures of effect; however, they do on measurement of the admission of CVD. Different categorisations of ethnicity data from routine (and other) databases can lead to different ethnic-specific estimates of epidemiological effects. There is an imperative to record ethnicity in a rational, systematic and consistent way.
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HYBRID SULFUR PROCESS REFERENCE DESIGN AND COST ANALYSIS
DOE Office of Scientific and Technical Information (OSTI.GOV)
Gorensek, M.; Summers, W.; Boltrunis, C.
2009-05-12
This report documents a detailed study to determine the expected efficiency and product costs for producing hydrogen via water-splitting using energy from an advanced nuclear reactor. It was determined that the overall efficiency from nuclear heat to hydrogen is high, and the cost of hydrogen is competitive under a high energy cost scenario. It would require over 40% more nuclear energy to generate an equivalent amount of hydrogen using conventional water-cooled nuclear reactors combined with water electrolysis compared to the proposed plant design described herein. There is a great deal of interest worldwide in reducing dependence on fossil fuels, whilemore » also minimizing the impact of the energy sector on global climate change. One potential opportunity to contribute to this effort is to replace the use of fossil fuels for hydrogen production by the use of water-splitting powered by nuclear energy. Hydrogen production is required for fertilizer (e.g. ammonia) production, oil refining, synfuels production, and other important industrial applications. It is typically produced by reacting natural gas, naphtha or coal with steam, which consumes significant amounts of energy and produces carbon dioxide as a byproduct. In the future, hydrogen could also be used as a transportation fuel, replacing petroleum. New processes are being developed that would permit hydrogen to be produced from water using only heat or a combination of heat and electricity produced by advanced, high temperature nuclear reactors. The U.S. Department of Energy (DOE) is developing these processes under a program known as the Nuclear Hydrogen Initiative (NHI). The Republic of South Africa (RSA) also is interested in developing advanced high temperature nuclear reactors and related chemical processes that could produce hydrogen fuel via water-splitting. This report focuses on the analysis of a nuclear hydrogen production system that combines the Pebble Bed Modular Reactor (PBMR), under development by PBMR (Pty.) Ltd. in the RSA, with the Hybrid Sulfur (HyS) Process, under development by the Savannah River National Laboratory (SRNL) in the US as part of the NHI. This work was performed by SRNL, Westinghouse Electric Company, Shaw, PBMR (Pty) Ltd., and Technology Insights under a Technical Consulting Agreement (TCA). Westinghouse Electric, serving as the lead for the PBMR process heat application team, established a cost-shared TCA with SRNL to prepare an updated HyS thermochemical water-splitting process flowsheet, a nuclear hydrogen plant preconceptual design and a cost estimate, including the cost of hydrogen production. SRNL was funded by DOE under the NHI program, and the Westinghouse team was self-funded. The results of this work are presented in this Final Report. Appendices have been attached to provide a detailed source of information in order to document the work under the TCA contract.« less
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netherland hydrological modeling instrument
NASA Astrophysics Data System (ADS)
Hoogewoud, J. C.; de Lange, W. J.; Veldhuizen, A.; Prinsen, G.
2012-04-01
Netherlands Hydrological Modeling Instrument A decision support system for water basin management. J.C. Hoogewoud , W.J. de Lange ,A. Veldhuizen , G. Prinsen , The Netherlands Hydrological modeling Instrument (NHI) is the center point of a framework of models, to coherently model the hydrological system and the multitude of functions it supports. Dutch hydrological institutes Deltares, Alterra, Netherlands Environmental Assessment Agency, RWS Waterdienst, STOWA and Vewin are cooperating in enhancing the NHI for adequate decision support. The instrument is used by three different ministries involved in national water policy matters, for instance the WFD, drought management, manure policy and climate change issues. The basis of the modeling instrument is a state-of-the-art on-line coupling of the groundwater system (MODFLOW), the unsaturated zone (metaSWAP) and the surface water system (MOZART-DM). It brings together hydro(geo)logical processes from the column to the basin scale, ranging from 250x250m plots to the river Rhine and includes salt water flow. The NHI is validated with an eight year run (1998-2006) with dry and wet periods. For this run different parts of the hydrology have been compared with measurements. For instance, water demands in dry periods (e.g. for irrigation), discharges at outlets, groundwater levels and evaporation. A validation alone is not enough to get support from stakeholders. Involvement from stakeholders in the modeling process is needed. There fore to gain sufficient support and trust in the instrument on different (policy) levels a couple of actions have been taken: 1. a transparent evaluation of modeling-results has been set up 2. an extensive program is running to cooperate with regional waterboards and suppliers of drinking water in improving the NHI 3. sharing (hydrological) data via newly setup Modeling Database for local and national models 4. Enhancing the NHI with "local" information. The NHI is and has been used for many decision supports and evaluations. The main focus of the instrument is operational drought management and evaluating adaptive measures for different climate scenario's. It has also been used though as a basis to evaluate water quality of WFD-water bodies and measures, nutrient-leaching and describing WFD groundwater bodies. There is a toolkit to translate the hydrological NHI results to values for different water users. For instance with the NHI results agricultural yields can be calculated, effects on ground water dependant ecosystems, subsidence, shipping, drinking water supply. This makes NHI a valuable decision support system in Dutch water management.
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Kirilov, I; Atzeni, M; Perra, A; Moro, D; Carta, M G
2018-01-01
The objective of this research is to verify whether European projects on Active Aging (AA) and Elderly Quality of Life (Qol) funded by the Seventh Framework Programme (FP7) produce an impact on literature similar to projects funded by the National Health Institute (NHI) of the United States on international literature using well-known bibliometric indicators. This effort may be useful in developing standardized and replicable procedures. Fifteen randomly selected projects on AA and Elderly Qol concluded in August 2017 and funded by FP7 were compared to similar projects funded by the US NHI with reference to papers published (Scopus and Scholar), papers published in Q1 journals, and the number of citations of the papers linked to the projects. In all the indicators considered, the European projects showed no difference with the US NHI projects. The EU-funded AA and Qol Elderly projects have an impact on scientific literature comparable to projects funded in the United States by the NHI Agency.Our results are consistent with the data on general medical research, which indicates that, European research remains at a high level of competitiveness.In this experimental study, our methodology appeared to be convincing and reliable and it could be applied to the extent of the impact of more extensive research areas.Our research did not evaluate the relationship between funding required by research and scientific productivity.
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Tan, Elise Chia-Hui
2015-01-01
Background Numerous studies have examined the impact of global budget payment systems of health insurance on patient access to medical care. In order to monitor the population’s accessibility to health services, a series of survey are often used to understand public perceptions of the health care provider. Taiwan implemented the single-payer National Health Insurance in 1995 and has been conducting a series of surveys to monitor public perception of the NHI after adopting a global budget payment system in 2002. Although telephone surveys are commonly used in obtaining public opinions on various public health issues, limitations such as higher cost and influence of interviewers do raise some concerns. Web-based surveys, one of the alternative methods, may be free from these problems. Objective Our aim was to examine the difference of sociodemographic characteristics, satisfaction of NHI and NHI-contracted health care providers, attitude toward NHI-related issues, behavior in seeking medical advice and self-reported health status between those who completed Web-based surveys and those reached by telephone. Methods This study compared the demographic factors of participants who took either a Web-based survey (1313 participants) or random digit dialing telephone survey (2411 participants) that contained identical questions. Results Compared to telephone survey respondents, Web-based respondents tended to be younger (P<.001), unmarried (P<.001), non-smokers (P<.001), with a higher education (P<.001), and a higher monthly household income (P<.001) and worse self-reported health status (P=.008); however, they were less likely to report suffering from a chronic disease (P<.001). Despite these differences in background characteristics, no significant differences were observed in their answers related to the seeking of medical care or NHI-related issues. Telephone survey respondents reported greater satisfaction with NHI services. Web-based surveys were also shown to provide a lower average cost per sample (US$0.71) compared to telephone surveys (US$3.98). Conclusions Web-based surveys provide a low-cost alternative method for the polling of public attitudes toward NHI-related issues. Despite general similarities between the two polling methods with regard to responses, respondents to telephone surveys reported a stronger agreement with regard to satisfaction with NHI services and a more positive self-reported health status. PMID:25886989
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3-D Synthetic Microstructure Generation with Ellipsoid Particles
2016-09-27
MATLAB scripts in Appendix A, Appendix B, and Appendix C by using 3 -D matrices, where the background is 0 and the particle is 1. For the 3 -D ellipses, it...iy(iy== 0 )=image_size(2); nlo = z0 - floor(diam/2); nhi = z0 + ceil(diam/2)-1; iz = mod(nlo:nhi,image_size( 3 ));iz(iz== 0 )=image_size( 3 ); Itest = logical...z0 + ceil(diam/2)-1; iz = mod(nlo:nhi,image_size( 3 )); iz(iz== 0 )=image_size( 3 ); Itest = logical(I(ix,iy,iz)); if sum(Itest(I_ellipse)) == 0 Itest
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National Health Insurance and Health Education: Strategies for Change.
ERIC Educational Resources Information Center
Dwore, Richard B.
1980-01-01
The concept of National Health Insurance (NHI) as one of several strategies for resolving health problems in the U.S. is discussed. NHI goals include comprehensive health care, quality health care, efficient delivery systems, phased-in benefits, and consumer representation. (JD)
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Ku, Li-Jung Elizabeth; Chiou, Meng-Jiun; Liu, Li-Fan
2015-07-01
The National Health Insurance (NHI) system in Taiwan launched a trial capitation provider payment programme in 2011, with the capitation formula based on patients' average NHI expenditure in the previous year. This study seeks to examine the concentration and persistence of health care expenditure among the elderly, and to assess the performance of the current capitation formula in predicting future high-cost users. This study analysed NHI expenditures for a nationally representative sample of people aged 65 years and over who took part in Taiwan's National Health Interview Survey, 2005. Expenditure concentration was assessed by the proportion of NHI expenditures attributable to four groups by expenditure percentile. Four transition probability matrixes examined changes in a person's position in the expenditure percentiles and generalized estimation equation models were estimated to identify significant predictors of a patient being in the top 10% of users. Between 2005 and 2009, the top 10% of users on average accounted for 55% of total NHI expenditures. Of the top 10% in 2005, 39% retained this position in 2006. However, expenditure persistence was the highest (77%) among the bottom 50% of users. NHI expenditure percentiles in both the baseline year and the prior year, and chronic conditions all significantly predicted future high expenditures. The model including chronic conditions performed better in predicting the top 10% of users (c-statistics increased from 0.772 to 0.904) than the model without. Given the increase in predictive ability, adding chronic conditions and baseline health care use data to Taiwan's capitation payment formula would correctly identify more high users. © The Author(s) 2015.
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Perspectives on National Health Insurance and Rehabilitation. Emerging Issues in Rehabilitation.
ERIC Educational Resources Information Center
Dorken, Herbert; LaRocca, Joseph
Major research findings are synthesized and innovations of current concern to vocational rehabilitation professionals are reported in this paper on national health insurance (NHI) and rehabilitation. Discussion covers the following topics: the concept of insurance, forms of health insurance, issues arising from hearings on NHI, perspectives of…
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Lan, Jesse Yu-Chen
2017-12-01
The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.
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Politics and medicine: the case of Israeli National Health Insurance.
Yishai, Y
1982-01-01
The paper focuses on the attempts to introduce a national health insurance system in Israel. So far all these attempts advanced through six public committees and various legislative initiatives have been futile. The major actors involved in the process of NHI formulation are (a) the sick funds, the largest of which (KH) nearly monopolizes the health services; (b) political parties which are affiliated with the sick funds; (c) the Israeli medical association. The labor oriented parties and sick funds aimed for the introduction of an NHI system which would strengthen KH and preserve its autonomy. The right wing parties and sick fund advocated nationalization of the NHI. The IMA took a mid-way position not identifying with either of the parties. By allying with a small coalition party it was effective in impeding the legislative process that was initiated by the Labor Party. The vigorous opposition of KH has hindered the adoption of the Likud's version of the NHI. Hence, the issue, torn between conflicting parties, reached a stalemate which is not likely to be resolved in the near future.
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A cost-effective add-on-value card-assisted firewall over Taiwan's NHI VPN framework.
Huang, Jyh-Win; Hou, Ting-Wei
2007-06-01
Besides the overall budget for building the infrastructure of a healthcare-service-based virtual private network (VPN) in Taiwan, two issues were considered critical for its acceptance by the country's 17,000 plus medical institutions. One was who was to pay for the network (ADSL or modem) connection fee; the other was who was to pay for the firewall/anti-virus software. This paper addresses the second issue by proposing an efficient freeware firewall, named card-assisted firewall (CAF), for NHI VPN edge-hosts, which is also an add-on-value application of the National Healthcare IC card that every insurant and medical professional has. The innovative concept is that any NHI VPN site (edge-host) can establish diversified secure-authenticated connections with other sites only by an authentication mechanism, which requires a NHI Java card state machine and the Access Control List of the host. It is different from two-factor authentication cards in four ways: (1) a PIN code is not a must; (2) it requires authentication with the remote IC card Data Centre; (3) the NHI cards are already available, no modification is needed, and there is no further cost for the deployment of the cards; (4) although the cards are in the reader, the communication cannot start unless the cards are in the corresponding states; i.e. the states allow communication. An implementation, on a Microsoft Windows XP platform, demonstrated the system's feasibility over an emulation of the NHI VPN framework. It maintained a high line speed, the driver took up 39 KB of disk space, installation was simple, not requiring any extra hardware or software, and the average packet processing time of the CAF driver measured was 0.3084 ms. The average overhead in comparing the Access Control List predefined routing in card, in an FTP testing experiment, was 5.7 micros (receiving) and 8 micros (sending).
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Wu, I-Chen; Hsieh, Hui-Min; Wu, Ming-Tsang
2015-01-09
To calculate the short-term risk-benefit effect of occasional and regular use of low-dose aspirin (≤100 mg/day) in primary prevention. Two retrospective cohort studies. Taiwan. 63 788 and 24 910 patients of two nationwide population-based studies were examined. Two databases of 1 000 000 patients were randomly sampled from data of Taiwan's National Health Insurance (NHI) for years 1997-2000 (NHI 2000) and 2005 (NHI 2005). In NHI 2000, 63 788 patients 30-95 years of age were found not to have previously been prescribed aspirin before 1 January 2000, but to have first been prescribed low-dose aspirin after that date. They were also found to be at risk of first hospitalisation for any major vascular diseases including haemorrhage (major gastrointestinal haemorrhage or cerebral haemorrhage) and ischaemia (acute myocardial infarction or ischaemic stroke) after their first prescription. We also applied it to NHI 2005, and the number of eligible patients was 24 910. Patients prescribed low-dose aspirin for <20% of the days of a 60-day follow-up period were considered to be occasional users, and those prescribed low-dose aspirin for ≥80% of the days were considered to be regular users. Differences in rate of haemorrhage and ischaemia between these users were used to calculate their net clinical risk. Vascular diseases. In NHI 2000, the overall unadjusted rates of haemorrhage and ischaemia were 0.09% and 0.21%, respectively, for occasional users and 0.32% and 2.30%, respectively, for regular users. Adjusted net clinical risk of low-dose aspirin use between the two groups was 2.24% (95% CI 2.03% to 2.48%; p<0.001). Similar results were also found in NHI 2005. Short-term regular use of low-dose aspirin might not be better than occasional use for preventing major vascular diseases in primary prevention. Prescribing regular low-dose aspirin for primary prevention should be done with caution. Future studies should explore the risk-benefit effect of long-term low-dose aspirin use in primary prevention. 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.
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Liao, Pei-An
2011-02-01
In this study, I investigate how the impact of the National Health Insurance (NHI) introduction in Taiwan in 1995 on the labor force participation (LFP) decisions of married women varies with income and family structures. Employing the difference-in-differences (DID) approach, I find that the NHI introduction reduced LFP of married women in the twenty-fifth to fiftieth percentiles of the income distribution between 17.8 and 21.7 percentage points (33%-40%). The difference-in-differences-in-differences (DIDID) results suggest that married women in different family structures (the presence of children under 3 or less healthy elderly household members) did not respond differently to the NHI introduction.
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Tsai, Yi-Wen; Hu, Teh-Wei
2002-09-01
Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.
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Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai
2011-03-01
Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one medication that might be duplicative to the prior prescriptions stored in NHI-IC cards. The rate of potential duplicate medication alerts for the Pediatric Department was higher than that for the Urology Department (2.78% versus 1.67%). However, the rate of revisions to prescriptions was higher in the Urology Department than the Pediatric Department. Overall, the rate of physicians reviewing and revising their prescriptions was 29.25%; the rate of physicians reviewing without revising their prescriptions was 43.62%; the rate of physicians turning off the alert screens right after the screens popped up (overridden) was 27.13%. Thus, physicians accepted alerts to review their prescriptions with patients in most situations (72.87%). Moreover, over the study period, the rate of total revisions made to prescriptions increased and the "overridden" rate decreased. Our approach enhances the capability of CPOE systems using NHI-IC cards as a nationwide infrastructure to provide more complete patient health information and medication history sharing among hospitals in Taiwan. Thus, our system can provide a better prescribing tool to help physicians detect potential duplicate medications for frequent doctor-shopping patients and hence enhance patient safety across hospital boundaries. However, the effectiveness of detecting duplicate medications with our approach is very much dependent on the completeness of NHI-IC cards, which in turn primarily depends on physician use of the cards when prescribing. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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Baladia, Eduard; Frutos Pérez-Surio, Alberto; Martínez-Rodríguez, Rodrigo
2016-06-30
Objetivos: dar a conocer las recomendaciones relacionadas con la Nutrición Humana y Dietética (NHyD) de la Guía de Práctica Clínica para el manejo de la enfermedad de Parkinson del Sistema Nacional de Salud (GPC-EP/SNS) y favorecer su difusión e implementación en la práctica. El objetivo secundario es presentar la implicación de los profesionales de la NHyD en la elaboración de la guía.Material y métodos: siguiendo el Manual Metodológico de Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud, se formularon las preguntas clínicas, se realizó una búsqueda sistemática para cada pregunta en bases de datos (PubMed/Medline, Embase, Cochrane Library, CRD, LILACS, IBECS y ClinicalTrials), se definieron los criterios de elegibilidad, al menos dos investigadores seleccionaron los estudios, se realizó lectura crítica de la literatura se resumió en tablas de síntesis de evidencia y se establecieron las recomendaciones.Resultados: se propusieron 14 preguntas relacionadas directamente con NHyD-Parkinson, de las cuales solamente 3 pudieron incluirse. Se formuló una pregunta relacionada con la terapia de logopedia aplicada en personas con EP que presentan problemas de deglución, tratamiento donde se imbrican los profesionales de la NHyD. De 642 artículos localizados, únicamente 2 pudieron ser incluidos para contestar las correspondientes preguntas. De las evidencias halladas, se derivaron 11 recomendaciones directa o indirectamente relacionados con la NHyD.Conclusiones: la implicación de profesionales sanitarios en equipos multidisciplinares mejora el resultado final de las guías y la atención sanitaria de los pacientes. Es necesario que los profesionales sanitarios de la NHyD (los/las dietistas-nutricionistas) se impliquen en iniciativas basadas en la mejor evidencia científica disponible y que formen parte de los equipos de trabajo multidisciplinares.
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China and Proliferation of Weapons of Mass Destruction and Missiles: Policy Issues
2010-08-16
nuclear weapons facilities, while experts from China worked at a uranium mine at Saghand and a centrifuge facility (for uranium enrichment) near...brief interruptions.”85 84 Barbara Opall -Rome and Vago Muradian, “Bush Privately Lauds...confiscated a rare metal used to produce alloy steel (called vanadium) being smuggled to North Korea. In the same month, China’s NHI Shenyang Mining
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Russel, Mehdi
2005-01-01
The Iranian government has considered using DALYs as an indicator to prioritize health service expenditures to reduce the burden of disease for the public. A cross-sectional study was designed to compare several measures of the burden of disease with the actual amounts of national health insurance (NHI) expenditures, in one province of Iran (Semnan) for a period of 2 months (September 2000 and February 2001). Furthermore, on the basis of the research findings, a questionnaire was designed and distributed to stakeholders at local and national levels to explore their ideas about the gap between the expenditures of the diseases group and their burden. A semi-structured interview was conducted to elicit participants' views on the research findings. The results of this study have revealed that, currently, there is no strong relation between the NHI expenditures and DALY (r = 0.41, p = 0.09), but that there are stronger relationships between the amounts of NHI reimbursements with YLL (r = 0.52, p < 0.05), mortality (r = 0.67, p < 0.01) and hospital days (r = 0.90, p < 0.01). Comparing each group of disorders' DALY with the resources allocated to them (cost per DALY) it was shown that diabetes mellitus, musculoskeletal diseases, maternal conditions, sense organ disorders received considerably generous funding; and, perinatal conditions, congenital abnormalities, nutritional deficiencies were relatively under-funded. The qualitative research results showed that the majority of respondents agreed that the differences presently existing between disorders' burden and NHI expenditures cannot be justified; and, further, that reducing the overall burden of disease must be one of the most important objectives for the NHI.
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Yang, Chiang-Hsing; Huang, Yu-Tung A; Hsueh, Ya-Seng A
2013-02-04
Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers' Gini coefficients also become close to one another. This study found that NHI's offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.
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Hung, Jung-Hua; Chang, Li
2008-03-01
Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).
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Tang, Chao-Hsiun; Wu, Yu-Ting; Huang, Siao-Yuan; Chen, Hsi-Hsien; Wu, Ming-Ju; Hsu, Bang-Gee; Tsai, Jer-Chia; Chen, Tso-Hsiao; Sue, Yuh-Mou
2017-03-21
Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan. 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/.
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Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An
2012-01-01
To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists. © 2011 National Rural Health Association.
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Wang, Guang-Xu
2012-12-01
This study evaluates the political feasibility of healthcare reform taking place in Taiwan in the past decade. Since Taiwan adopted National Health Insurance (NHI) in 1995, it has provided coverage for virtually all of the island's citizens. However, the imbalance between expenditure and revenue has resulted in a cycle of unsustainable spending which has necessitated financial reforms and political confrontations. By applying social network analysis, this paper examines multiple types of ties between policy elites and power distribution that have evolved in crucial policy events of the NHI's financial reforms between 1998 and 2010. Data sources include official documents and 62 social network interviews that were held with government officials and related unofficial policy participants. Blockmodeling and multidimensional scaling (MDS) are used to determine the major participants and network structures in the NHI domain, as well as the influential policy actors, based on information transmission, resource exchange, reputation attribution and action-set coalition networks in Taiwan's current political situation. The results show that although both public actors and all medical associations are the leading actors in the NHI reform, without good communication with societal actors, the promotion of reform proposals ends in failure. As a tool of political feasibility evaluation, social network analysis can map the political conflict between policy stakeholders systematically when policy makers pursue the result of policy adoption. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Low-budget policy tool to empower Israeli insureds to demand their rights in the healthcare system.
Brammli-Greenberg, Shuli; Waitzberg, Ruth; Medina-Artom, Tamar; Adijes-Toren, Ariella
2014-12-01
Since 1995 universal healthcare coverage has been provided in Israel through National Health Insurance (NHI). Although the country has lower rates of health spending than most OECD countries, the NHI Law stipulates that a broad benefits package will be provided by four competing Health Plans (HPs). These third-party payers manage healthcare utilization and cost through mechanisms that affect both provider and consumer behavior. Cost Containment is one of their main organizational objectives. The Ministry of Health (MoH) supervises HPs to ensure that they provide their members with adequate healthcare of high quality in accordance with the NHI Law and uphold the principles of efficiency and equity. In this paper we report on a policy instrument recently introduced by the MoH which enables it to share some of its responsibility for supervision with the insureds. This policy instrument is a website launched in 2014 that gives access to transparent information about the coverage of the NHI and voluntary health insurance (VHI) benefits packages. The idea is to empower insureds with knowledge and awareness of their rights and eligibility to benefits, so they can demand them from the HPs and/or private insurers; if refused, they can refer the case to the supervisor (the MoH). This policy instrument addresses market failures related to information asymmetry and can potentially improve competition among the HPs and within the VHI market. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
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Establishing a health promotion and development foundation in South Africa.
Perez, A M; Ayo-Yusuf, O A; Hofman, K; Kalideen, S; Maker, A; Mokonoto, D; Morojele, N; Naidoo, P; Parry, C D H; Rendall-Mkosi, K; Saloojee, Y
2013-01-14
South Africa has a 'quadruple burden of disease'. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa's HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.
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Lin, Ping-Yi; MacLennan, Sara; Hunt, Nigel; Cox, Tom
2015-01-01
Taiwan's NHI system is one of the most successful health care models for countries around the globe. However, little research has demonstrated the mental health issues associated with nursing transformational leadership style under the NHI system, especially in the quality of nurses' working lives in Taiwan. It is important to know the relationship between transformational leadership style and the mental health of nurses, organisational commitment and job satisfaction. The research aimed to understand the influences of nursing transformational leadership style on the quality of nurses' working lives in Taiwan. The research hypothesis was that transformational leadership styles would have positive influence on the quality of nurses' working lives. This was a cross-sectional quantitative study. Nurses from each type of hospital ownership (private, public and religious) were recruited. Participation was voluntary and signed informed consent was obtained. The inclusion criteria were nurses with at least one year's work experience in the hospitals. Self-administrated questionnaires were used. A total of 807 participants were contacted and 651 questionnaires were fully completed (response rate 80.7 %). A theory driven model was used to test the research hypotheses using structural equation modelling performed with AMOS 16.0. Transformational leadership contributes significantly to supervisor support. Workplace support, particularly from the supervisor, is an important mediator variable that explains the relationship between transformational leadership and job satisfaction. Organisational commitment was the strongest factor relevant to the general health well-being in Taiwanese nurses than job satisfaction. The hypothesized positive relationships between transformational leadership and all variables were supported by the data. Our findings have important consequences for organisational health. Our model demonstrates a complete picture of the work relationships on the quality of nurses' working lives. The results provided information about the subordinates' perceptions of transformational nursing leadership styles and mental health outcomes in different hospital settings, as well as identified organisational factors that could improve the quality of nurses' working lives.
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Neuroprosthetics and Solutions for Restoring Sensorimotor Function
2010-12-01
Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302...8217#*,6(0-;)?’) 8’.1,./’") 8.*/$.-) $S’.’%4)/*&.,(@/60$@,%) ET! NHI ) (46"*’()?*45)8’%.$@%3)/*&.,’&4.,"’( )*%) 45’) WXO)4,)"’./*%’)45’)’&4.*&$0)&6...8.*/$.-) $S’.’%4) /*&.,(@/60$@,%) ET! NHI ) *%) 45’) ",.($0) .,,4) 3$%30*$) EWXOI;) 45’) ’S’&4() ,1) ?5*&5) $.’) /’$(6.’") *%) 8.*/$.-)
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Neuroprosthetics and Solutions for Restoring Sensorimotor Function
2010-12-31
Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302...8217#*,6(0-;)?’) 8’.1,./’") 8.*/$.-) $S’.’%4)/*&.,(@/60$@,%) ET! NHI ) (46"*’()?*45)8’%.$@%3)/*&.,’&4.,"’( )*%) 45’) WXO)4,)"’./*%’)45’)’&4.*&$0)&6...8.*/$.-) $S’.’%4) /*&.,(@/60$@,%) ET! NHI ) *%) 45’) ",.($0) .,,4) 3$%30*$) EWXOI;) 45’) ’S’&4() ,1) ?5*&5) $.’) /’$(6.’") *%) 8.*/$.-)
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2009-03-19
including suggesstions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215...gen-bonded to the c=o and the NHz of the amide side-chain of Asn19t, as well as NHI ofArg184. The dependence of the carotenoid spectrum on the retinal...protonation of ASp85 [22]. This is unlikely to occur in the xan- thorhodopsin photocyc1e, because NHI and NH2 of Arg93 are both hydrogen-bonded to the peptide
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Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU
2013-01-01
Background: The increasing importance of the concept of patients’ satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. Aim: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. Subject and Methods: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient–staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. Results: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient–staff relationship (3.9), patient–staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). Conclusion: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status. PMID:23634326
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Iloh, Gup; Ofoedu, Jn; Njoku, Pu; Okafor, Goc; Amadi, An; Godswill-Uko, Eu
2013-01-01
The increasing importance of the concept of patients' satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient-staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient-staff relationship (3.9), patient-staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.
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User’s Manual for the AFSATCOM Terminal Upgrades Life Cycle Cost Model. Volume I.
1981-10-01
EFAIL (I,NS)*TNB(NS) NS *I[LRU(I) + RTS(NHI(I))]*NRTS(I)*DRCT(LO(NS)) + NRTS(NHI(I))*(l - COND(I))*DAD) where TNB(NS) = total number of bases within the...required anywhere in the ATU logistics system, i.e., if it ever fails, and equals 0 otherwise. Computed by: IUT(I) = U( EFAIL (I,NS)) NS IMC = initial depot...I)*XFPR*BRCT + CIMF(NS)* EFAIL (I,B)*NBC(B)LRU(I)*FINC*FPR(I)*XFPR*CRCT B NHB(B)=NS The terms in the equation for TDFPR(I) above account for increases
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Chang, Hsien-Yen; Weiner, Jonathan P
2010-01-18
Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies.
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Lin, Po-Hsien; Liao, Shih-Cheng; Chen, I-Ming; Kuo, Po-Hsiu; Shan, Jia-Chi; Lee, Ming-Been; Chen, Wei J
2017-11-01
National Health Insurance (NHI), launched in 1995 in Taiwan, lightens patient's financial burdens but its effect on the suicide risk in cancer patients is unclear. We aimed to investigate the impacts of the NHI on the suicide in newly diagnosed cancer patients. We identified patients with newly diagnosed cancer from the nationwide Taiwan Cancer Registration from 1985 to 2007, and ascertained suicide deaths from the national database of registered deaths between 1985 and 2009. Standardized mortality ratio (SMR) of suicide risk among patients with cancer was calculated, and the suicide risk ratios were examined by gender, age group, and prognosis. For the 916 337 registered cancer patients with 4 300 953 person-years, 2 543 died by suicide, with a suicide rate of 59.1 per 100 000 person-years. Compared to the general population, cancer patients had an SMR of 2.47 for suicide, with a higher figure for males (2.73), age 45 to 64 (2.89), and cancer of poor prognosis (3.19). The suicide risk was highest in the first 2 years after the initial diagnosis. Comparing the cohorts of the period before (1985 to 1992) and after (1996 to 2007) the launch of NHI, we saw a reduction in the SMR within the first 2 years after cancer diagnosis (20%), with more prominent reduction for females (29%), age under 45 (69%), and cancer of good prognosis (33%). A universal health coverage relieving both physical and psychological distress may account for the post-NHI reduction of immediate suicide risk in patients of newly diagnosed cancer. Copyright © 2017 John Wiley & Sons, Ltd.
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Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea.
Kim, Eun Kyoung; Shin, Ji Yeon; Castañeda, Anyela Marcela; Lee, Seung Jae; Yoon, Hyun Kyu; Kim, Yong Chul; Moon, Jee Youn
2017-10-01
The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016. Pain severity, changes in the morphine equivalent daily dosage (MEDD), any adverse events, and patients' satisfaction were determined. We calculated the financial break-even point of ITMP implantation via investigating the patient's actual medical costs and insurance information. During the studied period, 23 patients received ITMP implantation, and 20 patients were included in our study. Scores on an 11-point numeric rating scale (NRS) for pain were significantly reduced compared to the baseline value ( P < 0.001). The MEDD before ITMP implantation was 0.59 [IQR: 0.55-0.82]. The total MEDD increased steadily to 0.77 [IQR: 0.53-1.08] at 1 year, which was 126% of the baseline ( P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying. The financial break-even point was 28 months for ITMP treatment after the NHI reimbursement policy. ITMP provided effective chronic pain management with improved satisfaction and reasonable financial break-even point of 28 months with 50% financial coverage by NHI program.
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Analyzing the Historical Development and Transition of the Korean Health Care System.
Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun
2017-08-01
Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.
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Analyzing the Historical Development and Transition of the Korean Health Care System
Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun
2017-01-01
Objectives Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. Methods We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation’s economic development or governing strategy changes in response to changes in international circumstances such as globalization. Results The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea’s private-dominant health care provision system unchanged over several decades. Conclusion Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state’s power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe. PMID:28904846
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Optimizing operational water management with soil moisture data from Sentinel-1 satellites
NASA Astrophysics Data System (ADS)
Pezij, Michiel; Augustijn, Denie; Hendriks, Dimmie; Hulscher, Suzanne
2016-04-01
In the Netherlands, regional water authorities are responsible for management and maintenance of regional water bodies. Due to socio-economic developments (e.g. agricultural intensification and on-going urbanisation) and an increase in climate variability, the pressure on these water bodies is growing. Optimization of water availability by taking into account the needs of different users, both in wet and dry periods, is crucial for sustainable developments. To support timely and well-directed operational water management, accurate information on the current state of the system as well as reliable models to evaluate water management optimization measures are essential. Previous studies showed that the use of remote sensing data (for example soil moisture data) in water management offers many opportunities (e.g. Wanders et al. (2014)). However, these data are not yet used in operational applications at a large scale. The Sentinel-1 satellites programme offers high spatiotemporal resolution soil moisture data (1 image per 6 days with a spatial resolution of 10 by 10 m) that are freely available. In this study, these data will be used to improve the Netherlands Hydrological Instrument (NHI). The NHI consists of coupled models for the unsaturated zone (MetaSWAP), groundwater (iMODFLOW) and surface water (Mozart and DM). The NHI is used for scenario analyses and operational water management in the Netherlands (De Lange et al., 2014). Due to the lack of soil moisture data, the unsaturated zone model is not yet thoroughly validated and its output is not used by regional water authorities for decision-making. Therefore, the newly acquired remotely sensed soil moisture data will be used to improve the skill of the MetaSWAP-model and the NHI as whole. The research will focus among other things on the calibration of soil parameters by comparing model output (MetaSWAP) with the remotely sensed soil moisture data. Eventually, we want to apply data-assimilation to improve operational water management in cooperation with users. As a first step, the current simulation of soil moisture processes within the NHI will be reviewed. We want to present the findings of this assessment as well as the research methodology. This PhD-research is part of the Optimizing Water Availability with Sentinel-1 Satellites (OWAS1S)-project in which two other PhD-students are participating. They are focussing on the translation of raw Sentinel-1 satellite data to surface soil moisture data and the application of the remotely sensed soil moisture data on crop water availability and trafficability on field scale. References: De Lange, W. J., Prinsen, G. F., Hoogewoud, J. C., Veldhuizen, A. A., Verkaik, J., Oude Essink, G. H. P., van Walsum, P. E. V., Delsman, J. R., Hunink, J. C., Massop, H. T. L., & Kroon, T. (2014). An operational, multi-scale, multi-model system for consensus-based, integrated water management and policy analysis: The Netherlands Hydrological Instrument. Environmental Modelling & Software, 59, 98-108. doi: 10.1016/j.envsoft.2014.05.009 Wanders, N., Karssenberg, D., de Roo, A., de Jong, S. M., & Bierkens, M. F. P. (2014). The suitability of remotely sensed soil moisture for improving operational flood forecasting. Hydrology and Earth System Sciences, 18(6), 2343-2357. doi: 10.5194/hess-18-2343-2014
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Progressivity of health care financing and incidence of service benefits in Ghana.
Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di
2012-03-01
The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.
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2013-01-01
Background Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Methods Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. Results The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers’ Gini coefficients also become close to one another. Conclusions This study found that NHI’s offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan. PMID:23374629
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The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul
Kim, Jungah; Shon, Changwoo
2018-01-01
The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care. PMID:29673147
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Lifetime costs for peritoneal dialysis and hemodialysis in patients in Taiwan.
Kao, Tze-Wah; Chang, Yu-Yin; Chen, Pau-Chung; Hsu, Chih-Cheng; Chang, Yu-Kang; Chang, Yu-Hung; Lee, Lukas Jyuhn-Hsiarn; Wu, Kwan-Dun; Tsai, Tun-Jun; Wang, Jung-Der
2013-01-01
This study compared the lifetime costs for peritoneal dialysis (PD) and hemodialysis (HD) patients in Taiwan. Using the National Health Insurance (NHI) database of all end-stage renal disease patients on maintenance dialysis registered from July 1997 to December 2005, we matched eligible PD patients with eligible HD patients on age, sex, and diabetes status. The matched patients were followed until 31 December 2006. Patients were excluded if they were less than 18 years of age, had been diagnosed with cancer before dialysis, or had been dialyzed at centers or clinics other than hospitals. Outcomes-including life expectancy, total lifetime costs, and costs per life-year paid by the NHI-were estimated and compared. The 3136 pairs of matched PD and HD patients had a mean age of 53.2 ± 15.4 years. The total lifetime cost for PD patients (US$139 360 ± US$8 336) was significantly lower than that for HD patients (US$185 235 ± US$9 623, p < 0.001). Except for patients with diabetes (who had a short life expectancy), the total lifetime cost was significantly lower for PD patients than for HD patients regardless of sex and age (p < 0.01). In Taiwan, the total lifetime costs paid by the NHI were lower for PD than for HD patients.
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On the Origin of the High Column Density Turnover in the HI Column Density Distribution
DOE Office of Scientific and Technical Information (OSTI.GOV)
Erkal, Denis; Gnedin, Nickolay Y.; Kravtsov, Andrey V.
We study the high column density regime of the HI column density distribution function and argue that there are two distinct features: a turnover at NHI ~ 10^21 cm^-2 which is present at both z=0 and z ~ 3, and a lack of systems above NHI ~ 10^22 cm^-2 at z=0. Using observations of the column density distribution, we argue that the HI-H2 transition does not cause the turnover at NHI ~ 10^21 cm^-2, but can plausibly explain the turnover at NHI > 10^22 cm^-2. We compute the HI column density distribution of individual galaxies in the THINGS sample andmore » show that the turnover column density depends only weakly on metallicity. Furthermore, we show that the column density distribution of galaxies, corrected for inclination, is insensitive to the resolution of the HI map or to averaging in radial shells. Our results indicate that the similarity of HI column density distributions at z=3 and z=0 is due to the similarity of the maximum HI surface densities of high-z and low-z disks, set presumably by universal processes that shape properties of the gaseous disks of galaxies. Using fully cosmological simulations, we explore other candidate physical mechanisms that could produce a turnover in the column density distribution. We show that while turbulence within GMCs cannot affect the DLA column density distribution, stellar feedback can affect it significantly if the feedback is sufficiently effective in removing gas from the central 2-3 kpc of high-redshift galaxies. Finally, we argue that it is meaningful to compare column densities averaged over ~ kpc scales with those estimated from quasar spectra which probe sub-pc scales due to the steep power spectrum of HI column density fluctuations observed in nearby galaxies.« less
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The association between gas and galaxies - II. The two-point correlation function
NASA Astrophysics Data System (ADS)
Wilman, R. J.; Morris, S. L.; Jannuzi, B. T.; Davé, R.; Shone, A. M.
2007-02-01
We measure the two-point correlation function, ξAG, between galaxies and quasar absorption-line systems at z < 1, using the data set of Morris & Jannuzi on 16 lines-of-sight (LOS) with ultraviolet (UV) spectroscopy and galaxy multi-object spectroscopy (Paper I). The measurements are made in 2D redshift space out to π = 20h-1 Mpc (comoving) along the LOS and out to σ = 2h-1 Mpc projected; as a function of HI column density in the range NHI = 1013-1019cm-2, also for CIV absorption systems, and as a function of galaxy spectral type. This extends the absorber-galaxy pair analysis of Paper I. We find that the amplitude of the peak in ξAG at the smallest separations increases slowly as the lower limit on NHI is increased from 1013 to 1016cm-2, and then jumps sharply (albeit with substantial uncertainties) for NHI > 1017cm-2. For CIV absorbers, the peak strength of ξAG is roughly comparable to that of HI absorbers with NHI > 1016.5cm-2, consistent with the finding that the CIV absorbers are associated with strong HI absorbers. We do not reproduce the differences reported by Chen et al. between 1D ξAG measurements using galaxy subsamples of different spectral types. However, the full impact on the measurements of systematic differences in our samples is hard to quantify. We compare the observations with smoothed particle hydrodynamical (SPH) simulations and discover that in the observations ξAG is more concentrated to the smallest separations than in the simulations. The latter also display a `finger of god' elongation of ξAG along the LOS in redshift space, which is absent from our data, but similar to that found by Ryan-Weber for the cross-correlation of quasar absorbers and HI-emission-selected galaxies. The physical origin of these `fingers of god' is unclear, and we thus highlight several possible areas for further investigation.
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R. Kelman Wieder; Melanie A. Vile; Kimberli D. Scott; Cara M. Albright; Kelly J. McMillen; Dale H. Vitt; Mark E. Fenn
2016-01-01
Oil extraction and development activities in the Athabasca Oil Sands Region of northern Alberta, Canada, release NOx, SOx, and NHy to the atmosphere, ultimately resulting in increasing N and S inputs to surrounding ecosystems through atmospheric deposition. Peatlands are a major feature of the northern Alberta landscape, with bogs covering 6-10% of the land area, and...
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Infrastructure for Large-Scale Tests in Marine Autonomy
2012-02-01
suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis...8217+!0$%+()!()+($+!15+$! (#.%$&$)$-!%-!.BK*3$-(+$!$)&$-!.%$&$)+ *$+$+-3$)$$!. NHI
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Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?
Lo, H-Y; Yang, S-L; Lin, H-H; Bai, K-J; Lee, J-J; Lee, T-I; Chiang, C-Y
2016-03-01
The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients. Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.
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Resolving Fe-rich Neutral ISM in a Massive Quiescent Galaxy at z 0.4
NASA Astrophysics Data System (ADS)
Zahedy, Fakhri
2016-10-01
Roughly 40% of elliptical galaxies are found to contain cool gas but exhibit no on-going star formation, indicating that some feedback mechanisms are at work. While AGN feedback is commonly thought to be responsible for quenching star formation in massive halos, recent work has reiterated the importance of feedback from old stellar populations, including Type Ia supernovae (SNe Ia). In Zahedy et al. (2016), we reported detections of ultra-strong MgII absorption (>3.6 Ang) at 1-2 effective radii of a massive quiescent lensing galaxy at z=0.408. Strong MgII, FeII, MgI, and CaII absorption are found at the lens redshift along two lensed QSO sightlines separated by 8 kpc. The absorbers are resolved into 15 components with line-of-sight velocity spread of 600 km/s. The large observed ionic column densities, N>1e14 cm^-2 suggest large neutral hydrogen column densities N(HI)>1e18 cm^-2 and a significant neutral gas fraction. The most striking feature is the uniformly large Fe/Mg ratio across the full 600 km/s velocity range, suggesting a large contribution in chemical enrichment from SNe Ia (>20%). Here we propose QSO absorption-line spectroscopy of this unique system using STIS and the G140L grating with the slit oriented along the two lensed QSOs. The goal is to determine N(HI) from observations of the full Lyman absorption series and gas-phase metallicity of the interstellar medium at two locations separated by 8 kpc in an elliptical galaxy beyond the local universe. With a modest investment of HST time, we will be able to examine the extent SNe Ia-driven feedback in a distant quiescent galaxy using this unique double-lens system.
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Outpatient health care utilization of suicide decedents in their last year of life.
Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming
2012-08-01
The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care. © 2012 The American Association of Suicidology.
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FAST Mapping of Diffuse HI Gas in the Local Universe
NASA Astrophysics Data System (ADS)
Zhu, M.; Pisano, D. J.; Ai, M.; Jiao, Q.
2016-02-01
We propose to use the Five hundred meter Aperture Spherical radio Telescope (FAST) to map the diffuse intergalactic HI gas in the local universe at column densities of NHI=1018 cm-2 and below. The major science goal is to study gas accretion during galaxy evolution, and trace cosmic web features in the local universe. We disuss the technical feasibilty of such a deep survey, and have conducted test observations with the Arecibo 305 m telescope. Our preliminary results shows that, with about a few thousand hours of observing time, FAST will be able to map several hundred square degree regions at 1 σ of NHI=2×1017 cm-2 level out to a distance of 5-10 Mpc, and with a volume 1000 larger than that of the Local Group.
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1994-06-23
were studied as-cast and for pertItgoal FsI cNhi,, measured in the prsenlt work and calcult•ted for the after annealing for four days at 1000 ’C and...H. Eschrig MGP Research Group "Electron Systems," Technical University Dresden, D-01062 Dresden, Germany Magnetic and specific-heat studies of U2T2X...University, Kazan 420 008, Russia The phase transition in the continual random n-component Potts model is studied by the renormalization group method. It is
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Implementation of a commercial-grade dedication program - Benefits and lessons learned
DOE Office of Scientific and Technical Information (OSTI.GOV)
Harrington, M.; MacFarlane, I.
1991-01-01
The recent issuance of industry guidelines, the Nuclear Management and Resources Council procurement initiative, and a US Nuclear Regulatory Commission NRC generic letter on commercial-grade item dedication (CGD) has been viewed by many utility managers and executives as only adding to the existing burden of compliance with regulatory requirements. While the incorporation of these documents into existing CGD programs has created additional costs, the resulting enhanced dedication programs have also produced benefits beyond regulatory compliance, and some lessons have been learned. This paper discusses the benefits and the lessons learned during implementation of an enhanced CGD program at New Hampshiremore » Yankee's (NHY's) Seabrook nuclear plant. Based on NHY's experience, it is believed that the benefits described in this paper can be realized by other utilities implementing CGD programs.« less
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Wu, Hua-Bo; Xiao, De-Sheng
2017-03-06
We investigated the effects of aerobic exercise (AE) on trace element contents and redox status in the striatum of rats with different diet iron. Weaned female rats were randomly fed with iron-adequate diet (IAD), iron-deficient diet (IDD), and iron-overloaded diet (IOD). After feeding their respective diet for 1 month, the rats fed with same diet were divided into swimming and maintaining sedentary (S) group. After 3 months, the non-heme iron (NHI), Mn, Cu, and Zn in the striatum were measured. Meanwhile, malonaldehyde acid (MDA), total superoxide dismutase activity, hydroxyl radical scavenging activity, and total antioxidant capacity were also analyzed. As compared with respective S rats, Mn, Cu, and Zn contents were significantly decreased in IDDE, but no significantly changes could be seen in IADE or IODE. A negative correlation of NHI with Cu contents in IDDE and positive correlations of NHI with Cu, or Zn contents in IADE, or with Mn or Cu contents in IODE were observed. In addition, striatum MDA was significantly decreased and anti-oxidative variables were increased in IODE compared to IODS. Our results suggest that the modification of trace elements and redox status in the striatum of rats caused by AE depends on dietary iron contents and that AE may also regulate the metabolic relationship of iron storage with other trace elements. Copyright © 2017 Elsevier B.V. All rights reserved.
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Use of Chinese medicine by women with breast cancer: a nationwide cross-sectional study in Taiwan.
Lin, Yi-Hsien; Chiu, Jen-Hwey
2011-06-01
The National Health Insurance (NHI) provided Western medicine (WM) and Chinese medicine (CM) in Taiwan. This study aims to explore CM use by women with breast cancer under NHI. Using NHI Research Database, a retrospective cross-sectional study was conducted. Women with breast cancer were identified by diagnosis codes. Their claims of CM and WM outpatient services of 2007 were analyzed. Among 70,012 female breast cancer patients, the prevalence of insurance covered CM was 35.6%. Among all CM users, 4379 (17.5%) patients visited CM for breast cancer. More than half CM users (67.6%) had less than 6 visits and 16.3% users had more than 12 visits. The majority of CM users (87.6%) also used WM ambulatory services. Private clinics (76.7%) provided the most CM services, followed by private hospitals (16.9%). The most frequently used CM therapies were Chinese herbal medicine (80.5%), followed by acupuncture/traumatology manipulative therapies (22.3%). The average cost of CM was US$17.6 per visit and US$119.7 per user annually. CM users were more likely to be younger than 60 years old, employees, with higher income, and not living in Northern Taiwan. A significant portion of breast cancer patients used insurance covered CM. Most CM users also used WM. The potential of drug-herb interactions should be concerned. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Chang, Chao-Kai; Xirasagar, Sudha; Chen, Brian; Hussey, James R; Wang, I-Jong; Chen, Jen-Chieh; Lian, Ie-Bin
2015-01-01
Third-party payer systems are consistently associated with health care cost escalation. Taiwan's single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists' response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance-financed health care system. © The Author(s) 2015.
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Han, Kyu-Tae; Kim, Jeeyun; Nam, Chung Mo; Moon, Ki Tae; Lee, Sang Gyu; Kim, Seung Ju; Ju, Yeong Jun; Kwon, Jeoung A; Kim, Sun Jung; Kim, Woorim; Park, Eun-Cheol
2016-06-01
Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Provider Behavior Under Global Budgeting and Policy Responses
Chang, Chao-Kai; Xirasagar, Sudha; Chen, Brian; Hussey, James R.; Wang, I-Jong; Chen, Jen-Chieh; Lian, Ie-Bin
2015-01-01
Third-party payer systems are consistently associated with health care cost escalation. Taiwan’s single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance–financed health care system. PMID:26324511
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Chen, Chih-Chuan; Chen, Li-Sheng; Yen, Ming-Fang; Chen, Hsiu-Hsi; Liou, Horng-Huei
2012-02-01
We studied geographic variation in age- and gender-specific prevalence and incidence of epilepsy in four different areas of Taiwan. By using large-scale, National Health Insurance (NHI)-based data from 2000-2003 in Taiwan, we identified 131,287 patients diagnosed with epilepsy (ICD code 345) receiving at least of one of 11 antiepileptic drugs (AEDs). Information on age, gender, and location were also collected. The multivariable Poisson regression analysis was used to assess the heterogeneity of the morbidity of epilepsy in different regions. External data validation was also performed to assess the accuracy of capturing epilepsy cases through our NHI data set. The age-adjusted prevalence and incidence of epilepsy were 5.85 (per 1,000) between 2000 and 2003 and 97 (per 100,000 person-years) during the follow-up time from 2001 to 2003 in Taiwan. The sensitivity and specificity of ICD-9 coding for epilepsy in the NHI data set were 83.91% and 99.83%, respectively, resulting in a slight overestimation. Male patients had a higher probability of having epilepsy than did females. East Taiwan had significantly higher prevalence and incidence than did other areas. The age-specific incidence pattern in east Taiwan was atypical in that it revealed clustering in young and middle-aged groups. Our study demonstrated geographic variation in epidemiologic patterns of epilepsy within Taiwan. The findings are informative and provide insight into the clinical management of epilepsy based on consideration of different target groups in different areas. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.
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The influence of sense-contingent argument structure frequencies on ambiguity resolution in aphasia.
Huck, Anneline; Thompson, Robin L; Cruice, Madeline; Marshall, Jane
2017-06-01
Verbs with multiple senses can show varying argument structure frequencies, depending on the underlying sense. When acknowledge is used to mean 'recognise', it takes a direct object (DO), but when it is used to mean 'admit' it prefers a sentence complement (SC). The purpose of this study was to investigate whether people with aphasia (PWA) can exploit such meaning-structure probabilities during the reading of temporarily ambiguous sentences, as demonstrated for neurologically healthy individuals (NHI) in a self-paced reading study (Hare et al., 2003). Eleven people with mild or moderate aphasia and eleven neurologically healthy control participants read sentences while their eyes were tracked. Using adapted materials from the study by Hare et al. target sentences containing an SC structure (e.g. He acknowledged (that) his friends would probably help him a lot) were presented following a context prime that biased either a direct object (DO-bias) or sentence complement (SC-bias) reading of the verbs. Half of the stimuli sentences did not contain that so made the post verbal noun phrase (his friends) structurally ambiguous. Both groups of participants were influenced by structural ambiguity as well as by the context bias, indicating that PWA can, like NHI, use their knowledge of a verb's sense-based argument structure frequency during online sentence reading. However, the individuals with aphasia showed delayed reading patterns and some individual differences in their sensitivity to context and ambiguity cues. These differences compared to the NHI may contribute to difficulties in sentence comprehension in aphasia. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Wen, Tsun-Jen; Wen, Yu-Wen; Chien, Chun-Ru; Chiang, Shao-Chin; Hsu, William Wei-Yuan; Shen, Li-Jiuan; Hsiao, Fei-Yuan
2017-04-01
The beneficial effects of granulocyte colony-stimulating factor (G-CSF) prophylaxis on reducing the risk of chemotherapy-induced febrile neutropenia (CIFN) were well documented throughout the literature. However, existing data regarding its cost-effectiveness were conflicting. We estimated the cost-effectiveness of G-CSF prophylaxis in CIFN under Taiwan's National Health Insurance (NHI) system. Data on clinical outcomes and direct medical costs were derived for 5179 newly diagnosed breast cancer and 629 non-Hodgkin's lymphoma (NHL) patients from the NHI claims database. Patients were further categorized into three subgroups as "primary-", "secondary-" and "no -" prophylaxis based on their patterns of G-CSF use. Generalized estimating equations were applied to estimate the impact of G-CSF use on the incidence of CIFN. The incremental cost-effectiveness ratios of primary and secondary prophylactic G-CSF use were calculated and sensitivity analyses were performed. Primary prophylaxis of G-CSF decreased the incidence of CIFN by 27% and 83%, while secondary prophylaxis by 34% and 22% in breast cancer and NHL patients, respectively. Compared with those with no prophylaxis, the incremental cost per CIFN reduced in primary prophylaxis is $931 and $52 among patients with breast cancer and NHL, respectively. In contrast, secondary prophylaxis is dominated by no prophylaxis and primary prophylaxis in both cancer patients. Primary but not secondary prophylactic use of G-CSF was cost-effective in CIFN in breast cancer and NHL patients under Taiwan's NHI system. © 2016 John Wiley & Sons, Ltd.
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Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang
2016-11-01
To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.
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Lea, Michael A; Guzman, Yolanda; Desbordes, Charles
2016-04-01
Enhanced glycolysis in cancer cells presents a target for chemotherapy. Previous studies have indicated that proliferation of cancer cells can be inhibited by treatment with phenformin and with an inhibitor of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB) namely 3-(3-pyridinyl)-1-(4-pyridinyl)-2-propen-1-one (3PO). In the present work, the action of two inhibitors that are effective at lower concentrations than 3PO, namely 1-(3-pyridinyl)-3-(2-quinolinyl)-2-propen-1-one (PQP) and 1-(4-pyridinyl)-3-(2-quinolinyl)-2-propen-1-one (PFK15) were investigated. The inhibitors of lactate dehydrogenase (LDHA) studied in order of half-maximal inhibitory concentrations were methyl 1-hydroxy-6-phenyl-4-(trifluoromethyl)-1H-indole-2-carboxylate (NHI-2) < isosafrole < oxamate. In colonic and bladder cancer cells, additive growth inhibitory effects were seen with the LDHA inhibitors, of which NHI-2 was effective at the lowest concentrations. Growth inhibition was generally greater with PFK15 than with PQP. The increased acidification of the culture medium and glucose uptake caused by phenformin was blocked by combined treatment with PFKFB3 or LDHA inhibitors. The results suggest that combined treatment with phenformin and inhibitors of glycolysis can cause additive inhibition of cell proliferation and may mitigate lactic acidosis caused by phenformin when used as a single agent. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
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Jehu-Appiah, Caroline; Aryeetey, Genevieve; Spaan, Ernst; Agyepong, Irene; Baltussen, Rob
2010-05-01
This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana. Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making. We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.
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ERIC Educational Resources Information Center
Ginzberg, Eli
1975-01-01
A National Health Insurance (NHI) bill is discussed. Such a law would address primarly two issues: financial coverage for catastrophic illness and some broadening of entitlements for ambulatory care. Current need, financial support, Federal and local planning and priority objectives are reviewed. (Author/EB)
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Suchman, Lauren; Hart, Elizabeth; Montagu, Dominic
2018-06-13
Social health insurance (SHI), one mechanism for achieving universal health coverage, has become increasingly important in low- and middle-income countries (LMICs) as they work to achieve this goal. Although small private providers supply a significant proportion of healthcare in LMICs, integrating these providers into SHI systems is often challenging. Public-private partnerships in health are one way to address these challenges, but we know little about how these collaborations work, how effectively, and why. Drawing on semi-structured interviews conducted with National Health Insurance (NHI) officials in Kenya and Ghana, as well as with staff from several international NGOs (INGOs) representing social franchise networks that are partnering to increase private provider accreditation into the NHIs, this article examines one example of public-private collaboration in practice. We found that interviewees initially had incomplete knowledge about the potential for cross-sector synergy, but both sides were motivated to work together around shared goals and the potential for mutual benefit. The public-private relationship then evolved over time through regular face-to-face interactions, reciprocal feedback, and iterative workplan development. This process led to a collegial relationship that also has given small private providers more voice in the health system. In order to sustain this relationship, we recommend that both public and private sector representatives develop formalized protocols for working together, as well as less formal open channels for communication. Models for aggregating small private providers and delivering them to government programmes as a package have potential to facilitate public-private partnerships as well, but there is little evidence on how these models work in LMICs thus far.
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Gender difference in the effect of progesterone on neonatal hypoxic/ischemic brain injury in mouse.
Dong, Shuyu; Zhang, Qian; Kong, Delian; Zhou, Chao; Zhou, Jie; Han, Jingjing; Zhou, Yan; Jin, Guoliang; Hua, Xiaodong; Wang, Jun; Hua, Fang
2018-08-01
This study investigated the effects of progesterone (PROG) on neonatal hypoxic/ischemic (NHI) brain injury, the differences in effects between genders, and the underlying mechanisms. NHI brain injury was established in both male and female neonatal mice induced by occlusion of the left common carotid artery followed by hypoxia. The mice were treated with PROG or vehicle. Fluoro-Jade B staining (F-JB), long term behavior testing, and brain magnetic resonance image (MRI) were applied to evaluate neuronal death, neurological function, and brain damage. The underlying molecular mechanisms were also investigated by Western blots. The results showed that, in the male mice, administration of PROG significantly reduced neuronal death, improved the learning and memory function impaired by cerebral HI, decreased infarct size, and maintained the thickness of the cortex after cerebral HI. PROG treatment, however, did not show significant neuroprotective effects on female mice subjected to HI. In addition, the data demonstrated a gender difference in the expression of tumor necrosis factor receptor 1 (TNFR1), TNF receptor associated factor 6 (TRAF6), Fas associated protein with death domain (FADD), and TIR-domain-containing adapter-inducing interferon-β (TRIF) between males and females. Our results indicated that treatment with PROG had beneficial effects on NHI injured brain in acute stage and improved the long term cognitive function impaired by cerebral HI in male mice. In addition, the activation of TNF and TRIF mediated signaling in response to cerebral HI and the treatment of PROG varied between genders, which highly suggested that gender differences should be emphasized in evaluating neonatal HI brain injury and PROG effects, as well as the underlying mechanisms. Copyright © 2018 Elsevier Inc. All rights reserved.
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Cost-effectiveness of diabetes pay-for-performance incentive designs.
Hsieh, Hui-Min; Tsai, Shu-Ling; Shin, Shyi-Jang; Mau, Lih-Wen; Chiu, Herng-Chia
2015-02-01
Taiwan's National Health Insurance (NHI) Program implemented a diabetes pay-for-performance program (P4P) based on process-of-care measures in 2001. In late 2006, that P4P program was revised to also include achievement of intermediate health outcomes. This study examined to what extent these 2 P4P incentive designs have been cost-effective and what the difference in effect may have been. Analyzing data using 3 population-based longitudinal databases (NHI's P4P dataset, NHI's claims database, and Taiwan's death registry), we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in each phase. Propensity score matching was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings, and incremental cost-effectiveness ratios. QALYs for P4P patients and non-P4P patients were 2.08 and 1.99 in phase 1 and 2.08 and 2.02 in phase 2. The average incremental intervention costs per QALYs was TWD$335,546 in phase 1 and TWD$298,606 in phase 2. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD$602,167 in phase 1 and TWD$661,163 in phase 2. The findings indicated that both P4P programs were cost-effective and the resulting return on investment was 1.8:1 in phase 1 and 2.0:1 in phase 2. We conclude that the diabetes P4P program in both phases enabled the long-term cost-effective use of resources and cost-savings regardless of whether a bonus for intermediate outcome improvement was added to a process-based P4P incentive design.
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2010-01-01
Background Using non-steroidal anti-inflammatory drugs (NSAIDs) as a case, we used Taiwan's National Health Insurance (NHI) database, to empirically explore the association between policy interventions (price regulation, new drug entry, and an information shock) and drug expenditures, utilization, and market structure between 2001 and 2004. Methods All NSAIDs prescribed in ambulatory visits in the NHI system during our study period were included and aggregated quarterly. Segmented regression analysis for interrupted time series was used to examine the associations between two price regulations, two new drug entries (cyclooxygennase-2 inhibitors) and the rofecoxib safety signal and expenditures and utilization of all NSAIDs. Herfindahl index (HHI) was applied to further examine the association between these interventions and market structure of NSAIDs. Results New entry was the only variable that was significantly correlated with changes of expenditures (positive change, p = 0.02) and market structure of the NSAIDs market in the NHI system. The correlation between price regulation (first price regulation, p = 0.62; second price regulation, p = 0.26) and information shock (p = 0.31) and drug expenditure were not statistically significant. There was no significant change in the prescribing volume of NSAIDs per rheumatoid arthritis (RA) or osteoarthritis (OA) ambulatory visit during the observational period. The market share of NSAIDs had also been largely substituted by these new drugs up to 50%, in a three-year period and resulted in a more concentrated market structure (HHI 0.17). Conclusions Our empirical study found that new drug entry was the main driving force behind escalating drug spending, especially by altering the market share. PMID:20653979
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Caldwell, R I; Aldous, C
2016-12-21
According to the Constitution of South Africa (SA), citizens living in remote areas are entitled to the same level of healthcare as those with access to tertiary hospitals. Specialist outreach has been shown to achieve this. When SA's National Health Services Commission convened (1942 - 1944), Gluckman summarised: 'Where the need is greatest the supply of hospitals is least.' Primary healthcare (PHC) characterised the Kark's Pholela Health Centre and was highly regarded. Although PHC underpins National Health Insurance (NHI) planning, both preventive and curative healthcare are needed. The KwaZulu-Natal (KZN) provincial Department of Health and the University of KZN College of Health Sciences' 5-year plan for a decentralised clinical teaching platform (DCTP) is ambitious, requiring optimum co-operation between health department and university. Reservations can be addressed through sustained specialist outreach. Above all, the patient mustbe the chief beneficiary. The NHI and DCTP overlap with specialist outreach, but cannot do without it.
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The incidence of health financing in South Africa: findings from a recent data set.
Ataguba, John E; McIntyre, Di
2018-01-01
There is an international call for countries to ensure universal health coverage. This call has been embraced in South Africa (SA) in the form of a National Health Insurance (NHI). This is expected to be financed through general tax revenue with the possibility of additional earmarked taxes including a surcharge on personal income and/or a payroll tax for employers. Currently, health services are financed in SA through allocations from general tax revenue, direct out-of-pocket payments, and contributions to medical scheme. This paper uses the most recent data set to assess the progressivity of each health financing mechanism and overall financing system in SA. Applying standard and innovative methodologies for assessing progressivity, the study finds that general taxes and medical scheme contributions remain progressive, and direct out-of-pocket payments and indirect taxes are regressive. However, private health insurance contributions, across only the insured, are regressive. The policy implications of these findings are discussed in the context of the NHI.
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Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih
2008-03-29
Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998-1999 was about 6.54 times of that in 1990-1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities.
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Shen, Cheng-Che; Yang, Albert C; Hung, Jeng-Hsiu; Hu, Li-Yu; Tsai, Shih-Jen
2015-01-01
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. We used a nationwide population-based retrospective cohort study to explore the relationship between PCOS and the subsequent development of gynecological cancers including uterine, breast, or ovarian cancer. We identified subjects who were diagnosed with PCOS between January 1, 2000, and December 31, 2004, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed for patients without known PCOS who were also matched according to age. All PCOS and control patients were observed until diagnosed with breast cancer, ovarian cancer, or uterine cancer or until death, withdrawal from the NHI system, or December 31, 2009. The PCOS cohort consisted of 3,566 patients, and the comparison cohort consisted of 14,264 matched control patients without PCOS. The adjusted hazard ratio (HR) of uterine cancer and breast cancer in subjects with PCOS were higher (HR: 8.42 [95% confidence interval: 1.62-43.89] and HR: 1.99 [95% confidence interval: 1.05-3.77], respectively) than that of the controls during the follow-up. With the Monte Carlo method, only the mean adjusted HR of 1,000 comparisons for developing uterine cancer during the follow-up period was greater for the PCOS group than for the control groups (HR: 4.71, 95% confidence interval: 1.57-14.11). PCOS might increase the risk of subsequent newly diagnosed uterine cancer. It is critical that further large-scale, well-designed studies be conducted to confirm the association between PCOS and gynecological cancer risk. ©AlphaMed Press.
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Code of Federal Regulations, 2010 CFR
2010-04-01
... 23 Highways 1 2010-04-01 2010-04-01 false Selection. 260.109 Section 260.109 Highways FEDERAL... PROGRAMS Fellowship and Scholarship Grants § 260.109 Selection. (a) Candidates shall be rated by a selection panel appointed by the Director of the NHI. Members of the panel shall represent the highway...
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Targeting Prostate Cancer Metastasis
2015-09-01
Washington HeadQuarters Services, Directorate for lnformatiion Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Allington...r egulator in contr olling metastasis of p r ost a t e cancer and i nhi b i t i ng i t prevent s met ast asis . There are no drugs available to tar
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"The Neurosis That Has Possessed Us": Political Repression in the Cold War Medical Profession.
Chowkwanyun, Merlin
2018-04-27
Political repression played a central role in shaping the political complexion of the American medical profession, the policies it advocated, and those allowed to function comfortably in it. Previous work on the impact of McCarthyism and medicine focuses heavily on the mid-century failure of national health insurance (NHI) and medical reform organizations that suffered from McCarthyist attacks. The focus is national and birds-eye but says less about the impact on day-to-day life of physicians caught in a McCarthyist web; and how exactly the machinery of political repression within the medical profession worked on the ground. This study shifts orientation by using the abrupt dismissal of three Los Angeles physicians from their jobs as a starting point for exploring these dynamics. I argue that the rise of the medical profession and the repressive state in the mid-century, frequently studied apart, worked hand-in-hand, with institutions from each playing symbiotic and mutually reinforcing roles. I also explore tactics of resistance - rhetorical and organizational - to medical repression by physicians who came under attack.
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An essential hospital package for South Africa--selection criteria, costs and affordability.
Söderlund, N
1999-07-01
In 1995 the Committee of Enquiry into National Health Insurance (NHI) recommended that formally employed individuals and their employers be required to fund at least a minimum package of hospital cover for workers and their dependents. This has recently been echoed in a Department of Health policy paper on social health insurance. This research aims to define and cost a minimum package of essential hospital care for competing (public and private) health insurers in South Africa. CRITERIA FOR PACKAGE DEFINITION: Based on the objectives implict in the NHI Committee report, the following criteria were used to define the essential package: (i) the extent to which there was another appropriate responsible party who should pay for treatment; (ii) the degree of discretion in deciding whether or not to provide treatment (roughly equivalent to 'urgency'); and (iii) the cost and effectiveness of treatment. On the basis of the above criteria, 396 out of 598 possible interventions were included in the package. Using local mine hospital and private sector utilisation rates and mine hospital cost data, it was estimated that the essential inpatient package would cost around R502 per enrollee per year, using 1998 prices, for a working age population and their dependents. Age-sex standardised outpatient care costs in the mine hospital population studied were estimated at R183 per person per year. It was therefore estimated that the total inpatient and outpatient hospital package would cost around R685 per person per year. The results presented in this paper are intended to inform the process of defining a national essential hospital benefit package. Assuming that contributions were proportionally related to income, and that costs should not exceed 6% of wages, the package should be affordable to all of those earning above R20,000 per year. Significant additional work is required, firstly at a technical level to assess the appropriateness of the prioritization approach used here, and secondly to take the debate around essential hospital benefits to broader political and public forums.
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Psychologists Back Women, Chuck Magazine, Gear up for NHI
ERIC Educational Resources Information Center
Science, 1977
1977-01-01
Last year the American Psychological Association (APA) voted not to hold future conventions in states where the Equal Rights Amendment has not been passed. At its annual meeting, the APA also decided not to print a quarterly psychology magazine. Meeting emphasis concerning psychotherapy was in anticipation of Natural Health Insurance. (MA)
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Huang, Chun-Che; Li, Chung-Yi; Yang, Chiang-Hsing
2012-07-01
The study aimed to assess the number of medically indicated and elective cesarean deliveries among foreign-born and native-born mothers in Taiwan. National Health Insurance (NHI) inpatient datasets in Taiwan between 2001 and 2003 showed 673,830 singleton deliveries, of which 66,687 were to foreign-born mothers and 607,143 were to Taiwan-born mothers. Univariate and multivariate logistic regression models were used to estimate the likelihood of using inpatient services for medically indicated and elective cesarean delivery. During the study period, foreign-born mothers were significantly less likely to undergo medically indicated (odds ratio [OR], 0.82; 95% confidence interval (95% CI), 0.79-0.85) and elective (OR, 0.50; 95% CI, 0.47-0.53) cesarean delivery than Taiwan-born mothers after adjusting for clinical and nonclinical factors. Foreign-born mothers aged 18-50 years are less likely to undergo medically indicated and elective cesarean delivery under Taiwan's NHI coverage. As the birth rate for immigrant women increases, cross-cultural maternity care during pregnancy and childbirth for immigrant mothers needs to be addressed.
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Luchsinger, José A; Burgio, Louis; Mittelman, Mary; Dunner, Ilana; Levine, Jed A; Kong, Jian; Silver, Stephanie; Ramirez, Mildred; Teresi, Jeanne A
2016-01-01
Introduction The prevalence of dementia is increasing without a known cure, resulting in an increasing number of informal caregivers. Caring for a person with dementia results in increased stress and depressive symptoms. There are several behavioural interventions designed to alleviate stress and depressive symptoms in caregivers of persons with dementia with evidence of efficacy. Two of the best-known interventions are the New York University Caregiver Intervention (NYUCI) and the Resources for Enhancing Alzheimer's Caregivers Health (REACH). The effectiveness of the NYUCI and REACH has never been compared. There is also a paucity of data on which interventions are more effective in Hispanics in New York City. Thus, we proposed the Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE), a pragmatic clinical trial designed to compare the effectiveness of adaptations of the NYUCI and the REACH in informal Hispanic caregivers of persons with dementia in New York City. Methods and analysis NHiCE is a 6-month randomised controlled trial comparing the effectiveness of adaptations of the NYUCI and REACH among 200 Hispanic informal adult caregivers of persons with dementia. The planned number of sessions of the NYUCI and REACH are similar. The primary outcome measures are changes from baseline to 6 months in the Zarit Caregiver Burden Scale and Geriatric Depression Scale. Our primary approach to analyses will be intent-to-treat. The primary analyses will use mixed random effects models, and a full information maximum likelihood approach, with sensitivity analyses using generalised estimating equation. Ethics and dissemination NHiCE is approved by the Institutional Review Board of Columbia University Medical Center (protocol AAAM5150). A Data Safety Monitoring Board monitors the progress of the study. Dissemination will include reports of the characteristics of the study participants, as well as a report of the results of the clinical trial. Trial registration number NCT02092987, Pre-results. PMID:27888180
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Lyu, S; Arends, D; Nassar, M K; Brockmann, G A
2017-06-01
In our previous research, QTL analysis in an F 2 cross between the inbred New Hampshire (NHI) and White Leghorn (WL77) lines revealed a growth QTL in the distal part of chromosome 4. To physically reduce the chromosomal interval and the number of potential candidate genes, we performed fine mapping using individuals of generations F 10 , F 11 and F 12 in an advanced intercross line that had been established from the initial F 2 mapping population. Using nine single nucleotide polymorphism (SNP) markers within the QTL region for an association analysis with several growth traits from hatch to 20 weeks and body composition traits at 20 weeks, we could reduce the confidence interval from 26.9 to 3.4 Mb. Within the fine mapped region, markers rs14490774, rs314961352 and rs318175270 were in full linkage disequilibrium (D' = 1.0) and showed the strongest effect on growth and muscle mass (LOD ≥ 4.00). This reduced region contains 30 genes, compared to 292 genes in the original region. Chicken 60 K and 600 K SNP chips combined with DNA sequencing of the parental lines were used to call mutations in the reduced region. In the narrowed-down region, 489 sequence variants were detected between NHI and WL77. The most deleterious variants are a missense variant in ADGRA3 (SIFT = 0.02) and a frameshift deletion in the functional unknown gene ENSGALG00000014401 in NHI chicken. In addition, five synonymous variants were discovered in genes PPARGC1A, ADGRA3, PACRGL, SLIT2 and FAM184B. In our study, the confidence interval and the number of potential genes could be reduced 8- and 10- fold respectively. Further research will focus on functional effects of mutant genes. © 2017 Stichting International Foundation for Animal Genetics.
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Who pays for health care in Ghana?
2011-01-01
Background Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Methods Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Results Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. Conclusion For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced. PMID:21708026
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Venter, Fouche Hendrik Johannes; Wolfaardt, Jaqueline Elizabeth
2016-07-04
South Africa (SA) has limited scope for raising income taxes, and the proposed National Health Insurance (NHI) scheme will necessitate growth in the health sector budget. The NHI White Paper suggests five funding scenarios to meet the expected shortfall. These scenarios are a mixture of a surcharge on taxable income, an increase in value-added tax and a payroll tax. Five alternative options, suggested by the World Health Organization, are interrogated as ways to decrease the general taxation proposed in the White Paper. The five mechanisms (corporate tax, financial transaction levy, and taxes on tobacco, alcohol and unhealthy foods) were chosen based on their fund-raising potential and their mandatory element. A literature review provides the information for a discussion of the potential costs of each mechanism. Within specific assumptions, potential budgetary contribution is compared with the requirement. First, raising corporate tax rates could raise enough funds, but the losses due to capital flight might be too much for the local economy to bear. Second, a levy on currency transactions is unlikely to raise the required resources, even without a probable decrease in the number of transactions. Third, the increase in the tax on tobacco and alcohol would need to be very large, even assuming that consumption patterns would remain unchanged. Lastly, a tax on unhealthy food products is a new idea and could be explored as an option - especially as the SA Treasury has announced its future implementation. Implementing only one of the mechanisms is unlikely to increase available funding sufficiently, but if they are implemented together the welfare-maximising tax rate for each mechanism may be high enough to fulfil the NHI scheme's budgetary requirement, moderating the increases in the tax burden of the SA population.
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Private health insurance in South Korea: an international comparison.
Shin, Jaeun
2012-11-01
The goal of this study is to present the historical and policy background of the expansion of private health insurance in South Korea in the context of the National Health Insurance (NHI) system, and to provide empirical evidence on whether the increased role of private health insurance may counterbalance government financing, social security contributions, out-of-pocket payments, and help stabilize total health care spending. Using OECD Health Data 2011, we used a fixed effects model estimation. In this model, we allow error terms to be serially correlated over time in order to capture the association of private health insurance financing with three other components of health care financing and total health care spending. The descriptive observation of the South Korean health care financing shows that social security contributions are relatively limited in South Korea, implying that high out-of-pocket payments may be alleviated through the enhancement of NHI benefit coverage and an increase in social security contributions. Estimation results confirm that private health insurance financing is unlikely to reduce government spending on health care and social security contributions. We find evidence that out-of-pocket payments may be offset by private health insurance financing, but to a limited degree. Private health insurance financing is found to have a statistically significant positive association with total spending on health care. This indicates that the duplicated coverage effect on service demand may cancel out the potential efficiency gain from market initiatives driven by the active involvement of private health insurance. This study finds little evidence for the benefit of private insurance initiatives in coping with the fiscal challenges of the South Korean NHI program. Further studies on the managerial interplay among public and private insurers and on behavioral responses of providers and patients to a given structure of private-public financing are warranted to formulate the adequate balance between private health insurance and publicly funded universal coverage. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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Chang, Tien-Jyun; Jiang, Yi-Der; Chang, Chia-Hsiun; Chung, Ching-Hu; Yu, Neng-Chun; Chuang, Lee-Ming
2012-11-01
The prevalence of diabetes has increased worldwide. To obtain nationwide data on accountability and utilization of health resources among diabetes patients in Taiwan, an analysis of the claims data for the National Health Insurance (NHI) from 2000 to 2009 was conducted. One-third of the NHI claims database was randomly sampled from 2000 to 2009. Diabetes was defined by three or more outpatient visits with diagnostic codes [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): 250 or A code: A181] within 1 year, or one inpatient discharge diagnosis. Accountability items and NHI codes of various metabolic parameters and examinations were identified. Medical utilization was measured by the frequency and cost of care associated with ambulatory visits, hospitalizations, and emergency care within each year. The annual check-up frequency for various examinations significantly increased from 2000 to 2009. Both the average outpatient department (OPD) cost per diabetes patient/year and the average inpatient department (IPD) cost per time increased 1.34-fold in the past decade. The average OPD cost per diabetes patient and average IPD cost of each admission for diabetes patients was four times and 1.4 times compare with the general population, respectively. The annual average medical cost of each diabetes patient affected with both micro- and macrovascular complications was four times compared with those without vascular complications. There was an increasing trend for diabetes patients to visit regional hospital for OPD and IPD, whereas visits to the local hospital decreased in the past decade. Due to the increased frequency of annual check-ups after various examinations, the quality of diabetes management has improved in the past decade in Taiwan. As diabetes patients affected with both micro- and macrovascular complications incurred costs four times compared with those without complications, it is worth screening high-risk individuals to ensure earlier intervention and thus reduce diabetic complications and healthcare expenditure. Copyright © 2012. Published by Elsevier B.V.
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Who pays for health care in Ghana?
Akazili, James; Gyapong, John; McIntyre, Diane
2011-06-27
Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced.
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Cost-effectiveness analysis of carrier and prenatal genetic testing for X-linked hemophilia.
Tsai, Meng-Che; Cheng, Chao-Neng; Wang, Ru-Jay; Chen, Kow-Tong; Kuo, Mei-Chin; Lin, Shio-Jean
2015-08-01
Hemophilia involves a lifelong burden from the perspective of the patient and the entire healthcare system. Advances in genetic testing provide valuable information to hemophilia-affected families for family planning. The aim of this study was to analyze the cost-effectiveness of carrier and prenatal genetic testing in the health-economic framework in Taiwan. A questionnaire was developed to assess the attitudes towards genetic testing for hemophilia. We modeled clinical outcomes of the proposed testing scheme by using the decision tree method. Incremental cost-effectiveness analysis was conducted, based on data from the National Health Insurance (NHI) database and a questionnaire survey. From the NHI database, 1111 hemophilic patients were identified and required an average medical expenditure of approximately New Taiwan (NT) $2.1 million per patient-year in 2009. By using the decision tree model, we estimated that 26 potential carriers need to be tested to prevent one case of hemophilia. At a screening rate of 79%, carrier and prenatal genetic testing would cost NT $85.9 million, which would be offset by an incremental saving of NT $203 million per year by preventing 96 cases of hemophilia. Assuming that the life expectancy for hemophilic patients is 70 years, genetic testing could further save NT $14.2 billion. Higher screening rates would increase the savings for healthcare resources. Carrier and prenatal genetic testing for hemophilia is a cost-effective investment in healthcare allocation. A case management system should be integrated in the current practice to facilitate patient care (e.g., collecting family pedigrees and providing genetic counseling). Copyright © 2013. Published by Elsevier B.V.
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Chen, Likwang; Wahlqvist, Mark L; Teng, Nai-Chi; Lu, Hsin-Ming
2009-01-01
This study investigated the association between food insecurity and Taiwanese children's ambulatory medical care use for treating eighteen disease types linked to endocrine and metabolic disorders, nutrition, immunity, infections, asthma, mental health, injury, and poisoning. We used longitudinal data in the Taiwan National Health Insurance scheme (NHI) for 764,526 elementary children, and employed approximate NHI data to construct three indicators imputed to food insecurity: low birth weight status, economic status (poverty versus non-poverty), and time of year (summer break time versus semester time). We compared ambulatory care for these diseases between children with low birth weight and those not, and between children living in poverty and those not. A difference-in-differences method was adopted to examine the potential for a publicly- funded lunch program to reduce the harmful health effects of food insecurity on poor children. We found that children in poverty were significantly more likely to have ambulatory visits linked with diabetes, inherited disorders of metabolism, iron deficiency anemias, ill-defined symptoms concerning nutrition, metabolism and development, as well as mental disorders. Children with low birth weight also had a significantly higher likelihood of using care for other endocrine disorders and nutritional deficiencies, in addition to the above diseases. The study failed to find any significant effect of the semester school lunch program on alleviating the harmful health effects of food insecurity for poor children, suggesting that a more intensive food program or other program approaches might be required to help poor children overcome food insecurity and its related health outcomes.
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The shaping of pharmaceutical governance: the Israeli case.
Sax, Philip
2014-01-01
This article focuses on governance of the pharmaceutical sector in Israel. It traces the relationships between the state, industry, and sick funds from before the establishment of National Health Insurance (NHI) in 1995 to the beginning of this decade, in particular as they have grappled with the challenge of making national formulary decisions in a rational manner. Subsequent to the introduction of NHI there have been shifts in the modes and mix of governance. This research shows empirically that a relatively complex mix of hierarchical and network modes of governance can be successfully established over an extended period of time when flexibility is maintained through the implementation process. The system for defining and updating a standard basket of health services has coped well with the challenge of managing a range of difficult and potentially volatile stakeholder relationships in the pharmaceutical sector and of distancing ministers from controversies of funding and listing decisions. Government has succeeded in containing drug costs whilst still maintaining a basket of reimbursable drugs that, from an international perspective, is comprehensive and technologically advanced. On the other hand, network arrangements appear to have delayed the introduction of suitable accountability relationships and hindered their development. The state has traditionally played an intermediary role between unavoidable corporate interests of industry and sick funds, with little transparency and to the detriment of more pluralistic access to decision making. Governance arrangements in Israel appear to limit the potential and incentive of the state and the sick funds to realize their potential countervailing powers in subsidy and pricing decisions.
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The shaping of pharmaceutical governance: the Israeli case
2014-01-01
This article focuses on governance of the pharmaceutical sector in Israel. It traces the relationships between the state, industry, and sick funds from before the establishment of National Health Insurance (NHI) in 1995 to the beginning of this decade, in particular as they have grappled with the challenge of making national formulary decisions in a rational manner. Subsequent to the introduction of NHI there have been shifts in the modes and mix of governance. This research shows empirically that a relatively complex mix of hierarchical and network modes of governance can be successfully established over an extended period of time when flexibility is maintained through the implementation process. The system for defining and updating a standard basket of health services has coped well with the challenge of managing a range of difficult and potentially volatile stakeholder relationships in the pharmaceutical sector and of distancing ministers from controversies of funding and listing decisions. Government has succeeded in containing drug costs whilst still maintaining a basket of reimbursable drugs that, from an international perspective, is comprehensive and technologically advanced. On the other hand, network arrangements appear to have delayed the introduction of suitable accountability relationships and hindered their development. The state has traditionally played an intermediary role between unavoidable corporate interests of industry and sick funds, with little transparency and to the detriment of more pluralistic access to decision making. Governance arrangements in Israel appear to limit the potential and incentive of the state and the sick funds to realize their potential countervailing powers in subsidy and pricing decisions. PMID:24914409
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Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih
2008-01-01
Background Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. Conclusion We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities. PMID:18373869
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Estimating Mutual Information by Local Gaussian Approximation
2015-07-13
suggesstions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway...following conditions: lim N→∞ hi = 0 , lim N→∞ Nhi =∞, i = 1, 2, . . . , d. (9) Then the following holds: lim N→∞ E|f̂ (x)− f (x)| = 0 (10) lim N→∞ E|f̂ (x
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ERIC Educational Resources Information Center
Doyle, Timothy C.; And Others
A study was conducted to assess the impact of three anticipated changes in the health care system on the future requirements for registered nurses. The changes investigated were the introduction of national health insurance (NHI), the increased enrollment in health maintenance organizations (HMOs), and the reformulation of nursing roles. Following…
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Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life
ERIC Educational Resources Information Center
Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming
2012-01-01
The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901…
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Fusheini, Adam; Eyles, John
2016-10-07
Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. Yet ideological and practical issues make its achievement problematic.
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NASA Astrophysics Data System (ADS)
Lockman, Felix J.
This paper considers some effects of foreground Galactic gas on radiation received from extragalactic objects, with an emphasis on the use of the 21cm line to determine the total N(HI). In general, the opacity of the 21cm line makes it impossible to derive an accurate value of N(HI) by simply applying a formula to the observed emission, except in directions where there is very little interstellar matter. The 21cm line can be used to estimate the likelihood that there is significant molecular hydrogen in a particular direction, but carries little or no information on the amount of ionized gas, which can be a major source of foreground effects. Considerable discussion is devoted to the importance of small-scale angular structure in HI, with the conclusion that it will rarely contribute significantly to the total error compared to other factors (such as the effects of ionized gas) for extragalactic sight lines at high Galactic latitude. The direction of the Hubble/Chandra Deep Field North is used as an example of the complexities that might occur even in the absence of opacity or molecular gas.
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Kang, Hee-Chung; Hong, Jae-Seok
2011-08-16
With a greater emphasis on cost containment in many health care systems, it has become common to evaluate each physician's relative resource use. This study explored the major factors that influence the economic performance rankings of medical clinics in the Korea National Health Insurance (NHI) program by assessing the consistency between cost-efficiency indices constructed using different profiling criteria. Data on medical care benefit costs for outpatient care at medical clinics nationwide were collected from the NHI claims database. We calculated eight types of cost-efficiency index with different profiling criteria for each medical clinic and investigated the agreement between the decile rankings of each index pair using the weighted kappa statistic. The exclusion of pharmacy cost lowered agreement between rankings to the lowest level, and differences in case-mix classification also lowered agreement considerably. A medical clinic may be identified as either cost-efficient or cost-inefficient, even when using the same index, depending on the profiling criteria applied. Whether a country has a single insurance or a multiple-insurer system, it is very important to have standardized profiling criteria for the consolidated management of health care costs.
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Agency problems of global budget system in Taiwan's National Health Insurance.
Yan, Yu-Hua; Yang, Chen-Wei; Fang, Shih-Chieh
2014-05-01
The main purpose of this study was to investigate the agency problem presented by the global budget system followed by hospitals in Taiwan. In this study, we examine empirically the interaction between the principal: Bureau of National Health Insurance (BNHI) and agency: medical service providers (hospitals); we also describe actual medical service provider and hospital governance conditions from a agency theory perspective. This study identified a positive correlation between aversion to agency hazard (self-interest behavior, asymmetric information, and risk hedging) and agency problem risks (disregard of medical ethics, pursuit of extra-contract profit, disregard of professionalism, and cost orientation). Agency costs refer to BNHI auditing and monitoring expenditures used to prevent hospitals from deviating from NHI policy goals. This study also found agency costs negatively moderate the relationship between agency hazards and agency problems The main contribution of this study is its use of agency theory to clarify agency problems and several potential factors caused by the NHI system. This study also contributes to the field of health policy study by clarifying the nature and importance of agency problems in the health care sector. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Almualm, Yasmin; Alkaff, Sharifa Ezat; Aljunid, Syed; Alsagoff, Syed Sagoff
2013-05-14
This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrollment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered.
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Almualm, Yasmin; Alkaff, Sharifa Ezat; Aljunid, Syed; Alsagoff, Syed Sagoff
2013-01-01
This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrolment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered. PMID:23985101
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Chen, Chi-Liang; Chen, Likwang; Yang, Wei-Chih
2008-04-12
Controlling the growth of pharmaceutical expenditures is a major global challenge. Promotion of generic drug prescriptions or use is gaining increased support. There are substantial contextual differences in international experiences of implementing pharmaceutical policies related to generic drugs. Reporting these experiences from varied perspectives can inform future policy making. This study describes an experience of Taiwan, where patients with chronic (long-term) conditions are usually managed in hospitals and drugs are provided in this setting with costs reimbursed through the National Health Insurance (NHI). It investigates the effects of Taiwan's reimbursement rate adjustment based on chemical generic grouping in 2001. This research also demonstrates the use of micro-level longitudinal data to generate policy-relevant information. The research can be used to improve efficiency of health care resource use. We chose the three most-used classes of cardiovascular drugs for this investigation: beta blocking agents, calcium channel blockers mainly with vascular effects, and plain ACE inhibitors. For each drug class, we investigated changes in daily expense, consumption volume, and total expenditures from a pre-action period to a corresponding post-action period. We compared an exposure or "intervention" group of patients targeted by the action with a comparisonor "control" group of patients not targeted by the action. The data sources are a longitudinal database for 200,000 NHI enrolees, corresponding NHI registration data of health care facilities, and an archive recording all historical data on the reimbursement rates of drugs covered by the NHI. We adopted a fixed effects linear regression model to control for unobserved heterogeneity among patient-hospital groups. Additional descriptive statistics were applied to examine whether any inappropriate consumption of drugs in the three classes existed. The daily drug expense significantly decreased from the pre-action period to the post-action period for the exposure group. The average magnitudes of the decreases for the three classes of drugs mentioned above were 14.8%, 5.8% and 5.8%, respectively. In contrast, there was no reduction for the comparison group. The number of days of the prescription increased significantly from the pre- to the post-action period for both exposure and comparison groups. The total expense also significantly increased for both patient groups. For the exposure group, the average magnitudes of the growth in the total expenditure for the three classes of drugs were 47.7%, 60.0% and 55.3%, respectively. For the comparison group, they were 91.6%, 91.6% and 63.2%, respectively. After the action, approximately 50% of patients obtained more than 180 days of prescription drugs for a six-month period. The 2001 price adjustment action, based on generic grouping, significantly reduced the daily expense of each of the three classes of cardiovascular drugs. However, in response to this policy change, hospitals in Taiwan tended to greatly expand the volume of drugs prescribed for their regular patients. Consequently, the total expenditures for the three classes of drugs grew substantially after the action. These knock-on effects weakened the capability of the price adjustment action to control total pharmaceutical expenditures. This means that no saved resources were available for other health care uses. Such expansion of pharmaceutical consumption might also lead to inefficient use of the three drug classes: a large proportion of patients obtained more than one day of drugs per day in the post-action period, suggesting manipulation to increase reimbursement and offset price controls. We recommend that Taiwan's government use the NHI data to establish a monitoring system to detect inappropriate prescription patterns before implementing future policy changes. Such a monitoring system could then be used to deter hospitals from abusing their prescription volumes, making it possible to more effectively save health care resources by reducing drug reimbursement rates.
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ERIC Educational Resources Information Center
Lin, Jin-Ding; Lin, Ya-Wen; Yen, Chia-Feng; Loh, Ching-Hui; Chwo, Miao-Ju
2009-01-01
The purposes of the present study are to provide the first data on utilization, understanding and satisfaction of the National Health Insurance (NHI) premium subsidy for families of children with disabilities in Taipei. Data from the 2001 Taipei Early Intervention Utilization and Evaluation Survey for Aged 0-6 Children with Disabilities were…
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Mental disorders among workers in the healthcare industry: 2014 national health insurance data.
Kim, Min-Seok; Kim, Taeshik; Lee, Dongwook; Yook, Ji-Hoo; Hong, Yun-Chul; Lee, Seung-Yup; Yoon, Jin-Ha; Kang, Mo-Yeol
2018-01-01
Numerous studies have shown that healthcare professionals are exposed to psychological distress. However, since most of these studies assessed psychological distress using self-reporting questionnaires, the magnitude of the problem is largely unknown. We evaluated the risks of mood disorders, anxiety disorders, sleep disorders, and any psychiatric disorders in workers in healthcare industry using Korea National Health Insurance (NHI) claims data from 2014, which are based on actual diagnoses instead of self-evaluation. We used Korea 2014 NHI claims data and classified employees as workers in the healthcare industry, based on companies in the NHI database that were registered with hospitals, clinics, public healthcare, and other medical services. To estimate the standardized prevalence of the selected mental health disorders, we calculated the prevalence of diseases in each age group and sex using the age distribution of the Korea population. To compare the risk of selected mental disorders among workers in the healthcare industry with those in other industries, we considered age, sex, and income quartile characteristics and conducted propensity scored matching. In the matching study, workers in healthcare industry had higher odds ratios for mood disorders (1.13, 95% CI: 1.11-1.15), anxiety disorders (1.15, 95% CI: 1.13-1.17), sleep disorders (2.21, 95% CI: 2.18-2.24), and any psychiatric disorders (1.44, 95% CI: 1.43-1.46) than the reference group did. Among workers in healthcare industry, females had higher prevalence of psychiatric disorders than males, but the odds ratios for psychiatric disorders, compared to the reference group, were higher in male workers in healthcare industry than in females. The prevalence of mood disorders, anxiety disorders, sleep disorders, and all psychiatric disorders for workers in the healthcare industry was higher than that of other Korean workers. The strikingly high prevalence of sleep disorders could be related to the frequent night-shifts in these professions. The high prevalence of mental health problems among workers in healthcare industry is alarming and requires prompt action to protect the health of the "protectors."
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Allen-Unhammer, Anna; Wilson, Francis J H; Hestbaek, Lise
2016-01-01
The idea of chiropractors treating children is controversial, yet many parents seek chiropractic care for their children. The reasons for this are not well documented. Part one of this study aimed to document the profile of all paediatric patients consulting Norwegian chiropractors in 2013 using National Health Insurance data (NHI) with regards to age, gender and primary complaints. Part two aimed to provide a more detailed description of these patients in the form of a descriptive, paper-based survey. Part one involved Norwegian NHI data from 2013. Part two consisted of a year-long, paper-based survey. Chiropractors registered with the Norwegian chiropractic association (NKF) were invited to participate via email. Participating chiropractors were assigned one random month to collect data. All paediatric patients (or their parents) during that were asked to complete questionnaires containing information on presenting complaint, consequences of this complaint, age, and mode of referral. In general, there was good concordance between part one and two of the study in terms of age, gender and presenting complaint. The youngest children constituted the largest paediatric group in Norwegian chiropractic practice. Musculoskeletal problems were the most common reason for children visiting a chiropractor in all of the age categories, according to NHI data. Part two of the study found that one-third of young school children and adolescents reported pain lasting longer than 1-year. Eleven percent of children found that their complaint had severely affected their mood and 22 % felt their activities were very limited by their condition. Referrals from healthcare professionals were uncommon. The survey's results were based on 161 completed questionnaires, received from 15 % of the Norwegian chiropractors. Musculoskeletal problems constituted the most common presenting complaint for children and adolescents presenting to Norwegian chiropractors. A sizable proportion of children seemed to be adversely affected by their complaints in terms of low mood and limitations of daily activities. Chronic presentations were not uncommon. The small sample size of the survey demands that the results be interpreted with caution.
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Luchsinger, José A; Burgio, Louis; Mittelman, Mary; Dunner, Ilana; Levine, Jed A; Kong, Jian; Silver, Stephanie; Ramirez, Mildred; Teresi, Jeanne A
2016-11-25
The prevalence of dementia is increasing without a known cure, resulting in an increasing number of informal caregivers. Caring for a person with dementia results in increased stress and depressive symptoms. There are several behavioural interventions designed to alleviate stress and depressive symptoms in caregivers of persons with dementia with evidence of efficacy. Two of the best-known interventions are the New York University Caregiver Intervention (NYUCI) and the Resources for Enhancing Alzheimer's Caregivers Health (REACH). The effectiveness of the NYUCI and REACH has never been compared. There is also a paucity of data on which interventions are more effective in Hispanics in New York City. Thus, we proposed the Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE), a pragmatic clinical trial designed to compare the effectiveness of adaptations of the NYUCI and the REACH in informal Hispanic caregivers of persons with dementia in New York City. NHiCE is a 6-month randomised controlled trial comparing the effectiveness of adaptations of the NYUCI and REACH among 200 Hispanic informal adult caregivers of persons with dementia. The planned number of sessions of the NYUCI and REACH are similar. The primary outcome measures are changes from baseline to 6 months in the Zarit Caregiver Burden Scale and Geriatric Depression Scale. Our primary approach to analyses will be intent-to-treat. The primary analyses will use mixed random effects models, and a full information maximum likelihood approach, with sensitivity analyses using generalised estimating equation. NHiCE is approved by the Institutional Review Board of Columbia University Medical Center (protocol AAAM5150). A Data Safety Monitoring Board monitors the progress of the study. Dissemination will include reports of the characteristics of the study participants, as well as a report of the results of the clinical trial. NCT02092987, Pre-results. 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/.
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NASA Astrophysics Data System (ADS)
Zhu, Q.; Riley, W. J.; Tang, J.; Koven, C. D.
2016-01-01
Soil is a complex system where biotic (e.g., plant roots, micro-organisms) and abiotic (e.g., mineral surfaces) consumers compete for resources necessary for life (e.g., nitrogen, phosphorus). This competition is ecologically significant, since it regulates the dynamics of soil nutrients and controls aboveground plant productivity. Here we develop, calibrate and test a nutrient competition model that accounts for multiple soil nutrients interacting with multiple biotic and abiotic consumers. As applied here for tropical forests, the Nutrient COMpetition model (N-COM) includes three primary soil nutrients (NH4+, NO3- and POx; representing the sum of PO43-, HPO42- and H2PO4-) and five potential competitors (plant roots, decomposing microbes, nitrifiers, denitrifiers and mineral surfaces). The competition is formulated with a quasi-steady-state chemical equilibrium approximation to account for substrate (multiple substrates share one consumer) and consumer (multiple consumers compete for one substrate) effects. N-COM successfully reproduced observed soil heterotrophic respiration, N2O emissions, free phosphorus, sorbed phosphorus and NH4+ pools at a tropical forest site (Tapajos). The overall model uncertainty was moderately well constrained. Our sensitivity analysis revealed that soil nutrient competition was primarily regulated by consumer-substrate affinity rather than environmental factors such as soil temperature or soil moisture. Our results also imply that under strong nutrient limitation, relative competitiveness depends strongly on the competitor functional traits (affinity and nutrient carrier enzyme abundance). We then applied the N-COM model to analyze field nitrogen and phosphorus perturbation experiments in two tropical forest sites (in Hawaii and Puerto Rico) not used in model development or calibration. Under soil inorganic nitrogen and phosphorus elevated conditions, the model accurately replicated the experimentally observed competition among nutrient consumers. Although we used as many observations as we could obtain, more nutrient addition experiments in tropical systems would greatly benefit model testing and calibration. In summary, the N-COM model provides an ecologically consistent representation of nutrient competition appropriate for land BGC models integrated in Earth System Models.
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ERIC Educational Resources Information Center
Lee, Wui-Chiang; Chen, Tzeng-Ji
2012-01-01
The purpose of this study was to quantify morbidity burdens of children with intellectual disability (ID) and to examine its association with total medical utilization and expenditure on a national basis in Taiwan. People under 18 years of age that had been continuously enrolled in the National Health Insurance (NHI) between year 2008 and 2010…
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ERIC Educational Resources Information Center
Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An
2012-01-01
Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…
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Interaction of Chemical Agents with Nanoscale Molecular Junctions
2011-08-01
thiS burden to Department of Defense. Washilgton Headqualters Services. Directorate for lnformatie~n Operations and Reports (07()4.()188), 1215...The source of these contaminants were determined to be coming from the glovebox auxiliary vacuum pump, which normally operates continuously for...SAM- NHi NH2-SAM-Gold] molecular junction for analysis. In order to perform electron transport analysis of our nanoscale devices in a "real world
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Chang, Yu-Chia; Lin, Jin-Ding; Tung, Ho-Jui; Chiang, Po-Huang; Hsu, Shang-Wei
2014-02-01
This study analyzed the utilization and utilization determinants of outpatient physical therapy (PT) among children and adolescents with intellectual disabilities (ID) in Taiwan. A cross-sectional study was conducted to analyze 2007 national health insurance (NHI) claim data from 35,802 eighteen-year-old and younger persons with intellectual disabilities. A total of 3944 (11.02%) claimants received outpatient physical therapy. Variables that affected PT utilization included age, residence urbanization level, ID level, copayment status and major co-morbidity. The average annual PT visit frequency was 25.4 ± 33.0; pre-school children, claimants suffering from catastrophic disease and ID co-occurring with cerebral palsy had a higher mean cost per visit. Age, ID level, copayment status and co-morbidity were factors that influenced expenditure. Pre-school children, males, individuals who resided in the lowest urbanization areas and individuals with a catastrophic disease tended to use hospital services. The point prevalence of epilepsy and cerebral palsy were 12.10% and 19.80%, respectively. Despite the NHI program and government regulations to provide special services, the use of physical therapy for children and adolescents with intellectual disabilities was low, and the utilization decreased as the subjects aged. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Nassar, M K; Goraga, Z S; Brockmann, G A
2012-12-01
In order to identify genetic factors influencing muscle weight and carcass composition in chicken, a linkage analysis was performed with 278 F(2) males of reciprocal crosses between the extremely different inbred lines New Hampshire (NHI) and White Leghorn (WL77). The NHI line had been selected for high meat yield and the WL77 for low egg weight before inbreeding. Highly significant quantitative trait loci (QTL) controlling body weight and the weights of carcass, breast muscle, drumsticks-thighs and wings were identified on GGA4 between 151.5 and 160.5 cM and on GGA27 between 4 and 52 cM. These genomic regions explained 13.7-40.2% and 5.3-13.8% of the phenotypic F(2) variances of the corresponding traits respectively. Additional genome-wide highly significant QTL for the weight of drumsticks-thighs were mapped on GGA1, 5 and 7. Moreover, significant QTL controlling body weight were found on GGA2 and 11. The data obtained in this study can be used for increasing the mapping resolution and subsequent gene targeting on GGA4 and 27 by combining data with other crosses where the same QTL were found. © 2012 The Authors, Animal Genetics © 2012 Stichting International Foundation for Animal Genetics.
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Nassar, M K; Goraga, Z S; Brockmann, G A
2015-08-01
Reciprocal crosses between the inbred lines New Hampshire (NHI) and White Leghorn (WL77) comprising 579 F2 individuals were used to map QTL for body weight and composition. Here, we examine the growth performance until 20 weeks of age. Linkage analysis provided evidence for highly significant QTL on GGA1, 2, 4, 10 and 27 which had specific effects on early or late growth. The highest QTL effects, accounting for 4.6-25.6% of the phenotypic F2 variance, were found on the distal region of GGA4 between 142 and 170 cM (F ≥ 13.68). The NHI QTL allele increased body mass by 141.86 g at 20 weeks. Using body weight as a covariate in the analysis of body composition traits provided evidence for genes in the GGA4 QTL region affecting fat mass independently of body mass. The QTL effect size differed between sexes and depended on the direction of cross. TBC1D1, CCKAR and PPARGC1A are functional candidate genes in the QTL peak region. Our study confirmed the importance of the distal GGA4 region for chicken growth performance. The strong effect of the GGA4 QTL makes fine mapping and gene discovery feasible. © 2015 Stichting International Foundation for Animal Genetics.
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Goraga, Z S; Nassar, M K; Brockmann, G A
2012-04-01
A genome scan was performed to detect chromosomal regions that affect egg production traits in reciprocal crosses between two genetically and phenotypically extreme chicken lines: the partially inbred line New Hampshire (NHI) and the inbred line White Leghorn (WL77). The NHI line had been selected for high growth and WL77 for low egg weight before inbreeding. The result showed a highly significant region on chromosome 4 with multiple QTL for egg production traits between 19.2 and 82.1 Mb. This QTL region explained 4.3 and 16.1% of the phenotypic variance for number of eggs and egg weight in the F(2) population, respectively. The egg weight QTL effects are dependent on the direction of the cross. In addition, genome-wide suggestive QTL for egg weight were found on chromosomes 1, 5, and 9, and for number of eggs on chromosomes 5 and 7. A genome-wide significant QTL affecting age at first egg was mapped on chromosome 1. The difference between the parental lines and the highly significant QTL effects on chromosome 4 will further support fine mapping and candidate gene identification for egg production traits in chicken. © 2011 The Authors, Animal Genetics © 2011 Stichting International Foundation for Animal Genetics.
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Tan, Elise Chia-Hui; Pwu, Raoh-Fang; Chen, Duan-Rung; Yang, Ming-Chin
2014-03-01
In October 2001, a pay-for-performance (P4P) program for diabetes was implemented by the National Health Insurance (NHI), a single-payer program, in Taiwan. However, only limited information is available regarding the influence of this program on the patient's health-related quality of life. The aim of this study was to estimate the costs and consequences of enrolling patients in the P4P program from a single-payer perspective. A retrospective observational study of 529 diabetic patients was conducted between 2004 and 2005. The data used in the study were obtained from the National Health Interview Survey (NHIS) in Taiwan. Direct cost data were obtained from NHI claims data, which were linked to respondents in the NHIS using scrambled individual identification. The generic SF36 health instrument was employed to measure the quality-of-life-related health status and transformed into a utility index. Patients enrolled in the P4P program for at least 3 months were categorized as the P4P group. Following propensity score matching, 260 patients were included in the study. Outcomes included life-years, quality-adjusted life-years (QALYs), diabetes-related medical costs, overall medical costs, and incremental cost-effectiveness ratios (ICERs). A single-payer perspective was assumed, and costs were expressed in US dollars. Nonparametric bootstrapping was conducted to estimate confidence intervals for cost-effectiveness ratios. Following matching, no significant difference was noted between two groups with regard to the patients' age, gender, education, family income, smoking status, BMI, or whether insulin was used. The P4P group had an increase of 0.08 (95 % CI 0.077-0.080) in QALYs, and the additional diabetes-related medical cost was US$422.74 (95 % CI US$413.58-US$435.05), yielding an ICER of US$5413.93 (95 % CI US$5226.83-US$5562.97) per QALY gained. Our results provides decision makers with valuable information regarding the impact of the P4P program of diabetes care through a direct comparison of equivalent groups of patients receiving regular care. Under the single-payer NHI system, the use of financial incentives under the DM-P4P program may be an effective means to ensure the quality of follow-up treatment.
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A Cost-Sharing Exemption Program for Patients With Mental Illness in Taiwan: Who Enrolls?
Huang, Hsin-Hui; Chen, Chuan-Yu; Chou, Yiing-Jenq; Huang, Nicole
2015-11-01
The purpose of this study was to identify patient and provider characteristics associated with enrollment in a cost-sharing exemption program among people newly diagnosed as having schizophrenia. The study used a nationally representative sample from Taiwan's National Health Insurance (NHI) program. Enrollment in a cost-sharing exemption program among 1,824 individuals with schizophrenia was observed for one year and three years after the individuals received a diagnosis of schizophrenia for the first time. Generalized estimating equations were applied to estimate the effect of various patient and physician characteristics on the odds of enrollment. The one-year and three-year program enrollment rates were 52% and 58%, respectively. People ages 35 or older were significantly more likely to enroll compared with younger people. People with low incomes and people who were hospitalized for schizophrenia were significantly more likely to enroll. Regarding provider characteristics, patients cared for by psychiatrists (adjusted odds ratio [AOR]=1.10) or by psychiatric institutions (AOR=1.10) were significantly more likely to enroll in the cost-sharing exemption program within the first year of diagnosis. The results suggest that enrollment in the NHI's cost-sharing exemption program by people newly diagnosed as having schizophrenia was relatively low. The role of providers must not be overlooked. Effective strategies targeting high-risk subgroups for nonparticipation are necessary in addressing mental health parity.
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Guruprasad, K; Rajkumar, S
2000-06-01
The number of beta-turns in a representative set of 426 protein three-dimensional crystal structures selected from the recent Protein Data Bank has nearly doubled and the number of gamma-turns in a representative set of 320 proteins has increased over seven times since the previous analysis. Beta-turns (7153) and gamma-turns (911) extracted from these proteins were used to derive a revised set of type-dependent amino acid positional preferences and potentials. Compared with previous results, the preference for proline, methionine and tryptophan has increased and the preference for glutamine, valine, glutamic acid and alanine has decreased for beta-turns. Certain new amino acid preferences were observed for both turn types and individual amino acids showed turn-type dependent positional preferences. The rationale for new amino acid preferences are discussed in the light of hydrogen bonds and other interactions involving the turns. Where main-chain hydrogen bonds of the type NH(i + 3) --> CO(i) were not observed for some beta-turns, other main-chain hydrogen bonds or solvent interactions were observed that possibly stabilize such beta-turns. A number of unexpected isolated beta-turns with proline at i + 2 position were also observed. The NH(i + 2) --> CO(i) hydrogen bond was observed for almost all gamma-turns. Nearly 20% classic gamma-turns and 43% inverse gamma-turns are isolated turns.
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Sharma, Gangavaram V M; Nagendar, Pendem; Ramakrishna, Kallaganti V S; Chandramouli, Nagula; Choudhary, Madavi; Kunwar, Ajit C
2008-06-02
A new three-residue turn was serendipitously discovered in alpha/beta hybrid peptides derived from alternating C-linked carbo-beta-amino acids (beta-Caa) and L-Ala residues. The three-residue beta-alpha-beta turn at the C termini, nucleated by a helix at the N termini, resulted in helix-turn (HT) supersecondary structures in these peptides. The turn in the HT motif is stabilized by two H bonds-CO(i-2)-NH(i), with a seven-membered pseudoring (gamma turn) in the backward direction, and NH(i-2)-CO(i), with a 13-membered pseudoring in the forward direction (i being the last residue)--at the C termini. The study was extended to generalize the new three-residue turn (beta-alpha-beta) by using different alpha- and beta-amino acids. Furthermore, the HT motifs were efficiently converted, by an extension with helical oligomers at the C termini, into peptides with novel helix-turn-helix (HTH) tertiary structures. However, this resulted in the destabilization of the beta-alpha-beta turn with the concomitant nucleation of another three-residue turn, alpha-beta-beta, which is stabilized by 11- and 15-membered bifurcated H bonds. Extensive NMR spectroscopic studies were carried out to delineate the secondary and tertiary structures in these peptides, which are further supported by molecular dynamics (MD) investigations.
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Chou, Li-Fang
2014-01-01
While most drug policy researches paid attention to the financial impact of expensive drugs, the market situation of low-priced drugs in a country was seldom analyzed. We used the nationally representative claims datasets to explore the status within the National Health Insurance (NHI) in Taiwan. In 2007, a total of 12,443 distinct drug items had been prescribed 853,250,147 times with total expenditure of 105,216,950,198 new Taiwan dollars (NTD). Among them, 7,366 oral drug items accounted for 701,353,383 prescribed items and 68,133,988,960 NTD. Besides, 2,887 items (39.2% of oral drug items) belonged to cheap drugs with the unit price ≤1 NTD (about 0.03 of US dollar). While the top one item among all oral drugs had already a market share of 5.0%, 30 items 30.3% and 107 items 50.0%, the cheap drugs with aggregate 332,893,462 prescribed items (47.5% of all prescribed oral drug items) only accounted for 2,750,725,433 NTD (4.0% of expenditure for oral drugs and 2.6% of total drug expenditure). The drug market of Taiwan's NHI was abundant in cheap drugs. The unreasonably low prices of drugs might not guarantee the quality of pharmaceutical care and the sustainability of a healthy pharmaceutical industry in the long run. PMID:24719568
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Lee, Weon-Young; Shaw, Ian
2014-07-18
The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs) on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI) program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV) and the Korean Household Income and Expenditure Survey (KHIES) of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv) and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE) were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile), II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden.
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Wang, Bih-Ru; Chou, Chia-Lin; Hsu, Chia-Chen; Chou, Yueh-Ching; Chen, Tzeng-Ji; Chou, Li-Fang
2014-01-01
While most drug policy researches paid attention to the financial impact of expensive drugs, the market situation of low-priced drugs in a country was seldom analyzed. We used the nationally representative claims datasets to explore the status within the National Health Insurance (NHI) in Taiwan. In 2007, a total of 12,443 distinct drug items had been prescribed 853,250,147 times with total expenditure of 105,216,950,198 new Taiwan dollars (NTD). Among them, 7,366 oral drug items accounted for 701,353,383 prescribed items and 68,133,988,960 NTD. Besides, 2,887 items (39.2% of oral drug items) belonged to cheap drugs with the unit price ≤ 1 NTD (about 0.03 of US dollar). While the top one item among all oral drugs had already a market share of 5.0%, 30 items 30.3% and 107 items 50.0%, the cheap drugs with aggregate 332,893,462 prescribed items (47.5% of all prescribed oral drug items) only accounted for 2,750,725,433 NTD (4.0% of expenditure for oral drugs and 2.6% of total drug expenditure). The drug market of Taiwan's NHI was abundant in cheap drugs. The unreasonably low prices of drugs might not guarantee the quality of pharmaceutical care and the sustainability of a healthy pharmaceutical industry in the long run.
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Song, Sun Ok; Jung, Chang Hee; Song, Young Duk; Park, Cheol-Young; Kwon, Hyuk-Sang; Cha, Bong Soo; Park, Joong-Yeol; Lee, Ki-Up
2014-01-01
Background The National Health Insurance Service (NHIS) recently signed an agreement to provide limited open access to the databases within the Korean Diabetes Association for the benefit of Korean subjects with diabetes. Here, we present the history, structure, contents, and way to use data procurement in the Korean National Health Insurance (NHI) system for the benefit of Korean researchers. Methods The NHIS in Korea is a single-payer program and is mandatory for all residents in Korea. The three main healthcare programs of the NHI, Medical Aid, and long-term care insurance (LTCI) provide 100% coverage for the Korean population. The NHIS in Korea has adopted a fee-for-service system to pay health providers. Researchers can obtain health information from the four databases of the insured that contain data on health insurance claims, health check-ups and LTCI. Results Metabolic disease as chronic disease is increasing with aging society. NHIS data is based on mandatory, serial population data, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondary prevention of disease after data mining. Conclusion The NHIS database represents the entire Korean population and can be used as a population-based database. The integrated information technology of the NHIS database makes it a world-leading population-based epidemiology and disease research platform. PMID:25349827
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Hajdu, Bálint; Czakó, Gábor
2018-02-22
We report a comprehensive high-level explicitly correlated ab initio study on the X - + NH 2 Y [X,Y = F, Cl, Br, I] reactions characterizing the stationary points of the S N 2 (Y - + NH 2 X) and proton-transfer (HX + NHY - ) pathways as well as the reaction enthalpies of various endothermic additional product channels such as H - + NHXY, XY - + NH 2 , XY + NH 2 - , and XHY - + NH. Benchmark structures and harmonic vibrational frequencies are obtained at the CCSD(T)-F12b/aug-cc-pVTZ(-PP) level of theory, followed by CCSD(T)-F12b/aug-cc-pVnZ(-PP) [n = Q and 5] and core correlation energy computations. In the entrance and exit channels we find two equivalent hydrogen-bonded C 1 minima, X - ···HH'NY and X - ···H'HNY connected by a C s first-order saddle point, X - ···H 2 NY, as well as a halogen-bonded front-side complex, X - ···YNH 2 . S N 2 reactions can proceed via back-side attack Walden inversion and front-side attack retention pathways characterized by first-order saddle points, submerged [X-NH 2 -Y] - and high-energy [H 2 NXY] - , respectively. Product-like stationary points below the HX + NHY - asymptotes are involved in the proton-transfer processes.
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Song, Sun Ok; Jung, Chang Hee; Song, Young Duk; Park, Cheol-Young; Kwon, Hyuk-Sang; Cha, Bong Soo; Park, Joong-Yeol; Lee, Ki-Up; Ko, Kyung Soo; Lee, Byung-Wan
2014-10-01
The National Health Insurance Service (NHIS) recently signed an agreement to provide limited open access to the databases within the Korean Diabetes Association for the benefit of Korean subjects with diabetes. Here, we present the history, structure, contents, and way to use data procurement in the Korean National Health Insurance (NHI) system for the benefit of Korean researchers. The NHIS in Korea is a single-payer program and is mandatory for all residents in Korea. The three main healthcare programs of the NHI, Medical Aid, and long-term care insurance (LTCI) provide 100% coverage for the Korean population. The NHIS in Korea has adopted a fee-for-service system to pay health providers. Researchers can obtain health information from the four databases of the insured that contain data on health insurance claims, health check-ups and LTCI. Metabolic disease as chronic disease is increasing with aging society. NHIS data is based on mandatory, serial population data, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondary prevention of disease after data mining. The NHIS database represents the entire Korean population and can be used as a population-based database. The integrated information technology of the NHIS database makes it a world-leading population-based epidemiology and disease research platform.
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Kim, Sang Gyun; Lyu, Da Hyun; Park, Chan Mi; Lee, Na Rae; Kim, Jiyoung; Cha, Youngju; Jung, Hwoon-Yong
2018-06-21
This study was aimed to investigate the current clinical status of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in Korea based on a National Health Insurance (NHI) database between 2011 and 2014. The claims data of ESD for EGC in Korean NHI were reviewed using material codes of Health Insurance Review and Assessment Service between November 2011 and December 2014. The current clinical status was analyzed in terms of treatment pattern, in-hospital length of stay (LOS), total medical costs, and en bloc resection rate according to the hospital type. A total of 23,828 cases of ESD for EGC were evaluated. ESD was performed in 67.4% of cases in tertiary care hospitals, 31.8% in general hospitals, and 0.8% in hospitals, respectively. The median LOS was 5 days, and total median medical costs was approximately 1,300 US dollars. En bloc resection rate was 99%; 8.5% of cases underwent additional treatment within 90 days ESD, and 5.5% in 91 to 365 days after ESD. The clinical status was not significantly different according to the year and hospital type. A majority of ESD for EGC were performed in tertiary care hospitals in Korea. The clinical status showed excellent clinical outcomes and did not differ by the year and between the types of hospitals in Korea.
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[Kampo Medicine in the New Model Core Curriculum of Pharmaceutical Education].
Kobayashi, Yoshinori
2016-01-01
What should we educate for Kampo medicine in the model core curriculum of pharmaceutical education? The curricular core should be discussed considering the points mentioned below. (1) Positioning of Kampo medicine in the Japanese medical care system. Kampo medicine is an authorized medical care category in the National Health Insurance (NHI) program in Japan. The NHI drug price list carries 148 Kampo formulations. According to the report of the Japan Kampo Medicines Manufacturers Association in 2011, approximately 90% of Japanese physicians prescribe Kampo medicines. (2) Differences between Kampo medicine and western medicine: In Kampo medicine, the most suitable formula among various Kampo formulas to normalize the psychophysical state of individual patients is selected. In other words, if there is a complaint, there are always some treatments. (3) A strong point of Kampo medicine: Kampo medicine enables physicians to deal with difficult-to-treat conditions by western medicine alone. Also, by using the scale of Kampo medicine, each patient can grasp his or her own systemic state and improve their lifestyle. To extend healthy life expectancy, a basic knowledge of Kampo medicine may play a significant role in integrated health care. "The guide book of the approval standards for OTC Kampo products", "the pharmaceutical advanced educational guideline", and "the manual of the exam questions preparation for registered sales clerks" should also be consulted before selecting the area and contents that should be covered.
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NHI-PharmaCloud in Taiwan--A preliminary evaluation using the RE-AIM framework and lessons learned.
Huang, San-Kuei; Wang, Pen-Jen; Tseng, Wen-Fuh; Syu, Fei-Kai; Lee, Miaw-Chwen; Shih, Ru-Liang; Sheen, Mao-Ting; Chen, Michael S
2015-10-01
The aim of this article is to present the preliminary impact of a medication monitoring program, PharmaCloud, in Taiwan and analyze the embedded factors that have contributed to the performance thereof. This article also compared PharmaCloud with similar international programs in order to draw lessons learned. The five domains of the RE-AIM framework - reach, effectiveness, adoption, implementation, and maintenance - were examined using qualitative and quantitative data. A difference-in-differences model was applied to analyze the quantitative impact of PharmaCloud on drug utilization and drug expenses. The qualitative impact was evaluated by document analysis based on field reports from the participating medical institutions. Reach and adoption: although all of the major hospitals adopted PharmaCloud and some of the hospitals had high inquiry rates, more time and incentives are needed to raise the overall inquiry rate. Effectiveness: during the study period of 3 months, the number of medications per prescription declined in the intervention group was 0.15 more than that of the general population, and the drug expense per person declined in the intervention group was NT $567 (US $18.9) more than that of the general population. The potential savings could be between 2% and 5% of the total pharmaceutical expenditure. Medication duplication was found to have decreased more in the intervention group. a variety of innovations in care delivery are being developed in which the pharmacists play a more significant role. Maintenance: the embedded National Health Insurance would lend strong support for PharmaCloud to grow and thrive. PharmaCloud owes its effectiveness to the embedded National Health Insurance (NHI) program, which is universal and provides a comprehensive benefit package including more than 16,000 prescription drugs. An effective medication program is one that operates under the principle of universality and comprehensiveness, facilitates innovations, and has a substantial level of interoperability with the intra-hospital health information systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Chang, Chi Ching; Chiou, Chi Sheng; Lin, Hsiu Li; Wang, Li Hsuan; Chang, Yu Sheng; Lin, Hsiu-Chen
2015-01-01
The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis. PMID:26262880
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Erectile Dysfunction in Patients with Sleep Apnea--A Nationwide Population-Based Study.
Chen, Chia-Min; Tsai, Ming-Ju; Wei, Po-Ju; Su, Yu-Chung; Yang, Chih-Jen; Wu, Meng-Ni; Hsu, Chung-Yao; Hwang, Shang-Jyh; Chong, Inn-Wen; Huang, Ming-Shyan
2015-01-01
Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients.
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Localization and Specification of Copper Ions in Biofilms on Corroding Copper Surfaces.
1994-01-01
WW~nhi~. OC ;mmS 1 . Agency use unay (L-mUv umia. IA. "O" ,.ie. $3. Report Type and Dates Covered. I 1994 Final - Proceedings 4. Title and Subtitle. S...structure (XANES) techniques can be used to differentiate Cu’ 1 and Cu+2 species within biofilms attached to surfaces. Copper ions , uld not be... 1 The organism with associated polymer has been shown to bind copper ions from solution. Geesey et al.2 demonstrated that exopolymers produced by
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Substituent effects in infrared spectroscopy—VII. Meta and para substituted methanesulphonanilides
NASA Astrophysics Data System (ADS)
Laurence, C.; Berthelot, M.; Lucon, M.; Tsuno, Y.
Substituent effects on the NH frequencies of the conformers of methanesulphonanilides, their cyclic dimers and their hydrogen bonded complexes with acetonitrile have been analysed by means of the Hammet equation. An electron-withdrawing substituent may either increase or decrease ν(NH) in the XC 6H 4NHY series according to the electronic nature of the Y group. This can be explained by the non-monotonic dependence of the NH stretching frequency on the ionic character of the NH bond.
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Chen, Jien-Jiun; Lin, Lian-Yu; Yang, Yao-Hsu; Hwang, Juey-Jen; Chen, Pau-Chung; Lin, Jiunn-Lee; Chi, Nai-Hsin
2017-01-15
The usage of on or off cardiopulmonary bypass in patients with coronary artery disease receiving coronary artery bypass grafting (CABG) surgery had been debated and had not yet been investigated thoroughly in patients with end-stage renal disease (ESRD). We aimed to study cardiovascular outcomes and total mortality in these patients by using our National Health Insurance (NHI) database. By using our NHI ESRD claim database, we searched ESRD patients aged more than 18years, who received CABG and divided them into on pump and off pump groups. Baseline characteristics and underlying comorbidities were identified from the database. Propensity score (PS) method was used to match all the potential confounders between patients. Outcomes including mortality, myocardial infarction, stroke and repeat revascularization within 30days, 1year and whole follow-up period were also obtained. A total of 134,410 ESRD patients were identified in the database. We included 341 patients and 543 patients who received off pump and on pump CABG respectively. The hazard ratios of different outcomes at 30days, 1year and a median of 745days after CABG did not show significant different between on, or off pump groups before and after PS match. ESRD patients with CAD undergoing either on pump or off pump CABG surgery showed similar outcomes in 30days, 1year and whole follow-up period. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Willingness to pay to sustain and expand National Health Insurance services in Taiwan.
Lang, Hui-Chu; Lai, Mei-Shu
2008-12-17
The purpose of the present study was to investigate people's willingness to pay to sustain the current National Health Insurance (NHI) program in Taiwan and to extend that program to cover long-term care services. A survey was administered to 1800 inpatients and 1800 outpatients, selected from health care facilities across all accreditation levels that were operating under the supervision of six different regional branches of Taiwan's Bureau of National Health Insurance (BNHI). We used a contingent valuation method with closed-ended questions to elicit participants' willingness to pay for continued national heath insurance and additional institutional long-term care services. We divided participants into six subgroups and asked individuals in these groups referendum-like yes-no questions about whether they were willing to pay one of six price bids: New Taiwan Dollar (NT$) 50, NT$100, NT$200, NT$300, NT$400, or NT$500. Logistic regression was used to analyze willingness to pay. We found maximum willingness to pay for continued coverage by the NHI program and additional institutional long-term care services to be NT$66 and NT$137 dollars per month, respectively. We found that people were willing to pay more for their insurance coverage. With regard to methodology, we also found that using a contingent valuation method to elicit peoples' willingness to pay for health policy issues is valid. The results of the present referendum-like study can serve as a reference for future policy decision making.
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Outpatient-shopping behavior and survival rates in newly diagnosed cancer patients.
Chiou, Shang-Jyh; Wang, Shiow-Ing; Liu, Chien-Hsiang; Yaung, Chih-Liang
2012-09-01
To evaluate the appropriateness of the definition of outpatient-shopping behavior in Taiwanese patients. Linked study of 3 databases (Taiwan Cancer Registry, National Health Insurance [NHI] claim database, and death registry database). Outpatient shopping behavior was defined as making at least 4 or 5 physician visits to confirm a cancer diagnosis. We analyzed patient-related factors and the 5-year overall survival rate of the outpatient-shopping group compared with a nonshopping group. Using the household registration database and NHI database, we determined the proportion of outpatient shopping, characteristics of patients who did and did not shop for outpatient therapy, time between diagnosis and start of regular treatment, and medical service utilization in the shopping versus the nonshopping group. Patients with higher incomes were significantly more likely to shop for outpatient care. Patients with higher comorbidity scores were 1.4 times more likely to shop for outpatient care than patients with lower scores. Patients diagnosed with more advanced cancer were more likely to shop than those who were not. Patients might be more trusting of cancer diagnoses given at higher-level hospitals. The nonshopping groups had a longer duration of survival over 5 years. Health authorities should consider charging additional fees after a specific outpatient- shopping threshold is reached to reduce this behavior. The government may need to reassess the function of the medical sources network by shrinking it from the original 4 levels to 2 levels, or by enhancing the referral function among different hospital levels.
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Willingness to pay to sustain and expand National Health Insurance services in Taiwan
Lang, Hui-Chu; Lai, Mei-Shu
2008-01-01
Background The purpose of the present study was to investigate people's willingness to pay to sustain the current National Health Insurance (NHI) program in Taiwan and to extend that program to cover long-term care services. Methods A survey was administered to 1800 inpatients and 1800 outpatients, selected from health care facilities across all accreditation levels that were operating under the supervision of six different regional branches of Taiwan's Bureau of National Health Insurance (BNHI). We used a contingent valuation method with closed-ended questions to elicit participants' willingness to pay for continued national heath insurance and additional institutional long-term care services. We divided participants into six subgroups and asked individuals in these groups referendum-like yes-no questions about whether they were willing to pay one of six price bids: New Taiwan Dollar (NT$) 50, NT$100, NT$200, NT$300, NT$400, or NT$500. Logistic regression was used to analyze willingness to pay. Results We found maximum willingness to pay for continued coverage by the NHI program and additional institutional long-term care services to be NT$66 and NT$137 dollars per month, respectively. Conclusion We found that people were willing to pay more for their insurance coverage. With regard to methodology, we also found that using a contingent valuation method to elicit peoples' willingness to pay for health policy issues is valid. The results of the present referendum-like study can serve as a reference for future policy decision making. PMID:19091093
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Green Bank Telescope Observations of HI in the circumgalactic medium of M31
NASA Astrophysics Data System (ADS)
Denny, Lucas; Early, Laura; Berg, Michelle; Howk, Chris; Lehner, Nicolas; Lockman, Felix; wotta, Christopher
2018-01-01
The nearby spiral galaxy M31 contains an extensive gaseous circumgalactic medium (CGM) that is being studied in project AMIGA, a large HST program to obtain UV spectroscopy of the CGM in absorption against background AGN. As part of this project, sensitive HI 21cm emission observations were made using the Robert C. Byrd Green Bank Telescope (GBT) toward 48 AGN at impact parameters between 25 kpc and 340 kpc. No emission was detected to a 5-sigma limit on log(NHI) of 17.6 cm-2 (Howk et al 2017, ApJ, 846, 141). We now report on a search for HI emission in 1x1 degree fields around 8 of the AGN to 5-sigma limits on log(NHI) of 17.9 cm-2. The new observations cover ~10 times the area of the M31 CGM covered by the Howk et al pointings, though at somewhat reduced sensitivity. Again, no HI emission was detected with the exception of the "Davies Cloud", a high-velocity cloud of M31 that has been known for some time. We will discuss the absence of significant HI emission in the context of the COS-Halos study of 44 galaxies at z~0.2, and how this finding may relate to the existence of HI clouds between M31 and M33 (Wolfe et al. 2016, ApJ, 816, 81).The GBT is a facility of the National Science Foundation, operated under a cooperative agreement by Associated Universities, Inc.
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Hsu, Ming-I; Tang, Chao-Hsiun; Hsu, Pei-Yang; Huang, Yu-Tung; Long, Cheng-Yu; Huang, Kuan-Hui; Wu, Ming-Ping
2012-01-01
To describe the changing trend, repeat operation rate, and distribution of laparoscopy, as compared with laparotomy, in treating ectopic pregnancy, according to patient age, preoperative conditions, surgeon age, and hospital accreditation level, in Taiwan over 11-years. Retrospective cohort study (Canadian Task Force classification II-2). Population-based nationwide insurance database. Women who underwent either laparotomy or laparoscopy because of ectopic pregnancy. Women who had National Health Insurance (NHI) underwent various surgical procedures to treat ectopic pregnancy. Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI Research Database, released by the NHI program in Taiwan between 1997 and 2007. A total of 43 170 women with 44 928 operations were identified. Only the primary surgeries, via either laparotomy or laparoscopy, performed because of ectopic pregnancy were included for analysis. The annual number of procedures to treat ectopic pregnancies decreased in the later years of the 11-year study. Laparotomy decreased significantly, from 81.2% in 1997 to 26.2% in 2007, whereas laparoscopic procedures increased significantly, from 18.8% in 1997 to 73.8% in 2007, as evidenced at log-linear regression analysis (p < .001). The rate of repeat operations because of persistent ectopic pregnancy was higher in the laparoscopy group than in the laparotomy group (0.38% vs 0.14 %; p < .001). Patients were more likely to undergo the same type of operation for the repeated surgery (i.e., laparotomy to laparotomy in 73.1% or laparoscopy to laparoscopy in 80.2%; p = 0.43). Use of laparoscopy (58.1%) and laparotomy (41.9%) differed according to patient age, preoperative comorbidities, surgeon age, and hospital accreditation level and ownership type. With older patients, those with preoperative anemia or shock, and elder surgeons, there was a greater chance that laparotomy would be performed. The probability of undergoing laparotomy was greater in patients in regional hospitals, local hospitals, and office-based clinics compared with those in medical centers. There has been considerable change in the type of surgical approach used to treat ectopic pregnancy in Taiwan over the past 11 years. Laparoscopy is preferred to laparotomy, and has become the standard surgical approach to treating ectopic pregnancies in Taiwan. However, laparoscopy is associated with a higher rate of repeat operations. The laparoscopic approach signifies a profound change in treating ectopic pregnancies among patients, surgeons, and hospital types. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.
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Lin, Chienhung; Chao, Hailun
2012-09-25
The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens. It was financed by mandatory premium contributions made by employers, employees, and the government. Since then, the government has faced increasing challenges to control NHI expenditures. The aim of this study was to determine trends in the provision of dental services in Taiwan after the implementation of global budgeting in 1998 and to identify areas of possible concern. This longitudinal before/after study was based on data from the National Health Insurance Research Database from 1996 to 2001. These data were subjected to logistic regression analysis. Linear regression analysis was used to examine changes in delivery of specific services after global budgeting implementation. Utilization of hospital and clinic services was compared. Reimbursement for dental services increased significantly while the number of visits per patient remained steady in both hospitals and clinics. In hospitals, visits for root canal procedures, ionomer restoration, tooth extraction and tooth scaling increased significantly. In dental clinics, visits for amalgam restoration decreased significantly while those for ionomer restoration, tooth extraction, and tooth scaling increased significantly. After the adoption of global budgeting, expenditures for dental services increased dramatically while the number of visits per patient did not, indicating a possible shift in patients to hospital facilities that received additional National Health Insurance funding. The identified trends indicate increased utilization of dental services and uneven distribution of care and dentists. These trends may be compromising the quality of dental care delivered in Taiwan.
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Lee, Tae-Jin; Cheong, Chelim
2017-11-01
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a "copayment ceiling," which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients' income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
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Population aging and its impacts: strategies of the health-care system in Taipei.
Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung
2010-11-01
Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.
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Building a national electronic medical record exchange system - experiences in Taiwan.
Li, Yu-Chuan Jack; Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei
2015-08-01
There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure. By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds. Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Chang, Chia-Hsuin; Chang, Yi-Cheng; Lin, Jou-Wei; Chen, Shu-Ting; Chuang, Lee-Ming; Lai, Mei-Shu
2015-03-01
Metformin is the first-line oral therapy for type 2 diabetes with proven benefits against cardiovascular risk. Recent evidence suggested that acarbose might be similar to metformin in glucose-lowering efficacy and cardiovascular risk reduction. Therefore, international guidelines have suggested the use of acarbose as alternative first-line antidiabetic therapy. To compare the cardiovascular outcomes in the first-line users of acarbose vs metformin. DESIGN, SETTING, PATIENTS, AND OUTCOME MEASURES: A nationwide cohort study was conducted by analyzing the Taiwan National Health Insurance (NHI) Database. A total of 17,366 acarbose initiators and 230,023 metformin initiators were identified between January 1, 2009 and December 31, 2010. The primary outcome is hospitalization due to any cardiovascular events, including acute myocardial infarction, congestive heart failure, and ischemic stroke. The propensity score method was used to adjust for baseline differences between the two groups. Patients were followed from drug initiation to the earliest of outcome occurrence, death or disenrollment from NHI, or study termination. In intention-to-treat analyses, acarbose was associated with a higher risk of any cardiovascular event (adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI], 1.01-1.09), heart failure (HR, 1.08; 95% CI, 1.00-1.16), and ischemic stroke (HR, 1.05, 95% CI, 1.00-1.10) than metformin. No significant difference in risk was found in subgroups of patients with or without underlying hypertension, ischemic heart disease, or cerebrovascular disease. Similar results were found in auxiliary as-treated analyses or analyses stratified by propensity score quintiles. Our data do not support that acarbose has a cardio-protective effect similar to metformin as a first-line antidiabetic agent.
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Brecht, Mary-Lynn; Herbeck, Diane
2014-06-01
This paper describes methamphetamine (MA) use patterns, specifically the duration of continuing abstinence ("time to relapse") for periods averaging 5 years post-discharge from treatment for MA use, and the relationship with selected user and treatment characteristics. A sample of 350 treatment admissions from a large county substance use disorder (SUD) treatment system was randomly selected (within gender, race/ethnicity, treatment modality strata). Retrospective self-report data are from natural history interviews (NHI) conducted approximately 3 years after treatment and a follow-up of 2-3 years later. Relapse is defined as any use of MA with time as the number of months of continuous MA abstinence after treatment discharge until relapse. This outcome was constructed from a monthly MA use timeline using NHI data. A Cox model was used to examine time to relapse and predictors. Sixty-one percent of the sample relapsed to MA use within 1 year after treatment discharge and 14% during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious MA-related psychiatric/behavioral problems (hazard ratio [HR]=0.75, p=0.027), longer duration of the index treatment episode (HR=0.93, p=0.001), and participating in self-help or other treatment during the post-treatment abstinence period (HR=0.29, p<0.001); risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems (HR=1.35, p=0.020) and involvement in MA sales (HR=1.48, p=0.002). Results contribute a long-term perspective on patterns of MA use following treatment and support a need for early post-treatment and long-term continuing care and relapse-prevention services. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.
Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H
2018-05-03
Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018. Published by Elsevier Inc.
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2012-01-01
Background The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens. It was financed by mandatory premium contributions made by employers, employees, and the government. Since then, the government has faced increasing challenges to control NHI expenditures. The aim of this study was to determine trends in the provision of dental services in Taiwan after the implementation of global budgeting in 1998 and to identify areas of possible concern. Methods This longitudinal before/after study was based on data from the National Health Insurance Research Database from 1996 to 2001. These data were subjected to logistic regression analysis. Linear regression analysis was used to examine changes in delivery of specific services after global budgeting implementation. Utilization of hospital and clinic services was compared. Results Reimbursement for dental services increased significantly while the number of visits per patient remained steady in both hospitals and clinics. In hospitals, visits for root canal procedures, ionomer restoration, tooth extraction and tooth scaling increased significantly. In dental clinics, visits for amalgam restoration decreased significantly while those for ionomer restoration, tooth extraction, and tooth scaling increased significantly. After the adoption of global budgeting, expenditures for dental services increased dramatically while the number of visits per patient did not, indicating a possible shift in patients to hospital facilities that received additional National Health Insurance funding. Conclusions The identified trends indicate increased utilization of dental services and uneven distribution of care and dentists. These trends may be compromising the quality of dental care delivered in Taiwan. PMID:23009095
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Yang, Ya-Ting; Iqbal, Usman; Ko, Hua-Lin; Wu, Chia-Rong; Chiu, Hsien-Tsai; Lin, Yi-Chieh; Lin, Wender; Elsa Hsu, Yi-Hsin
2015-06-01
The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey. Community-based study. A total of 4249 middle-aged and elderly subjects were recruited. None. Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively. Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with <30 min. The middle-aged and elderly who perceived inconvenient to access health care tended to shop in pharmacy stores compared with those with perceived convenience. Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly who were facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation system for improving accessibility. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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Chen, Chin-Ming; Lai, Chih-Cheng; Cheng, Kuo-Chen; Weng, Shih-Feng; Liu, Wei-Lun; Shen, Hsiu-Nien
2015-10-01
Patients with end-stage renal disease (ESRD(Pos)) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure. The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD(Neg)) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV. The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality. ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.
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2017-01-01
Objectives To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. Methods This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. Results The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. Conclusions The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design. PMID:29207446
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HIDEEP - an extragalactic blind survey for very low column-density neutral hydrogen
NASA Astrophysics Data System (ADS)
Minchin, R. F.; Disney, M. J.; Boyce, P. J.; de Blok, W. J. G.; Parker, Q. A.; Banks, G. D.; Freeman, K. C.; Garcia, D. A.; Gibson, B. K.; Grossi, M.; Haynes, R. F.; Knezek, P. M.; Lang, R. H.; Malin, D. F.; Price, R. M.; Stewart, I. M.; Wright, A. E.
2003-12-01
We have carried out an extremely long integration time (9000 s beam-1) 21-cm blind survey of 60 deg2 in Centaurus using the Parkes multibeam system. We find that the noise continues to fall as throughout, enabling us to reach an HI column-density limit of 4.2 × 1018 cm-2 for galaxies with a velocity width of 200 km s-1 in the central 32 deg2 region, making this the deepest survey to date in terms of column density sensitivity. The HI data are complemented by very deep optical observations from digital stacking of multi-exposure UK Schmidt Telescope R-band films, which reach an isophotal level of 26.5 R mag arcsec-2 (~=27.5 B mag arcsec-2). 173 HI sources have been found, 96 of which have been uniquely identified with optical counterparts in the overlap area. There is not a single source without an optical counterpart. Although we have not measured the column densities directly, we have inferred them from the optical sizes of their counterparts. All appear to have a column density of NHI= 1020.65+/-0.38. This is at least an order of magnitude above our sensitivity limit, with a scatter only marginally larger than the errors on NHI. This needs explaining. If confirmed it means that HI surveys will only find low surface brightness (LSB) galaxies with high MHI/LB. Gas-rich LSB galaxies with lower HI mass to light ratios do not exist. The paucity of low column-density galaxies also implies that no significant population will be missed by the all-sky HI surveys being carried out at Parkes and Jodrell Bank.
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Patterns of outpatient care utilization by seniors under the National Health Insurance in Taiwan.
Hsu, Wen-Chin; Hsu, Yi-Ping
2016-05-01
Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program. We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables. In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas. This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people. Copyright © 2015. Published by Elsevier B.V.
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Joo, Young Bin; Sung, Yoon-Kyoung; Shim, Jee-Seon; Kim, Jae-Hoon; Lee, Eui-Kyung; Lee, Hye-Soon; Bae, Sang-Cheol
2015-05-01
Avascular necrosis (AVN) is one of the most frequent types of organ damage in systemic lupus erythematosus (SLE). However, little is currently known about the epidemiology of AVN in SLE patients. The aim of this study was to estimate the prevalence and incidence of AVN in Korean patients with SLE based on National Health Insurance (NHI) claims data and to determine the risk factors for AVN among SLE patients. This study was conducted using the 2006-2010 data of 25,358 SLE patients from the NHI program. AVN cases were defined as those with at least one diagnosis of AVN. The prevalence was calculated by dividing the number of AVN cases by the number of SLE cases in the same year. The annual incidence was calculated by dividing the number of incident AVN cases by the number of SLE-prevalent cases not previously diagnosed with AVN. Patients who developed AVN in 2008-2010 were compared with SLE patients who did not develop AVN to identify any risk factors. The prevalence of AVN among SLE patients (2006-2010) was 31.5-34.2 per 1,000 persons and was similar in all the years studied. The incidence per 1,000 persons of AVN among SLE patients was 8.6 [95 % confidence interval (95 % CI) 6.9-10.3] in 2008, 9.8 (95 % CI 8.0-11.6) in 2009, and 8.4 (95 % CI 6.8-10.0) in 2010. Regression analysis indicated that taking an oral corticosteroid [odds ratio (OR) 2.12, 95 % CI 1.39-3.23] or an intravenous corticosteroid (OR 1.5, 95 % CI 1.2-1.89) was significantly associated with AVN. In addition, AVN was associated with use of immunosuppressive agents (OR 2.12, 95 % CI 1.66-2.72), hydroxychloroquine (OR 1.4, 95 % CI 1.09-1.81), and lipid-lowering agents (OR 1.78, 95 % CI 1.24-2.57) among the prescribed medications, and with hypertension (OR 1.39, 95 % CI 1.08-1.79) among the comorbidities. The prevalence and incidence of AVN among SLE patients, which were 31.5-34.2 and 8.4-9.8 per 1,000 persons, respectively, may be representative of the entire population of symptomatic AVN patients with SLE in Korea. AVN is associated with the use of corticosteroids, immunosuppressants, hydroxychloroquine, lipid-lowering agents, and with hypertension. Studies of large, prospective cohorts are needed to confirm these results.
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Gross, Revital; Harrison, Michael I
2006-04-01
Managed competition was introduced into the Israeli health care system with the enactment of the National Health Insurance (NHI) Law of 1995, which radically transformed health management organizations' (HMO) regulatory and competitive environments. We conducted an in-depth, qualitative analysis of the strategies developed by two Israeli HMOs in response to this change, and developed the concept of a "strategic repertoire" to integrate diverse theories of organizational adaptation to environmental change. Although the responses of these organizations to managed competition were broadly comparable, they diverged from one another in important ways. Our analysis highlights how the interaction among organizational history, managerial choice, and environmental constraints creates divergence in organizational responses to national policy initiatives. Policy implications arising from the findings include ways of anticipating unintended consequences of policy initiatives, such as involving provider organizations in the structuring of reform, or simulating their response in advance, based on expert knowledge of their strategic repertoires; and the need to include mechanisms for obtaining feedback on organizational responses in the implementation of reform. This will facilitate the adjustment of program regulations and incentives in response to emerging practices.
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Realtime, Object-oriented Reduction of Parkes Multibeam Data using AIPS++
NASA Astrophysics Data System (ADS)
Barnes, D. G.
An overview of the Australia Telescope National Facility (ATNF) Parkes Multibeam Software is presented. The new thirteen-beam Parkes {21 cm} Multibeam Receiver is being used for the neutral hydrogen (Hi) Parkes All Sky Survey (HIPASS). This survey will search the entire southern sky for Hi in the redshift range {$-1200$ km s$^{-1}$} to {$+12600$ km s$^{-1}$}; with a limiting column density of {$N_Hi \\simeq 5 \\times 1017$ cm$^{-2}$}. Observations for the survey began in late February, 1997, and will continue through to the year 2000. A complete reduction package for the HIPASS survey has been developed, based on the AIPS++ library. The major software component is realtime, and uses advanced inter-process communication coupled to a graphical user interface, provided by AIPS++, to apply bandpass removal, flux calibration, velocity frame conversion and spectral smoothing to 26 spectra of 1024 channels each, every five seconds. AIPS++ connections have been added to ATNF-developed visualization software to provide on-line visual monitoring of the data quality. The non-realtime component of the software is responsible for gridding the spectra into position-velocity cubes; typically 200000 spectra are gridded into an $8^\\circ \\times 8^\\circ$ cube.
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Chen, Chiu-Ying; Hung, Hui-Jung; Chang, Kuang-Hsi; Hsu, Chung Y; Muo, Chih-Hsin; Tsai, Chon-Haw; Wu, Trong-Neng
2017-01-01
Previous studies revealed that chronic exposure to air pollution can significantly increase the risk of the development of Parkinson's disease (PD), but this relationship is inconclusive as large-scale prospective studies are limited and the results are inconsistent. Therefore, the purpose of this study was to ascertain the adverse health effects of air pollution exposure in a nationwide population using a longitudinal approach. We conducted a nested case-control study using the National Health Insurance Research Dataset (NHIRD), which consisted of 1,000,000 beneficiaries in the National Health Insurance Program (NHI) in the year 2000 and their medical records from 1995 to 2013 and using public data on air pollution concentrations from monitoring stations across Taiwan released from the Environmental Protection Administration to identify people with ages ≥ 40 years living in areas with monitoring stations during 1995-1999 as study subjects. Then, we excluded subjects with PD, dementia, stroke and diabetes diagnosed before Jan. 1, 2000 and obtained 54,524 subjects to follow until Dec. 31, 2013. In this observational period, 1060 newly diagnosed PD cases were identified. 4240 controls were randomly selected from those without PD using a matching strategy for age, sex, the year of PD diagnosis and the year of entering the NHI program at a ratio of 1:4. Ten elements of air pollution were examined, and multiple logistic regression models were used to measure their risks in subsequent PD development. The incidence of PD in adults aged ≥ 40 years was 1.9%, and the median duration for disease onset was 8.45 years. None of the chemical compounds (SO2, O3, CO, NOx, NO, NO2, THC, CH4, or NMHC) significantly affected the incidence of PD except for particulate matter. PM10 exposure showed significant effects on the likelihood of PD development (T3 level: > 65μg/m3 versus T1 level: ≤ 54μg/m3; OR = 1.35, 95% CI = 1.12-1.62, 0.001 ≤ P < 0.01). In addition, comorbid conditions such as dementia (ORs = 3.53-3.93, Ps < 0.001), stroke (ORs = 2.99-3.01, Ps < 0.001), depression (ORs = 2.51-2.64, Ps < 0.001), head injury (ORs = 1.24-1.29, 0.001 ≤ Ps < 0.01 or 0.01 ≤ Ps < 0.05), sleep disorder (OR = 1.23-1.26, 0.001 ≤ Ps < 0.01), and hypertension (ORs = 1.18-1.19, 0.01 ≤ Ps < 0.05) also significantly increased the risk for PD development. Although PM10 plays a significant role in PD development, the associated chemical/metal compounds that are capable of inducing adverse biological mechanisms still warrant further exploration. Because of a link between comorbid conditions and PM exposure, research on the causal relationship between long-term exposure to PM and the development of PD should be considered with caution because other possible modifiers or mediators, comorbid diseases in particular, may be involved.
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2012-12-07
Commander, U.S. Forces- Afghanistan -- - ·--·- --· I A., B. l., and B.2. FOR OFFICl/rlJ BSE O:PflrlI ii F0R 0FFiCM-L HSE 0Nhi’ Table of...Our Response 13 Appendices A. Scope and Methodology 15 Use of Computer Processed Data 16 Prior Coverage 16 1 F0R 0FFiCIA±i HSE 0Nl-J’l F61t...security screening process for escorted entry while on U.S. Forces’ installations in Afghanistan. FOR 0ff’ICikb HSE 0"Pfb Y 5 F6:K 6FFl€1A:b ffl
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Kuo, Chang-Fu; Grainge, Matthew J; See, Lai-Chu; Yu, Kuang-Hui; Luo, Shue-Fen; Valdes, Ana M; Zhang, Weiya; Doherty, Michael
2015-01-01
Objective To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. Methods Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. Results RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. Conclusions This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic. PMID:24265412
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Honda, Ayako; Ryan, Mandy; van Niekerk, Robert; McIntyre, Diane
2015-06-01
The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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Kim, Jin-Hyeong; Noh, Juhwan; Choi, Jae-Woo; Park, Eun-Cheol
2017-06-19
Background: Exposure to smoke, including environmental tobacco smoke (ETS), is a well-known risk factor for diabetes. Low socioeconomic status, especially lack of education, is also a risk factor for diabetes. Therefore, we assessed the association of demographic, socioeconomic, clinical, and behavior risk factor-related variables and smoking status, including ETS exposure, with the prevalence of diabetes. Methods: Data were from the 2007-2013 Korea National Health and Nutritional Evaluation Survey (KNHANES). Multivariable logistic regression examined associations between various lifestyle and health factors and the prevalence of diabetes while controlling for potential confounding variables. Subgroup analysis was performed according to smoking status to determine factors associated with diabetes. Results: Of 19,303 individuals analyzed, 1325 (11.4%) had diabetes. Greater average age, male sex, lower educational level, unemployment, and coexisting health problems were significantly associated with diabetes. Individuals with only elementary, middle, or high school level education had significantly greater odds ratios ( p < 0.05) compared to college graduates; smokers and nonsmokers exposed to ETS had significantly greater OR ( p < 0.05) than nonsmokers unexposed to ETS. Subgroup analysis of diabetics according to smoking status revealed significant associations ( p < 0.05) for diabetic nonsmokers exposed to ETS with female sex, single status, elementary level education, urban residence, National Health Insurance (NHI), hypertension, a lack of alcohol intake, and a lack of moderate physical activity. For diabetic smokers, there were significant associations ( p < 0.05) with elementary education, urban residence, a lack of moderate physical activity, a lack of alcohol intake, and NHI. Conclusions: The results suggested that smoking status, as well as ETS exposure, was associated with a higher prevalence of diabetes, especially in populations with less education. Thus, we should direct efforts for controlling diabetes toward individuals with lower levels of education and those who are smokers and nonsmokers exposed to ETS.
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Tsai, Ming-Lung; Mao, Chun-Tai; Chen, Dong-Yi; Hsieh, I-Chang; Wen, Ming-Shien; Chen, Tien-Hsing
2015-01-01
Carotid artery stenosis is one of the leading causes of ischemic stroke. Carotid artery stenting has become well-established as an effective treatment option for carotid artery stenosis. For this study, we aimed to determine the efficacy and safety of carotid stenting in a population-based large cohort of patients by analyzing the Taiwan National Healthcare Insurance (NHI) database. 2,849 patients who received carotid artery stents in the NHI database from 2004 to 2010 were identified. We analyzed the risk factors of outcomes including major adverse cardiovascular events including death, acute myocardial infarction, and cerebral vascular accidents at 30 days, 1 year, and overall period and further evaluated cause of death after carotid artery stenting. The periprocedural stroke rate was 2.7% and the recurrent stroke rate for the overall follow-up period was 20.3%. Male, diabetes mellitus, and heart failure were significant risk factors for overall recurrent stroke (Hazard Ratio (HR) = 1.35, p = 0.006; HR = 1.23, p = 0.014; HR = 1.61, p < 0.001, respectively). The periprocedural acute myocardial infarction rate was 0.3%. Age and Diabetes mellitus were the significant factors to predict periprocedural myocardial infarction (HR = 3.06, p = 0.019; HR = 1.68, p < 0.001, respectively). Periprocedural and overall mortality rates were 1.9% and 17.3%, respectively. The most significant periprocedural mortality risk factor was acute renal failure. Age, diabetes mellitus, acute or chronic renal failure, heart failure, liver disease, and malignancy were factors correlated to the overall period mortality. Periprocedural acute renal failure significantly increased the mortality rate and the number of major adverse cardiovascular events, and the predict power persisted more than one year after the procedure. Age and diabetes mellitus were significant risk factors to predict acute myocardial infarction after carotid artery stenting.
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Consumers' Perspectives on National Health Insurance in South Africa: Using a Mobile Health Approach
Stuttaford, Maria C
2014-01-01
Background Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform. PMID:25351980
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2011-01-01
Background This study aimed to evaluate social evolution in Taiwan in recent decades using the changing pattern of care provided by grandparents for their grandchildren as an indicator. Methods Data from the second, fourth and sixth wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were used for the analysis. This survey collected individual characteristics, including age, gender, education, ethnicity, dwelling place, living with partners, co-resident with children, employment status, self-reported health status and their provision of care for their grandchildren. Information about the attitudes toward National Health Insurance (NHI) was further collected in a questionnaire of 1999 following the implementation of NHI in 1995. By elders, we mean persons 60 or more years old. By grandchildren, we mean persons under 16 years of age. First, changes in individual characteristics were compared during these study periods (chi-square test). Then the logistic regression was performed to determine how significantly elders' grandchild-care behavior was associated with their individual characteristics. Results The percentage of elders providing grandchild care increased from 7.7% in 1993 to 13.6% in 1999, and then to 19.4% in 2007. By analysis, significant association was found between behavior in taking care of grandchildren and individuals of lower age, grandmothers, those living with partners or co-residing with children, those unemployed and those with better self-reported health status. And the effect of year was confirmed in the multivariable analysis. Conclusions This study pointed out the changing pattern of elders' behavior in taking care of their grandchildren as the main indicator and their related individual characteristics. We argue the need for improving social security policies in an ageing society. We suggest that the interaction between population policies and those of social welfare, including policies for health care and childcare, should be carefully evaluated. PMID:21835009
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Jong, Maw-Shiou; Hwang, Shinn-Jang; Chen, Yu-Chun; Chen, Tzeng-Ji; Chen, Fun-Jou; Chen, Fang-Pey
2010-07-01
Constipation is a common gastrointestinal problem worldwide. The aim of this study was to determine the frequency of use and prescriptive patterns of Chinese herbal medicine (CHM) in treating constipation by analyzing the claims data of traditional Chinese medicine (TCM) from the National Health Insurance (NHI) in Taiwan. The computerized claims dataset of the TCM office visits and the corresponding prescription files in 2004 compiled by the NHI Research Institute in Taiwan were linked and processed. Visit files with the single diagnostic coding of constipation (ICD-9-CM code 564.0) were extracted to analyze the frequency and pattern of corresponding CHM prescriptions. The association rule was applied to analyze the co-prescription of CHM in treating constipation. There were 152,564 subjects who visited TCM clinics only for constipation in Taiwan during 2004 and received a total of 387,268 CHM prescriptions. Subjects between 20 and 29 years of age comprised the largest number of those treated (25.5%). Female subjects used CHM for constipation more frequently than male subjects (female:male = 3.31:1). There was an average of 4.6 items of single Chinese herbs or formula in a single prescription for constipation. Ma-zi-renwan was the most commonly prescribed herbal formula, while Da-huang (Rheum palmatum) was the most commonly used single Chinese herb. According to the association rule, the most common prescribed pattern of 2-drug combination of CHM for treating constipation was Ban-xia-xie-xin-tang plus Ma-zi-ren-wan, while the 3-drug combination of CHM was Fang-feng-tong-sheng-san, Rheum palmatum and Ma-zi-ren-wan. This study showed the pattern of single Chinese herbs or herbal formulae used in treating constipation in Taiwan. Further clinical trials are needed to evaluate the efficacy and safety of these CHMs in treating constipation. 2010 Elsevier. Published by Elsevier B.V. All rights reserved.
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Chao, C-H; Chen, H-J; Wang, H-Y; Li, T-C; Kao, C-H
2015-07-01
Chronic fatigue syndrome (CFS) is a complex disorder characterized by profound and persistent fatigue and several comorbidities. CFS was previously reported to be associated with female sexual dysfunction. We propose that CFS might also be associated with organic erectile dysfunction (organic ED). We conducted a retrospective cohort study by using data from the National Health Insurance (NHI) Research Database. We identified 2156 male patients who were newly diagnosed with CFS between January 1, 2003 and December 31, 2006. After excluding those younger than 20 years and prevalent cases, 1976 patients were subjected to analysis, and 7904 people served as healthy controls. All study subjects were followed up from the index date to the date of organic ED diagnosis, withdrawal from the NHI program, or the end of 2011. Compared with the non-CFS cohort, the incidence density rate of organic ED was 1.88-fold higher than that in the CFS cohort (3.23 vs. 1.73 per 1000 person-years) with an adjusted hazard ratio (HR) of 1.88 (95% CI = 1.26-2.81) when adjusting for sex and comorbidities. The combined impacts of patients with CFS and cardiovascular disease (CVD), diabetes mellitus (DM), chronic kidney disease (CKD), depression, and anxiety showed a significant by joint association with organic ED risk compared with patients with no CFS and no counterpart comorbidity. The greatest magnitude of adjusted HR of ED for CFS was observed in individuals without any comorbidity (3.87, 1.95-7.66). The incidence of organic ED is higher among males aged 40 years and over for both CFS and non-CFS cohorts. As the number of comorbidity increases, the incidence of organic ED increases in males without CFS. Higher incidence of organic ED was observed in males with CVD, DM, CKD, depression, or anxiety for both CFS and non-CFS cohorts. © 2015 American Society of Andrology and European Academy of Andrology.
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Periodontal disease with treatment reduces subsequent cancer risks.
Hwang, Ing-Ming; Sun, Li-Min; Lin, Cheng-Li; Lee, Chun-Feng; Kao, Chia-Hung
2014-10-01
The aim of our study was to evaluate the relationship between routine treatment of periodontal disease (PD) and the subsequent risks for cancers in Taiwan. Study participants were selected from the Taiwan National Health Insurance (NHI) system database. The PD with a routine treatment cohort contained 38 902 patients. For each treatment cohort participant, two age- and sex-matched comparison (control) cohort participants were randomly selected. Cox's proportional hazards regression analysis was used to estimate the effects of PD with treatment on the subsequent risk of cancer. The overall risk of developing cancer was significantly lower in the treatment cohort than in the patients without treatment (adjusted Hazard ratio = 0.72, 95% confidence interval = 0.68-0.76). The risks of developing most gastrointestinal tract, lung, gynecological and brain malignancies were significantly lower in the treatment cohort than in the comparison cohort. In contrast, the risks of prostate and thyroid cancers were significantly higher in the treatment cohort than in the comparison cohort. Our findings suggest that PD with treatment is associated with a significantly reduced overall risk of cancer and reduced risks of certain types of cancers. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Wu, Hsing-Hao
2008-12-01
In the face of the information age, Internet and telecommunication technologies have been widely applied in various settings. These innovational technologies have been used in the areas of e-commerce, long distance learning programs, entertainment, e-government, and so on. In recent years, the evolution of Internet technology is also pervading the health care industry. This dramatic trend may significantly alter traditional medical practice as well as the means of delivery of health care. The idea of telemedicine is to use modern information technology as a means or platform to deliver health care service in remote areas and to manage medical information in digitalized forms. The progress of developing telemedicine, however, is rather slow. The main reason for this slow progress is not technological but rather legal. Health care providers are reluctant to promote this innovation in medical service mainly due to uncertain legal consequences and ethical concerns. Although there are many legal challenges surrounding telemedicine, this note will examine major legal issues including licensure, malpractice liability, and privacy protection. Furthermore, I will discuss the potential of applying telemedicine programs in Taiwan's National Health Insurance Program (hereinafter referred to as NHI).
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Saito, Takeshi; Tominaga, Aya; Nozawa, Mayu; Unei, Hiroko; Hatano, Yayoi; Fujita, Yuji; Iseki, Ken; Hori, Yasushi
2013-09-01
In a 2008 survey of the 73 emergency and critical care centers around the nation that were equipped with the drug and chemical analytical instrument provided by the Ministry of Welfare (currently the Ministry of Health, Labour, and Welfare) in 1998, 36 of those facilities were using the analytical instruments. Of these 36 facilities, a follow-up survey of the 17 facilities that recorded 50 or analyses per year. Responses were gained from 16 of the facilities and we learned that of those, 14 facilities (87.5%) were conducting analyses using the instrument. There was a positive mutual correlation between the annual number of cases of the 14 facilities conducting analyses with the instrument and the number of work hours. Depending on the instrument in use, average analytical instrument parts and maintenance expenses were roughly three million yen and consumables required a maximum three million yen for analysis of 51-200 cases per year. From this, we calculate that such expenses can be covered under the allowed budget for advanced emergency and critical care centers of 5,000 NHI points (1 point = 10 yen). We found there were few facilities using the instrument for all 15 of the toxic substances recommended for testing by the Japanese Society for Clinical Toxicology. There tended to be no use of the analytical instrument for compounds with no toxicology cases. However, flexible responses were noted at each facility in relation to frequently analyzed compounds. It is thought that a reevaluation of compounds subject to analysis is required.
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Gamma-Ray Bursts: Lighting Up the High-Redshift Universe
NASA Astrophysics Data System (ADS)
Toy, Vicki Louise
Gamma-ray bursts (GRBs) are the most luminous events in the Universe with Egamma,iso ˜ 1048-54 erg. Leading models hypothesize that GRBs are created from inter- nal collisions within collimated and ultrarelativistic jets. The jets then shock-heat the surrounding material (e.g. interstellar medium) to create GRB afterglows. These afterglows are extremely useful probes of the Universe because long GRBs are (1) bright events that can be used as backlights for absorption studies, (2) able to probe at all redshifts massive stars exist, and (3) transient events that allow us to follow- up on the host galaxies at late times. In this thesis we study the environments of GRBs. We first explore the relationship between GRB and supernova (SN) using a nearby GRB-SN (GRB 130702A/SN 2013dx) at z = 0.145. There are only nine other GRB-SNe that were close enough to have extensive spectroscopic and photometric follow-up of the SN at late times. We create a quasi-bolometic light curve of SN 2013dx and fit an analytical equation to the quasi-bolometric light curve combined with measurements of the photospheric velocity to determine SN parameters: mass of 56Ni, kinetic energy, and ejecta mass. We examine the relationship between SN parameters and E gamma,iso for the 10 well-studied GRB-SNe, but find no correlations despite numerical simulation predictions that the mass of 56Ni should correlate with the degree of asymmetry. We then move to larger distance scales and use GRB afterglows as bright back- lights to study distant galaxies. We examine the galactic environments of Damped Lyman-alpha systems (DLAs; NHI ≥ 1020.3 cm-2 ) identified with GRB afterglows at z ˜ 2 - 6. We use late-time photometry after the GRB afterglow has faded to determine star formation rates (SFRs) from rest-frame ultraviolet measurements or spectral energy distribution (SED) models from multiband photometry. We com- pare our sample's SFRs to a sample of quasars (QSOs) DLA host galaxies. Despite the overlapping NHI and redshift ranges, our GRB-DLA galaxies have much larger SFRs than the QSO-DLA host galaxy sample; this may suggest that the QSO-DLA and GRB-DLA galaxy populations are different. We also compare star formation efficiencies to the local Universe and simulations at z = 3. A large portion of this thesis has focused on the development of a new ground- based GRB afterglow follow-up instrument, the Rapid infrared IMAger-Spectrometer (RIMAS), that will target high-redshift GRB afterglows to study early galaxy envi- ronments. RIMAS covers 0.97-2.37 mum and can simultaneously observe two band-passes in any observing mode: photometry, low-resolution spectroscopy (R ˜ 30), or high-resolution spectroscopy (R ˜ 4000). In particular, this thesis focuses on RIMAS's three detectors: two science grade Teledyne HgCdTe Astronomy Wide Area Infrared Imager with 2K x 2K, Reference Pixels and Guide Mode (H2RG) and a slit-viewer Spitzer Legacy Indium-Antimonide (InSb) array. We describe the detector hardware and characterization in detail and discuss general infrared detector troubleshooting methods at both cryogenic and room temperatures. Several software packages have been developed for RIMAS throughout this thesis work. We introduce RIMAS's quick reduction pipeline that takes raw images from a single acquisition and returns a single result frame. We then present a generalized data reduction pipeline that we have tested on two currently operational photometers. We also describe our detailed and realistic RIMAS throughput models for all three observing modes as well as our online observer calculators with these throughput models. All of our data products are open source and are publicly available on Github repositories with detailed documentation.
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Time-dependent Optical Spectroscopy of GRB 010222: Clues to the Gamma-Ray Burst Environment
NASA Astrophysics Data System (ADS)
Mirabal, N.; Halpern, J. P.; Kulkarni, S. R.; Castro, S.; Bloom, J. S.; Djorgovski, S. G.; Galama, T. J.; Harrison, F. A.; Frail, D. A.; Price, P. A.; Reichart, D. E.; Ebeling, H.; Bunker, A.; Dawson, S.; Dey, A.; Spinrad, H.; Stern, D.
2002-10-01
We present sequential optical spectra of the afterglow of GRB 010222 obtained 1 day apart using the Low-Resolution Imaging Spectrometer (LRIS) and the Echellette Spectrograph and Imager (ESI) on the Keck Telescopes. Three low-ionization absorption systems are spectroscopically identified at z1=1.47688, z2=1.15628, and z3=0.92747. The higher resolution ESI spectrum reveals two distinct components in the highest redshift system at z1a=1.47590 and z1b=1.47688. We interpret the z1b=1.47688 system as an absorption feature of the disk of the host galaxy of GRB 010222. The best-fitted power-law optical continuum and [Zn/Cr] ratio imply low dust content or a local gray dust component near the burst site. In addition, we do not detect strong signatures of vibrationally excited states of H2. If the gamma-ray burst took place in a superbubble or young stellar cluster, there are no outstanding signatures of an ionized absorber either. Analysis of the spectral time dependence at low resolution shows no significant evidence for absorption-line variability. This lack of variability is confronted with time-dependent photoionization simulations designed to apply the observed flux from GRB 010222 to a variety of assumed atomic gas densities and cloud radii. The absence of time dependence in the absorption lines implies that high-density environments are disfavored. In particular, if the GRB environment was dust free, its density was unlikely to exceed nHI=102 cm-3. If depletion of metals onto dust is similar to Galactic values or less than solar abundances are present, then nHI>=2×104 cm-3 is probably ruled out in the immediate vicinity of the burst. Based on data obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California, and NASA and was made possible with the generous financial support of the W. M. Keck Foundation.
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Kuo, Chang-Fu; Grainge, Matthew J; See, Lai-Chu; Yu, Kuang-Hui; Luo, Shue-Fen; Valdes, Ana M; Zhang, Weiya; Doherty, Michael
2015-02-01
To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic. 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.
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Rascle, Pauline; Morelle, Magali; Toulmonde, Maud; Ranchere Vince, Dominique; Le Cesne, Axel; Terrier, Philippe; Neuville, Agnès; Meeus, Pierre; Farsi, Fadila; Ducimetière, Françoise; Blay, Jean-Yves; Ray Coquard, Isabelle; Coindre, Jean-Michel
2018-01-01
Objective This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. Methods We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. Results A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6–10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. Conclusions Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI. PMID:29621244
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Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R
2009-09-01
Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.
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Benjamin, Laure; Buthion, Valérie; Vidal-Trécan, Gwenaëlle; Briot, Pascal
2014-06-20
Oral anticancer drugs (OADs) allow treating a growing range of cancers. Despite their convenience, their acceptance by healthcare professionals and patients may be affected by medical, economical and organizational factors. The way the healthcare payment system (HPS) reimburses OADs or finances hospital activities may impact patients' access to such drugs. We discuss how the HPS in France and USA may generate disincentives to the use of OADs in certain circumstances. French public and private hospitals are financed by National Health Insurance (NHI) according to the nature and volume of medical services provided annually. Patients receiving intravenous anticancer drugs (IADs) in a hospital setting generate services, while those receiving OADs shift a part of service provision from the hospital to the community. In 2013, two million outpatient IADs sessions were performed, representing a cost of €815 million to the NHI, but positive contribution margin of €86 million to hospitals. Substitution of IADs by OADs mechanically induces a shortfall in hospital income related to hospitalizations. Such economic constraints may partially contribute to making physicians reluctant to prescribe OADs. In the US healthcare system, coverage for OADs is less favorable than coverage for injectable anticancer drugs. In 2006, a Cancer Drug Coverage Parity Act was adopted by several states in order to provide patients with better coverage for OADs. Nonetheless, the complexity of reimbursement systems and multiple reimbursement channels from private insurance represent real economic barriers which may prevent patients with low income being treated with OADs. From an organizational perspective, in both countries the use of OADs generates additional activities related to physician consultations, therapeutic education and healthcare coordination between hospitals and community settings, which are not considered in the funding of hospitals activities so far. Funding of healthcare services is a critical factor influencing in part the choice of cancer treatments and this is expected to become increasingly important as economic constraints grow. Drug reimbursement systems and hospital financing changes, coupled with other accompanying measures, should contribute to improve equal and safe patient access to appropriate anticancer drugs and improve the management and care pathway of cancer patients.
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Perrier, Lionel; Rascle, Pauline; Morelle, Magali; Toulmonde, Maud; Ranchere Vince, Dominique; Le Cesne, Axel; Terrier, Philippe; Neuville, Agnès; Meeus, Pierre; Farsi, Fadila; Ducimetière, Françoise; Blay, Jean-Yves; Ray Coquard, Isabelle; Coindre, Jean-Michel
2018-01-01
This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6-10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.
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Completeness and timeliness of tuberculosis notification in Taiwan
2011-01-01
Tuberculosis (TB) is a notifiable disease by the Communicable Disease Control Law in Taiwan. Several measures have been undertaken to improve reporting of TB but the completeness and timeliness of TB notification in Taiwan has not yet been systemically evaluated. Methods To assess completeness and timeliness of TB notification, potential TB cases diagnosed by health care facilities in the year 2005-2007 were identified using the reimbursement database of national health insurance (NHI), which has 99% population coverage in Taiwan. Potential TB patients required notification were defined as those who have TB-related ICD-9 codes (010-018) in the NHI reimbursement database in 2005-2007, who were not diagnosed with TB in previous year, and who have been prescribed with 2 or more types of anti-TB drugs. Each potential TB case was matched to the national TB registry maintained at Taiwan Centers for Disease Control (CDC) by using national identity number or, if non-citizen, passport number to determine whether the patients had been notified to local public health authorities and Taiwan CDC. The difference in the number of days between date of anti-tuberculosis treatment and date of notification was calculated to determine the timeliness of TB reporting. Results Of the 57,405 TB patients who were prescribed with 2 or more anti-tuberculosis drugs, 55,291 (96.3%) were notified to National TB Registry and 2,114 (3.7%) were not. Of the 55,291 notified cases, 45,250 (81.8%) were notified within 7 days of anti-tuberculosis treatment (timely reporting) and 10,041(18.2%) after 7 days (delayed reporting). Factors significantly associated with failure of notification are younger age, previously notified cases, foreigner, those who visited clinics and those who visited health care facilities only once or twice in 6 months. Conclusion A small proportion of TB cases were not notified and a substantial proportion of notified TB cases had delayed reporting, findings with implication for strengthening surveillance of tuberculosis in Taiwan. Countries where the completeness and timeliness of TB notification has not yet been evaluated should take similar action to strengthen surveillance of TB. PMID:22151346
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Van Pham, H T; Kim, Jaisoo
2014-01-01
Using a new culture method for unculturable soil bacteria, we discovered a novel species, NHI-38(T), from the forest soil of Kyonggi University campus, South Korea. It was a Gram-positive, rod-shaped, and endospore-forming bacterial strain. It grew over a wide pH range (6.5-9.5), with an optimum range of pH 7-9, and in a wide range of temperatures (15-60 °C), with an optimum range of 35-45 °C. Growth was possible at 0-2 % NaCl concentration, and the optimal range was between 0.5 and 1.5 % NaCl. Phylogenetic analysis based on 16S rRNA gene sequences showed that this new species clustered within the genus Bacillus; it was closely related to "Bacillus abyssalis" SCSIO 15042(T) (98.86 %), B. methanolicus NCIMB 13113(T) (95.97 %), B. vietnamensis 15-1(T) (95.8 %), B. seohaeanensis BH724(T) (95.5 %), B. timonensis MM10403188(T) (95.33 %), and B. subtilis subsp. subtilis NCIB 3610(T) (94.87 %). The main fatty acid components of this bacterium were iso-C15:0 (35.92 %), summed feature 3 (C16:1ω7c/C16:1ω6c; 16.92 %), and anteiso-C15:0 (14.19 %). The predominant quinone in this bacterial strain was MK-7. The polar lipid profile primarily comprised phosphatidylethanolamine, phosphatidylglycerol, and diphosphatidylglycerol. The genomic DNA G+C composition of the isolate was 40.7 mol%. The DNA-DNA hybridization results indicated that this strain was distinct from other Bacillus species, the degree of similarity being 50 % with "B. abyssalis", 56 % with B. methanolicus, 47 % with B. vietnamensis, 43 % with B. seohaeanensis, 46 % with B. timonensis, and 32 % with B. subtilis. Based on our results, we regard strain NHI-38(T) as a novel member of the Bacillus genus, and we propose the name Bacillus thaonhiensis (=KACC 17216(T) = KEMB 9005-019(T) = JCM 18863(T)).
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The COS-Halos Survey: Metallicities in the Low-redshift Circumgalactic Medium
NASA Astrophysics Data System (ADS)
Prochaska, J. Xavier; Werk, Jessica K.; Worseck, Gábor; Tripp, Todd M.; Tumlinson, Jason; Burchett, Joseph N.; Fox, Andrew J.; Fumagalli, Michele; Lehner, Nicolas; Peeples, Molly S.; Tejos, Nicolas
2017-03-01
We analyze new far-ultraviolet spectra of 13 quasars from the z˜ 0.2 COS-Halos survey that cover the H I Lyman limit of 14 circumgalactic medium (CGM) systems. These data yield precise estimates or more constraining limits than previous COS-Halos measurements on the H I column densities {N}{{H}{{I}}}. We then apply a Monte-Carlo Markov chain approach on 32 systems from COS-Halos to estimate the metallicity of the cool (T˜ {10}4 K) CGM gas that gives rise to low-ionization state metal lines, under the assumption of photoionization equilibrium with the extragalactic UV background. The principle results are: (1) the CGM of field L* galaxies exhibits a declining H I surface density with impact parameter {R}\\perp (at > 99.5 % confidence), (2) the transmission of ionizing radiation through CGM gas alone is 70 ± 7% (3) the metallicity distribution function of the cool CGM is unimodal with a median of {10}-0.51 {Z}⊙ and a 95% interval ≈ 1/50 {Z}⊙ to > 3 {Z}⊙ ; the incidence of metal-poor (< 1/100 {Z}⊙ ) gas is low, implying any such gas discovered along quasar sightlines is typically unrelated to L* galaxies; (4) we find an unexpected increase in gas metallicity with declining {N}{{H}{{I}}} (at > 99.9 % confidence) and, therefore, also with increasing {R}\\perp ; the high metallicity at large radii implies early enrichment; and (5) a non-parametric estimate of the cool CGM gas mass is {M}{CGM}{cool}=(9.2+/- 4.3)× {10}10 {M}⊙ , which together with new mass estimates for the hot CGM may resolve the galactic missing baryons problem. Future analyses of halo gas should focus on the underlying astrophysics governing the CGM, rather than processes that simply expel the medium from the halo. Based on observations made with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These observations are associated with programs 13033 and 11598.
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Shen, Cheng-Che; Yang, Albert C; Hung, Jeng-Hsiu; Hu, Li-Yu; Chiang, Yung-Yen; Tsai, Shih-Jen
2016-01-01
Pelvic inflammatory disease (PID) a common infection in women that is associated with significant morbidity and is a major cause of infertility. A clear temporal causal relationship between PID and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between PID and the subsequent development of psychiatric disorders. We identified subjects who were newly diagnosed with PID between 1 January 2000 and 31 December 2002 in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed for patients without PID. A total of 21 930 PID and 21 930 matched control patients were observed until diagnosed with psychiatric disorders, or until death, withdrawal from the NHI system, or until 31 December 2009. Adjusted hazard ratio (HR) of bipolar disorder, depressive disorder, anxiety disorder and sleep disorder in subjects with PID were significantly higher (HR: 2.671, 2.173, 2.006 and 2.251, respectively) than that of the controls during the follow-up. PID may increase the risk of subsequent newly diagnosed bipolar disorder, depressive disorder, anxiety disorder and sleep disorder, which will impair life quality. Our findings highlight that clinicians should pay particular attention to psychiatric comorbidities in PID patients.
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Sun, Ming-Hui; Liao, Yaping Joyce; Lin, Che-Chen; Chiang, Rayleigh Ping-Ying; Wei, James Cheng-Chung
2018-04-26
Obstructive sleep apnea (OSA) is associated with many systemic diseases including diabetes, hypertension, stroke, and cardiovascular disease. The aim of our study was to investigate the association between OSA and optic neuropathy (ON), and to evaluate the efficacy of treatment for OSA on the risk of ON. We used the data from the Longitudinal Health Insurance Database, which involved one million insurants from Taiwan National Health Insurance program (Taiwan NHI). OSA patients had a 1.95-fold higher risk of ON compared with non-OSA patients in all age group. The risk was significantly higher (adjusted hazard ratio: 4.21) in the group aged <45 years and male individuals (adjusted hazard ratio: 1.93). Meanwhile, sleep apnea was associated with ON regardless of the existence of comorbidity or not. OSA patients treated with continuous positive airway pressure (CPAP) had an adjusted 2.31-fold higher hazard of developing ON compared to controls, and those without any treatment had an adjusted 1.82-fold higher hazard of developing ON compared to controls. Moreover, ON patients had a 1.45-fold higher risk of OSA, and those aged between 45 and 64 years (hazard ratio: 1.76) and male individuals (hazard ratio: 1.55) had highest risk. Our study showed that OSA increased the risk of developing ON after controlling the comorbidities; however, treatment with CPAP did not reduce the risk of ON. Further large population study accessing to medical records about the severity of OSA and treatment for OSA is needed to clarify the efficacy of treatment for OSA in reducing the risk of ON.
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Migraine and risk of narcolepsy in children: A nationwide longitudinal study.
Yang, Chun-Pai; Hsieh, Meng-Lun; Chiang, Jen-Huai; Chang, Hsing-Yi; Hsieh, Vivian Chia-Rong
2017-01-01
The association between migraine and narcolepsy remains controversial. We aim to investigate whether migraine is associated with an increased risk of developing narcolepsy in children. In this longitudinal study, nationwide medical-claims data of pediatric patients (0-17y) with migraine are identified using the National Health Insurance Research Database (NHIRD) between 1997 and 2010 in Taiwan. Two cohorts are selected: migraine cases (n = 8,923) and propensity score-matched non-migraine controls (n = 35,692). Children with previous history of narcolepsy or headache before the index date are excluded. Cohorts are followed until the end of 2012, their withdrawal from the NHI program, or incidence of narcolepsy (ICD-9-CM: 347). Cox proportional hazards regression models are used to estimate hazard ratios (HRs) and 95% confidence intervals of developing narcolepsy in children with migraine compared to their non-migraine controls. A total of 13 incident cases with narcolepsy are observed during follow-up, with incidence rates of 0.1915 and 0.0278 per 1,000 person-years in migraine and non-migraine children, respectively. After a mean follow-up period of 4.68 and 5.04 years in the case and control cohort, respectively, the former exhibited a greater risk of developing narcolepsy compared to the latter (adjusted hazard ratio (aHR) = 5.30, 95% confidence interval (CI): 1.61, 17.4; p = 0.006). This finding persisted after controlling for potential confounders like baseline comorbidities and concurrent medication uptake, and in our analyses with migraine subtypes. Migraine is an independent risk factor for narcolepsy development in children. Further studies are needed to validate our findings and to explore the exact pathophysiological mechanisms linking migraine and narcolepsy.
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Discovery of a Dwarf Poststarburst Galaxy near a High Column Density Local Lyα Absorber
NASA Astrophysics Data System (ADS)
Stocke, John T.; Keeney, Brian A.; McLin, Kevin M.; Rosenberg, Jessica L.; Weymann, R. J.; Giroux, Mark L.
2004-07-01
We report the discovery of a dwarf (MB=-13.9) poststarburst galaxy coincident in recession velocity (within uncertainties) with the highest column density absorber (NHI=1015.85 cm-2 at cz=1586 km s- 1) in the 3C 273 sight line. This galaxy is by far the closest galaxy to this absorber, projected just 71h-170 kpc on the sky from the sight line. The mean properties of the stellar populations in this galaxy are consistent with a massive starburst ~3.5 Gyr ago, whose attendant supernovae, we argue, could have driven sufficient gas from this galaxy to explain the nearby absorber. Beyond its proximity on the sky and in recession velocity, the further evidence in favor of this conclusion includes both a match in the metallicities of absorber and galaxy and the fact that the absorber has an overabundance of Si/C, suggesting recent Type II supernova enrichment. Thus, this galaxy and its ejecta are in the expected intermediate stage in the fading dwarf evolutionary sequence envisioned by Babul & Rees to explain the abundance of faint blue galaxies at intermediate redshifts. While this one instance of a QSO metal-line absorber and a nearby dwarf galaxy is not proof of a trend, a similar dwarf galaxy would be too faint to be observed by galaxy surveys around more distant metal-line absorbers. Thus, we cannot exclude the possibility that dwarf galaxies are primarily responsible for weak (NHI=1014-1017 cm-2) metal-line absorption systems in general. If a large fraction of the dwarf galaxies expected to exist at high redshift had a similar history (i.e., they had a massive starburst that removed all or most of their gas), these galaxies could account for at least several hundred high-z metal-line absorbers along the line of sight to a high-z QSO. The volume-filling factor for this gas, however, would be less than 1%. ID="FN1"> 1Based on observations made with the Apache Point 3.5 m telescope, operated by the Astronomical Research Consortium, and the 2.6 m du Pont telescope of the Las Campanas Observatory, operated by the Carnegie Institution of Washington, DC, and Pasadena, CA.
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NASA Astrophysics Data System (ADS)
Al-Fulaij, O. A.; Jeragh, B.; El-Sayed, A. E. M.; El-Defrawy, M. M.; El-Asmy, A. A.
2015-02-01
New metal complexes of Co(II), Ni(II) Cu(II), Zn(II), Cd(II), Pd(II) and Hg(II) with 2,3-butanedione isonicotinylhydrazone [BINH] have been prepared and investigated. Single crystal for BINH is grown and solved as orthorhombic with P 21 21 2 space group. The formula of the ligand was assigned based on the elemental analysis, mass spectra and conductivity measurements. The complexes assigned the formulae [M(BINH-H)Cl]ṡnH2O (Mdbnd Co(II), Ni(II), Cu(II), Zn(II); n = 0 or 1); [Hg(BINH-H)(H2O)2Cl]; [Cd(BINH)Cl2]ṡ2H2O and [Pd(BINH)Cl2]ṡH2O. All complexes are nonelectrolytes. BINH acts as a tridentate ligand in [M(BINH-H)Cl]ṡnH2O and [Hg(BINH-H)(H2O)2Cl] coordinating through Cdbnd Oketonic, Csbnd Oamedic and Cdbnd Nhy and as a neutral bidentate through Cdbnd Oketonic and Cdbnd Nhy in [Cd(BINH)Cl2]ṡ2H2O and [Pd(BINH)Cl2]ṡH2O; the pyridine nitrogen has no rule in coordination. The data are supported by NMR (1H and 13C) spectra. The magnetic moments and electronic spectra provide a tetrahedral structure for the Co(II), Ni(II), Cu(II), Zn(II) and Cd(II) complexes; square-planar for the Pd(II) complex and octahedral for the Hg(II) complex. The TGA of the complexes depicted the outer and inner water molecules as well as the final residue. The cobalt and cadmium complexes ended with the metal while the Cu(II), Zn(II) and Pd(II) complexes ended with complex species. [Hg(BINH-H)(H2O)2Cl] has no residue. The ligand is inactive against all tested organisms except for Bacillus thuringiensis. The Hg(II) complex is found more active than the other complexes. The flotation technique is found applicable for the separation of micro amount (10 ppm) of Zr4+ using 10 ppm of BINH and 1 × 10-5 mol L-1 of oleic acid at pH 6 with efficiency of 98% with no interferences.
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Chen, Bradley; Fan, Victoria Y; Chou, Yiing-Jenq; Kuo, Chin-Chi
2017-01-26
Despite the urgent need for evidence to guide the end-of-life (EOL) care for patients with chronic kidney disease (CKD), we have limited knowledge of the costs and intensity of EOL care in this population. The present study examined patterns and predictors for EOL care intensity among elderly patients with CKD. We conducted a retrospective nationwide cohort study utilizing the Taiwan National Health Insurance (NHI) Research Database. A total of 65,124 CKD patients aged ≥ 60 years, who died in hospitals or shortly after discharge between 2002 and 2012 were analyzed. The primary outcomes were inpatient expenses and use of surgical interventions in the last 30 days of life. Utilization of intensive care unit (ICU), mechanical ventilation, resuscitation, and dialysis was also examined in a sub-sample of 2072 patients with detailed prescription data. Multivariate log-linear and logistic regression analyses were performed to assess patient-, physician-, and facility-specific predictors and the potential impact of a 2009 payment policy to reimburse hospice care for non-cancer patients. During the last 30 days of life, average inpatients costs for elderly CKD patients were approximately US$10,260, with 40.9% receiving surgical interventions, 40.2% experiencing ICU admission, 45.3% undergoing mechanical ventilation, 14.7% receiving resuscitation and 42.0% receiving dialysis. Significant variability was observed in the inpatient costs and use of intensive services. Costs were lower among individuals with the following characteristics: advanced age; high income; high Charlson Comorbidity Index scores; treatment by older physicians, nephrologists, and family medicine physicians; and treatment at local hospitals. Similar findings were obtained for the use of surgical interventions and other intensive services. A declining trend was detected in the costs of EOL care, use of surgical interventions and resuscitation between 2009 and 2012, which is consistent with the impact of a 2009 NHI payment policy to reimburse non-cancer hospice care. Overall EOL costs and rates of intensive service use among older patients with CKD were high, with significant variability across various patient and provider characteristics. Several opportunities exist for providers and policy makers to reduce costs and enhance the value of EOL care for this population.
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2014-01-01
Background Oral anticancer drugs (OADs) allow treating a growing range of cancers. Despite their convenience, their acceptance by healthcare professionals and patients may be affected by medical, economical and organizational factors. The way the healthcare payment system (HPS) reimburses OADs or finances hospital activities may impact patients’ access to such drugs. We discuss how the HPS in France and USA may generate disincentives to the use of OADs in certain circumstances. Discussion French public and private hospitals are financed by National Health Insurance (NHI) according to the nature and volume of medical services provided annually. Patients receiving intravenous anticancer drugs (IADs) in a hospital setting generate services, while those receiving OADs shift a part of service provision from the hospital to the community. In 2013, two million outpatient IADs sessions were performed, representing a cost of €815 million to the NHI, but positive contribution margin of €86 million to hospitals. Substitution of IADs by OADs mechanically induces a shortfall in hospital income related to hospitalizations. Such economic constraints may partially contribute to making physicians reluctant to prescribe OADs. In the US healthcare system, coverage for OADs is less favorable than coverage for injectable anticancer drugs. In 2006, a Cancer Drug Coverage Parity Act was adopted by several states in order to provide patients with better coverage for OADs. Nonetheless, the complexity of reimbursement systems and multiple reimbursement channels from private insurance represent real economic barriers which may prevent patients with low income being treated with OADs. From an organizational perspective, in both countries the use of OADs generates additional activities related to physician consultations, therapeutic education and healthcare coordination between hospitals and community settings, which are not considered in the funding of hospitals activities so far. Summary Funding of healthcare services is a critical factor influencing in part the choice of cancer treatments and this is expected to become increasingly important as economic constraints grow. Drug reimbursement systems and hospital financing changes, coupled with other accompanying measures, should contribute to improve equal and safe patient access to appropriate anticancer drugs and improve the management and care pathway of cancer patients. PMID:24950778
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Adomah-Afari, Augustine
2015-01-01
The purpose of this paper is to explore challenges to the performance and sustainability of mutual health organisations (MHOs) and health institutions towards enhancing access to quality health care (HC) in Ghana. Data were gathered through interviews and documentary review. Problems with late release of reimbursement funds for discharging with claims by the central government has impacted heavily on the financial and strategic management and decision-making processes of the MHOs and health institutions. The lack of in-depth analysis of the financial viability of the MHOs; and the limited number of schemes selected. Recommends the need to ensure prompt release of reimbursement funds by government to enable the MHOs to reimburse claims to health institutions. There is a perceived tension between the MHOs and HC institutions due to late release of reimbursement funds by the government. Contributes to understanding of how the NHI Act influences the operations of MHOs and health institutions towards increasing access to quality HC and financing.
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Density probability distribution functions of diffuse gas in the Milky Way
NASA Astrophysics Data System (ADS)
Berkhuijsen, E. M.; Fletcher, A.
2008-10-01
In a search for the signature of turbulence in the diffuse interstellar medium (ISM) in gas density distributions, we determined the probability distribution functions (PDFs) of the average volume densities of the diffuse gas. The densities were derived from dispersion measures and HI column densities towards pulsars and stars at known distances. The PDFs of the average densities of the diffuse ionized gas (DIG) and the diffuse atomic gas are close to lognormal, especially when lines of sight at |b| < 5° and |b| >= 5° are considered separately. The PDF of
at high |b| is twice as wide as that at low |b|. The width of the PDF of the DIG is about 30 per cent smaller than that of the warm HI at the same latitudes. The results reported here provide strong support for the existence of a lognormal density PDF in the diffuse ISM, consistent with a turbulent origin of density structure in the diffuse gas. -
Studies on an inactivated vaccine against rabies virus in domestic animals.
Monaco, F; Franchi, P M; Lelli, R
2006-01-01
An inactivated vaccine against rabies virus was prepared from the attenuated ATCC PV-12 viral rabbit Pasteur strain. The virus was grown on Baby Hamster Kidney (BHK21) cells, and the supernatant was purified by filtration and inactivated with beta-propriolactone. The inactivated product was checked according to the NHI and European Pharmacopoeia methods. Part of the product was then lyophilised and the other part was adjuvanted with Al(OH)3. Both parts were used to vaccinate and boost groups of horses, cattle and sheep at different intervals. Their immunogenicity was compared with a similar commercial product. Blood samples were collected on a regular basis and the antibody titre was determined by the Fluorescence Antibody Virus Neutralisation (FAVN) test. No significant differences were found between species after both inoculations even though the immune response increased in intensity and duration after the booster dose in all the animals tested and was stronger and lasted longer with the adjuvanted aliquot.
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He, Huiying; Yang, Rui; Li, Yajun; Ma, Aisheng; Cao, Lanqin; Wu, Xiaoming; Chen, Biyun; Tian, Hui; Gao, Yajun
2017-01-01
Oilseed rape (Brassica napus) characteristically has high N uptake efficiency and low N utilization efficiency (NUtE, seed yield/shoot N accumulation). Determining the NUtE phenotype of various genotypes in different growth conditions is a way of finding target traits to improve oilseed rape NUtE. The aim of this study was to compare oilseed rape genotypes grown on contrasting N supply rates in pot and field experiments to investigate the genotypic variations of NUtE and to identify indicators of N efficient genotypes. For 50 oilseed rape genotypes, NUtE, dry matter and N partitioning, morphological characteristics, and the yield components were investigated under high and low N supplies in a greenhouse pot experiment and a field trial. Although the genotype rankings of NUtE were different between the pot experiment and the field trial, some genotypes performed consistently in both two environments. N-responder, N-nonresponder, N-efficient and N-inefficient genotypes were identified from these genotypes with consistent NUtE. The correlations between the pot experiment and the field trial in NUtE were only 0.34 at high N supplies and no significant correlations were found at low N supplies. However, Pearson coefficient correlation (r) and principal component analysis showed NUtE had similar genetic correlations with other traits across the pot and field experiment. Among the yield components, only seeds per silique showed strong and positive correlations with NUtE under varying N supply in both experiments (r = 0.47**; 0.49**; 0.47**; 0.54**). At high and low N supply, NUtE was positively correlated with seed yield (r = 0.45**; 0.53**; 0.39**; 0.87**), nitrogen harvest index (NHI, r = 0.68**; 0.82**; 0.99**; 0.89**), and harvest index (HI, r = 0.79**; 0.83**; 0.90**; 0.78**) and negatively correlated with biomass distribution to stem and leaf (r = −0.34**; −0.45**; −0.37**; 0.62**), all aboveground plant section N concentration (r from −0.30* to −0.80**), N distribution to the vegetative parts (silique husk, stem and leaf) (r from −0.40** to −0.83**). N-efficient (N-responder) genotypes produced more seeds per silique and had significantly higher NHI and HI than did N-inefficient (N-nonresponder) genotypes. In conclusion, across the pot and field experiments, the 50 genotypes had similar underlying traits correlated with NUtE and seeds per silique may be a good indicator of NUtE. PMID:29163565
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The WSRT Virgo Hi filament survey. II. Cross correlation data
NASA Astrophysics Data System (ADS)
Popping, A.; Braun, R.
2011-04-01
Context. The extended environment of galaxies contains a wealth of information about the formation and life cycle of galaxies which are regulated by accretion and feedback processes. Observations of neutral hydrogen are routinely used to image the high brightness disks of galaxies and to study their kinematics. Deeper observations will give more insight into the distribution of diffuse gas in the extended halo of the galaxies and the inter-galactic medium, where numerical simulations predict a cosmic web of extended structures and gaseous filaments. Aims: To observe the extended environment of galaxies, column density sensitivities have to be achieved that probe the regime of Lyman limit systems. H i observations are typically limited to a brightness sensitivity of NHI ~ 1019 cm-2, but this must be improved upon by ~2 orders of magnitude. Methods: In this paper we present the interferometric data of the Westerbork Virgo H i Filament Survey (WVFS) - the total power product of this survey has been published in an earlier paper. By observing at extreme hour angles, a filled aperture is simulated of 300 × 25 m in size, that has the typical collecting power and sensitivity of a single dish telescope, but the well defined bandpass characteristics of an interferometer. With the very good surface brightness sensitivity of the data, we hope to make new H i detections of diffuse systems with moderate angular resolution. Results: The survey maps 135 degrees in Right Ascension between 8 and 17 h and 11 degrees in Declination between - 1 and 10 degrees, including the galaxy filament connecting the Local Group with the Virgo Cluster. Only positive declinations could be completely processed and analysed due to projection effects. A typical flux sensitivity of 6 mJy beam-1 over 16 km s-1 is achieved, that corresponds to a brightness sensitivity of NHI ~ 1018 cm-2. An unbiased search has been done with a high significance threshold as well a search with a lower significance limit but requiring an optical counterpart. In total, 199 objects have been detected, of which 17 are new H i detections. Conclusions: By observing at extreme hour angles with the WSRT, a filled aperture can be simulated in projection, with a very good brightness sensitivity, comparable to that of a single dish telescope. Despite some technical challenges, the data provide valuable constraints on faint, circum-galactic H i features. Appendix is only available at electronic form at http://www.aanda.org
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Saviano, M; Iacovino, R; Menchise, V; Benedetti, E; Bonora, G M; Gatos, M; Graci, L; Formaggio, F; Crisma, M; Toniolo, C
2000-02-01
Two complete series of N-protected, monodispersed oligopeptide esters to the pentamer level from 1-aminocyclododecane-1-carboxylic acid (Ac(12)c), an alpha-amino acid conformationally constrained through C(alpha)(i) <--> C(alpha)(i) cyclization, and either L-Ala or Aib residues, along with the N-protected Ac(12)c homopeptide alkylamide series from monomer to trimer, have been synthesized by solution methods and fully characterized. The solution-preferred conformations of these peptides have been assessed by Fourier transform ir absorption and (1)H-nmr techniques. Moreover, the molecular structures of one derivative (Z-Ac(12)c-OH) and three peptides [the tripeptide ester Z-L-Ala-Ac(12)c-L-Ala-OMe, the tripeptide alkylamide Z-(Ac(12)c)(3)-NHiPr, and the tetrapeptide ester Z-(Aib)(2)-Ac(12)c-Aib-OtBu (Aib, alpha-aminoisobutyric acid)] have been determined in the crystal state by x-ray diffraction. The results obtained point to the conclusion that beta-bends and 3(10)-helices are preferentially adopted by peptides based on Ac(12)c, the largest cycloaliphatic C-disubstituted glycine known. A comparison with the structural tendencies extracted from published works on peptides from Aib, the prototype of C-disubstituted glycines, and the other extensively studied members of the class of 1-aminocycloalkane-1-carboxylic acids (Ac(n) c, with n = 3-9), is made and the implications for the use of the Ac(12)c residue in the Ac(n) c scan approach of conformationally restricted analogues of bioactive peptides are briefly discussed. Copyright 2000 John Wiley & Sons, Inc.
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Lee, Chun-Feng; Lin, Kuan-Yu; Lin, Ming-Chia; Lin, Cheng-Li; Chang, Shih-Ni; Kao, Chia-Hung
2014-11-01
Sleep disorders (SD), including apnea and nonapnea, and burning mouth syndrome (BMS) have been mutually associated with systemic diseases. Based on our research, the association between BMS and SD has not been elucidated. We determined whether SD patients have an increased risk of BMS. We used information from health insurance claims obtained from the Taiwanese National Health Insurance (NHI) program. We identified patients newly diagnosed with sleep apnea syndrome between 1998 and 2001 as the apnea SD cohort, and newly diagnosed patients with nonapnea SD as the nonapnea SD cohort. The non-SD cohort was 1:2 frequency matched the case group according to sex, age, and index year. We analyzed the risks of BMS by using Cox proportional hazards regression models. Compared with the non-SD cohort, both of the apnea SD (adjusted HR = 2.56, 95% CI = 1.30-5.05) and nonapnea SD (adjusted HR = 2.89, 95% CI = 2.51-3.34) were associated with a significantly higher risk of BMS. The hazard ratio (HR) increased with increased age in the apnea SD cohort and in the nonapnea SD cohort compared with patients younger than 40 years of age. Female apnea SD patients (IRR = 4.63, 95% CI = 3.82-5.61) had a higher risk of developing BMS than did male patients (IRR = 1.76, 95% CI = 1.39-2.24). Based on our research, SD might increase the risk of BMS. Copyright © 2014 Elsevier B.V. All rights reserved.
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Absorption systems at z ˜ 2 as a probe of the circum galactic medium: a probabilistic approach
NASA Astrophysics Data System (ADS)
Mongardi, C.; Viel, M.; D'Odorico, V.; Kim, T.-S.; Barai, P.; Murante, G.; Monaco, P.
2018-05-01
We characterize the properties of the intergalactic medium (IGM) around a sample of galaxies extracted from state-of-the-art hydrodynamical simulations of structure formation in a cosmological volume of 25 Mpc comoving at z ˜ 2. The simulations are based on two different sub-resolution schemes for star formation and supernova feedback: the MUlti-Phase Particle Integrator (MUPPI) scheme and the Effective Model. We develop a quantitative and probabilistic analysis based on the apparent optical depth method of the properties of the absorbers as a function of impact parameter from their nearby galaxies: in such a way we probe different environments from circumgalactic medium (CGM) to low density filaments. Absorbers' properties are then compared with a spectroscopic observational data set obtained from high resolution quasar spectra. Our main focus is on the NCIV - NHI relation around simulated galaxies: the results obtained with MUPPI and the Effective model are remarkably similar, with small differences only confined to regions at impact parameters b = [1 - 3] × rvir. Using {C IV} as a tracer of the metallicity, we obtain evidence that the observed metal absorption systems have the highest probability to be confined in a region of 150-400 kpc around galaxies. Near-filament environments have instead metallicities too low to be probed by present-day telescopes, but could be probed by future spectroscopical studies. Finally we compute {C IV} covering fractions which are in agreement with observational data.
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NASA Astrophysics Data System (ADS)
Linsky, Jeffrey L.; Wood, Brian E.
1996-05-01
We analyze high-resolution spectra of the nearby (1.34 pc) stars alpha Cen A (G2 V) and alpha Cen B (K1 V), which were obtained with the Goddard High Resolution Spectrograph on the Hubble Space Telescope. The observations consist of echelle spectra of the Mg II 2800 A and Fe II 2599 A resonance lines and the Lyman-alpha lines of hydrogen and deuterium. The interstellar gas has a velocity (v = - 18.0 +/- 0.2 km/s) consistent with the local flow vector proposed for this line of sight by Lailement & Berlin (1992). The temperature and nonthermal velocity inferred from the Fe II, Mg II, and D I line profiles are T = 5400 +/- 500 K and xi = 1.20 +/- 0.25 km/s, respectively. However, single-component fits to the H I Lyman-alpha lines yield a Doppler parameter (bHI = 11.80 km/s) that implies a significantly warmer temperature of 8350 K, and the velocity of the H I absorption (v = - 15.8 +/- 0.2 km/s) is redshifted by about 2.2 km/s with respect to the Fe II, Mg II, and D I lines. The one-component model of the interstellar gas suggests natural logarithm N base HI = 18.03 +/- 0.01 and D/H = (5.7 +/- 0.2) x 10-6 . These parameters lead to a good fit to the observed spectra, but this model does not explain the higher temperature and redshift of H I relative to the other interstellar lines. The most sensible way to resolve the discrepancy between H(I) and the other lines is to add a second absorption component to the H(I) lines. This second component is hotter (T approx. equals 30,000 K), is redshifted relative to the primary component by 2-4 km/s, and has a column density too low to be detected in the Fe(II), Mg(II), and D(I) lines. We propose that the gas responsible for this component is located near the heliopause, consisting of the heated H I gas from the interstellar medium that is compressed by the solar wind. This so-called 'hydrogen wall' is predicted by recent multifluid gasdynamical models of the interstellar gas and solar wind interaction. Our data provide the first measurements of the temperature and column density of H(I) in the hydrogen wall. After considering the effects that a corresponding hydrogen wall around alpha Cen would have on our analysis, our best estimates for the parameters of the solar hydrogen wall are natural log N(2)(H(I)) = 14.74 +/- 0.24, b(2)(H(I)) = 21.9 +/- 1.7 km/s (corresponding to T = 29,000 +/- 5000 K), and v(2)(H(I)) greater than -16km/s. Unfortunately, the existence of this heated H(I) reduces our ability to compute the H(I) column density of the interstellar medium accurately because, with slight alterations to our assumed stellar Lyman-alpha profiles, we discovered that acceptable two-component fits also exist with natural log N(H(I))approx. 17.6. We, therefore, quote large error bars for the H I column density along the alpha Cen line of sight, natural log N(H(I)) = 17.80 +/- 0.30. For this range in N(H(I)), n(H(I)) = 0.15 /cu.cm (+/- a factor of 2) and D/H = (0.5-1.9) x 10-5. This is the first direct measurement of the H(I) density in a local cloud and allows us to predict the distance from the Sun to the edge of the local cloud along various lines of sight. This range in D/H is consistent with the value D/H = 1.6 x 10-5 previously derived for the Capella and Procyon lines of sight. We cannot tell whether D/H ratio varies or is constant in the local interstellar medium, but we do find that the D(I)/Mg(II) ratio for the alpha Cen line of sight is about 4 times smaller than for the Capella and Procyon lines of sight. Therefore, either D/H or the Mg depletion varies significantly over distance scales of only a few parsecs.
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Chen, Chi-Chen; Cheng, Shou-Hsia
2010-11-01
To examine the effects of market competition on patient-perceived quality of care under a single-payer system in Taiwan. Data came from two nationwide surveys conducted on discharged patients and National Health Insurance (NHI) hospital claim datasets in 2002 and 2004. Competition was measured by the Herfindahl-Hirschman Index (HHI). Quality of care was measured by patient-rated hospital performance including interpersonal skills and clinical competence domains. We used the instrumental variable approach to address the endogeneity between competition and patient-perceived quality of care. The results showed that HHI was significantly associated with a decrease in the perceived interpersonal skills (coefficient of -0.460; p<0.001), indicating that the interpersonal skill level increases in competition. A similar association was found for the perceived clinical competence (coefficient of -0.457; p=0.001). Quality of care from the patients' perspective is sensitive to the degree of competition. By using patient-reported data, this study provides new evidence concerning competition and quality of care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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A logNHI = 22.6 Damped Lyα Absorber in a Dark Gamma-Ray Burst: The Environment of GRB 050401
NASA Astrophysics Data System (ADS)
Watson, D.; Fynbo, J. P. U.; Ledoux, C.; Vreeswijk, P.; Hjorth, J.; Smette, A.; Andersen, A. C.; Aoki, K.; Augusteijn, T.; Beardmore, A. P.; Bersier, D.; Castro Cerón, J. M.; D'Avanzo, P.; Diaz-Fraile, D.; Gorosabel, J.; Hirst, P.; Jakobsson, P.; Jensen, B. L.; Kawai, N.; Kosugi, G.; Laursen, P.; Levan, A.; Masegosa, J.; Näränen, J.; Page, K. L.; Pedersen, K.; Pozanenko, A.; Reeves, J. N.; Rumyantsev, V.; Shahbaz, T.; Sharapov, D.; Sollerman, J.; Starling, R. L. C.; Tanvir, N.; Torstensson, K.; Wiersema, K.
2006-12-01
The optical afterglow spectrum of GRB 050401 (at z=2.8992+/-0.0004) shows the presence of a damped Lyα absorber (DLA), with logNHI=22.6+/-0.3. This is the highest column density ever observed in a DLA and is about 5 times larger than the strongest DLA detected so far in any QSO spectrum. From the optical spectrum, we also find a very large Zn column density, implying an abundance of [Zn/H]=-1.0+/-0.4. These large columns are supported by the early X-ray spectrum from Swift XRT, which shows a column density (in excess of Galactic) of logNH=22.21+0.06-0.08 assuming solar abundances (at z=2.9). The comparison of this X-ray column density, which is dominated by absorption due to α-chain elements, and the H I column density derived from the Lyα absorption line allows us to derive a metallicity for the absorbing matter of [α/H]=-0.4+/-0.3. The optical spectrum is reddened and can be well reproduced with a power law with SMC extinction, where AV=0.62+/-0.06. But the total optical extinction can also be constrained independent of the shape of the extinction curve: from the optical to X-ray spectral energy distribution, we find 0.5<~AV<~4.5. However, even this upper limit, independent of the shape of the extinction curve, is still well below the dust column that is inferred from the X-ray column density, i.e., AV=9.1+1.4-1.5. This discrepancy might be explained by a small dust content with high metallicity (low dust-to-metals ratio). ``Gray'' extinction cannot explain the discrepancy, since we are comparing the metallicity to a measurement of the total extinction (without reference to the reddening). Little dust with high metallicity may be produced by sublimation of dust grains or may naturally exist in systems younger than a few hundred megayears. Based in part on observations made at the European Southern Observatory, Paranal, Chile under program 075.D-0270, with the Nordic Optical Telescope, operated on the island of La Palma jointly by Denmark, Finland, Iceland, Norway, and Sweden, in the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofisica de Canarias, with the Wide Field Camera (WFCAM) on the United Kingdom Infrared Telescope, which is operated by the Joint Astronomy Centre on behalf of the UK Particle Physics and Astronomy Research Council, and on data collected at the Subaru Telescope, which is operated by the National Astronomical Observatory of Japan.
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Dust and Diffuse Interstellar Bands in the za = 0.524 Absorption System toward AO 0235+164
NASA Astrophysics Data System (ADS)
Junkkarinen, V. T.; Cohen, Ross D.; Beaver, E. A.; Burbidge, E. M.; Lyons, R. W.; Madejski, G.
2004-10-01
We present new Hubble Space Telescope (HST) Space Telescope Imaging Spectrograph (STIS) NUV-MAMA and STIS CCD observations of the BL Lac object AO 0235+164 and the intervening damped Lyα (DLA) line at za=0.524. The line profile gives N(HI)=(5+/-1)×1021 cm-2 and, combined with the H I 21 cm absorption data, leads to a spin temperature of Ts=220+/-60 K. Those spectra also show a strong, broad feature at the expected position of the 2175 Å graphitic dust feature at za=0.524. Assuming a Galactic-type dust extinction curve at za=0.524 gives a dust-to-gas ratio of 0.19 times the Galactic value, but the fit, assuming that the underlying, unreddened spectrum is a single power law, is poor in the far-UV. A dust-to-gas ratio of 0.19 times the Galactic value is similar to the LMC, but the AO 0235+164 spectrum does not fit either the LMC extinction curve or the SMC extinction curve (which has practically no 2175 Å feature). A possible interpretation includes dust similar to that in the Galaxy, but with fewer of the small particles that produce the far-UV extinction. The metallicity of the za=0.524 absorber, estimated from the observed N(HI) and excess X-ray absorption (beyond Galactic) derived from contemporaneous and archival ASCA and ROSAT X-ray data, is Z=0.72+/-0.28 Zsolar, implying in turn a dust-to-metals ratio of 0.27 times the Galactic value. If the dust mass density is the same in the za=0.524 DLA system as in our Galaxy, only 14% (+/-6%) of the metals (by mass) are in dust, compared to 51%, 36%, and 46% for the Galaxy, LMC, and SMC, respectively. Such a dusty za=0.524 AO 0235+164 absorption system is a good example of the kind of DLA system that will be missed because of selection effects, which in turn can bias the measurement of the comoving density of interstellar gas (in units of the closure density), Ωg, as a function of z. Based on observations with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555. Some of the data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California, and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation.
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Poverty related risk for potentially preventable hospitalisations among children in Taiwan.
Chen, Likwang; Lu, Hsin-Ming; Shih, Shu-Fang; Kuo, Ken N; Chen, Chi-Liang; Huang, Lynn Chu
2010-07-07
This study investigated the incidence of potentially preventable hospitalisations in the first two years of life among children in the National Health Insurance (NHI) system of Taiwan. It also examined income disparities in potentially preventable hospitalisations across four economic categories: below a government-established poverty line and low-, middle-, and upper-income. Five major diseases causing potentially preventable hospitalisations were investigated: gastroenteritis and dehydration, asthma and chronic bronchitis, acute upper respiratory infections, lower respiratory infections, and acute injuries and poisonings. NHI data on enrolee registrations and use of ambulatory and hospital care by all children born between July 1, 2003 and June 30, 2004 (n = 218,158) was used for the study. The negative binomial regression method was used to identify factors associated with total inpatient care and the severity level for various types of potentially preventable hospitalisations during the first two years of life. This study found high inpatient expenses for lower respiratory infections for children in all income categories. Furthermore, results from the multivariate analysis indicate that children in the lowest economic category used inpatient care to a much greater extent than better-off children for problems considered potentially avoidable through primary prevention or through timely outpatient care. This was especially true for acute injuries and poisonings and for lower respiratory infections. On average, and controlling for other variables, a child in poverty spent 6.1 times more days in inpatient care for acute injuries and poisonings (p < 0.01) and 2.7 times more days for lower respiratory infections (p < 0.01) before age two, compared with a similarly-aged high-income child. The results also suggest a connection between economic status and the severity of a condition causing a potentially avoidable hospital admission. On average, length of stay for each admission for gastroenteritis and dehydration for children in poverty was 1.3 times that for high-income children (p < 0.01). Both the ratios for lower respiratory infections and for acute upper respiratory infections were 1.2 (p < 0.01 for both). There were high hospital admission rates and lengths of stays for lower respiratory infections among young children in all income categories. Hospital care use of young children in the poorest category was significantly higher for acute injuries and poisonings as well as for lower respiratory infections, compared with those of better-off children. The findings suggest the need for increased attention to these two disease types. It particularly calls for more research on the causes of high hospital care use for lower respiratory infections and on the reasons for large economic disparities in hospital care use for acute injuries and poisonings.
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Health Physics Code System for Evaluating Accidents Involving Radioactive Materials.
DOE Office of Scientific and Technical Information (OSTI.GOV)
2014-10-01
Version 03 The HOTSPOT Health Physics codes were created to provide Health Physics personnel with a fast, field-portable calculational tool for evaluating accidents involving radioactive materials. HOTSPOT codes provide a first-order approximation of the radiation effects associated with the atmospheric release of radioactive materials. The developer's website is: http://www.llnl.gov/nhi/hotspot/. Four general programs, PLUME, EXPLOSION, FIRE, and RESUSPENSION, calculate a downwind assessment following the release of radioactive material resulting from a continuous or puff release, explosive release, fuel fire, or an area contamination event. Additional programs deal specifically with the release of plutonium, uranium, and tritium to expedite an initial assessmentmore » of accidents involving nuclear weapons. The FIDLER program can calibrate radiation survey instruments for ground survey measurements and initial screening of personnel for possible plutonium uptake in the lung. The HOTSPOT codes are fast, portable, easy to use, and fully documented in electronic help files. HOTSPOT supports color high resolution monitors and printers for concentration plots and contours. The codes have been extensively used by the DOS community since 1985. Tables and graphical output can be directed to the computer screen, printer, or a disk file. The graphical output consists of dose and ground contamination as a function of plume centerline downwind distance, and radiation dose and ground contamination contours. Users have the option of displaying scenario text on the plots. HOTSPOT 3.0.1 fixes three significant Windows 7 issues: Executable installed properly under "Program Files/HotSpot 3.0". Installation package now smaller: removed dependency on older Windows DLL files which previously needed to; Forms now properly scale based on DPI instead of font for users who change their screen resolution to something other than 100%. This is a more common feature in Windows 7; Windows installer was starting everytime most users started the program, even after HotSpot was already installed. Now, after the program is installed the installer may come up once for each new user but only the first time they run HotSpot on a particular machine. So no user should see the installer come up more than once over many uses; and GPS capability updated to directly use a serial port through a USB connection. Non-USB connections should still work. Fixed table output inconsistencies for fire scenarios.« less
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Kim, Jae-Hyun; Lee, Kwang-Soo; Yoo, Ki-Bong; Park, Eun-Cheol
2015-01-01
Study Objectives Health care utilization has progressively increased, especially among Medical Aid beneficiaries in South Korea. The Medical Aid classifies beneficiaries into two categories, type 1 and 2, on the basis of being incapable (those under 18 or over 65 years of age, or disabled) or capable of working, respectively. Medical Aid has a high possibility for health care utilization due to high coverage level. In South Korea, the national health insurance (NHI) achieved very short time to establish coverage for the entire Korean population. However there there remaine a number of problems to be solved. Therefore, the objective of this study was to investigate the differences in health care utilization between Medical Aid beneficiaries and Health Insurance beneficiaries. Methods & Design Data were collected from the Korean Welfare Panel Study from 2008 to 2012 using propensity score matching. Of the 2,316 research subjects, 579 had Medical Aid and 1,737 had health insurance. We also analyzed three dependent variables: days spent in the hospital, number of outpatient visits, and hospitalizations per year. Analysis of variance and longitudinal data analysis were used. Results The number of outpatient visits was 1.431 times higher (p<0.0001) in Medical Aid beneficiaries, the number of hospitalizations per year was 1.604 times higher (p<0.0001) in Medical Aid beneficiaries, and the number of days spent in the hospital per year was 1.282 times higher (p<0.268) for Medical Aid beneficiaries than in individuals with Health Insurance. Medical Aid patients had a 0.874 times lower frequency of having an unmet needs due to economic barrier (95% confidence interval: 0.662-1.156). Conclusions Health insurance coverage has an impact on health care utilization. More health care utilization among Medical Aid beneficiaries appears to have a high possibility of a moral hazard risk under the Health Insurance program. Therefore, the moral hazard for Medical Aid beneficiaries should be avoided. PMID:25816234
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A Search for HI Self-Absorption in the SGPS
NASA Astrophysics Data System (ADS)
Kavars, D. W.; Dickey, J. D.; McClure-Griffiths, N. M.; Gaensler, B. M.; Green, A. J.
2003-12-01
Using data from the Southern Galactic Plane Survey(SGPS) we present a routine to search for cold HI clouds in the Galaxy, based on their HI self-absorption(HISA) signature. The data was obtained using the Australia Telescope Compact Array and the Parkes Radio Telescope. The SGPS, because of its good angular and velocity resolution, is excellent for searching for HISA clouds. We have already analyzed a few of the more prominent HISA features, finding spin temperatures, Ts ˜ 20K, column densities, NHI ˜ 2 x 1020}cm{-2, and optical depths of ˜ 1. The next step is to search the entire SGPS. A search by eye is possible, but is biased towards the most pronounced features. To better understand the role HISA plays in the ISM, an automated search technique is required. Our routine takes the first and second derivatives of the HI emission brightness temperature with respect to velocity. Due to the sharp drop in the emission profile through a HISA cloud, the derivative profiles show characteristic positive and/or negative peaks. These peaks represent a population of clouds separate from random HI emission fluctuations. By setting thresholds on the derivative maps and defining HISA only if it passes both derivative tests, we can build an unbiased catalog of HISA candidates in the Galaxy. The number distribution can be used to put constraints on the parameters used to find the spin temperature and optical depth, allowing us to more accurately determine the temperature, column density, and optical depth distribution of HISA clouds. We also compare HISA with 12CO emission. In the Inner Galaxy from l=313 deg to l=338 deg we find 30-50% of HISA is associated with 12CO at a brightness temperature of at least 1K. This work was supported by NSF grant AST 97-32695 to the University of Minnesota.
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Russo, Annapina; Pellosi, Diogo Silva; Pagliara, Valentina; Milone, Maria Rita; Pucci, Biagio; Caetano, Wilker; Hioka, Noboru; Budillon, Alfredo; Ungaro, Francesca; Russo, Giulia; Quaglia, Fabiana
2016-09-10
With the aim to develop alternative therapeutic tools for the treatment of resistant cancers, here we propose targeted Pluronic(®) P123/F127 mixed micelles (PMM) delivering niclosamide (NCL) as a repositioning strategy to treat multidrug resistant non-small lung cancer cell lines. To build multifunctional PMM for targeting and imaging, Pluronic(®) F127 was conjugated with biotin, while Pluronic(®) P123 was fluorescently tagged with rhodamine B, in both cases at one of the two hydroxyl end groups. This design intended to avoid any interference of rhodamine B on biotin exposition on PMM surface, which is a key fundamental for cell trafficking studies. Biotin-decorated PMM were internalized more efficiently than non-targeted PMM in A549 lung cancer cells, while very low internalization was found in NHI3T3 normal fibroblasts. Biotin-decorated PMM entrapped NCL with good efficiency, displayed sustained drug release in protein-rich media and improved cytotoxicity in A549 cells as compared to free NCL (P<0.01). To go in depth into the actual therapeutic potential of NCL-loaded PMM, a cisplatin-resistant A549 lung cancer cell line (CPr-A549) was developed and its multidrug resistance tested against common chemotherapeutics. Free NCL was able to overcome chemoresistance showing cytotoxic effects in this cell line ascribable to nucleolar stress, which was associated to a significant increase of the ribosomal protein rpL3 and consequent up-regulation of p21. It is noteworthy that biotin-decorated PMM carrying NCL at low doses demonstrated a significantly higher cytotoxicity than free NCL in CPr-A549. These results point at NCL-based regimen with targeted PMM as a possible second-line chemotherapy for lung cancer showing cisplatin or multidrug resistance. Copyright © 2016 Elsevier B.V. All rights reserved.
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Zakharova, Valeria M.; Serpi, Michaela; Krylov, Ivan S.; Peterson, Larryn W.; Breitenbach, Julie M.; Borysko, Katherine Z.; Drach, John C.; Collins, Mindy; Hilfinger, John M.; Kashemirov, Boris A.; McKenna, Charles E.
2011-01-01
Eight novel single amino acid (6–11) and dipeptide (12, 13) tyrosine P-O esters of cyclic cidofovir ((S)-cHPMPCa, 4) and its cyclic adenine analog ((S)-cHPMPA, 3) were synthesized and evaluated as prodrugs. In vitro IC50 values for the prodrugs vs vaccinia, cowpox, human cytomegalo- and herpes simplex type 1 viruses were similar to those for the parent drugs ((S)-HPMPC, 2, (S)-HPMPA, 1; IC50 0.3 – 30 µM); there were no cytoxicity with KB or HFF cells at ≤ 100 µM. The prodrugs exhibited a wide range of half-lives in rat intestinal homogenate at pH 6.5 (<30 – 1732 min) with differences of 3–10× between phostonate diastereomers. The tyrosine-alkylamide derivatives of 3 and 4 were the most stable. (L)-Tyr-NHiBu cHPMPA (11) was converted in rat or mouse plasma solely to two active metabolites and had significantly enhanced oral bioavailability vs parent drug 1 in a mouse model (39 % vs <5 %). PMID:21812420
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Broad Halpha Wing Formation in the Planetary Nebula IC 4997.
Lee; Hyung
2000-02-10
The young and compact planetary nebula IC 4997 is known to exhibit very broad wings with a width exceeding 5000 km s-1 around Halpha. We propose that the broad wings are formed through Rayleigh-Raman scattering that involves atomic hydrogen, by which Lybeta photons with a velocity width of a few 102 km s-1 are converted to optical photons and fill the Halpha broad wing region. The conversion efficiency reaches 0.6 near the line center, where the scattering optical depth is much larger than 1, and rapidly decreases in the far wings. Assuming that close to the central star there exists an unresolved inner compact core of high density, nH approximately 109-1010 cm-3, we use the photoionization code "CLOUDY" to show that sufficient Lybeta photons for scattering are produced. Using a top-hat-incident profile for the Lybeta flux and a scattering region with a H i column density NHi=2x1020 cm-2 and a substantial covering factor, we perform a profile-fitting analysis in order to obtain a satisfactory fit to the observed flux. We briefly discuss the astrophysical implications of the Rayleigh-Raman processes in planetary nebulae and other emission objects.
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Hospital response to a global budget program under universal health insurance in Taiwan.
Cheng, Shou-Hsia; Chen, Chi-Chen; Chang, Wei-Ling
2009-10-01
Global budget programs are utilized in many countries to control soaring healthcare expenditures. The present study was designed to evaluate the responses of Taiwanese hospitals to a new global budget program implemented in 2002. Using data obtained from the Bureau of National Health Insurance (NHI) and two nationwide surveys conducted before and after the global budget program, changes in the length of stay, treatment intensity, insurance claims, and out-of-pocket fees were compared in 2002 and 2004. The analysis was conducted using the Generalized Estimating Equations (GEEs) method. Regression models revealed that implementation of the global budget was followed by a 7% increase in length of stay and a 15% increase in the number of prescribed procedures and medications per admission. The claim expenses increased by 14%, and out-of-pocket fees per admission increased by 6%. Among the hospitals, no coalition action was found during the study period. In the present study, it appears that hospitals attempted to increase per-case expense claims to protect their reimbursement from possible discounts under a global budget cap. How Taiwanese hospitals respond to this challenge in the future deserves continued, long-term observation.
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Hou, Sheng-Wen; Lee, Yi-Kung; Hsu, Chen-Yang; Lee, Ching-Chih; Su, Yung-Cheng
2013-01-01
The risk of acute pancreatitis in patients on long-term peritoneal dialysis is higher as compared to the general population. However, the relationship between long-term hemodialysis and acute pancreatitis has never been established. We investigated the incidence of acute pancreatitis among patients on long-term hemodialysis in Taiwan to evaluate if there is a higher risk of acute pancreatitis in comparison to the general population. We utilized a National Health Insurance (NHI) claims data sample containing one million beneficiaries. We followed all adult beneficiaries from January 1, 2007 until December 31, 2010 to see if they had been hospitalized for acute pancreatitis during this period. We further identified patients on chronic hemodialysis and compared their risk of acute pancreatitis with the general population. This study included 2603 patients with long-term hemodialysis and 773,140 patients without hemodialysis. After controlling for age, gender, Charlson Comorbidity Index Score, geographic region, socioeconomic status and urbanization level, the adjusted hazard ratio was 3.44 (95% Confidence interval, 2.5-4.7). The risk of acute pancreatitis in patients on long-term hemodialysis is significantly higher in comparison to the general population.
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Income-Related Inequalities in Access to Dental Care Services in Japan.
Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira
2017-05-12
Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.
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Previous history of tuberculosis is associated with rheumatoid arthritis.
Shen, T-C; Lin, C-L; Wei, C-C; Chen, C-H; Tu, C-Y; Hsia, T-C; Shih, C-M; Hsu, W-H; Chung, C-J; Sung, F-C; Kao, C-H
2015-11-01
Previous studies have suggested that mycobacterial infections could trigger autoimmune diseases, including rheumatoid arthritis (RA). To explore the association between previous tuberculosis (TB) and RA. We conducted a case-control study using data obtained from the National Health Insurance (NHI) system of Taiwan. We identified 26 535 adults with RA from 2002 to 2011, with the date of diagnosis as the index date. This number was randomly selected and frequency-matched four times by age, sex and the year of index date from among non-RA individuals. Odds ratios (ORs) of RA were calculated for associations with TB. Compared with controls, RA patients had a crude OR of 1.77 for TB (95%CI 1.61-1.94). The strength of the association between RA and TB remained at the same level after controlling for other potential risk factors (adjusted OR 1.73, 95%CI 1.57-1.90), although RA patients tended to have a higher prevalence of hypertension, coronary artery disease and kidney disease. TB was much more prevalent in RA patients than in control subjects. Prospective cohort studies are required to establish a causal relationship between previous TB and RA.
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The Relationship Between N(Htotal) and E(B-V) at High Galactic Latitude
NASA Astrophysics Data System (ADS)
Doppel, Jessica Erin; Magnani, Loris A.
2017-06-01
We studied the gas-to-dust ratio at high Galactic latitudes (|b| ≥ 20° and 30°). The gas content was measured by the column density of atomic hydrogen from the Leiden/Argentine/Bonn survey and the dust by E(B-V) from the Schlafly et al. (2014) compilation. We do not see significant variation as a function of galactic quadrant or hemisphere. Our results are similar to other studies that used different techniques for deriving N(HI), N(H2), or E(B-V). Like Liszt (2013), we see a higher slope [N(HI)/E(B-V)] if we choose only those points with E(B-V) ≤ 0.1 mag. We also see the break in slope he noted at 0.08 mag. We examined lines of sight that coincided with the Georgia/Harvard Smithsonian CfA high-latitude CO(1-0) surveys. Although at |b| ≥ 30° there were only about 200 CO detections, those points lie systematically below our best fit lines to the data. We can convert the CO line intensities to N(H2) and determine a global CO-H2 conversion factor for the high latitude sky.
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NASA Technical Reports Server (NTRS)
Linsky, Jeffrey L.; Wood, Brian E.
1996-01-01
We analyze high-resolution spectra of the nearby (1.34 pc) stars alpha Cen A (G2 V) and alpha Cen B (K1 V), which were obtained with the Goddard High Resolution Spectrograph on the Hubble Space Telescope. The observations consist of echelle spectra of the Mg II 2800 A and Fe II 2599 A resonance lines and the Lyman-alpha lines of hydrogen and deuterium. The interstellar gas has a velocity (v = - 18.0 +/- 0.2 km/s) consistent with the local flow vector proposed for this line of sight by Lailement & Berlin (1992). The temperature and nonthermal velocity inferred from the Fe II, Mg II, and D I line profiles are T = 5400 +/- 500 K and xi = 1.20 +/- 0.25 km/s, respectively. However, single-component fits to the H I Lyman-alpha lines yield a Doppler parameter (b(sub HI) = 11.80 km/s) that implies a significantly warmer temperature of 8350 K, and the velocity of the H I absorption (v = - 15.8 +/- 0.2 km/s) is redshifted by about 2.2 km/s with respect to the Fe II, Mg II, and D I lines. The one-component model of the interstellar gas suggests natural logarithm N base HI = 18.03 +/- 0.01 and D/H = (5.7 +/- 0.2) x 10(exp -6) . These parameters lead to a good fit to the observed spectra, but this model does not explain the higher temperature and redshift of H I relative to the other interstellar lines. The most sensible way to resolve the discrepancy between H(I) and the other lines is to add a second absorption component to the H(I) lines. This second component is hotter (T approx. equals 30,000 K), is redshifted relative to the primary component by 2-4 km/s, and has a column density too low to be detected in the Fe(II), Mg(II), and D(I) lines. We propose that the gas responsible for this component is located near the heliopause, consisting of the heated H I gas from the interstellar medium that is compressed by the solar wind. This so-called 'hydrogen wall' is predicted by recent multifluid gasdynamical models of the interstellar gas and solar wind interaction. Our data provide the first measurements of the temperature and column density of H(I) in the hydrogen wall. After considering the effects that a corresponding hydrogen wall around alpha Cen would have on our analysis, our best estimates for the parameters of the solar hydrogen wall are natural log N(sup (2))(H(I)) = 14.74 +/- 0.24, b(sup (2))(H(I)) = 21.9 +/- 1.7 km/s (corresponding to T = 29,000 +/- 5000 K), and v(sup (2))(H(I)) greater than -16km/s. Unfortunately, the existence of this heated H(I) reduces our ability to compute the H(I) column density of the interstellar medium accurately because, with slight alterations to our assumed stellar Lyman-alpha profiles, we discovered that acceptable two-component fits also exist with natural log N(H(I))approx. 17.6. We, therefore, quote large error bars for the H I column density along the alpha Cen line of sight, natural log N(H(I)) = 17.80 +/- 0.30. For this range in N(H(I)), n(H(I)) = 0.15 /cu.cm (+/- a factor of 2) and D/H = (0.5-1.9) x 10(exp -5). This is the first direct measurement of the H(I) density in a local cloud and allows us to predict the distance from the Sun to the edge of the local cloud along various lines of sight. This range in D/H is consistent with the value D/H = 1.6 x 10(exp -5) previously derived for the Capella and Procyon lines of sight. We cannot tell whether D/H ratio varies or is constant in the local interstellar medium, but we do find that the D(I)/Mg(II) ratio for the alpha Cen line of sight is about 4 times smaller than for the Capella and Procyon lines of sight. Therefore, either D/H or the Mg depletion varies significantly over distance scales of only a few parsecs.
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Urinary Calculi and Risk of Cancer
Shih, Chia-Jen; Chen, Yung-Tai; Ou, Shuo-Ming; Yang, Wu-Chang; Chen, Tzeng-Ji; Tarng, Der-Cherng
2014-01-01
Abstract Previous studies have shown that urinary calculi are associated with increased risks of urinary tract cancers. However, the association between urinary calculi and overall cancers is a largely undefined body of knowledge. We conducted a nationwide population-based cohort study using Taiwan's National Health Insurance Research Database from 2000 and 2009. Patients were excluded if they had antecedent cancers or urinary calculi before the enrollment. All study subjects were followed until the occurrence of cancer, dropout from the NHI program, death, or the end of 2010. Patterns of cancer incidence in patients with urinary calculi were compared with those of the general population using standardized incidence ratio (SIR). A total of 43,516 patients with urinary calculi were included. After a median follow-up of 5.3 years, 1891 patients developed cancer. The risk of overall cancers was significantly increased (SIR, 1.75; 95% confidence interval [CI], 1.68–1.83). We observed that urinary calculi was associated with higher risk of cancers of kidney (4.24; 95% CI, 3.47–5.13), bladder (3.30; 95% CI, 2.69–4.00), thyroid (2.50; 95% CI, 1.78–3.40), hematologic origin (2.41; 95% CI, 1.92–2.99), breast (1.84; 95% CI, 1.54–2.20), lung (1.82; 95% CI, 1.59–2.07), digestive tract (1.69; 95% CI, 1.57–1.82), and head and neck (1.54; 95% CI, 1.32–1.79), respectively. Our study shows that urinary calculi are associated with higher risk of systemic cancers in addition to urinary tract cancers. Further study is required to validate this association. PMID:25546684
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Kim, Agnus M; Cho, Seongcheol; Kim, Hyun Joo; Jo, Min-Woo; Eun, Sang Jun; Lee, Jin Yong
2018-06-22
Korea has experienced an overall expansion of access to care in the past few decades, which necessitated the reconsideration of the role of the public health clinics (PHC) as a primary care provider. The recent controversy about the outpatient copayment waiver for the elderly in the PHC is in the same vein. This study compared the outpatient utilization of the PHC and private clinics, and investigated its factors. Data were acquired from the National Patient Sample in 2013. Compared with private clinics, the patients in the PHC were more elderly and had less severe conditions. Being elderly, the status of National Health Insurance (NHI) beneficiaries, less comorbidities, and low total claim costs were found to be factors for choosing the PHC over private clinics. These results suggest that the elderly, who are the main beneficiaries of copayment waivers in the PHC, are the most likely to use the outpatient service by the PHC. The functions of the PHC need to be rearranged according to the recent advancements in the health care system in Korea. Diverting the resources and efforts from outpatient care to functions that best serve the health of the population should be considered.
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Wham, Carol; Baggett, Fiona; Teh, Ruth; Moyes, Simon; Kēpa, Mere; Connolly, Martin; Jatrana, Santosh; Kerse, Ngaire
2015-08-01
To investigate factors related to hospital admission for infection, specifically examining nutrient intakes of Māori in advanced age (80+ years). Face-to-face interviews with 200 Māori (85 men) to obtain demographic, social and health information. Diagnoses were validated against medical records. Detailed nutritional assessment using the 24-hour multiple-pass recall method was collected on two separate days. FOODfiles was used to analyse nutrient intake. National Health Index (NHI) numbers were matched to hospitalisations over a two-year period (12 months prior and 12 months following dietary assessment). Selected International Classification of Disease (ICD) codes were used to identify admissions related to infection. A total of 18% of participants were hospitalised due to infection, most commonly lower respiratory tract infection. Controlling for age, gender, NZ deprivation index, diabetes, CVD and chronic lung disease, a lower energy-adjusted protein intake was independently associated with hospitalisation due to infection: OR (95%CI) 1.14 (1.00-1.29), p=0.046. Protein intake may have a protective effect on the nutrition-related morbidity of older Māori. Improving dietary protein intake is a simple strategy for dietary modification aiming to decrease the risk of infections that lead to hospitalisation and other morbidities. © 2015 Public Health Association of Australia.
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Fenny, Ama P; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S
2014-10-27
Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah.Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.
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Fenny, Ama P.; Asante, Felix A.; Enemark, Ulrika; Hansen, Kristian S.
2015-01-01
Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah. Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries. PMID:25560361
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A New, Large-scale Map of Interstellar Reddening Derived from H I Emission
NASA Astrophysics Data System (ADS)
Lenz, Daniel; Hensley, Brandon S.; Doré, Olivier
2017-09-01
We present a new map of interstellar reddening, covering the 39% of the sky with low H I column densities ({N}{{H}{{I}}}< 4× {10}20 cm-2 or E(B-V)≈ 45 mmag) at 16\\buildrel{ \\prime}\\over{.} 1 resolution, based on all-sky observations of Galactic H I emission by the HI4PI Survey. In this low-column-density regime, we derive a characteristic value of {N}{{H}{{I}}}/E(B-V)=8.8 × {10}21 {{cm}}2 {{mag}}-1 for gas with | {v}{LSR}| < 90 km s-1 and find no significant reddening associated with gas at higher velocities. We compare our H I-based reddening map with the Schlegel et al. (SFD) reddening map and find them consistent to within a scatter of ≃ 5 mmag. Further, the differences between our map and the SFD map are in excellent agreement with the low-resolution (4\\buildrel{\\circ}\\over{.} 5) corrections to the SFD map derived by Peek and Graves based on observed reddening toward passive galaxies. We therefore argue that our H I-based map provides the most accurate interstellar reddening estimates in the low-column-density regime to date. Our reddening map is made publicly available at doi.org/10.7910/DVN/AFJNWJ.
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Cheng, Yung-Yi; Hsieh, Chen-Hsi; Tsai, Tung-Hu
2018-04-01
With an increasing number of cancer patients seeking an improved quality of life, complementary and alternative therapies are becoming more common ways to achieve such improvements. The potential risks of concurrent administration are serious and must be addressed. However, comprehensive evidence for the risks and benefits of combining anticancer drugs with traditional herbs is rare. Pharmacokinetic investigations are an efficient way to understand the influence of concomitant remedies. Therefore, this study aimed to collect the results of pharmacokinetic studies relating to the concurrent use of cancer chemotherapy and complementary and alternative therapies. According to the National Health Insurance (NHI) database in Taiwan and several publications, the three most commonly prescribed formulations for cancer patients are Xiang-Sha-Liu-Jun-Zi-Tang, Jia-Wei-Xiao-Yao-San and Bu-Zhong-Yi-Qi-Tang. The three most commonly prescribed single herbs for cancer patients are Hedyotis diffusa, Scutellaria barbata, and Astragalus membranaceus. Few studies have discussed herb-drug interactions involving these herbs from a pharmacokinetics perspective. Here, we reviewed Jia-Wei-Xiao-Yao-San, Long-Dan-Xie-Gan-Tang, Curcuma longa and milk thistle to provide information based on pharmacokinetic evidence for healthcare professionals to use in educating patients about the risks of the concomitant use of various remedies. Copyright © 2018. Published by Elsevier B.V.
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Kwon, Bo Yeon; Lee, Eunil; Lee, Suji; Heo, Seulkee; Jo, Kyunghee; Kim, Jinsun; Park, Man Sik
2015-01-01
Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. PMID:26580643
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Shih, Ya-Chen Tina; Pan, I-Wen; Tsai, Yi-Wen
2009-01-01
Health information technology offers a powerful tool to monitor the performance of a healthcare system. Advances in computer technology and capacity combined with lower start-up costs will allow developing countries to achieve greater impact when they initiate electronic health information systems. We focused on the integrated health information system that was established in Taiwan in conjunction with the launch of the National Health Insurance (NHI) programme. We used data from that health information system to conduct a cost-effectiveness analysis of chemotherapy use among breast cancer patients. We then used this analysis to discuss what policy makers can learn from this type of analysis. We identified a cohort of patients in the NHI Research Database who had been diagnosed with breast cancer in 2001 and had received chemotherapy following surgical removal of the tumour. We followed these patients for 3 years and conducted a cost-effectiveness analysis from the payer's perspective. Using the net benefit regression approach, we compared the cost effectiveness of the two most commonly prescribed first-line chemotherapy regimens for the treatment of breast cancer in 2001 in Taiwan. The dependent variable of the regression model was the individual-level net benefit, and the independent variables included a binary variable indicating the choice of chemotherapy regimen, the patients' age, co-morbidity, type of surgery, geographic region and type of treatment facility. We employed both frequentist and Bayesian approaches in our net benefit regression analyses. In the Bayesian analysis, we applied non-informative priors to all parameters in the base-case analyses. We then explored the use of informative priors in the sensitivity analysis, using cost-effectiveness data published in the literature to form the prior distributions for the relevant parameters. Over 60% of surgically treated breast cancer patients received either CMF (cyclophosphamide, methotrexate, fluorouracil) or CEF (cyclophosphamide, epirubicin, fluorouracil). A comparison of patient characteristics indicated that patients in the CEF group tended to be younger (47.8 vs 49.1 years; p = 0.016), and were significantly more likely to have undergone a mastectomy (84% vs 76%; p < 0.001) and to have been treated in a teaching hospital (26% vs 13%; p < 0.001). We also observed significant variations in geographic region of the location of facilities between treatment groups. On average, CEF was not cost effective in the treatment of patients with breast cancer in Taiwan, although analyses stratified by geographic region suggested a wide variation across regions. At a societal willingness to pay (WTP) of new Taiwanese dollar ($NT)1 500 000 ($US80 000), the probability that CEF was more cost effective than CMF was 0.0%, 0.0%, 0.0% and 3.9% for the Taipei metropolitan area, and the north, middle and the combined south and east region, respectively; the probability became 0.6%, 0.0%, 1.3% and 54.5%, respectively, at a WTP of $NT5 000 000 ($US270 000). After co-variate adjustments, the probabilities were 0.0%, 0.0%, 0.0% and 0.8%, respectively at a WTP of $NT1 500 000, and were 0.0%, 0.0%, 1.4% and 34.7% at $NT5 000 000. Sensitivity analyses showed that CEF potentially could have been more cost effective than CMF within a reasonable range of societal WTP (i.e. $NT1 000 000-3 000 000 or $US55 000-160 000) had the optimal dosage level for CEF been established for breast cancer patients in Taiwan. A population-based, fully integrated electronic health information system provides useful data to assess the cost effectiveness of competing treatments and interventions in current practice. This research may potentially inform policy makers of modifications that can be instituted to improve the cost effectiveness of a new therapy. However, findings from this study need to be interpreted with caution because the study provided information only on the short-term cost effectiveness (i.e. 3 years) of CEF compared with CMF. It is possible that a future analysis will reach a different conclusion when more years of follow-up data become available.
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Enabling the use of climate model data in the Dutch climate effect community
NASA Astrophysics Data System (ADS)
Som de Cerff, Wim; Plieger, Maarten
2010-05-01
Within the climate effect community the usage of climate model data is emerging. Where mostly climate time series and weather generators were used, there is a shift to incorporate climate model data into climate effect models. The use of climate model data within the climate effect models is difficult, due to missing metadata, resolution and projection issues, data formats and availability of the parameters of interest. Often the climate effect modelers are not aware of available climate model data or are not aware of how they can use it. Together with seven other partners (CERFACS, CNR-IPSL, SMHI, INHGA, CMCC, WUR, MF-CNRM), KNMI is involved in the FP7 IS ENES (http://www.enes.org) project work package 10/JRA5 ‘Bridging Climate Research Data and the Needs of the Impact Community. The aims of this work package are to enhance the use of Climate Research Data and to enhance the interaction with climate effect/impact communities. Phase one is to define use cases together with the Dutch climate effect community, which describe the intended use of climate model data in climate effect models. We defined four use cases: 1) FEWS hydrological Framework (Deltares) 2) METAPHOR, a plants and species dispersion model (Wageningen University) 3) Natuurplanner, an Ecological model suite (Wageningen University) 4) Land use models (Free University/JRC). Also the other partners in JRA5 have defined use cases, which are representative for the climate effect and impact communities in their country. Goal is to find commonalities between all defined use cases. The common functionality will be implemented as e-tools and incorporated in the IS-ENES data portal. Common issues relate to e.g., need for high resolution: downscaling from GCM to local scale (also involves interpolation); parameter selection; finding extremes; averaging methods. At the conference we will describe the FEWS case in more detail: Delft FEWS is an open shell system (in development since 1995) for performing hydrological predictions and the handling of time series data. The most important capabilities of FEWS are importing of meteorological and hydrological data and organizing the workflows of the different models which can be used within FEWS, like the Netherlands Hydrological Instrumentarium (NHI). Besides predictions, the system is currently being used for hydrological climate effects studies. Currently regionally downscaled data are used, but using model data will be the next step. This coupling of climate model data to FEWS will open a wider rage of climate impact and effect research, but it is a difficult task to accomplish. Issues to be dealt with are: regridding, downscaling, format conversion, extraction of required data and addition of descriptive metadata, including quality and uncertainty parameters. Finding an appropriate solution involves several iterations: first, the use case was defined, then we just provided a single data file containing some data of interest provided via FTP, next this data was offered through OGC services. Currently we are working on providing larger datasets and improving on the parameters and metadata. We will present the results (e-tools/data) and experiences gained on implementing the described use cases. Note that we are currently using experimental data, as the official climate model runs are not available yet.
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South Africa's protracted struggle for equal distribution and equitable access - still not there.
van Rensburg, Hendrik C J
2014-05-08
The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa's transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce.Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows.
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The structure of galactic HI in directions of low total column density
NASA Technical Reports Server (NTRS)
Lockman, F. J.; Jahoda, K.; Mccammon, D.
1985-01-01
A detailed 21 cm study of areas of that have the smallest known amount of HI in the northern sky was performed. These observations were corrected for stray radiation. The region of main interest, around alpha = 10(h)45(m), delta = 57 deg 20', has a minimium N(HI) of 4.5 x 10 to the 19th power/sq cm. Spectra taken at 21' resolution over a field 4 x 3 deg in this direction show up to four HI line components. Two, near 0 and -50 km/s, are ubiquitous. There is also a narrow component at -10 km/s attributable to a diffuse cloud covering half of the field, and scattered patches of HI at v -100 km/s. the low and intermediate velocity components have a broad line width and are so smoothly distributed across the region that it is unlikely that they contain significant unresolved angular structure. Eight other low column density directions were also observed. Their spectra typically have several components, but the total column density is always 7 x 10 to the 19th power/sq cm and changes smoothly along a 2 deg strip. Half of the directions show narrow lines arising from weak diffuse HI clouds that contain 0.5 to 3.0 x 10 to the 19th power/sq cm.
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Hydrogen-bonded turns in proteins: the case for a recount.
Panasik, Nick; Fleming, Patrick J; Rose, George D
2005-11-01
Beta-turns are sites at which proteins change their overall chain direction, and they occur with high frequency in globular proteins. The Protein Data Bank has many instances of conformations that resemble beta-turns but lack the characteristic N-H(i) --> O=C(i - 3) hydrogen bond of an authentic beta-turn. Here, we identify potential hydrogen-bonded beta-turns in the coil library, a Web-accessible database utility comprised of all residues not in repetitive secondary structure, neither alpha-helix nor beta-sheet (http://www.roselab.jhu.edu/coil). In particular, candidate turns were identified as four-residue segments satisfying highly relaxed geometric criteria but lacking a strictly defined hydrogen bond. Such candidates were then subjected to a minimization protocol to determine whether slight changes in torsion angles are sufficient to shift the conformation into reference-quality geometry without deviating significantly from the original structure. This approach of applying constrained minimization to known structures reveals a substantial population of previously unidentified, stringently defined, hydrogen-bonded beta-turns. In particular, 33% of coil library residues were classified as beta-turns prior to minimization. After minimization, 45% of such residues could be classified as beta-turns, with another 8% in 3(10) helixes (which closely resemble type III beta-turns). Of the remaining coil library residues, 37% have backbone dihedral angles in left-handed polyproline II structure.
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Han, Kyu-Tae; Kim, Sun Jung; Jang, Sung-In; Kim, Seung Ju; Lee, Seo Yoon; Lee, Hyo Jung; Park, Eun-Cheol
2015-01-01
Cerebrovascular diseases are the second-highest cause of death in South Korea (9.6% of all causes of mortality in 2013). South Korea has a shortage of trained medical personnel compared with other countries and the demands for health care are continuously increasing. Our study sought to determine the relationship between hospital human resources and the outcomes of stroke patients. We used data from NHI claims (n=99,464) at 120 hospitals to analyze readmission or death within 30 days after discharge or hospitalization for stroke patients during 2010-2013. We used multilevel models that included both patient-level and hospital-level variables to examine factors associated with readmission or death within 30 days. A total of 1782 (1.8%) patients were readmitted within 30 days, and death occurred within 30 days for 6926 (7.0%) patients. Patients cared for by a higher percentages of specialists or registered nurses had a lower risk of readmission or death within 30 days (readmission per 10% increase in registered nurses, OR=0.89 and SD=0.85-0.94; death per 10% increase in specialists, OR=0.93 and SD=0.89-0.98). The percentages of specialist and registered nurses caring for stroke patients were positively correlated with better patient outcomes, particularly for patients with cerebral infarction. Copyright © 2015 Elsevier B.V. All rights reserved.
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VÄn phòng Công nháºn Chất lượng (BoA)
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NASA Astrophysics Data System (ADS)
Yao, Yiming; Chang, Shuai; Zhao, Yangyang; Tang, Jianhui; Sun, Hongwen; Xie, Zhiyong
2017-10-01
Air samples were collected using high-volume samplers at two coastal towns on the Bohai Sea in China, 320 km apart, and at a background site (North Huangcheng Island) in the Bohai Sea, 50 km from the coast. A suite of neutral and ionic per- and poly-fluoroalkyl substances (PFASs) was investigated. Urban activity was related to high levels of neutral PFASs at Tianjin while perfluorooctanoic carboxylic acid (PFOA) was dominant in the atmosphere at Weifang, possibly due to industrial sources. Polyfluoroalkyl phosphoric acid diesters (diPAPs) occurred in the particle phase only, with a total concentration range of 0.02-6.72 pg m-3. The dominant homologue was 6:2 diPAP. PFASs profiles at NHI suggested direct atmospheric transport of neutral and ionic PFASs from source regions. Temperature-dependent partitioning of fluorotelomer alcohols (FTOHs) was observed in winter, when total concentrations and particle-phase fractions of FTOHs were significantly higher as compared to those in summer. Correlation analyses suggested more active gas-phase degradation of FTOHs in summer and likely heterogeneous degradation in both seasons. Overall, it is necessary to account for ionic PFASs in both gas and particle phases and particulate matter was important for atmospheric transport and for determining the fate of PFASs, especially in areas close to a source region.
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Discovery of an Ultraviolet Counterpart to an Ultrafast X-Ray Outflow in the Quasar PG 1211+143
NASA Astrophysics Data System (ADS)
Kriss, Gerard A.; Lee, Julia C.; Danehkar, Ashkbiz; Nowak, Michael A.; Fang, Taotao; Hardcastle, Martin J.; Neilsen, Joseph; Young, Andrew
2018-02-01
We observed the quasar PG 1211+143 using the Cosmic Origins Spectrograph on the Hubble Space Telescope in 2015 April as part of a joint campaign with the Chandra X-ray Observatory and the Jansky Very Large Array. Our ultraviolet spectra cover the wavelength range 912–2100 Å. We find a broad absorption feature (∼ 1080 {km} {{{s}}}-1) at an observed wavelength of 1240 Å. Interpreting this as H I Lyα, in the rest frame of PG 1211+143 (z = 0.0809), this corresponds to an outflow velocity of ‑16,980 {km} {{{s}}}-1 (outflow redshift {z}{out}∼ -0.0551), matching the moderate ionization X-ray absorption system detected in our Chandra observation and reported previously by Pounds et al. With a minimum H I column density of {log} {N}{{H}{{I}}}> 14.5, and no absorption in other UV resonance lines, this Lyα absorber is consistent with arising in the same ultrafast outflow as the X-ray absorbing gas. The Lyα feature is weak or absent in archival ultraviolet spectra of PG 1211+143, strongly suggesting that this absorption is transient, and intrinsic to PG 1211+143. Such a simultaneous detection in two independent wavebands for the first time gives strong confirmation of the reality of an ultrafast outflow in an active galactic nucleus.
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Hydrogen and Oxygen Gas Monitoring System Design and Operation
DOE Office of Scientific and Technical Information (OSTI.GOV)
Lee C. Cadwallader; Kevin G. DeWall; J. Stephen Herring
2007-06-01
This paper describes pertinent design practices of selecting types of monitors, monitor unit placement, setpoint selection, and maintenance considerations for gas monitors. While hydrogen gas monitors and enriched oxygen atmosphere monitors as they would be needed for hydrogen production experiments are the primary focus of this paper, monitors for carbon monoxide and carbon dioxide are also discussed. The experiences of designing, installing, and calibrating gas monitors for a laboratory where experiments in support of the DOE Nuclear Hydrogen Initiative (NHI) are described along with codes, standards, and regulations for these monitors. Information from the literature about best operating practices ismore » also presented. The NHI program has two types of activities. The first, near-term activity is laboratory and pilot-plant experimentation with different processes in the kilogram per day scale to select the most promising types of processes for future applications of hydrogen production. Prudent design calls for indoor gas monitors to sense any hydrogen leaks within these laboratory rooms. The second, longer-term activity is the prototype, or large-scale plants to produce tons of hydrogen per day. These large, outdoor production plants will require area (or “fencepost”) monitoring of hydrogen gas leaks. Some processes will have oxygen production with hydrogen production, and any oxygen releases are also safety concerns since oxygen gas is the strongest oxidizer. Monitoring of these gases is important for personnel safety of both indoor and outdoor experiments. There is some guidance available about proper placement of monitors. The fixed point, stationary monitor can only function if the intruding gas contacts the monitor. Therefore, monitor placement is vital to proper monitoring of the room or area. Factors in sensor location selection include: indoor or outdoor site, the location and nature of potential vapor/gas sources, chemical and physical data of the gases or vapors, liquids with volatility need sensors near the potential sources of release, nature and concentration of gas releases, natural and mechanical ventilation, detector installation locations not vulnerable to mechanical or water damage from normal operations, and locations that lend themselves to convenient maintenance and calibration. The guidance also states that sensors should be located in all areas where hazardous accumulations of gas may occur. Such areas might not be close to release points but might be areas with restricted air movement. Heavier than air gases are likely to accumulate in pits, trenches, drains, and other low areas. Lighter than air gases are more likely to accumulate in overhead spaces, above drop ceilings, etc. In general, sensors should be located close to any potential sources of major release of gas. The paper gives data on monitor sensitivity and expected lifetimes to support the monitor selection process. Proper selection of indoor and outdoor locations for monitors is described, accounting for the vapor densities of hydrogen and oxygen. The latest information on monitor alarm setpoint selection is presented. Typically, monitors require recalibration at least every six months, or more frequently for inhospitable locations, so ready access to the monitors is an important issue to consider in monitor siting. Gas monitors, depending on their type, can be susceptible to blockages of the detector element (i.e., dus« less
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South Africa’s protracted struggle for equal distribution and equitable access – still not there
2014-01-01
The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa’s transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce. Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows. PMID:24885691
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Wu, Li-Chih; Leong, Pui-Ying; Yeo, Kai-Jieh; Li, Ting-Yu; Wang, Yu-Hsun; Chiou, Jeng-Yuan; Wei, James Cheng-Chung
2016-01-01
Abstract The aim of the study is to assess the effects of celecoxib and sulfasalazine on the risk of coronary artery disease (CAD) in patients with ankylosing spondylitis (AS). Using the claims data of Taiwan National Health Insurance (NHI) database, a nationally representative data that contain the medical records of 23 million Taiwan residents, we randomly selected 1 million cohort from the database, and then we enrolled only patients who were newly diagnosed with AS (n = 4829) between year 2001 and 2010, excluding patients who had CAD (ICD-9- CM codes: 410–414) before the diagnosis of AS (n = 4112). According to propensity score matched 1:2 on age, gender, AS duration, Charlson comorbidity index, hypertension, and hyperlipidemia, 236 and 472 patients were included in the case (AS with CAD) and control (AS without CAD) groups, respectively. We used the WHO defined daily dose (DDD) as a tool to assess the dosage of sulfasalazine and celecoxib exposure. Conditional logistic regression was used to estimate the crude and adjusted odds ratios (ORs) and 95% confidence interval (CI) for the risk of CAD associated with use of sulfasalazine and celecoxib. Among 4112 AS patients, 8.4% (346/4112) developed CAD. CAD in AS patients were positively associated with age of 35 to 65, Charlson comorbidities index (CCI), hypertension, and hyperlipidemia. There was no gender difference between case and control groups. After adjustment for age, gender, CCI, hypertension, and hyperlipidemia, sulfasalazine users with an average daily dose ≥ 0.5 DDD (0.5 gm/day) had negative association with CAD events as compared to sulfasalazine nonusers (OR 0.63; 95% CI, 0.40–0.99, P < 0.05). NSAIDs, including celecoxib, etoricoxib, but no naproxen and diclofenac were negatively associated with CAD. Celecoxib users, with an average daily dose > 1.5 DDD, were negatively associated with CAD events, compared to celecoxib nonusers (OR 0.34; 95% CI, 0.13–0.89; P < 0.05). In this 10-year population-based case-control study, 8.4% of AS patients developed CAD. Sulfasalazine usage at an average dose of ≥ 0.5 gm/day demonstrated negative association with CAD events in patients with AS. PMID:27603385
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NASA Astrophysics Data System (ADS)
Abdel-Rahman, Laila H.; El-Khatib, Rafat M.; Nassr, Lobna A. E.; Abu-Dief, Ahmed M.
2013-05-01
New Fe(II) Schiff base amino acid complexes derived from the condensation of o-hydroxynaphthaldehyde with L-alanine, L-phenylalanine, L-aspartic acid, L-histidine and L-arginine were synthesized and characterized by elemental analysis, IR, electronic spectra, and conductance measurements. The stoichiometry and the stability constants of the complexes were determined spectrophotometrically. The investigated Schiff bases exhibited tridentate coordination mode with the general formulae [Fe(HL)2]·nH2O for all amino acids except L-histidine. But in case of L-histidine, the ligand acts as tetradentate ([FeL(H2O)2]·2H2O), where HL = mono anion and L = dianion of the ligand. The structure of the prepared complexes is suggested to be octahedral. The prepared complexes were tested for their toxicity on chick embryos and found to be safe until a concentration of 100 μg/egg with full embryos formation. The interaction between CT-DNA and the investigated complexes were followed by spectrophotometry and viscosity measurements. It was found that, the prepared complexes bind to DNA via classical intercalative mode and showed a different DNA cleavage activity with the sequence: nhi > nari > nali > nasi > nphali. The thermodynamic Profile of the binding of nphali complex and CT-DNA was constructed by analyzing the experimental data of absorption titration and UV melting studies with the McGhee equation, van't Hoff's equation, and the Gibbs-Helmholtz equation.
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Kim, Jee Ae; Yoon, Seokjun; Kim, Log Young; Kim, Dong Sook
2017-05-01
Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data. © 2017 The Korean Academy of Medical Sciences.
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The mean free path of hydrogen ionizing photons during the epoch of reionization
NASA Astrophysics Data System (ADS)
Rahmati, Alireza; Schaye, Joop
2018-05-01
We use the Aurora radiation-hydrodynamical simulations to study the mean free path (MFP) for hydrogen ionizing photons during the epoch of reionization. We directly measure the MFP by averaging the distance 1 Ry photons travel before reaching an optical depth of unity along random lines-of-sight. During reionization the free paths tend to end in neutral gas with densities near the cosmic mean, while after reionization the end points tend to be overdense but highly ionized. Despite the increasing importance of discrete, over-dense systems, the cumulative contribution of systems with NHI ≲ 1016.5 cm-2 suffices to drive the MFP at z ≈ 6, while at earlier times higher column densities are more important. After reionization the typical size of HI systems is close to the local Jeans length, but during reionization it is much larger. The mean free path for photons originating close to galaxies, {MFP_{gal}}, is much smaller than the cosmic MFP. After reionization this enhancement can remain significant up to starting distances of ˜1 comoving Mpc. During reionization, however, {MFP_{gal}} for distances ˜102 - 103 comoving kpc typically exceeds the cosmic MFP. These findings have important consequences for models that interpret the intergalactic MFP as the distance escaped ionizing photons can travel from galaxies before being absorbed and may cause them to under-estimate the required escape fraction from galaxies, and/or the required emissivity of ionizing photons after reionization.
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Nassar, M K; Goraga, Z S; Brockmann, G A
2013-02-01
In this study, a genome scan was performed to detect genomic loci that affect fat deposition in white adipose tissues and muscles in 278 F (2) males of reciprocal crosses between the genetically and phenotypically extreme inbred chicken lines New Hampshire (NHI) and White Leghorn (WL77). Genome-wide highly significant quantitative trait loci (QTL) influencing fat deposition in white adipose tissues were found on GGA2 and 4. The peak QTL positions for different visceral and subcutaneous white adipose tissues were located between 41.4 and 112.4 Mb on GGA2 and between 76.2 and 78.7 Mb on GGA4, which explained 4.2-10.4% and 4.3-11.6% respectively of the phenotypic F (2) variances. Contrary to our expectations, the QTL allele descending from the lean line WL77 on GGA4 led to increased fat deposition. We suggest a transgressive action of the obesity allele only if it is not in the genetic background of the line WL77. Additional highly significant loci for subcutaneous adipose tissue mass were identified on GGA12 and 15. For intramuscular fat content, a suggestive QTL was located on GGA14. The analysed crosses provide a valuable resource for further fine mapping of fatness genes and subsequent gene discovery. © 2012 The Authors, Animal Genetics © 2012 Stichting International Foundation for Animal Genetics.
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Hsieh, Shu-Ching; Lin, I-Hsin; Tseng, Wei-Lum; Lee, Chang-Hsing; Wang, Jung-Der
2008-10-23
Some Chinese herbal products (CHPs) may contain aristolochic acid (AA) or may be adulterated by the herbs suspected of containing AA which is nephrotoxic and carcinogenic. This study aims to identify the risk and the prescription profile of AA-containing CHPs (AA-CHPs) in Taiwan. A longitudinal analysis was conducted on a randomly sampled cohort of 200,000 patients using the data from the National Health Insurance (NHI) in Taiwan between 1997 and 2003. During the 7-year study period, 78,644 patients were prescribed with AA-CHPs; most patients were females, or middle-aged, or both. A total of 526,867 prescriptions were made to use 1,218 licensed AA-CHPs. Over 85% of the AA-exposed patients took less than 60 g of AA-herbs; however, about 7% were exposed to a cumulated dose of over 100 g of Radix et Rhizoma Asari (Xixin), Caulis Akebiae (Mutong) or Fructus Aristolochiae (Madouling). Patients of respiratory and musculoskeletal diseases received most of the AA-CHP prescriptions. The most frequently prescribed AA-CHPs Shujing Huoxie Tang, Chuanqiong Chadiao San and Longdan Xiegan Tang, containing Radix Stephaniae Tetrandrae, Radix et Rhizoma Asari and Caulis Akebiae, respectively. About one-third of people in Taiwan have been prescribed with AA-CHPs between 1997 and 2003. Although the cumulated doses were not large, further actions should be carried out to ensure the safe use of AA-CHPs.
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Hsieh, Shu-Ching; Lin, I-Hsin; Tseng, Wei-Lum; Lee, Chang-Hsing; Wang, Jung-Der
2008-01-01
Background Some Chinese herbal products (CHPs) may contain aristolochic acid (AA) or may be adulterated by the herbs suspected of containing AA which is nephrotoxic and carcinogenic. This study aims to identify the risk and the prescription profile of AA-containing CHPs (AA-CHPs) in Taiwan. Methods A longitudinal analysis was conducted on a randomly sampled cohort of 200,000 patients using the data from the National Health Insurance (NHI) in Taiwan between 1997 and 2003. Results During the 7-year study period, 78,644 patients were prescribed with AA-CHPs; most patients were females, or middle-aged, or both. A total of 526,867 prescriptions were made to use 1,218 licensed AA-CHPs. Over 85% of the AA-exposed patients took less than 60 g of AA-herbs; however, about 7% were exposed to a cumulated dose of over 100 g of Radix et Rhizoma Asari (Xixin), Caulis Akebiae (Mutong) or Fructus Aristolochiae (Madouling). Patients of respiratory and musculoskeletal diseases received most of the AA-CHP prescriptions. The most frequently prescribed AA-CHPs Shujing Huoxie Tang, Chuanqiong Chadiao San and Longdan Xiegan Tang, containing Radix Stephaniae Tetrandrae, Radix et Rhizoma Asari and Caulis Akebiae, respectively. Conclusion About one-third of people in Taiwan have been prescribed with AA-CHPs between 1997 and 2003. Although the cumulated doses were not large, further actions should be carried out to ensure the safe use of AA-CHPs. PMID:18945373
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NASA Technical Reports Server (NTRS)
Sonneborn, George; Andre, Martial; Oliveira, Cristina; Hebrard, Guillaume; Howk, J. Christopher; Tripp, Todd M.; Chayer, Pierre; Friedman, Scott D.; Kruk, Jeffery W.; Jenkins, Edward B.;
2002-01-01
High resolution far-ultraviolet spectra of the O-type subdwarf BD+28(deg)4211 were obtained with the Far Ultraviolet Spectroscopic Explorer to measure the interstellar deuterium, nitrogen, and oxygen abundances in this direction. The interstellar D(I) transitions are analyzed down to Ly(ioat) at 920.7 A. The star was observed several times at different target offsets in the direction of spectral dispersion. The aligned and coedited spectra have high signal-to-noise ratios (S/N=50-100). D(I), N(I), and O(I) transitions were analyzed with curve-of-growth and profile fitting techniques. A model of interstellar molecular hydrogen on the line of sight was derived from H(II) lines in the FUSE spectra and used to help analyze some features where blending with H(II) was significant. The H(I) column density was determined from high resolution HST/STIS spectra of Ly(alpha) to be log N(H(I))= 19.846+/-0.035(2sigma), which is higher than is typical for sight lines in the local ISM studied for D/H. We found that D/H=(1.39+/-0.21)x 10(exp -5)(2sigma) and O/H=(2.37+/-0.55)x10(exp -4)(2sigma). O/H toward BD+28(deg)4211 appears to be significantly below the mean O/H ratio for the ISM and the Local Bubble.
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Lin, Lian-Yu; Lee, Chang-Hsing; Yu, Chih-Chieh; Tsai, Chia-Ti; Lai, Ling-Pin; Hwang, Juey-Jen; Chen, Pau-Chung; Lin, Jiunn-Lee
2011-07-01
Atrial fibrillation (AF) is a risk factor for ischemic stroke. Stroke-prevention strategies based on risk schemes have been developed but most of the data are from western people. Our goal is to investigate the risk factors of ischemic stroke in Taiwanese with AF in a nation-wide database. A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. By using ambulatory and inpatient claim data, we included subjects with AF and were above 20 years old. We excluded those who had ever taken warfarin or aspirin or had valvular heart diseases. A total of 7920 patients (3633 women, 4287 men) were included in the final analyses. Cox regression analysis showed that the risk factors for ischemic stroke were age (OR=1.338 for age 65-74 years vs. age 20-64 years, P=0.014; OR=1.652 for age over 75 years vs. age 20-64 years, P<0.001), hypertension (HTN) (OR=2.656, P<0.001), diabetes mellitus (DM) (OR=1.341, P=0.005), heart failure (OR=1.611, P<0.001), previous ischemic stroke or transient ischemic accident (TIA) (OR=2.752, P<0.001) and peripheral arterial disease (PAD) (OR=1.814, P=0.006). The gender, coronary artery disease, history of myocardial infarction and chronic renal insufficiency were not associated with ischemic stroke. The rate of ischemic stroke was much lower in current cohort as compared with that in whites. Frequent used risk schemes including CHADS₂ and CHA₂DS₂-VASC had comparable but only limited ability to predict ischemic stroke in subjects with AF. Compare with western people, hypertension plays a more important role in ischemic stroke in Taiwanese with AF and the incidence is lower. A substantial number of ischemic strokes cannot be accurately predicted by current risk schemes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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Rhee, Chin Kook; Yoon, Hyoung Kyu; Yoo, Kwang Ha; Kim, Young Sam; Lee, Sei Won; Park, Yong Bum; Lee, Jin Hwa; Kim, Yuri; Kim, Kyungjoo; Kim, Jinhee; Oh, Yeon Mok; Lee, Sang Do
2014-04-01
Little information is available regarding medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease (COPD) and asthma. The purpose of this study is to analyze medical utilization and cost in patients with overlap syndrome and to compare them to COPD patients without asthma. Using the 2009 Korean National Health Insurance (NHI) database, COPD patients were identified. Medical utilization and costs were also analyzed. Of a total of 185,147 patients identified with COPD, 101,004 patients were classified with overlap syndrome of COPD and asthma and 84,143 patients with COPD without asthma. In 2009, the percentages of emergency room visits, admissions, and intensive care unit admissions were 14.6%, 30.5%, and 0.5%, respectively, in the patients with overlap syndrome group and 5.0%, 14.1%, and 0.2%, respectively, in the COPD patients without asthma group (p < 0.05 for all comparisons). The cost of medical utilization was 790 ± 71 US dollars per person and 3,373 ± 4,628 dollars per person for outpatient and inpatient services, respectively, in the patients with overlap syndrome and 413 ± 512 and 3,010 ± 5,013, respectively, in the COPD patients without asthma (p < 0.05 for all comparisons). Multiple linear regression showed that age, sex, overlap syndrome, hospitalization in the last year, low socioeconomic status, and type of hospital use were significant factors affecting medical utilization and cost. In patients with overlap syndrome, both medical utilization and cost were higher than in COPD patients without asthma.
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Lin, Chia-Yen; Yeh, Wei-Ju
2017-01-01
The health costs of colorectal cancer have increased over the years in Taiwan. The National Health Insurance Administration (NHI) and the Health Promotion Administration of the Ministry of Health and Welfare (MOHW) in Taiwan advocate that people have to change their unhealthy behaviors; however, the number of patients of colorectal cancer is increasing annually. This research discussed the effects of healthy diet advocacy advertisements (ads) on healthy diet behavior intentions as influenced by the interactions between regulatory focus theory (RFT) and message framing effects. Both regulatory focus theory and message framing effect were discussed for the relationship between advertisement and behavior change in many fields, such as health-related behavior, pro-environmental behavior, consumer choice, etc. We executed an experiment with four different types of public health advocacy ads. A 2 (regulatory focus: promotion vs. prevention) × 2 (message framing: gain framing vs. loss framing) two-factor experiment was adopted, and 201 valid participants responded to the questionnaire. Results indicated that if the ad’s regulatory focus is promotion focus, viewers’ attitudes toward the ad and their behavior intentions are more positive when the slogan of the ad is gain framing rather than loss framing via the multiple analysis of variance (MANOVA), and vice versa. Respondents found the communication easier to comprehend when the ads evoked the respondents’ regulatory focus and applied the appropriate message framing, thus improving the efficacy of health-related advertising. We offer suggestions regarding the future use of health-related advertising for the MOHW. PMID:29207544
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Multiple morbidity combinations impact on medical expenditures among older adults.
Chi, Mei-ju; Lee, Cheng-yi; Wu, Shwu-chong
2011-01-01
This study aims to explore the medical needs of patients who have different combinations of multiple chronic diseases in order to improve care strategy for chronic patients. This study was based on a national probability proportional to size (PPS) sampling to older adults over 50 years old. We collaborated the files of the 2000-2001 health insurance claims and selected 8 types of common chronic diseases among seniors, for the discussion of multiple combinations of chronic diseases, including hypertension, diabetes, heart disease, stroke, dementia, cancer, arthritis and chronic obstructive pulmonary disease. Among the NHI users, there are 50.6% of the cases suffering from at least one chronic disease, 27.3% suffering from two types of chronic diseases and above. From possible combinations of eight common chronic diseases, it is found hypertension has the highest prevalence rate (7.5%); arthritis ranks the next (6.2%); the combination of hypertension and heart disease ranks the third (3.4%). In the 22 types of major chronic disease clusters, the average total medical expense for people who have five or more chronic diseases ranks the highest, USD 4465; the combination of hypertension, diabetes, heart disease, and arthritis ranks the next, USD 2703; the combination of hypertension, diabetes, and heart disease ranks the third, USD 2550; cancer only ranks the fourth, USD 2487. Our study may provide statistical data concerning co-morbidity among older adults and their medical needs. Through our analysis, the major population that exhausts the medical resources may be discovered. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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Vulnerability and Inequality in an Increasingly Wetter World: A Namibia Case Study
NASA Astrophysics Data System (ADS)
Kelly, M.; Silva, J.; Mandl, D.; Sohlberg, R. A.
2016-12-01
Over the past two decades, Namibia has experienced increased instances of flooding that have grown in intensity and duration. Major flooding events in 2008 and 2009 displaced hundreds of thousands of people, causing thousands to remain in flood relocation camps for months at a time. Due to lack of topographic relief in the region, water tends to sit until it evaporates. Both inter-annual variability and changes in climate may lead to even greater rainfall and flooding in the future. In 2009, 29% of Namibians lived below the national poverty line (World Bank) and many make their living off of subsistence farming, as well as trading livestock. Using socio-economic data collected from the Namibia Household Income & Expenditure Survey (NHIES) reports by the Namibia Statistics Agency for the years 1993-1994, 2003-2004, and 2009-2010, and Landsat imagery for the corresponding years, we aim to characterize flood impact and flood vulnerability. Water coverage maps of Namibia were created for each time period using Landsat imagery overlain with socio-economic data to see how flooding impacts socio-variables such as income, inequality, access to livestock and grazing lands, and consumption over time. Because Namibia is not a data-rich environment, it is difficult to obtain the fine granularity of socio-data needed to put a dollar value on loss and vulnerability in flood prone areas. We hope the findings of this study will draw attention to these problems and allow us to access the data needed to more accurately characterize flood vulnerability in Namibia.
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Lin, Chia-Yen; Yeh, Wei-Ju
2017-12-04
The health costs of colorectal cancer have increased over the years in Taiwan. The National Health Insurance Administration (NHI) and the Health Promotion Administration of the Ministry of Health and Welfare (MOHW) in Taiwan advocate that people have to change their unhealthy behaviors; however, the number of patients of colorectal cancer is increasing annually. This research discussed the effects of healthy diet advocacy advertisements (ads) on healthy diet behavior intentions as influenced by the interactions between regulatory focus theory (RFT) and message framing effects. Both regulatory focus theory and message framing effect were discussed for the relationship between advertisement and behavior change in many fields, such as health-related behavior, pro-environmental behavior, consumer choice, etc. We executed an experiment with four different types of public health advocacy ads. A 2 (regulatory focus: promotion vs. prevention) × 2 (message framing: gain framing vs. loss framing) two-factor experiment was adopted, and 201 valid participants responded to the questionnaire. Results indicated that if the ad's regulatory focus is promotion focus, viewers' attitudes toward the ad and their behavior intentions are more positive when the slogan of the ad is gain framing rather than loss framing via the multiple analysis of variance (MANOVA), and vice versa. Respondents found the communication easier to comprehend when the ads evoked the respondents' regulatory focus and applied the appropriate message framing, thus improving the efficacy of health-related advertising. We offer suggestions regarding the future use of health-related advertising for the MOHW.
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Health care reform and change in public-private mix of financing: a Korean case.
Jeong, Hyoung-Sun
2005-10-01
The objective of this paper is to examine the changes in the Korean health care system invoked by the reform (in the latter part of 2000) in regard to the separation of drug prescription and dispensation, especially from the point of view of the public-private financing mix. It seeks particularly to estimate and analyse the relative financing mix in terms of both modes of production and types of medical provider. The data used to estimate health care expenditure financed by out-of-pocket expenditure by were sourced from the National Health and Nutritional Survey (conducted by interviewing representatives of households) and the General Household Survey (a household diary survey). National Health Insurance data, etc. were used to estimate health expenditure financed by public sources. This study concentrates on the short-run empirical links between the reform and the public-private mix in finance. The reform increased remarkably the public share in total health expenditure. This public share increase has been prominent particularly in the case of expenditure on drugs since the reform has absorbed much of the previously uncovered drugs into the National Health Insurance coverage. However, a higher public share in medical goods than in out-patient care would raise an issue in terms of prioritization of benefit packages. The five-fold increase in the public share of expenditure at pharmacies reflects not only the fact that drugs previously not covered by NHI are covered now but also the fact that prescribed drugs are currently purchased mainly at pharmacies, as opposed to in doctors' clinics, as a result of the reform.
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Lin, Jiun-Nong; Lin, Cheng-Li; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Sung, Fung-Chang; Kao, Chia-Hung
2015-10-01
The association between enterovirus infections in children and risk of leukaemia is unclear. We aimed to assess the risk of leukaemia after enterovirus infection in children. We did a nationwide retrospective cohort study by analysing data from the National Health Insurance Research Database (NHIRD) in Taiwan. Children with enterovirus infections aged younger than 18 years were identified. With use of computer-generated random numbers, children not infected with enterovirus were randomly selected and frequency matched (1:1) with children infected with enterovirus by sex, age, urbanisation level, parental occupation, and index year of enterovirus infection. We only included children with complete baseline data for age and sex and who had at least three clinic visits with the diagnosis of enterovirus infection. The diagnosis date of the first clinic visit for the enterovirus infection was defined as the index date for initiation of follow-up person-year measurement and participants. All study patients were followed up until they developed leukaemia, were lost to follow-up, withdrew from the NHI programme, or until the end of the study without leukaemia (censored). Our primary endpoint was a diagnosis of leukaemia during follow-up. Insurance claims data for 3 054 336 children younger than 18 years were randomly selected from all insured children in the NHIRD. We identified 282 360 children infected with enterovirus and 282 355 children not infected with enterovirus between Jan 1, 2000, and Dec 31, 2007. The incidence density rates of leukaemia were 3·26 per 100 000 person-years for the enterovirus-infected and 5·84 per 100 000 person-years for the non-enterovirus-infected cohorts. The risk of leukaemia was significantly lower in the enterovirus-infected cohort than in the non-enterovirus-infected cohort (adjusted subhazard ratio [SHR] 0·44, 95% CI 0·31-0·60; p<0·0001). Children infected with enterovirus have a reduced risk of both lymphocytic leukaemia (adjusted SHR 0·44, 0·30-0·65; p<0·0001) and acute myeloid leukaemia (adjusted SHR 0·40, 0·17-0·97; p=0·04). Herpangina and hand-foot-and-mouth disease were the main diseases associated with the reduced risk of leukaemia. The association between enterovirus infection and the reduced risk of developing leukaemia supports Greaves' delayed infection hypothesis for the cause of childhood leukaemia. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Choi, Hoon-Hee; Han, Kyu-Tae; Nam, Chung Mo; Moon, Ki Tae; Kim, Woorim; Park, Eun-Cheol
2016-01-01
Objective The number of patients requiring haemodialysis has gradually increased in South Korea. Owing to this growth, concerns have been raised regarding haemodialysis quality of care, and healthcare professionals must consider alternatives for appropriate management of patients with chronic kidney disease (CKD). Therefore, we investigated the association between risk of hospitalisation of outpatients who received haemodialysis due to end-stage renal disease (ESRD) and the human resources of the haemodialysis unit. Setting We used data from National Health Insurance (NHI) claims during October 2013 to September 2014. Participants These data comprised 40 543 outpatients with ESRD (4 751 047 outpatient cases) who received haemodialysis. Interventions No interventions were made. Outcome measure We performed Poisson regression analysis using a generalised estimating equation that included both patient and haemodialysis unit characteristics to examine the factors associated with hospitalisation of outpatients with ESRD. Results Among 4 751 047 outpatient cases, 27 997 (0.59%) were hospitalised during the study period. A higher proportion of haemodialysis patient care specialists and a higher number of nurses experienced in haemodialysis were inversely associated with the risk of hospitalisation (per 10% increase in haemodialysis patient care specialists: relative risk (RR)=0.987, 95% CI 0.981 to 0.993; per 10-person increase in nurses who provided haemodialysis: RR=0.876, 95% CI 0.833 to 0.921). In addition, such associations were greater in severe patients. Conclusions Our findings suggest that haemodialysis units with high-quality, haemodialysis-specialised human resources could positively affect the outcomes of outpatients with ESRD. Based on our findings, health policymakers and professionals should implement strategies for the optimal management of patients with CKD. PMID:27534988
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Modelling of Lyman-alpha emitting galaxies and ionized bubbles at the epoch of reionization
NASA Astrophysics Data System (ADS)
Yajima, Hidenobu; Sugimura, Kazuyuki; Hasegawa, Kenji
2018-07-01
Understanding {Ly{α}} emitting galaxies (LAEs) can be a key to reveal cosmic reionization and galaxy formation in the early Universe. Based on halo merger trees and {Ly{α}} radiation transfer calculations, we model redshift evolution of LAEs and their observational properties at z ≥ 6. We consider ionized bubbles associated with individual LAEs and IGM (integer-galactic medium) transmission of {Ly{α}} photons. We find that {Ly{α}} luminosity tightly correlates with halo mass and stellar mass, while the relation with star formation rate has a large dispersion. Comparing our models with the observed luminosity function by Konno et al., we suggest that LAEs at z ˜ 7 have galactic wind of V_out ≳ 100 km s^{-1} and H I column density of N_HI ≳ 10^{20} cm^{-2}. Number density of bright LAEs rapidly decreases as redshift increases, due to both lower star formation rate and smaller H II bubbles. Our model predicts future wide deep surveys with next-generation telescopes, such as James Webb Space Telescope, European Extremely Large Telescope, and Thirty Metre Telescope, can detect LAEs at z ˜ 10 with a number density of n_LAE ˜ {a few } × 10^{-6} Mpc^{-3} for the flux sensitivity of 10^{-18} erg cm^{-2} s^{-1}. When giant H II bubbles are formed by clustering LAEs, the number density of observable LAEs can increase by a factor of few. By combining these surveys with future 21-cm observations, it could be possible to detect both LAEs with L_{Lyα }≳ 10^{42} erg s^{-1} and their associated giant H II bubbles with the size {≳ } 250 kpc at z ˜ 10.
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Modelling of Lyman-alpha emitting galaxies and ionized bubbles at the epoch of reionization
NASA Astrophysics Data System (ADS)
Yajima, Hidenobu; Sugimura, Kazuyuki; Hasegawa, Kenji
2018-04-01
Understanding {Ly{α }} emitting galaxies (LAEs) can be a key to reveal cosmic reionization and galaxy formation in the early Universe. Based on halo merger trees and {Ly{α }} radiation transfer calculations, we model redshift evolution of LAEs and their observational properties at z ≥ 6. We consider ionized bubbles associated with individual LAEs and IGM transmission of {Ly{α }} photons. We find that {Ly{α }} luminosity tightly correlates with halo mass and stellar mass, while the relation with star formation rate has a large dispersion. Comparing our models with the observed luminosity function by Konno et al., we suggest that LAEs at z ˜ 7 have galactic wind of V_out ≳ 100 km s^{-1} and HI column density of N_HI ≳ 10^{20} cm^{-2}. Number density of bright LAEs rapidly decreases as redshift increases, due to both lower star formation rate and smaller HII bubbles. Our model predicts future wide deep surveys with next generation telescopes, such as JWST, E-ELT and TMT, can detect LAEs at z ˜ 10 with a number density of n_LAE ˜ a few × 10^{-6} Mpc^{-3} for the flux sensitivity of 10^{-18} erg cm^{-2} s^{-1}. When giant HII bubbles are formed by clustering LAEs, the number density of observable LAEs can increase by a factor of few. By combining these surveys with future 21-cm observations, it could be possible to detect both LAEs with L_{Lyα }≳ 10^{42} erg s^{-1} and their associated giant HII bubbles with the size ≳ 250 kpc at z ˜ 10.
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Ting, Chin-Tsung; Kuo, Chian-Jue; Hu, Hsiao-Yun; Lee, Ya-Ling; Tsai, Tung-Hu
2017-02-20
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Chinese herbal medicine (CHM) is frequently provided to HCC patients. The aim of this study was to understand the prescription frequency and patterns of CHM for HCC patients by analyzing the claims data from the National Health Insurance (NHI) in Taiwan. We identified 73918 newly diagnosed HCC subjects from the database of Registry for Catastrophic Illness during 2002 to 2009 and to analyze the frequency and pattern of corresponding CHM prescriptions for HCC patients. There were a total of 685,079 single Chinese herbal prescriptions and 553,952 Chinese herbal formula prescriptions used for 17,373 HCC subjects before 2 years of HCC diagnosis. Among the 13,093 HCC subjects who used CHMs after HCC diagnosis, there were 462,786 single Chinese herbal prescriptions and 300,153 Chinese herbal formula prescriptions were counted. By adjusting with person-year and ratio of standardized incidence rate, the top ten prescribed single herbal drugs and Chinese herbal formulas for HCC patients were described in our study. Among them, we concluded that, Oldenlandia diffusa (Chinese herbal name: Bai-Hua-She-She-Cao), Radix et Rhizoma Rhei (Da Huang) and the herbal preparation of Xiao-Chai-Hu-Tang and Gan-Lu-Yin, were the most obviously increased and important CHMs been used for HCC patients. We established an accurate and validated method for the actual frequency and patterns of CHM use in treating HCC in Taiwan. We propose that these breakthrough findings may have important implications for HCC therapy, clinical trials and modernization of CHM.
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Lin, Chia-Yen
2015-01-01
The health medical costs of colorectal cancer are increasingly higher in Taiwan. The National Health Insurance Administration (NHI) and The Health Promotion Administration of the Ministry of Health and Welfare (MOHW) in Taiwan encourage individuals to adopt an earnest approach to healthy behavior through advocacy advertising. However, the number of colorectal cancer patients continues to increase annually. Our study explored the effects of health-related advertisements (ads) on healthy behavior intentions as influenced by regulatory focus theory (RFT) and construal level theory (CLT). We conducted an experiment with different public health advocacy ads. A 2 (regulatory focus: promotion vs. prevention) × 2 (temporal distance: one month vs. one year) × 2 (graphics-text ratio: more pictures and less text vs. fewer pictures and more text) three-factor experiment was adopted. The multiple analysis of variance (MANOVA) results revealed that ads with higher construal levels (i.e., more text) had greater effects with a promotion-oriented regulatory focus. However, no significant differences were found in either attitude toward the ads or behavior intention when the regulatory focus was prevention. In addition, according to the young testers and those who were psychologically distant from colorectal cancer, different temporal distances and different construal levels had no statistically significantly effects on attitudes toward advertising or on behavior intentions. The results revealed that viewers found the information easier to understand when the ads triggered the regulatory focuses of the viewers and applied an appropriate graphics-text ratio, which resulted in favorable health-related advertising effectiveness. Thus, we provide two suggestions regarding the use of health-related advertising for MOHW in the future. PMID:25826394
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Shen, Li-Jiuan; Chou, Hua; Huang, Chih-Fen; Chou, Guann-Miaw; Chan, Wing Kai; Wu, Fe-Lin Lin
2011-07-01
Concerns exist regarding the additional cost of patient care when patients are enrolled in clinical trials at hospitals. To assess the avoidance of drug costs by conducting sponsored clinical trials, a retrospective analysis evaluating drug cost avoidance in all sponsored clinical trials was conducted in 2008 at the most prominent medical center in Taiwan. The National Health Insurance (NHI) reimbursement prices of either the investigated drugs or the standardized drug therapy for each specific disease were used to calculate the cost avoidance. Drug cost avoidance from sponsored clinical trials per year, per trial, per patient, in different therapeutic areas, and in different phases was analyzed. Three quarters of the cost avoidance in drug expenditures from 194 sponsored clinical trials were estimated. All cost values are in US Dollars. Around $11.2 million was avoided at the center in 2008. The average value of cost avoidance was $58,000/trial-year or $3,900/participant-year. The early-phase trials and phase III trials accounted for 25% and 56% of all trials, respectively, while they constituted 32% and 49% of the total costs avoided, respectively. The most frequently conducted and highest cost-avoiding trials were those for antineoplastic agents, especially targeted therapy which accounted for 85% of the total cost avoidance of anti-cancer trials. This study demonstrates the profoundly positive economic impact on the healthcare system in Taiwan by sponsored clinical trials. To understand the trend of economic benefits of the trials on pharmaceutical expenditure, it would be important to analyze the cost avoidance of trials regularly in an institution. Copyright © 2011 Elsevier Inc. All rights reserved.
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Yang, Nan-Ping; Lee, Yi-Hui; Lin, Ching-Heng; Chung, Yuan-Chang; Chen, Wen-Jone; Chou, Pesus
2009-01-01
Background We surveyed the emergency medical system (EMS) in Taiwan to provide information to policymakers responsible for decisions regarding the redistribution of national medical resources. Methods A systematic sampling method was used to randomly sample a representative database from the National Health Insurance (NHI) database in Taiwan, during the period from 2000 to 2004. Results We identified 10,124, 10,408, 11,209, 10,686, and 11,914 emergency room visits in 2000, 2001, 2002, 2003, and 2004, respectively. There were more males than females, and the majority of adults were younger than 50 years. Diagnose of injury/poisoning was the most frequently noted diagnostic category in emergency departments (EDs) in Taiwan. There were 13,196 (24.3%) and 2,952 (5.4%) patients with 2 and 3 concomitant diagnoses, respectively. There was a significant association between advanced age and the existence of multiple diagnoses (P < 0.001). With the exception of the ill-defined symptoms/signs/conditions, the two most frequent diagnoses were diseases of the circulatory system and diseases of the respiratory system in patients aged 65 years or older. On average, treatment-associated expenditure and drug-associated expenditure in Taiwan EDs averaged NT$1,155 ($35.0) and NT$190 ($5.8), respectively, which was equal to 64.5% and 10.6% of the total ED-associated cost. General ED medical expenditure increased with patient age; the increased cost ratio due to age was estimated at 8% per year (P < 0.001). Conclusions The frequency of major health problems diagnosed at ED visits varied by age: more complicated complaints and multiple diagnoses were more frequent in older patients. In Taiwan, the ED system remains overloaded, possibly because of the low cost of an ED visit. PMID:19164870
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NASA Astrophysics Data System (ADS)
Khaire, Vikram
2017-08-01
There exists a large void in our understanding of the intergalactic medium (IGM) at z=0.5-1.5, spanning a significant cosmic time of 4 Gyr. This hole resulted from a paucity of near-UV QSO spectra, which were historically very expensive to obtain. However, with the advent of COS and the HST UV initiative, sufficient STIS/COS NUV spectra have finally become available, enabling the first statistical analyses. We propose a comprehensive study of the z 1 IGM using the Ly-alpha forest of 26 archival QSO spectra. This analysis will: (1) measure the distribution of HI absorbers to several percent precision down to log NHI < 13 to test our model of the IGM, and determine the extragalactic UV background (UVB) at that epoch; (2) measure the Ly-alpha forest power spectrum to 12%, providing another precision test of LCDM and our theory of the IGM; (3) measure the thermal state of the IGM, which reflects the balance of heating (photoheating, HI/HeII reionization) and cooling (Hubble expansion) of cosmic baryons, and directly verify the predicted cooldown of IGM gas after reionization for the first time; (4) generate high-quality reductions, coadds, and continuum fits that will be released to the public to enable other science cases. These results, along with our state-of-the-art hydrodynamical simulations, and theoretical models of the UVB, will fill the 4 Gyr hole in our understanding of the IGM. When combined with existing HST and ground-based data from lower and higher z, they will lead to a complete, empirical description of the IGM from HI reionization to the present, spanning more than 10 Gyr of cosmic history, adding substantially to Hubble's legacy of discovery on the IGM.
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Lv, Jinling; Liu, Hua; Wang, Xihe; Li, Kaihui; Tian, Changyan; Liu, Xuejun
2016-01-01
Few systematic studies have been carried out on integrated N balance in extremely arid oasis agricultural areas. A two-year field experiment was conducted to evaluate the N input and output balances under long-term fertilization conditions. Five treatments were chosen, namely CK (no fertilizer), NPK, NPKS (10% straw return N and 90% chemical N), NPKM (one third urea-N, two thirds sheep manure) and NPKM+ (1.5 times NPKM). The results show an abundance of dry and wet N deposition (33 kg N ha-1 yr-1) in this area. All treatments (excluding CK) showed no significant difference in wheat production (P>0.05). NPKM gave higher cotton yields (P<0.05). In both crops, NPKM and NPKS treatments had a relatively higher N harvest index (NHI). 15N-labeled results reveal that the fertilizer N in all N treatments leached to<1 m depth and a high proportion of fertilizer-N remained in the top 60 cm of the soil profile. The NPKM+ treatment had the highest residual soil mineral N (Nmin, 558 kg Nd ha-1), and NPKM and NPKS treatments had relatively low soil Nmin values (275 and 293 kg N ha-1, respectively). Most of the treatments exhibited very high apparent N losses, especially the NPKM+ treatment (369kg N ha-1). Our arid research area had a strikingly high N loss compared to less arid agricultural areas. Nitrogen inputs therefore need careful reconsideration, especially the initial soil Nmin, fertilizer N inputs, dry and wet deposition, and appropriate organic and straw inputs which are all factors that must be taken into account under very arid conditions. PMID:27798654
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Hsieh, Shu-Ching; Lai, Jung-Nien; Lee, Chuan-Fang; Hu, Fu-Chang; Tseng, Wei-Lum; Wang, Jung-Der
2008-06-01
The consumption of Chinese herbal products (CHPs) is increasing exponentially. However, the scientific evidence is lacking and there is an urgent requirement for detailed pharmacoepidemiological information on CHP usage. This study was to investigate CHP prescription patterns in Taiwan. We carried out a cross-sectional analysis on a cohort of 200,000 patients based on 2004 data from the National Health Insurance (NHI) reimbursement database. Data mining techniques were applied to explore CHP co-prescription patterns. A total of 46,938 patients had been prescribed CHPs on at least one occasion in 2004. Patients using CHPs were generally female and middle-aged, made more outpatient visits, had fewer hospitalizations and consumed more medical resources than non-users of CHPs. A total of 1,073,030 CHPs were contained within 220,123 prescriptions, for which acute nasopharyngitis was the most common indication. Yan hu suo and Jia Wei Xiao Yao San were the most frequently prescribed single herb (SH) and herbal formula (HF), respectively. The results of the data mining showed that the best predictions were provided by co-prescriptions of 'Mo yao and Ru xiang', 'Ye jiao teng and Suan Zao Ren Tan' and 'Dang Gui Nian Tong Tang and Shu Jing Huo Xue Tang' in the groups of SH-SH, SH-HF and HF-HF, respectively. This study provides national-level CHP prescription profiles and utilization rates, and documents, for the first time, HF-HF prescription combinations in Chinese medicine (CM) practices in Taiwan. We conclude that more studies are needed to validate the safety and effectiveness of CHP prescriptions.
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Touati, Mohamed; Lamarsalle, Ludovic; Moreau, Stéphane; Vergnenègre, Françoise; Lefort, Sophie; Brillat, Catherine; Jeannet, Laetitia; Lagarde, Aline; Daulange, Annick; Jaccard, Arnaud; Vergnenègre, Alain; Bordessoule, Dominique
2016-12-01
At home injectable chemotherapy for patients receiving treatment for hematological diseases is still in debate. Given the expense of new innovative medicines, at home treatment has been proposed as a suitable option for improving patient quality of life and decreasing treatment costs. We decided to assess the cost of bortezomib administration in France among multiple myeloma patients from an economic standpoint. Patients in this study were treated within a regional hematological network combining outpatient hospital care and Hospital care at Home administration. To make the cost comparison, our team simulated outpatient hospital care expenses. Fifty-four consecutive multiple myeloma patients who received at least one injection of bortezomib in Hospital care at Home from January 2009 to December 2011 were included in the study. The median number of injections was 12 (range 1-44) at home and 6 (range 0-30) in the outpatient care unit. When compared with the cost simulation of outpatient hospital care alone, bortezomib administration with combined care was significantly less expensive for the National Health Insurance (NHI) budget. The mean total cost per patient and per injection was 954.20 € for combined outpatient and Hospital care at Home vs 1143.42 € for outpatient hospital care alone. This resulted in an estimated 16.5 % cost saving (Wilcoxon signed-rank test, p < 0.0001). The greatest savings were observed in administration costs (37.5 % less) and transportation costs (68.1 % less). This study reflects results for a regionally implemented program for multiple myeloma patients treated with bortezomib in routine practice in a large rural area.
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A Search for H I Lyα Counterparts to Ultrafast X-Ray Outflows
NASA Astrophysics Data System (ADS)
Kriss, Gerard A.; Lee, Julia C.; Danehkar, Ashkbiz
2018-06-01
Prompted by the H I Lyα absorption associated with the X-ray ultrafast outflow at ‑17,300 km s‑1 in the quasar PG 1211+143, we have searched archival UV spectra at the expected locations of H I Lyα absorption for a large sample of ultrafast outflows identified in XMM-Newton and Suzaku observations. Sixteen of the X-ray outflows have predicted H I Lyα wavelengths falling within the bandpass of spectra from either the Far Ultraviolet Spectroscopic Explorer or the Hubble Space Telescope, although none of the archival observations were simultaneous with the X-ray observations in which ultrafast X-ray outflows (UFOs) were detected. In our spectra broad features with FWHM of 1000 km s‑1 have 2σ upper limits on the H I column density of generally ≲2 × 1013 cm‑2. Using grids of photoionization models covering a broad range of spectral energy distributions (SEDs), we find that producing Fe XXVI Lyα X-ray absorption with equivalent widths >30 eV and associated H I Lyα absorption with {N}{{H}{{I}}}< 2× {10}13 {cm}}-2 requires total absorbing column densities {N}{{H}}> 5× {10}22 {cm}}-2 and ionization parameters log ξ ≳ 3.7. Nevertheless, a wide range of SEDs would predict observable H I Lyα absorption if ionization parameters are only slightly below peak ionization fractions for Fe XXV and Fe XXVI. The lack of Lyα features in the archival UV spectra indicates that the UFOs have very high ionization parameters, that they have very hard UV-ionizing spectra, or that they were not present at the time of the UV spectral observations owing to variability.
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Lin, Chia-Yen
2015-03-27
The health medical costs of colorectal cancer are increasingly higher in Taiwan. The National Health Insurance Administration (NHI) and The Health Promotion Administration of the Ministry of Health and Welfare (MOHW) in Taiwan encourage individuals to adopt an earnest approach to healthy behavior through advocacy advertising. However, the number of colorectal cancer patients continues to increase annually. Our study explored the effects of health-related advertisements (ads) on healthy behavior intentions as influenced by regulatory focus theory (RFT) and construal level theory (CLT). We conducted an experiment with different public health advocacy ads. A 2 (regulatory focus: promotion vs. prevention) × 2 (temporal distance: one month vs. one year) × 2 (graphics-text ratio: more pictures and less text vs. fewer pictures and more text) three-factor experiment was adopted. The multiple analysis of variance (MANOVA) results revealed that ads with higher construal levels (i.e., more text) had greater effects with a promotion-oriented regulatory focus. However, no significant differences were found in either attitude toward the ads or behavior intention when the regulatory focus was prevention. In addition, according to the young testers and those who were psychologically distant from colorectal cancer, different temporal distances and different construal levels had no statistically significantly effects on attitudes toward advertising or on behavior intentions. The results revealed that viewers found the information easier to understand when the ads triggered the regulatory focuses of the viewers and applied an appropriate graphics-text ratio, which resulted in favorable health-related advertising effectiveness. Thus, we provide two suggestions regarding the use of health-related advertising for MOHW in the future.
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Bipolar disorder and the risk of fracture: A nationwide population-based cohort study.
Su, Jian-An; Cheng, Bi-Hua; Huang, Yin-Cheng; Lee, Chuan-Pin; Yang, Yao-Hsu; Lu, Mong-Liang; Hsu, Chung-Yao; Lee, Yena; McIntyre, Roger S; Chin Lin, Tzu; Chin-Hung Chen, Vincent
2017-08-15
The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder. The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls. Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively p<0.001). The hazard ratio (HR) was 1.33 (95% confidence interval [CI]＝1.23-1.48, p<0.001) after adjusting for covariates. Persons with bipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture. The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset. Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture. Copyright © 2017 Elsevier B.V. All rights reserved.
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Tang, Chao-Hsiun; Wang, Han-I; Hsu, Chun-Sen; Su, Hung-Wen; Chen, Mei-Ju; Lin, Herng-Ching
2006-10-09
Over the past decade, about one-third of all births nationwide in Taiwan were delivered by cesarean section (CS). Previous studies in the US and Europe have documented the need for risk adjustment for fairer comparisons among providers. In this study, we set out to determine the impact that adjustment for patient-specific risk factors has on CS among different physicians in Taiwan. There were 172,511 live births which occurred in either hospitals or obstetrics/gynecology clinics between 1 January and 31 December 2003, and for whom birth certificate data could be linked with National Health Insurance (NHI) claims data, available as the sample for this study. Physicians were divided into four equivalent groups based upon the quartile distribution of their crude (actual) CS rates. Stepwise logistic regressions were conducted to develop a predictive model and to determine the expected (risk-adjusted) CS rate and 95% confidence interval (CI) for each physician. The actual rates were then compared with the expected CS rates to see the proportion of physicians whose actual rates were below, within, or above the predicted CI in each quartile. The proportion of physicians whose CS rates were above the predicted CI increased as the quartile moved to the higher level. However, more than half of the physicians whose actual rates were higher than the predicted CI were not in the highest quartile. Conversely, there were some physicians (40 of 258 physicians) in the highest quartile who were actually providing obstetric care that was appropriate to the risk. When a stricter standard was applied to the assessment of physician performance by excluding physicians in quartile 4 for predicting CS rates, as many as 60% of physicians were found to have higher CS rates than the predicted CI, and indeed, the CS rates of no physicians in either quartile 3 or quartile 4 were below the predicted CI. Overall, our study found that the comparison of unadjusted CS rates might not provide a valid reflection of the quality of obstetric care delivered by physicians, and may ultimately lead to biased judgments by purchasers. Our study has also shown that when we changed the standard of quality assessment, the evaluation results also changed.
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2012-01-01
Background Although methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community. Methods The study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged ≥ 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) ≥ 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined. Results 128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP. Conclusions The results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients. PMID:22429858
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Spending on medicines in Israel in an international context.
Sax, Philip
2005-05-01
Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.
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The Spectral and Environment Properties of z ∼ 2.0–2.5 Quasar Pairs
NASA Astrophysics Data System (ADS)
Lusso, Elisabeta; Fumagalli, Michele; Rafelski, Marc; Neeleman, Marcel; Prochaska, Jason X.; Hennawi, Joseph F.; O’Meara, John M.; Theuns, Tom
2018-06-01
We present the first results from our survey of intervening and proximate Lyman limit systems (LLSs) at z ∼ 2.0–2.5 using the Wide Field Camera 3 on board the Hubble Space Telescope. The quasars in our sample are projected pairs with proper transverse separations R ⊥ ≤ 150 kpc and line-of-sight velocity separations ≲11,000 km s‑1. We construct a stacked ultraviolet (rest-frame wavelengths 700–2000 Å) spectrum of pairs corrected for the intervening Lyman forest and Lyman continuum absorption. The observed spectral composite presents a moderate flux excess for the most prominent broad emission lines, a ∼30% decrease in flux at λ = 800–900 Å compared to a stack of brighter quasars not in pairs at similar redshifts, and lower values of the mean free path of the H I ionizing radiation for pairs ({λ }mfp}912 = 140.7 ± 20.2 {h}70-1 Mpc) compared to single quasars ({λ }mfp}912 = 213.8 ± 28 {h}70-1 Mpc) at the average redshift z ≃ 2.44. From the modeling of LLS absorption in these pairs, we find a higher (∼20%) incidence of proximate LLSs with log {N}{{H}{{I}}} ≥ 17.2 at δv < 5000 km s‑1 compared to single quasars (∼6%). These two rates are different at the 5σ level. Moreover, we find that optically thick absorbers are equally shared between foreground and background quasars. Based on these pieces of evidence, we conclude that there is a moderate excess of gas-absorbing Lyman continuum photons in our closely projected quasar pairs compared to single quasars. We argue that this gas arises mostly within large-scale structures or partially neutral regions inside the dark matter halos where these close pairs reside.
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Lee, Myung Ha; Lee, Yoon Young; Jung, Da Won; Park, Boyoung; Yun, E Hwa; Lee, Hoo-Yeon; Jun, Jae Kwan; Choi, Kui Son
2012-01-01
This study assessed the effectiveness of three intervention strategies to improve the participation rate of gastric cancer screening among people who had never undergone such screening, and those who had been screened for the disease, but not recently. It was conducted in the Ilsandong-gu District of Goyang City, Korea. The population for the current study was restricted to male residents, aged 40-65 years, who received an invitation letter to undergo gastric cancer screening from the National Health Insurance (NHI) Corporation at the beginning of 2010. The subjects were divided into two categories according to their screening history: never-screened, and ever-screened. A total of 2,065 men were eligible: 803 never-screened and 1,262 ever-screened. In each screening category they were randomly assigned to one of three intervention groups: 1) tailored telephone counseling; 2) tailored postcard reminder after tailored telephone counseling;and 3) tailored telephone counseling after tailored postcard reminder. At 3 months post-intervention, never- screened men with any intervention were more likely to undergo gastric cancer screening (OR=2.75, 95% CI: 1.22-6.18) compared to those in the reference group (no intervention). However, there was no statistically significant intervention effect in ever-screened men (OR=1.21, 95% CI: 0.65-2.27). Examination of the intervention effects by intervention group among never-screened men showed that those in the postcard reminder after telephone counseling group to be statistically significantly more likely to undergo gastric cancer screening (OR=4.49, 95% CI: 1.79-11.29) than the reference group (no intervention). Our results highlight that use of tailored postcard reminders after tailored telephone counseling is an effective method to increase participation in gastric cancer screening among men who had never been screened.
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The political economy of healthy system reform in Israel.
Chernichovsky, D; Chinitz, D
1995-01-01
On June 15, 1994, the Israeli Parliament voted to enact the National Health Insurance bill (NHI). The bill marks the end of a process that lasted for virtually as long as Israel's almost 50 year history. Israel's attempts at health reform began long before the current spate of reforms in many Western countries. Faced with many of the same problems of access, equity and cost control common to many of its counterparts, Israel initiated a reform process based on the recommendations of a prominent State Commission of Inquiry into the Israeli Health System (the Netanyahu Commission) which reported to the Government in 1990. The Commission's proposals were based on a diagnosis indicating that the major problems of the system stem from the lack of clarity regarding the rights of citizens to health care, the lack of a clear allocation of responsibility and accountability among government, insurance or sick funds, and providers in the system, and undue centralization of system operations. This diagnosis led to three major planks for reform: (1) enactment of national health insurance legislation granting a basic package of care to each citizen and hence bringing most of the system's finance under public auspices; (2) divesting the Government from the organization, management and provision of care; hence integrating the management of preventive and psychiatric services provided by the government with the primary and other services provided by sick funds, and granting financial and operational independence to at least government hospitals; and (3) restructuring the Ministry of Health. As is often the case in public policy, more consensus surrounds the diagnosis than the solutions. As a result, nearly four years of implementation efforts have only recently resulted in a major breakthrough. In this paper we make an effort to outline the inherent weaknesses of the Israeli health care system that have led to the crisis in the mid 1980s, summarize the recommendations of the State Commission for structural change in the system, and review the politics of implementing the recommended reforms.
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Association of chronic obstructive pulmonary disease and hemorrhoids
Lin, Lih-Hwa; Siu, Justin Ji-Yuen; Liao, Po-Chi; Chiang, Jen-Huai; Chou, Pei-Chi; Chen, Huey-Yi; Ho, Tsung-Jung; Tsai, Ming-Yen; Chen, Yung-Hsiang; Chen, Wen-Chi
2017-01-01
Abstract According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the “interior–exterior” relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490–492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50–1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77–0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20–39 years), 1.19 (95% CI: 1.14–1.26), and 1.18 (95% CI: 1.12–1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine. PMID:28272246
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Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study.
Lin, Lih-Hwa; Siu, Justin Ji-Yuen; Liao, Po-Chi; Chiang, Jen-Huai; Chou, Pei-Chi; Chen, Huey-Yi; Ho, Tsung-Jung; Tsai, Ming-Yen; Chen, Yung-Hsiang; Chen, Wen-Chi
2017-03-01
According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.
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NASA Astrophysics Data System (ADS)
Abdel-Rahman, Laila H.; El-Khatib, Rafat M.; Nassr, Lobna A. E.; Abu-Dief, Ahmed M.; Lashin, Fakhr El-Din
2013-07-01
In this study, new Fe(II) Schiff base amino acid chelates derived from the condensation of o-hydroxynaphthaldehyde with L-alanine, L-phenylalanine, L-aspartic acid, L-histidine and L-arginine were synthesized and characterized via elemental, thermogravimetric analysis, molar conductance, IR, electronic, mass spectra and magnetic moment measurements. The stoichiometry and the stability constants of the complexes were determined spectrophotometrically. Correlation of all spectroscopic data suggested that Schiff bases ligands exhibited tridentate with ONO sites coordinating to the metal ions via protonated phenolic-OH, azomethine-N and carboxylate-O with the general formulae [Fe(HL)2]·nH2O. But in case of L-histidine, the ligand acts as tetradentate via deprotonated phenolic-OH, azomethine-N, carboxylate-O and N-imidazole ring ([FeL(H2O)2]·2H2O), where HL = mono anion and L = dianion of the ligand. The structure of the prepared complexes is suggested to be octahedral. The prepared complexes were tested for their teratogenicity on chick embryos and found to be safe until a concentration of 100 μg/egg with full embryos formation. Moreover, the interaction between CT-DNA and the investigated complexes were followed by spectrophotometric and viscosity measurements. It was found that, the prepared complexes bind to DNA via classical intercalative mode and showed a different DNA activity with the sequence: nhi > nari > nali > nasi > nphali. Furthermore, the free ligands and their complexes are screened for their in vitro antibacterial and antifungal activity against three types of bacteria, Escherichia coli, Pseudomonas aeruginosa and Bacillus cereus and three types of anti fungal cultures, Penicillium purpurogenium, Aspergillus flavus and Trichotheium rosium in order to assess their antimicrobial potential. The results show that the metal complexes are more reactive with respect to their corresponding Schiff base amino acid ligands.
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Chen, Mei-Jyh; Chen, Chieh-Chang; Fang, Yu-Jen; Lee, Ji-Yuh; Wu, Jeng-Yih; Luo, Jiing-Chyuan; Liou, Tai-Cherng; Chang, Wen-Hsiung; Tseng, Cheng-Hao; Wu, Chun-Ying; Yang, Tsung-Hua; Chang, Chun-Chao; Wang, Hsiu‐Po; Sheu, Bor-Shyang; Lin, Jaw-Town; Bair, Ming-Jong; Wu, Ming-Shiang
2015-01-01
Objective The Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance. Methods The defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method. Results The DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000–2007 to 8.3% in 2008–2010 and 13.4% in 2011–2012 (p=0.001). The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p<0.001), which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance. Conclusions The low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan might be attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance. PMID:25942450
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Choi, Hoon-Hee; Han, Kyu-Tae; Nam, Chung Mo; Moon, Ki Tae; Kim, Woorim; Park, Eun-Cheol
2016-08-17
The number of patients requiring haemodialysis has gradually increased in South Korea. Owing to this growth, concerns have been raised regarding haemodialysis quality of care, and healthcare professionals must consider alternatives for appropriate management of patients with chronic kidney disease (CKD). Therefore, we investigated the association between risk of hospitalisation of outpatients who received haemodialysis due to end-stage renal disease (ESRD) and the human resources of the haemodialysis unit. We used data from National Health Insurance (NHI) claims during October 2013 to September 2014. These data comprised 40 543 outpatients with ESRD (4 751 047 outpatient cases) who received haemodialysis. No interventions were made. We performed Poisson regression analysis using a generalised estimating equation that included both patient and haemodialysis unit characteristics to examine the factors associated with hospitalisation of outpatients with ESRD. Among 4 751 047 outpatient cases, 27 997 (0.59%) were hospitalised during the study period. A higher proportion of haemodialysis patient care specialists and a higher number of nurses experienced in haemodialysis were inversely associated with the risk of hospitalisation (per 10% increase in haemodialysis patient care specialists: relative risk (RR)=0.987, 95% CI 0.981 to 0.993; per 10-person increase in nurses who provided haemodialysis: RR=0.876, 95% CI 0.833 to 0.921). In addition, such associations were greater in severe patients. Our findings suggest that haemodialysis units with high-quality, haemodialysis-specialised human resources could positively affect the outcomes of outpatients with ESRD. Based on our findings, health policymakers and professionals should implement strategies for the optimal management of patients with CKD. 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/
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Yen, Yu-Hsuan; Chen, Hsiang-Yin; Wuan-Jin, Leu; Lin, You-Meei; Shen, Wan C; Cheng, Kuei-Ju
2012-02-01
A pharmacist-managed antibiotic intravenous to oral (i.v.-top. o.) conversion program has been incorporated to minimize unnecessary i.v. antibiotic usage. This study evaluated the clinical and economical impacts of a pharmacist-directed i.v.-to-p.o. conversion program for levofloxacin in Taiwan. Data was retrospectively collected by chart review during the pre-intervention period (PIP). During the intervention proactive conversion period (PCP), pharmacists reviewed and intervened on all levofloxacin orders. The detailed reimbursements for medications and inpatient expenses from the Bureau of National Health Insurance (NHI), Taiwan were calculated. The clinical impacts during the PIP and PCP were compared with the duration of the i.v. levofloxacin therapy, total used i.v./p.o. ratio levofloxacin, and total length of hospital stay. The financial impact was compared with medication costs and total inpatient expenditures. The mean length of hospital stay was significantly decreased from 27.2 days to 16.1 days (p = 0.001) after the conversion program was implemented. The i.v. over p.o. ratio for DDD was 3.0 ± 0.6 vs. 2.1 ± 0.6 for PIP vs. PCP group (p = 0.032). The cost of the levofloxacin was significantly decreased ($ 568.9 ± 262.9 vs. $ 449.0 ± 266.4, PIP vs. PCP, p = 0.044). The total inpatient expenditures were also significantly reduced ($ 6,096 ± 5,164.0 vs. $ 3,649.6 ± 3, 740.4, PIP vs. PCP, p = 0.017). The pharmacist-managed i.v.-to-p.o. conversion service not only decreased the length of hospital stays, but also produced significant cost savings, both on medication costs and the total inpatient expenditures. This represents strong evidence for implementing the i.v.-to-p.o. conversion service in Taiwan.
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Huang, Yuegao; Coman, Daniel; Ali, Meser M.; Hyder, Fahmeed
2014-01-01
Relaxivity based magnetic resonance of phosphonated ligands chelated with gadolinium (Gd3+) shows promise for pH imaging. However instead of monitoring the paramagnetic effect of lanthanide complexes on the relaxivity of water protons, biosensor (or molecular) imaging with magnetic resonance is also possible by detecting either the non-exchangeable or the exchangeable protons on the lanthanide complexes themselves. The non-exchangeable protons (e.g., –CHx, where 3≥x≥1) are detected using a three-dimensional chemical shift imaging method called Biosensor Imaging of Redundant Deviation in Shifts (BIRDS), whereas the exchangeable protons (e.g., –OH or –NHy, where 2≥y≥1) are measured with Chemical Exchange Saturation Transfer (CEST) contrast. Here we tested the feasibility of BIRDS and CEST for pH imaging of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraaminophosphonate (DOTA-4AmP8−) chelated with thulium (Tm3+) and ytterbium (Yb3+). BIRDS and CEST experiments show that both complexes are responsive to pH and temperature changes. Higher pH and temperature sensitivities are obtained with BIRDS for either complex when using the chemical shift difference between two proton resonances vs. using the chemical shift of a single proton resonance, thereby eliminating the need to use water resonance as reference. While CEST contrast for both agents is linearly dependent on pH within a relatively large range (i.e., 6.3-7.9), much stronger CEST contrast is obtained with YbDOTA-4AmP5− than with TmDOTA-4AmP5−. In addition, we demonstrate the prospect of using BIRDS to calibrate CEST as new platform for quantitative pH imaging. PMID:24801742
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Feasibility and validity of International Classification of Diseases based case mix indices.
Yang, Che-Ming; Reinke, William
2006-10-06
Severity of illness is an omnipresent confounder in health services research. Resource consumption can be applied as a proxy of severity. The most commonly cited hospital resource consumption measure is the case mix index (CMI) and the best-known illustration of the CMI is the Diagnosis Related Group (DRG) CMI used by Medicare in the U.S. For countries that do not have DRG type CMIs, the adjustment for severity has been troublesome for either reimbursement or research purposes. The research objective of this study is to ascertain the construct validity of CMIs derived from International Classification of Diseases (ICD) in comparison with DRG CMI. The study population included 551 acute care hospitals in Taiwan and 2,462,006 inpatient reimbursement claims. The 18th version of GROUPER, the Medicare DRG classification software, was applied to Taiwan's 1998 National Health Insurance (NHI) inpatient claim data to derive the Medicare DRG CMI. The same weighting principles were then applied to determine the ICD principal diagnoses and procedures based costliness and length of stay (LOS) CMIs. Further analyses were conducted based on stratifications according to teaching status, accreditation levels, and ownership categories. The best ICD-based substitute for the DRG costliness CMI (DRGCMI) is the ICD principal diagnosis costliness CMI (ICDCMI-DC) in general and in most categories with Spearman's correlation coefficients ranging from 0.938-0.462. The highest correlation appeared in the non-profit sector. ICD procedure costliness CMI (ICDCMI-PC) outperformed ICDCMI-DC only at the medical center level, which consists of tertiary care hospitals and is more procedure intensive. The results of our study indicate that an ICD-based CMI can quite fairly approximate the DRGCMI, especially ICDCMI-DC. Therefore, substituting ICDs for DRGs in computing the CMI ought to be feasible and valid in countries that have not implemented DRGs.
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Huang, Yuegao; Coman, Daniel; Ali, Meser M; Hyder, Fahmeed
2015-01-01
Relaxivity-based magnetic resonance of phosphonated ligands chelated with gadolinium (Gd(3+)) shows promise for pH imaging. However instead of monitoring the paramagnetic effect of lanthanide complexes on the relaxivity of water protons, biosensor (or molecular) imaging with magnetic resonance is also possible by detecting either the nonexchangeable or the exchangeable protons on the lanthanide complexes themselves. The nonexchangeable protons (e.g. -CHx, where 3 ≥ x ≥ 1) are detected using a three-dimensional chemical shift imaging method called biosensor imaging of redundant deviation in shifts (BIRDS), whereas the exchangeable protons (e.g. -OH or -NHy , where 2 ≥ y ≥ 1) are measured with chemical exchange saturation transfer (CEST) contrast. Here we tested the feasibility of BIRDS and CEST for pH imaging of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraaminophosphonate (DOTA-4AmP(8-)) chelated with thulium (Tm(3+) ) and ytterbium (Yb(3+)). BIRDS and CEST experiments show that both complexes are responsive to pH and temperature changes. Higher pH and temperature sensitivities are obtained with BIRDS for either complex when using the chemical shift difference between two proton resonances vs using the chemical shift of a single proton resonance, thereby eliminating the need to use water resonance as reference. While CEST contrast for both agents is linearly dependent on pH within a relatively large range (i.e. 6.3-7.9), much stronger CEST contrast is obtained with YbDOTA-4AmP(5-) than with TmDOTA-4AmP(5-). In addition, we demonstrate the prospect of using BIRDS to calibrate CEST as new platform for quantitative pH imaging. Copyright © 2014 John Wiley & Sons, Ltd.
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Exeter, Daniel J; Sabel, Clive E; Hanham, Grant; Lee, Arier C; Wells, Susan
2015-05-01
The association between area-level disadvantage and health and social outcomes is unequivocal. However, less is known about the health impact of residential mobility, particularly at intra-urban scales. We used an encrypted National Health Index (eNHI) number to link individual-level data recorded in routine national health databases to construct a cohort of 641,532 participants aged 30+ years to investigate the association between moving and CVD hospitalisations in Auckland, New Zealand. Residential mobility was measured for participants according to changes in the census Meshblock of usual residence, obtained from the Primary Health Organisation (PHO) database for every calendar quarter between 1/1/2006 and 31/12/2012. The NZDep2006 area deprivation score at the start and end of a participant's inclusion in the study was used to measure deprivation mobility. We investigated the relative risk of movers being hospitalised for CVD relative to stayers using multi-variable binomial regression models, controlling for age, gender, deprivation and ethnicity. Considered together, movers were 1.22 (1.19-1.26) times more likely than stayers to be hospitalised for CVD. Using the 5×5 deprivation origin-destination matrix to model a patient's risk of CVD based on upward, downward or sideways deprivation mobility, movers within the least deprived (NZDep2006 Quintile 1) areas were 10% less likely than stayers to be hospitalised for CVD, while movers within the most deprived (NZDep2006 Q5) areas were 45% more likely than stayers to have had their first CVD hospitalisation in 2006-2012 (RR: 1.45 [1.35-1.55]). Participants who moved upward also had higher relative risks of having a CVD event, although their risk was less than those observed for participants experiencing downward deprivation mobility. This research suggests that residential mobility is an important determinant of CVD in Auckland. Further investigation is required to determine the impact moving has on the risk of CVD by ethnicity. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Fenny, Ama Pokuaa; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S
2015-04-12
Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy. Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study. Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities. Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.
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7 CFR 1924.9 - Inspection of development work.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 12 2011-01-01 2011-01-01 false Inspection of development work. 1924.9 Section 1924.9... Inspection of development work. The following policies will govern the inspection of all development work. (a... practicable, will make final inspection of all development work and periodic inspections as appropriate to...
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7 CFR 1924.5 - Planning development work.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 12 2011-01-01 2011-01-01 false Planning development work. 1924.5 Section 1924.5... Planning development work. (a) Extent of development. For an FO loan, the plans for development will... for development work. The total cash cost of all planned development will be shown on Form FmHA or its...
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24 CFR 983.154 - Conduct of development work.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Conduct of development work. 983... Constructed Units § 983.154 Conduct of development work. (a) Development requirements. The owner must carry out development work in accordance with the Agreement and the requirements of this section. (b) Labor...
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7 CFR 1924.6 - Performing development work.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 12 2011-01-01 2011-01-01 false Performing development work. 1924.6 Section 1924.6... Performing development work. All construction work will be performed by one, or a combination, of the following methods: Contract, borrower, mutual self-help, or owner-builder. All development work must be...
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7 CFR 1948.83 - Performance of site development work.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 7 Agriculture 13 2010-01-01 2009-01-01 true Performance of site development work. 1948.83 Section 1948.83 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE... Development Assistance Program § 1948.83 Performance of site development work. Site development work will be...
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Tones, Megan; Pillay, Hitendra; Fraser, Jennifer
2010-01-01
Contemporary lifespan development models of adaptive development have been applied to the workforce to examine characteristics of the ageing employee. Few studies have examined adaptive development in terms of worker perceptions of workplace, or their learning and development issues. This study used the recently developed Revised Learning and Development Survey to investigate employee selection and engagement of learning and development goals, opportunities for learning and development at work, and constraints to learning and development at work. Demographic and career goal variables were tested amongst a sample of private hospital employees, almost all of whom were nurses. Workers under 45 years of age perceived greater opportunities for training and development than more mature aged workers. Age and physical demands interacted such that physical demands of work were associated with lower engagement in learning and development goals in mature aged workers. The opposite was observed amongst younger workers. Engagement in learning and development goals at work predicted goals associated with an intention to decrease work hours or change jobs to a different industry when opportunities to learn via work tasks were limited. At the same time limited opportunities for training and development and perceptions of constraints to development at work predicted the intention to change jobs. Results indicate consideration must be paid to employee perceptions in the workplace in relation to goals. They may be important factors in designing strategies to retain workers.
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24 CFR 570.415 - Community Development Work Study Program.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Community Development Work Study... Grants § 570.415 Community Development Work Study Program. (a) Applicability and objectives. HUD makes... students who participate in a work study program while enrolled in full-time graduate programs in community...
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Social Work Education. Coombe Lodge Report, Study Conference 74/208.
ERIC Educational Resources Information Center
Further Education Staff Coll., Blagdon (England).
Papers presented on social work education in Britain include: Current developments in social work education (P.H. Young); selection of students (M. Elizabeth Edwards); the management of curriculum development (J. Snelling); the management of a social work department (M.J. McAllister); current issues and developments in social work training (D.C.G.…
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[Job stressors in software developers--a comparison with other occupations].
Kadokura, M
1997-09-01
The aim of this study is to investigate the difference in job stressors among software developers, the sales staff and the clerical staff (n = 2,079) in two companies (A Co. and B Co.) using a self-administered questionnaire that included a job stressor scale and the 30-item General Health Questionnaire (GHQ). We developed the job stressor scale based on the interviews with out-patients who engaged in software development and previous studies about job stressors. Factor analysis with a seven-factor solution showed that seven subscales were abstracted from the job stressor scale, namely, quantitative load of work, dissatisfaction with work, demanding work, uneasiness about work, human relations, ambiguity of work and shortage of private time. Each subscale was significantly (r = .313-.442, p < 0.0001) correlated with the GHQ score and proved to be a reliable instrument, as indicated by a Cronbach's alpha of greater than 0.73. Stepwise multiple regression analysis revealed that quantitative load of work and shortage of private time subscale scores were significantly high in software developers in A Co. Software developers in A Co. tended to score higher (P < .10) than the others in demanding work and ambiguity of work subscale. All subscale scores were significantly low in the clerical staff in B Co. There was no significant difference between the sales staff and software developers in B Co. Results of the interviews with out-patients showed that demanding work, hard deadline, ambiguity of work and precarious work would cause trouble in software developers. The implications of these findings with respect to occupational issues related to software developers are discussed.
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Mierswa, Tobias; Kellmann, Michael
2017-03-30
Recovery processes in leisure time influence the effect of psychosocial work factors on health issues. However, this function of recovery has been neglected in research regarding the influence of work-related risk factors on low back pain (LBP) development. The aim of this prospective study was to examine the function of psychological detachment - a relevant recovery experience - concerning the influence of psychosocial work factors on LBP development. A moderating function of detachment for the interplay of work factors and LBP was assumed. Sixty pain-free administrative employees of German universities completed an online survey 3 times during a 6-month period. Generalized estimating equations were used to estimate risk-factors of LBP. Analyses revealed an increased chance of LBP development for smokers and a decreasing chance when work resources were high. Detachment had no direct influence on LBP development, although it moderated the influence of work stressors and work resources on LBP. On the one hand, high detachment values seem to protect against an increased chance of LBP development when employees were confronted with high work stressors, while on the other hand high detachment values enhance the protective effect of high work resources. The results indicated a moderating role of detachment concerning the influence of psychosocial work factors on LBP development. Therefore, it is necessary to include recovery processes in future research regarding LBP development and consequently in LBP prevention concepts. Int J Occup Med Environ Health 2017;30(2):313-327. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
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Development of the Work-Family Interface Scale.
ERIC Educational Resources Information Center
Curbow, Barbara; McDonnell, Karen; Spratt, Kai; Griffin, Joan; Agnew, Jacqueline
2003-01-01
Developed and tested a 20-item measure of work-family interface with child care providers. Confirmed five factors: general overload, conflict of family to work, spillover of family to work, spillover of work to family, and conflict of work to family. Regression lines for low, medium, and high levels of work-family interface indicated that high…
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So You Think You Want to Save the World
Bodnar, Benjamin E.
2011-01-01
There is increasing interest among both medical and other professional communities in becoming involved in global health, development, and other charitable work. There has also been a proliferation of opportunities in the field. Nonetheless, it is still difficult to find practical information on the daily realities of development work or advice on the difficulties inherent to this type of work. This article is intended for individuals who are interested in becoming involved in global health and development work. Through a discussion that touches on development economics, the history, psychology, and current state of development aid, the common conflicts, as well as the rewards of development work, this article aims to prepare the interested individual for the experience of global health and development work. The article also provides practical suggestions and references for those searching for an opportunity in the field, with an emphasis on global health opportunities. PMID:21966040
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So you think you want to save the world.
Bodnar, Benjamin E
2011-09-01
There is increasing interest among both medical and other professional communities in becoming involved in global health, development, and other charitable work. There has also been a proliferation of opportunities in the field. Nonetheless, it is still difficult to find practical information on the daily realities of development work or advice on the difficulties inherent to this type of work. This article is intended for individuals who are interested in becoming involved in global health and development work. Through a discussion that touches on development economics, the history, psychology, and current state of development aid, the common conflicts, as well as the rewards of development work, this article aims to prepare the interested individual for the experience of global health and development work. The article also provides practical suggestions and references for those searching for an opportunity in the field, with an emphasis on global health opportunities. Copyright © 2011.
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State Workforce Policy Initiative.
ERIC Educational Resources Information Center
Public/Private Ventures, Philadelphia, PA.
Surging demand for workers, growing income inequality, and passage of welfare reforms have made work force development one of the United States' key national concerns. Public/Private Ventures has been working with various states to design work force development strategies that seek to address the concerns of many work force development specialists…
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Correlates and perceived outcomes of four types of employee development activity.
Birdi, K; Allan, C; Warr, P
1997-12-01
Participation in 4 different types of development activity was studied in a sample of manufacturing employees (N = 1,798). It was found that similar sets of variables were linked to greater participation in 3 activities: required training courses in work time, work-based development activity in work time, and career planning activity in work time or an individual's own time. Three kinds of reported benefits were studied, and the occurrence of these benefits was found to vary between different types of development activity. Overall job satisfaction and organizational commitment were significantly associated with prior participation in required training courses and work-based development activity. However, voluntary learning in one's own time was completely unrelated to these work attitudes.
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Development of an instrument for assessing workstyle in checkout cashier work (BAsIK).
Kjellberg, Katarina; Palm, Peter; Josephson, Malin
2012-01-01
Checkout cashier work consists of handling a large number of items during a work shift, which implies repetitive movements of the shoulders, arms and hands/wrists, and a high work rate. The work is associated with a high prevalence of disorders in the neck and upper extremity. The concept of workstyle explains how ergonomic and psychosocial factors interact in the development of work-related upper extremity disorders. The aim of the project was to develop an instrument for the occupational health services to be used in the efforts to prevent upper extremity disorders in checkout cashier work. The instrument is based on the workstyle concept and is intended to be used as a tool to identify high-risk workstyle and needs for interventions, such as training and education. The instrument, BAsIK, consists of four parts; a questionnaire about workstyle, an observation protocol for work technique, a checklist about the design of the checkout and a questionnaire about work organization. The instrument was developed by selecting workstyle items developed for office work and adapting them to checkout cashier work, discussions with researchers and ergonomists, focus-group interviews with cashiers, observations of video recordings of cashiers, and studies of existing guidelines and checklists.
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Work, Discretion and Learning: Processes of Life Learning and Development at Work
ERIC Educational Resources Information Center
Billett, Stephen
2015-01-01
Knowing how adults learn through work is central to understanding their development across working lives. That development is important for their personal trajectories, and ability to contribute, sustain and advance the interests of their workplaces, and collectively to the social and economic viability of their communities and nations. This paper…
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48 CFR 227.7107-2 - Contracts for construction supplies and research and development work.
Code of Federal Regulations, 2010 CFR
2010-10-01
... supplies and research and development work. 227.7107-2 Section 227.7107-2 Federal Acquisition Regulations... research and development work. Use the provisions and clauses required by 227-7103-6 and 227.7203-6 when..., or research work, or test and evaluation studies of structures, equipment, processes, or materials...
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NASA Technical Reports Server (NTRS)
Connelly, L. C.
1977-01-01
The mission planning processor is a user oriented tool for consumables management and is part of the total consumables subsystem management concept. The approach to be used in developing a working model of the mission planning processor is documented. The approach includes top-down design, structured programming techniques, and application of NASA approved software development standards. This development approach: (1) promotes cost effective software development, (2) enhances the quality and reliability of the working model, (3) encourages the sharing of the working model through a standard approach, and (4) promotes portability of the working model to other computer systems.
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ERIC Educational Resources Information Center
Arani, Mohammad Reza Sarkar; Alagamandan, Jafar; Tourani, Heidar
2004-01-01
The work-based learning model of human resource development has captured a great deal of attention and has gained increasing importance in higher education in recent years. Work-based learning is a powerful phenomenon that attempts to help policy-makers, managers and curriculum developers improve the quality of the decision and organizational…
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Factors promoting sustainable work in women with fibromyalgia.
Palstam, Annie; Gard, Gunvor; Mannerkorpi, Kaisa
2013-09-01
To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM). A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis. Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports. Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM. Work disability is a common consequence of fibromyalgia (FM). Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability. The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM.
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ERIC Educational Resources Information Center
Morgeson, Frederick P.; Humphrey, Stephen E.
2006-01-01
Although there are thousands of studies investigating work and job design, existing measures are incomplete. In an effort to address this gap, the authors reviewed the work design literature, identified and integrated previously described work characteristics, and developed a measure to tap those work characteristics. The resultant Work Design…
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Group Work as Facilitation of Spiritual Development for Drug and Alcohol Abusers.
ERIC Educational Resources Information Center
Page, Richard C.; Berkow, Daniel N.
1998-01-01
Describes group work designed to promote spiritual development with drug and alcohol abusers. Provides a definition of spirituality. Discusses research that relates to the spiritual development of members of drug and alcohol groups. Compares the ways that group work and Alcoholics Anonymous promote spiritual development. (Author/MKA)
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7 CFR 1924.12 - Warranty of development work.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 12 2011-01-01 2011-01-01 false Warranty of development work. 1924.12 Section 1924.12... Warranty of development work. (a) Form FmHA or its successor agency under Public Law 103-354 1924-19... upon final acceptance of the work by the owner and FmHA or its successor agency under Public Law 103...
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WORK-ED. (World of Related Knowledge and Educational Development). A Manual for Trainers.
ERIC Educational Resources Information Center
Fraleigh, Virginia A.
This manual is designed to assist personnel responsible for training teachers in the implementation of the World of Related Knowledge and Educational Development (WORK-ED). (The program is a career education course for ninth graders developed to enable students who have not chosen the traditional college-prep high school course to make career…
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NASA Technical Reports Server (NTRS)
Garcia, Janette
2016-01-01
The National Aeronautics and Space Administration (NASA) is creating a way to send humans beyond low Earth orbit, and later to Mars. Kennedy Space Center (KSC) is working to make this possible by developing a Spaceport Command and Control System (SCCS) which will allow the launch of Space Launch System (SLS). This paper's focus is on the work performed by the author in her first and second part of the internship as a remote application software developer. During the first part of her internship, the author worked on the SCCS's software application layer by assisting multiple ground subsystems teams including Launch Accessories (LACC) and Environmental Control System (ECS) on the design, development, integration, and testing of remote control software applications. Then, on the second part of the internship, the author worked on the development of robot software at the Swamp Works Laboratory which is a research and technology development group which focuses on inventing new technology to help future In-Situ Resource Utilization (ISRU) missions.
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Maurer, Todd J; Weiss, Elizabeth M; Barbeite, Francisco G
2003-08-01
Eight hundred employees from across the U.S. work force participated in a detailed 13-month longitudinal study of involvement in learning and development activities. A new model was posited and tested in which the hypothesized sequence was as follows: worker age --> individual and situational antecedents --> perceived benefits of participation and self-efficacy for development --> attitudes toward development --> intentions to participate --> participation. The results depict a person who is oriented toward employee development as having participated in development activities before, perceiving themselves as possessing qualities needed for learning, having social support for development at work and outside of work, being job involved, having insight into his or her career, and believing in the need for development, in his or her ability to develop skills and to receive intrinsic benefits from participating. Given the aging work force, a detailed treatment of age differences in development is presented. Implications for new ideas in practice and future research are discussed.
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Campbell, Ian; Scott, Nina; Seneviratne, Sanjeewa; Kollias, James; Walters, David; Taylor, Corey; Roder, David
2015-01-01
The Quality Audit (BQA) program of the Breast Surgeons of Australia and New Zealand (NZ) collects data on early female breast cancer and its treatment. BQA data covered approximately half all early breast cancers diagnosed in NZ during roll-out of the BQA program in 1998-2010. Coverage increased progressively to about 80% by 2008. This is the biggest NZ breast cancer database outside the NZ Cancer Registry and it includes cancer and clinical management data not collected by the Registry. We used these BQA data to compare socio-demographic and cancer characteristics and survivals by ethnicity. BQA data for 1998-2010 diagnoses were linked to NZ death records using the National Health Index (NHI) for linking. Live cases were followed up to December 31st 2010. Socio-demographic and invasive cancer characteristics and disease-specific survivals were compared by ethnicity. Five-year survivals were 87% for Maori, 84% for Pacific, 91% for other NZ cases and 90% overall. This compared with the 86% survival reported for all female breast cases covered by the NZ Cancer Registry which also included more advanced stages. Patterns of survival by clinical risk factors accorded with patterns expected from the scientific literature. Compared with Other cases, Maori and Pacific women were younger, came from more deprived areas, and had larger cancers with more ductal and fewer lobular histology types. Their cancers were also less likely to have a triple negative phenotype. More of the Pacific women had vascular invasion. Maori women were more likely to reside in areas more remote from regional cancer centres, whereas Pacific women generally lived closer to these centres than Other NZ cases. NZ BQA data indicate previously unreported differences in breast cancer biology by ethnicity. Maori and Pacific women had reduced breast cancer survival compared with Other NZ women, after adjusting for socio-demographic and cancer characteristics. The potential contributions to survival differences of variations in service access, timeliness and quality of care, need to be examined, along with effects of co- morbidity and biological factors.
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Sohn, Woon Yong; Habka, Sana; Gloaguen, Eric; Mons, Michel
2017-07-14
The presence in crystallized proteins of a local anchoring between the side chain of a His residue, located in the central position of a γ- or β-turn, and its local main chain environment, was assessed by the comparison of protein structures with relevant isolated model peptides. Gas phase laser spectroscopy, combined with relevant quantum chemistry methods, was used to characterize the γ- and β-turn structures in these model peptides. A conformer-selective NH stretch infrared study provided evidence for the formation in vacuo of two types of short-range H-bonded motifs, labelled ε-6 δ and δ- δ 7/π H , bridging the His side chain (in its gauche+ rotamer) to the neighbouring NH(i) and CO(i) sites of the backbone; each side chain-backbone motif was found to be specific of the tautomer (ε or δ) adopted by the His side chain in its neutral form. A close comparison between β- and γ-turns, selected from the Protein Data Bank, and the gas phase models demonstrated that a significant proportion of the gauche+ His rotamer distribution of proteins was well described by the corresponding gas phase H-bonded structures. This is consistent with the persistence of local 6 δ and δ 7/π H intramolecular interactions in proteins, emphasizing the relevance of gas phase data to secondary structures that are poorly accessible to solvents, e.g., in the case of a specific compact topology (Xxx-His β-turns). Deviations from the gas phase structures were also observed, mainly in His-Xxx β-turns, and assigned to solvent accessible turn structures. They were well accounted for by theoretical models of microhydrated turns, in which a few solvent molecules take over the gas phase motifs, constituting a water-mediated local anchoring of the His side chain to the backbone. Finally, the present gas phase benchmark models also pinpointed weaknesses in the protein structure determination by X-ray diffraction analysis; in particular, besides the lack of tautomer information, inaccuracies in the description of imidazole ring flip rotamerism were identified.
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The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation
Fusheini, Adam
2016-01-01
Background: National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. Methods: Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. Results: Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. Conclusion: The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others. PMID:27694681
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Lin, Tsai-Hui; Yen, Hung-Rong; Chiang, Jen-Huai; Sun, Mao-Feng; Chang, Hen-Hong; Huang, Sheng-Teng
2017-04-18
There is a decided lack of in-depth studies to evaluate the effectiveness of Chinese Herbal Medicine (CHM) as an adjuvant therapy on the incidence of chronic hepatitis in patients with colon cancer. The aim of this study is to assess whether CHM treatment decreased the incidence of chronic hepatitis in colon cancer patients who received conventional Western medical treatment. A Taiwanese nationwide population-based study of colon cancer patients receiving Western medicine treatment in conjunction with CHM treatment, using data provided by the National Health Insurance (NHI) Research Database, was conducted. A total of 61676 patients were diagnosed with colon cancer in Taiwan within the defined study period, from 1997 to 2010. After randomly equal matching for age, sex, excluding patients younger than 18 years of age, chronic hepatitis before colon cancer diagnosis date, receiving acupuncture and/or moxibustion and taking CHM for less than 30 days, data from 155 patients were analyzed. Hazard ratios of incidence rate of chronic hepatitis were used to determine the influence of CHM and the therapeutic potential of herbal products in treating patients with colon cancer. CHM used for patients with colon cancer exhibited significantly decreased incidence rates of chronic hepatitis [hazard ratio (HR)=0.53; 95% confidence interval (CI):0.38-0.74], with multivariate adjustment, compared to those without CHM use. The protective effect of CHM treatment with statistical significance across the stratification of age, gender, co-morbidity and treatment modality was noted. The cumulative incidence of chronic hepatitis was also reduced in patients with colon cancer receiving CHM treatment during a five-year period. In this study, we provide the ten most used single herbs and herbal formulas that were prescribed for patients with colon cancer; moreover, we identify the eight single herbs and five formulas used in CHM treatment which significantly decreased incidence of chronic hepatitis among colon cancer patients. This nationwide retrospective cohort study determined that therapy using CHM as an adjuvant modality may have a significant impact on liver protection in patients with colon cancer. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
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VizieR Online Data Catalog: HI4PI spectra and column density maps (HI4PI team+, 2016)
NASA Astrophysics Data System (ADS)
Hi4PI Collaboration; Ben Bekhti, N.; Floeer, L.; Keller, R.; Kerp, J.; Lenz, D.; Winkel, B.; Bailin, J.; Calabretta, M. R.; Dedes, L.; Ford, H. A.; Gibson, B. K.; Haud, U.; Janowiecki, S.; Kalberla, P. M. W.; Lockman, F. J.; McClure-Griffiths, N. M.; Murphy, T.; Nakanishi, H.; Pisano, D. J.; Staveley-Smith, L.
2016-09-01
The HI4PI data release comprises 21-cm neutral atomic hydrogen data of the Milky Way (-600km/s
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The Politico-Economic Challenges of Ghana's National Health Insurance Scheme Implementation.
Fusheini, Adam
2016-04-27
National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others. © 2016 by Kerman University of Medical Sciences
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Epistemological Development in Social Work Education
ERIC Educational Resources Information Center
Anderson-Meger, Jennifer
2014-01-01
Epistemological development is an important factor in facilitating learner identity and developing critical thinking aptitudes. This qualitative action research study explored undergraduate social work students' epistemological beliefs about knowledge, how knowledge is constructed, and implications for social work education. Data collection…
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; Sponsored Work Regional Economic Development Technology Opportunities User Facilities About Us Metrics In diverse economic development. With an integrated portfolio of R&D work, we leverage partnerships with Partnerships & Sponsored Work Regional Economic Development Technology Opportunities User Facilities
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ERIC Educational Resources Information Center
STAPLES, RICHARD M., COMP.
THIS ARTICLE DISCUSSES SCHOOL SOCIAL WORK DEVELOPMENT, PRACTICE, AND BASIC PRINCIPLES, THE ORGANIZATION OF SCHOOL SOCIAL WORK PROGRAMS IS DISCUSSED IN TERMS OF--(1) THE DEVELOPMENT OF NEW SCHOOL SOCIAL WORK PROGRAMS, (2) ADMINISTRATIVE ASPECTS, AND (3) EXISTING SCHOOL PROGRAMS. REFERRAL POLICIES AND PROCEDURES ARE COVERED. THE MANY ROLES OF THE…
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Nonstandard working schedules and health: the systematic search for a comprehensive model.
Merkus, Suzanne L; Holte, Kari Anne; Huysmans, Maaike A; van Mechelen, Willem; van der Beek, Allard J
2015-10-23
Theoretical models on shift work fall short of describing relevant health-related pathways associated with the broader concept of nonstandard working schedules. Shift work models neither combine relevant working time characteristics applicable to nonstandard schedules nor include the role of rest periods and recovery in the development of health complaints. Therefore, this paper aimed to develop a comprehensive model on nonstandard working schedules to address these shortcomings. A literature review was conducted using a systematic search and selection process. Two searches were performed: one associating the working time characteristics time-of-day and working time duration with health and one associating recovery after work with health. Data extracted from the models were used to develop a comprehensive model on nonstandard working schedules and health. For models on the working time characteristics, the search strategy yielded 3044 references, of which 26 met the inclusion criteria that contained 22 distinctive models. For models on recovery after work, the search strategy yielded 896 references, of which seven met the inclusion criteria containing seven distinctive models. Of the models on the working time characteristics, three combined time-of-day with working time duration, 18 were on time-of-day (i.e. shift work), and one was on working time duration. The model developed in the paper has a comprehensive approach to working hours and other work-related risk factors and proposes that they should be balanced by positive non-work factors to maintain health. Physiological processes leading to health complaints are circadian disruption, sleep deprivation, and activation that should be counterbalanced by (re-)entrainment, restorative sleep, and recovery, respectively, to maintain health. A comprehensive model on nonstandard working schedules and health was developed. The model proposes that work and non-work as well as their associated physiological processes need to be balanced to maintain good health. The model gives researchers a useful overview over the various risk factors and pathways associated with health that should be considered when studying any form of nonstandard working schedule.
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Work-based learning: challenges and opportunities.
Gallagher, Ann; Holland, Lesley
This article discusses some of the challenges and opportunities arising from the development and implementation of an innovative work-based open and distance learning programme available exclusively to healthcare assistants working in general health and mental health practice. The programme is based on a partnership between the sponsoring organisation and the Open University. The focus is on the development of standards of proficiency, service user involvement, partnership working, skills development and the pedagogic implications of a work-based learning format.
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Using mediation techniques to manage conflict and create healthy work environments.
Gerardi, Debra
2004-01-01
Healthcare organizations must find ways for managing conflict and developing effective working relationships to create healthy work environments. The effects of unresolved conflict on clinical outcomes, staff retention, and the financial health of the organization lead to many unnecessary costs that divert resources from clinical care. The complexity of delivering critical care services makes conflict resolution difficult. Developing collaborative working relationships helps to manage conflict in complex environments. Working relationships are based on the ability to deal with differences. Dealing with differences requires skill development and techniques for balancing interests and communicating effectively. Techniques used by mediators are effective for resolving disputes and developing working relationships. With practice, these techniques are easily transferable to the clinical setting. Listening for understanding, reframing, elevating the definition of the problem, and forming clear agreements can foster working relationships, decrease the level of conflict, and create healthy work environments that benefit patients and professionals.
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Solution of basic operational problems of water-development works at the Votkinsk hydroproject
DOE Office of Scientific and Technical Information (OSTI.GOV)
Deev, A. P.; Borisevich, L. A.; Fisenko, V. F.
2012-11-15
Basic operational problems of water-development works at the Votkinsk HPP are examined. Measures for restoration of normal safety conditions for the water-development works at the HPP, which had been taken during service, are presented.
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Social Work Experience and Development in China
ERIC Educational Resources Information Center
Sibin, Wang
2013-01-01
This article presents the experience and limitations of government-run social work and the nonprofessional nature of social work, and suggests that the rapid development of social work and its professionalization are the inevitable results of the reform in the system. The author maintains that under market socialism, social work requires the…
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A Multidimensional Measure of Work Valences
ERIC Educational Resources Information Center
Porfeli, Erik J.; Lee, Bora; Weigold, Ingrid K.
2012-01-01
Work valence is derived from expectancy-valence theory and the literature on children's vocational development and is presumed to be a general appraisal of work that emerges during the childhood period. Work valence serves to promote and inhibit the motivation and tasks associated with vocational development. A measure of work valence, composed of…
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Ouellet, Sylvie
2012-01-01
Questions related to job skills and the teaching situations that best promote skill development are investigated by specialists in various fields, notably among them, ergonomists. This paper presents the findings of an ergonomic intervention study whose aim was to develop a meat-deboning training program by taking into account both the training content to be constructed and the working conditions that might facilitate or hinder skill development. One-on-one interviews and group discussions, on-the-job and videotape playback observations, as well as self-confrontation interviews were carried out. Activity analysis revealed major variability in work methods. The reasoning behind the experienced workers' actions and the experiential job knowledge they had developed were brought to light and served to develop the training content. The determining factors in the choice of work methods were identified, allowing adjustments to be made to the working conditions that might hinder skill development. The ergonomic process that implied taking working conditions into account in our study may make a significant contribution to vocational didactics, which is based on the cognitive analysis of work for the purpose of improving the effectiveness of job-skills training.
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Kähnert, H; Exner, A-K; Brand, S; Leibbrand, B
2016-06-01
The knowledge about contents and arrangement of work-related measures in oncological rehabilitation is limited. The aim of the study was to develop a multimodal work-related module called Perspective Job for the oncological rehabilitation as well as to evaluate the process of development and the module itself. Perspective Job was developed within a rehabilitation team. For an examination of the process of development and of the module expert interviews with clinic employees and group interviews with patients were conducted. Group interviews were conducted before as well as after the implementation of Perspective Job to demonstrate changes in the rehabilitation from the patients point of view. Participants were oncological patients with substantial work-related problems. The module Perspective Job consists of work-related therapies as well as job trainings. The expert interviews illustrates: The process of development is valued as positive and meaningful by the rehabilitation team. Furthermore synergetic effects were used and the exchange of information and the communication within the team were promoted. The interviews with the patient emphasized that most perspective job therapies were classified as work-related and that an individual occupation-oriented care took place. The promoting exchanges of experience between the participants has been positively evaluated. In addition, they seemed to be well-prepared for the return to work. The development of a work-related module in the rehabilitation team is possible. The process was valued by the team members positively and promoted the multiprofessional cooperation. An occupationally oriented arrangement of the rehabilitation was solely perceived by the participants of Perspective Job, which felt better prepared to reintegrate into working life. The results emphasize the importance of teamwork for the development and implementation of work-related therapy modules for the oncological rehabilitation. © Georg Thieme Verlag KG Stuttgart · New York.
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What Works: 20 Years of Curriculum Development and Research for Advanced Learners, 1988-2008
ERIC Educational Resources Information Center
VanTassel-Baska, Joyce, Ed.; Stambaugh, Tamra, Ed.
2009-01-01
The purpose of this document is to highlight "what works" based on the curriculum development and research work of the Center for Gifted Education during the past 20 years. Areas of study include curriculum development, instruction, assessment, and professional development. Through the use of the Integrated Curriculum Model as a template for …
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Code of Federal Regulations, 2013 CFR
2013-04-01
..., Development and Technology Transfer Program Management § 420.207 What are the requirements for research, development, and technology transfer work programs? (a) The State DOT's RD&T work program must, as a minimum... 23 Highways 1 2013-04-01 2013-04-01 false What are the requirements for research, development, and...
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Code of Federal Regulations, 2010 CFR
2010-04-01
..., Development and Technology Transfer Program Management § 420.207 What are the requirements for research, development, and technology transfer work programs? (a) The State DOT's RD&T work program must, as a minimum... 23 Highways 1 2010-04-01 2010-04-01 false What are the requirements for research, development, and...
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Code of Federal Regulations, 2014 CFR
2014-04-01
..., Development and Technology Transfer Program Management § 420.207 What are the requirements for research, development, and technology transfer work programs? (a) The State DOT's RD&T work program must, as a minimum... 23 Highways 1 2014-04-01 2014-04-01 false What are the requirements for research, development, and...
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Code of Federal Regulations, 2012 CFR
2012-04-01
..., Development and Technology Transfer Program Management § 420.207 What are the requirements for research, development, and technology transfer work programs? (a) The State DOT's RD&T work program must, as a minimum... 23 Highways 1 2012-04-01 2012-04-01 false What are the requirements for research, development, and...
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Code of Federal Regulations, 2011 CFR
2011-04-01
..., Development and Technology Transfer Program Management § 420.207 What are the requirements for research, development, and technology transfer work programs? (a) The State DOT's RD&T work program must, as a minimum... 23 Highways 1 2011-04-01 2011-04-01 false What are the requirements for research, development, and...
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24 CFR 901.25 - Indicator #4, work orders.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Indicator #4, work orders. 901.25... DEVELOPMENT PUBLIC HOUSING MANAGEMENT ASSESSMENT PROGRAM § 901.25 Indicator #4, work orders. This indicator... work orders. Implicit in this indicator is the adequacy of the PHA's work order system in terms of how...
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Working Memory Underpins Cognitive Development, Learning, and Education
Cowan, Nelson
2014-01-01
Working memory is the retention of a small amount of information in a readily accessible form. It facilitates planning, comprehension, reasoning, and problem-solving. I examine the historical roots and conceptual development of the concept and the theoretical and practical implications of current debates about working memory mechanisms. Then I explore the nature of cognitive developmental improvements in working memory, the role of working memory in learning, and some potential implications of working memory and its development for the education of children and adults. The use of working memory is quite ubiquitous in human thought, but the best way to improve education using what we know about working memory is still controversial. I hope to provide some directions for research and educational practice. PMID:25346585
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[Workflow involving preventive health care promotes the economic development of a company].
Braun, M
2003-12-01
Today's working society obviously develops from industrial production to knowledge-intensive service. In service-oriented working conditions, the importance of the human being as a main performer of economic success increases. Thus, the development leads to a changing spectrum of occupational health risks. Together with socio-demographic developments, individual strain-oriented health disorders connected to one's occupation might endanger an enterprise's capacity of performance and innovation as well as its sustainable enterprise development. Only healthy, motivated and qualified employees are able and ready to keep their creative and customer-oriented potential harnessed and thereby work to the best of their ability. Consequently, occupational health gains a more important role within the enterprise. Although in many enterprises the benefit contribution of preventive work design has not yet been considered that relevant, enterprises have realised that a preventive health-oriented work design might help to better manage current business challenges. An up-to-date definition of health includes the goals of health improvement, personality development as well as a comprehensive well-being. Health is a prerequisite and result of a productive reflection upon the conditions and challenges of work. Business practice shows that a preventive work design should involve an economic benefit for the enterprise. If occupational health is seen as a characteristic of quality and a prerequisite for sustainable enterprise development, economic potentials of preventive work designs will expand considerably.
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7 CFR 1.78 - Development of special working relationships.
Code of Federal Regulations, 2014 CFR
2014-01-01
... 7 Agriculture 1 2014-01-01 2014-01-01 false Development of special working relationships. 1.78 Section 1.78 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Cooperative Production of Television Films § 1.78 Development of special working relationships. (a) Preliminary. Prior to...
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7 CFR 1.78 - Development of special working relationships.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 1 2011-01-01 2011-01-01 false Development of special working relationships. 1.78 Section 1.78 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Cooperative Production of Television Films § 1.78 Development of special working relationships. (a) Preliminary. Prior to...
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7 CFR 1.78 - Development of special working relationships.
Code of Federal Regulations, 2013 CFR
2013-01-01
... 7 Agriculture 1 2013-01-01 2013-01-01 false Development of special working relationships. 1.78 Section 1.78 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Cooperative Production of Television Films § 1.78 Development of special working relationships. (a) Preliminary. Prior to...
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7 CFR 1.78 - Development of special working relationships.
Code of Federal Regulations, 2012 CFR
2012-01-01
... 7 Agriculture 1 2012-01-01 2012-01-01 false Development of special working relationships. 1.78 Section 1.78 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Cooperative Production of Television Films § 1.78 Development of special working relationships. (a) Preliminary. Prior to...
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7 CFR 1.78 - Development of special working relationships.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 7 Agriculture 1 2010-01-01 2010-01-01 false Development of special working relationships. 1.78 Section 1.78 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Cooperative Production of Television Films § 1.78 Development of special working relationships. (a) Preliminary. Prior to...
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Hospital nurses' wellbeing at work: a theoretical model.
Utriainen, Kati; Ala-Mursula, Leena; Kyngäs, Helvi
2015-09-01
To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was used. The main concepts were: patients' experience of high-quality care; assistance and support among nurses; nurses' togetherness and cooperation; fluent practical organisation of work; challenging and meaningful work; freedom to express diverse feelings in the work community; well-conducted everyday nursing; status related to the work itself; fair and supportive leadership; opportunities for professional development; fluent communication with other professionals; and being together with other nurses in an informal way. Themes included: collegial relationships; enhancing high-quality patient care; supportive and fair leadership; challenging, meaningful and well organised work; and opportunities for professional development. Object-dependent wellbeing was supported. Managers should focus on strengthening the positive aspect of wellbeing at work, focusing on providing fluently organised work practices, fair and supportive leadership and togetherness while allowing nurses to implement their own ideas and promote the experience of meaningfulness. © 2014 John Wiley & Sons Ltd.
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[The role of psychosocial work factors in the development of musculoskeletal disorders in workers].
Bugajska, Joanna; Zołnierczyk-Zreda, Dorota; Jedryka-Góral, Anna
2011-01-01
The aim of the study was to determine the role of psychosocial work factors in the development of musculoskeletal disorders in workers. It should be stressed that over a decade these disorders have been the subject of studies because of complaints reported not only by workers performing heavy physical work or working in awkward, forced body posture. It has also been acknowledged that stress at work caused by various psychosocial work factors can significantly influence their development. One of the models, most popular nowadays, was used in the study. It takes into account various risk factors in the etiology of cervical spine disorders. Based on this model it was shown that certain psychosocial and cultural variables (e.g., work demands and control, individual variables, individual values, work group's culture) may constitute occupational stressors and, when combined with physical load factors, may lead to stress and musculoskeletal disorders. It was also indicated that such psychosocial work factors as excessive work demands (quantitative or qualitative), inadequate control at work or lack of social support are the most frequent sources of work-related stress. The article presents the results of some prospective studies in which the role of these factors in the development of musculoskeletal disorders has been considered. Apart from work properties (factors), the role of other psychological variables was shown; these include: work involvement, perfectionism, negative affectivity or work style, which in numerous studies turned out to be important risk factors in the development of musculoskeletal disorders. Finally, potential mechanisms underlying the relationships between psychosocial factors and musculoskeletal disorders were indicated. However, it was stressed that the majority of them still require to be confirmed in future descriptive or experimental studies.
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ERIC Educational Resources Information Center
Portwood, Derek
2007-01-01
Work-based learning's preoccupation with developing award-bearing programmes has affected the scope and style of work-based research. While offering development opportunities for work-based research, the emphasis of work-based learning programmes on the individual learner has curtailed the use of collaborative research. This article explores how…
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ERIC Educational Resources Information Center
Lee, Bora; Landberg, Monique; Lee, Ki-Hak
2016-01-01
This study examined how the endorsement of work values changed over time and investigated the role of socioeconomic status in the development of work values. A 5-year longitudinal sample of Korean adolescents was used. Three work values were measured: Extrinsic reward, working conditions, and personal development. Findings indicate that Korean…
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The Development of a Pharmacy Student Work Values Inventory (PSWVI).
ERIC Educational Resources Information Center
Woodward, Jean Bouchard; Kirk, Kenneth W.
1987-01-01
An instrument developed to measure pharmacy student work values revealed 11 reliable factors: quality patient care; supervision and company policy; work creativity/variety; status; management/leadership; economic return; work schedule; family responsibilities; job security; co-worker relationships; and policies and procedures. There were…
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Developing Meaningfulness at Work through Emotional Intelligence Training
ERIC Educational Resources Information Center
Thory, Kathryn
2016-01-01
To date, there remains a significant gap in the human resource development (HRD) literature in understanding how training and development contributes to meaningful work. In addition, little is known about how individuals proactively make their work more meaningful. This article shows how emotional intelligence (EI) training promotes learning about…
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Knowledge Collisions: Perspectives from CED Practitioners Working with Women. NALL Working Paper.
ERIC Educational Resources Information Center
Stratton, Mary; Jackson, Ted
A study explored the ways that front-line community development workers across Canada gained information needed to work with women participants in community economic development initiatives. Data were gathered through focus groups, a preliminary study with 15 key informants employed in community development organizations, and structured telephone…
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Organisational and Task Factors Influencing Teachers' Professional Development at Work
ERIC Educational Resources Information Center
Evers, Arnoud T.; Van der Heijden, Béatrice I. J. M.; Kreijns, Karel
2016-01-01
Purpose: The purpose of this paper is to investigate organisational (cultural and relational) and task factors which potentially enhance teachers' professional development at work (TPD at Work). The development of lifelong learning competencies and, consequently, the careers of teachers, has become a permanent issue on the agenda of schools…
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The Development of Attitudes Toward Work Among Upper Elementary School Age Children
ERIC Educational Resources Information Center
Kuldau, Janice E.; Hollis, Joseph W.
1971-01-01
Fourth, fifth and sixth grade students were sampled using the Kuldau Occupational Development Inventory to discover their attitudes toward the world of work. The conclusion drawn was that children had developed attitudes towards five factors: money, status, working conditions, independence and self expression. (Author/CG)
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Adolescent Work, Vocational Development, and Education
Zimmer-Gembeck, Melanie J.; Mortimer, Jeylan T.
2006-01-01
This review examines contemporary issues in vocational development with emphasis on adolescents’ work experiences in social context. Attention is directed to the changing social and cultural context for vocational development, the influence of work experience on adolescent development and educational achievement, and theoretical approaches that guide contemporary studies of vocational development and career maturity. In light of the utility of current theories, new directions are suggested to enhance understanding of adolescent employment, vocational development, and educational pursuits. Social policy initiatives to promote adolescents’ exercise of agency and their vocational development are considered. PMID:17387375
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Jen Gustetic visits Swamp Works
2016-10-28
Jenn Gustetic, NASA's Small Business Innovation Research Program executive, talks with Rob Mueller, senior technologist and co-founder of Kennedy Space Center's Swamp Works. Gustetic met team members and viewed many of the pioneering technologies and innovations in development at Kennedy. Swamp Works is a hands-on, lean development environment for innovation following the philosophies pioneered in Kelly Johnson's Skunk Works and Werner von Braun's development shops. The Swamp Works establishes rapid, innovative and cost-effective exploration mission solutions through a highly collaborative, "no walls" approach, leveraging partnerships across NASA, industry and academia.
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Ergonomics principles to design clothing work for electrical workers in Colombia.
Castillo, Juan; Cubillos, A
2012-01-01
The recent development of the Colombian legislation, have been identified the need to develop protective clothing to work according to specifications from the work done and in compliance with international standards. These involve the development and design of new strategies and measures for work clothing design. In this study we analyzes the activities of the workers in the electrical sector, the method analyzes the risks activity data in various activities, that activities include power generation plants, local facilities, industrial facilities and maintenance of urban and rural networks. The analyses method is focused on ergonomic approach, risk analysis is done, we evaluate the role of security expert and we use a design algorithm developed for this purpose. The result of this study is the identification of constraints and variables that contribute to the development of a model of analysis that leads to the development the work protective clothes.
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ERIC Educational Resources Information Center
Szapacs, Cindy
2006-01-01
Teaching strategies that work for typically developing children often do not work for those diagnosed with an autism spectrum disorder. However, teaching strategies that work for children with autism do work for typically developing children. In this article, the author explains how the principles and concepts of Applied Behavior Analysis can be…
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Working memory in Farsi-speaking children with normal development and cochlear implant.
Soleymani, Zahra; Amidfar, Meysam; Dadgar, Hooshang; Jalaie, Shohre
2014-04-01
Working memory has an important role in language acquisition and development of cognition skills. The ability of encoding, storage and retrieval of phonological codes, as activities of working memory, acquired by audition sense. Children with cochlear implant experience a period that they are not able to perceive sounds. In order to assess the effect of hearing on working memory, we investigated working memory as a cognition skill in children with normal development and cochlear implant. Fifty students with normal hearing and 50 students with cochlear implant aged 5-7 years participated in this study. Children educated in the preschool, the first and second grades. Children with normal development were matched based on age, gender, and grade of education with cochlear implant. Two components of working memory including phonological loop and central executive were compared between two groups. Phonological loop assessed by nonword repetition task and forward digit span. To assess central executive component backward digit span was used. The developmental trend was studied in children with normal development and cochlear implant as well. The effect of age at implantation in children with cochlear implants on components of working memory was investigated. There are significant differences between children with normal development and cochlear implant in all tasks that assess working memory (p < 0.001). The children's age at implantation was negatively correlated with all tasks (p < 0.001). In contrast, duration of usage of cochlear implant set was positively correlated with all tasks (p < 0.001). The comparison of working memory between different grades showed significant differences both in children with normal development and in children with cochlear implant (p < 0.05). These results implied that children with cochlear implant may experience difficulties in working memory. Therefore, these children have problems in encoding, practicing, and repeating phonological units. The results also suggested working memory develops when the child grows up. In cochlear implant children, with decreasing age at implantation and increasing their experience in perceiving sound, working memory skills improved. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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University Students' Conceptions and Practice of Collaborative Work on Writing
ERIC Educational Resources Information Center
Mutwarasibo, Faustin
2013-01-01
Collaborative work is widely regarded as a valuable tool in the development of student-centred learning. Its importance can be viewed in two ways: First of all, when students are regularly exposed to collaborative work (i.e. pair work or group work) they are likely to develop or improve a range of communication and interpersonal skills. It is also…
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Adult Literacy in Developing Countries: A Contemporary Annotated Bibliography.
ERIC Educational Resources Information Center
Puchner, Laurel D.
This bibliography provides a list of 65 selected works on the topic of adult literacy in developing countries. It is a contemporary list, including only works published in the last 15 years. The works are organized into subject categories. Works are listed only once; in cases where a work could be listed under more than one category, it is listed…
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Using computer software to improve group decision-making.
Mockler, R J; Dologite, D G
1991-08-01
This article provides a review of some of the work done in the area of knowledge-based systems for strategic planning. Since 1985, with the founding of the Center for Knowledge-based Systems for Business Management, the project has focused on developing knowledge-based systems (KBS) based on these models. In addition, the project also involves developing a variety of computer and non-computer methods and techniques for assisting both technical and non-technical managers and individuals to do decision modelling and KBS development. This paper presents a summary of one segment of the project: a description of integrative groupware useful in strategic planning. The work described here is part of an ongoing research project. As part of this project, for example, over 200 non-technical and technical business managers, most of them working full-time during the project, developed over 160 KBS prototype systems in conjunction with MBA course in strategic planning and management decision making. Based on replies to a survey of this test group, 28 per cent of the survey respondents reported their KBS were used at work, 21 per cent reportedly received promotions, pay rises or new jobs based on their KBS development work, and 12 per cent reported their work led to participation in other KBS development projects at work. All but two of the survey respondents reported that their work on the KBS development project led to a substantial increase in their job knowledge or performance.
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7 CFR 1924.6 - Performing development work.
Code of Federal Regulations, 2012 CFR
2012-01-01
.... The letter of credit must remain in effect until the date of final acceptance of work by the owner and... Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... Performing development work. All construction work will be performed by one, or a combination, of the...
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7 CFR 1924.6 - Performing development work.
Code of Federal Regulations, 2014 CFR
2014-01-01
.... The letter of credit must remain in effect until the date of final acceptance of work by the owner and... Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... Performing development work. All construction work will be performed by one, or a combination, of the...
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7 CFR 1924.6 - Performing development work.
Code of Federal Regulations, 2013 CFR
2013-01-01
.... The letter of credit must remain in effect until the date of final acceptance of work by the owner and... Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... Performing development work. All construction work will be performed by one, or a combination, of the...
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Community Work Development: A Marketing Model.
ERIC Educational Resources Information Center
Como, Perry; Hagner, David
This manual is concerned with developing community-based work for persons with disabilities, particularly disabled workers in segregated settings and individuals who are considered not yet ready for or capable of work. The first part of the publication deals with the following topics: the concepts of community, work, and severe disabilities; the…
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The Emerging Workforce Development System. Policy Issues Monograph 97-01.
ERIC Educational Resources Information Center
Pines, Marion; Callahan, Jim
State policies and activities for systematizing work force development were examined through a survey completed by individuals involved in work force development in 40 states and case studies of policies and programs in Texas, Utah, Florida, and Michigan. Throughout all levels of government and the private sector, consensus that work force…
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ERIC Educational Resources Information Center
Goldman, Ellen F.
2008-01-01
The ability to think strategically is an increasingly important requirement for managers at all organizational levels. HRD (human resource development) professionals have attempted to help develop this ability through work experiences. However, research identifying which work experiences are most beneficial is limited. As a result, HRD efforts may…
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Code of Federal Regulations, 2010 CFR
2010-10-01
... contracts involving both research and development and other work. 250.104-3-70 Section 250.104-3-70 Federal... MANAGEMENT EXTRAORDINARY CONTRACTUAL ACTIONS AND THE SAFETY ACT Extraordinary Contractual Actions 250.104-3-70 Indemnification under contracts involving both research and development and other work. When...
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ERIC Educational Resources Information Center
Schutte, Marc; Spottl, Georg
2011-01-01
Developing countries such as Malaysia and Oman have recently established occupational standards based on core work processes (functional clusters of work objects, activities and performance requirements), to which competencies (performance determinants) can be linked. While the development of work-process-based occupational standards is supposed…
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Program Development for the Acquisition of Work and Social Skills. [The Granville Project].
ERIC Educational Resources Information Center
Hauritz, Margory; And Others
The paper discusses program development at the Granville Work Preparation Centre in Australia, which teaches mildly retarded adolescents work and social skills. Some broad parameters considered in program development are listed and include recognition of the Center's industrial setting, and disruption in routines through extra movement of trainees…
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ERIC Educational Resources Information Center
Pizzolato, Jane Elizabeth; Olson, Avery B.
2016-01-01
Through a one year-long, qualitative study of welfare-to-work students, this study investigates the developing epistemologies of women enrolled in a community college CalWORKs program. We investigate how poverty as a macro-environment and the community college as a micro-environment influence participants' epistemological development. Findings…
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Women's Career Development Patterns.
ERIC Educational Resources Information Center
Schreiber, Pamela J.
1998-01-01
Women's career development is characterized by balance of work and family, career interruptions, and diverse career paths. Alternative work arrangements such as flexible schedules, telecommuting, and entrepreneurial opportunities may offer women more options for work. (SK)
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Soeker, Mohammed Shaheed; De Jongh, Jo Celene; Diedericks, Amy; Matthys, Kelly; Swart, Nicole; van der Pol, Petra
2018-01-01
Protective workshops and sheltered employment settings have been instrumental in developing the work skills of people with disabilities, however there has been a void in the literature about its influence on the ability of individuals to find employment in the open labor market. The aim of the study is to explore the experiences and perceptions of people with disabilities about the development of their work skills for transitioning into the open labor market. Five individuals with various types of disabilities and two key informants participated in the study. The research study was positioned within the qualitative paradigm specifically utilizing an exploratory and descriptive research design. In order to gather data from the participants, semi structured interviews were used. Three themes emerged from the findings of the study. Theme one, designated as "Reaching a ceiling", reflected the barriers that the participants experienced regarding work skills development. Theme two, designated as "Enablers for growth within the workplace", related to the enabling factors related to development of the work skills of persons with a disability (PWD). The final theme related to the meaning that PWD associated to their worker role and was designated as "A sense of universality". The participants highlighted that they felt their coworkers in the workshops were "like family" to them and thoroughly enjoyed the work tasks and work environment, expressing specific support from their fellow workers. Through reaching their goals, engaging in their work tasks and having the sense of universality in the workplace, the workers felt that the work they participated in gave them meaning to their life. The findings of the study indicated that managers of protective workshops and sheltered employment settings should consider selecting work tasks that enable the development of skills needed in the open labour market. A work skills development system whereby PWD in these workshops could determine their own career progression is advocated.
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2014-01-01
Background After the implementation of new healthcare reform, Chinese government paid increasing attention to developing community health service (CHS). The current focus is mainly on cultivating community general practitioners but paying less attention to the working status and occupational demands of in-service CHS workers. Work passion is playing an important role for medical workers. With work passion, CHS workers’ team will become more stable and more effective, ensuring the sustainable development of CHS system. At present, the work passion of CHS workers is relatively low. Studying on influencing factors of work passion of CHS workers, promoting their work passion, and making them keep enthusiasm for work are significant. Methods A total of 100 CHS organizations were sampled randomly in 10 cities from 5 Chinese provinces for this study. A total of 3450 CHS workers from these CHS institutions took part in the surveys. Questionnaires were used to collect data, including socio-demographic information, work passion and opinion on influencing causes, and work-related satisfaction. Pearson chi-square statistical method was used to identify the factors related to CHS workers’ work passion. Binary logistic regression was performed to determine the significant factors that influence CHS workers’ work passion. Results A total of 38.77% of those who accomplished the questionnaire expressed that they didn’t have passion for current work. The related factors that influence CHS workers’ work passion are (1) socio-demographic factors such as age, and years of employment, and (2) other work-related factors such as learning and training opportunities, compensation packages, work stress, and personal development opportunities. CHS workers were most dissatisfied with the balance between remuneration and workload, job promotion opportunities. Conclusions Based on the results, the government should concern for CHS workers’ working status and work-related demands, pay more attention and meet their demands for reasonable compensation packages and self-development, balance the income and workload, provide more learning and training opportunities and personal development opportunities for CHS workers, in order to promote CHS workers’ work satisfaction, improve their work passion and enthusiasm. PMID:24885642
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Luo, Zhenni; Bai, Xue; Min, Rui; Tang, Changmin; Fang, Pengqian
2014-05-01
After the implementation of new healthcare reform, Chinese government paid increasing attention to developing community health service (CHS). The current focus is mainly on cultivating community general practitioners but paying less attention to the working status and occupational demands of in-service CHS workers. Work passion is playing an important role for medical workers. With work passion, CHS workers' team will become more stable and more effective, ensuring the sustainable development of CHS system. At present, the work passion of CHS workers is relatively low. Studying on influencing factors of work passion of CHS workers, promoting their work passion, and making them keep enthusiasm for work are significant. A total of 100 CHS organizations were sampled randomly in 10 cities from 5 Chinese provinces for this study. A total of 3450 CHS workers from these CHS institutions took part in the surveys. Questionnaires were used to collect data, including socio-demographic information, work passion and opinion on influencing causes, and work-related satisfaction. Pearson chi-square statistical method was used to identify the factors related to CHS workers' work passion. Binary logistic regression was performed to determine the significant factors that influence CHS workers' work passion. A total of 38.77% of those who accomplished the questionnaire expressed that they didn't have passion for current work. The related factors that influence CHS workers' work passion are (1) socio-demographic factors such as age, and years of employment, and (2) other work-related factors such as learning and training opportunities, compensation packages, work stress, and personal development opportunities. CHS workers were most dissatisfied with the balance between remuneration and workload, job promotion opportunities. Based on the results, the government should concern for CHS workers' working status and work-related demands, pay more attention and meet their demands for reasonable compensation packages and self-development, balance the income and workload, provide more learning and training opportunities and personal development opportunities for CHS workers, in order to promote CHS workers' work satisfaction, improve their work passion and enthusiasm.
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Gaining Control of Occupational Injury and Illness in the U.S. Navy Civilian Work Force
1990-01-16
caring for the back. Also monitored by the supervisor is a work -hardening program developed by the clinic physical therapist and physician that... development of a work -hardening program for the returning injured employee to ensure a safe re-entry to the workplace. e. "Green Table" and Medical...physical therapist work closely in developing effective programs for the treatment of occupational injuries. Having an onsite physical therapist available
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Development of a Work Control System for Propulsion Testing at Stennis Space Center (SSC)
NASA Technical Reports Server (NTRS)
Messer, Elizabeth A.
2004-01-01
In 1996, Stennis Space Center was given management authority for all Propulsion Testing for NASA. Over the next few years several research and development (R&D) test facilities were completed and brought up to full operation in what is known as the E-Complex Test Facility at Stennis Space Center. This paper will explain the requirements and steps taken to develop the current Test Operations' electronic work control system. The Work Control System developed includes work authorization documents such as test preparation sheets, discrepancy reports, pre-test briefing reports, and test requests.
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Career development in schizophrenia: a heuristic framework.
Gioia, Deborah
2005-06-01
Adults with schizophrenia continue to have poor rates of competitive employment. We have learned how to support individuals in the workplace with supported employment (SE); but have paid limited attention to early vocational identity development, work antecedents, illness characteristics, and career preferences. Vocational identity development is an important and natural condition of human growth for all persons and is well-researched in career counseling. For young adults with schizophrenia, the predictor of positive work outcome with the most evidence has been that working competitively prior to illness leads to better chances for work post-diagnosis. A heuristic framework is proposed to conceptualize how pre-illness vocational development (paid and unpaid) plus life cycle supports can provide direction to the individual in their work recovery.
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Frone, Michael R.; Tidwell, Marie-Cecile O.
2015-01-01
Although work fatigue represents an important construct in several substantive areas, prior conceptual definitions and measures have been inadequate in a number of ways. The goals of the present study were to develop a conceptual definition and outline the desirable characteristics of a work fatigue measure; briefly examine several prior measures of work fatigue-related constructs; and develop and evaluate a new measure of work fatigue. The Three-Dimensional Work Fatigue Inventory (3D-WFI) provides separate and commensurate assessments of physical, mental, and emotional work fatigue. Results from a pilot study (N = 207) and a broader evaluative study of U.S. wage and salary workers (N = 2,477) suggest that the 3D-WFI is psychometrically sound and evinces a meaningful pattern of relations with variables that comprise the nomological network of work fatigue. As with all new measures, additional research is required to evaluate fully the utility of the 3D-WFI in research on work fatigue. PMID:25602275
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Mechanisation and automation technologies development in work at construction sites
NASA Astrophysics Data System (ADS)
Sobotka, A.; Pacewicz, K.
2017-10-01
Implementing construction work that creates buildings is a very complicated and laborious task and requires the use of various types of machines and equipment. For years there has been a desire for designers and technologists to introduce devices that replace people’s work on machine construction, automation and even robots. Technologies for building construction are still being developed and implemented to limit people’s hard work and improve work efficiency and quality in innovative architectonical and construction solutions. New opportunities for improving work on the construction site include computerisation of technological processes and construction management for projects and processes. The aim of the paper was to analyse the development of mechanisation, automation and computerisation of construction processes and selected building technologies, with special attention paid to 3D printing technology. The state of mechanisation of construction works in Poland and trends in its development in construction technologies are presented. These studies were conducted on the basis of the available literature and a survey of Polish construction companies.
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The Role and Challenges of School Social Work: An Examination from Practice in Osaka
ERIC Educational Resources Information Center
Yamano, Noriko
2011-01-01
This article describes the development of school social work in the Osaka Prefecture of Japan. The article focuses on micro, mezzo, and macro levels of school social work and documents the growth and development of school social work since 2005. (Contains 3 tables and 2 figures.)
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ERIC Educational Resources Information Center
Honoré, Nastasya; Noël, Marie-Pascale
2017-01-01
Working memory capacities are associated with mathematical development. Many studies have tried to improve working memory abilities through training. Furthermore, the central executive has been shown to be the component of working memory, which is the most strongly related to numerical and arithmetical skills. Therefore, we developed a training…
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Linking School-to-Work Transition and Rural Development Strategies.
ERIC Educational Resources Information Center
Harmon, Hobart L.
The School-to-Work Opportunities Act of 1994 established a national framework to guide the development of statewide school-to-work (STW) opportunities systems in each state. Governors apply to the National School-to-Work Office for 5-year federal implementation grants. Early research on implementation of STW in rural areas suggests that…
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ERIC Educational Resources Information Center
Sossou, Marie-Antoinette; Dubus, Nicole
2013-01-01
This paper examines a developing model for building an international social work placement that meets the needs of the host agency and community first. The paper addresses the challenges for social work departments to develop a strong learning environment while also keeping primary the needs of the host community and agency.
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ERIC Educational Resources Information Center
Campbell, Robert E.; And Others
This student guide supplements a career development unit on coping in the world of work designed to assist students in developing coping strategies to deal with work entry and job adjustment problems. (Other components of the unit--instructor's handbook, handout/transparency masters, and filmstrip/sound cassette programs, are available…
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ERIC Educational Resources Information Center
Lofthouse, Rachel; Thomas, Ulrike
2017-01-01
Teachers are often encouraged to work in partnerships to support their professional development. In this article we focus on three forms of working partnerships based in English secondary schools. Each has an intended function of developing teaching practices. The cases of mentoring, coaching and an adapted lesson study come from both initial…
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ERIC Educational Resources Information Center
Ko, Wen-Hwa; Chen, Chieh-Ying
2017-01-01
This research focuses on the research and development competence and school-to-work transition on occupation selection for hospitality students with the use of social cognitive career theory. The positive attitude construct is the most identifiable for the research and development competences. For the school-to-work constructs, the most…
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Automated Work Package: Conceptual Design and Data Architecture
DOE Office of Scientific and Technical Information (OSTI.GOV)
Al Rashdan, Ahmad; Oxstrand, Johanna; Agarwal, Vivek
The automated work package (AWP) is one of the U.S. Department of Energy’s (DOE) Light Water Reactor Sustainability Program efforts to enhance the safety and economics of the nuclear power industry. An AWP is an adaptive and interactive work package that intelligently drives the work process according to the plant condition, resources status, and users progress. The AWP aims to automate several manual tasks of the work process to enhance human performance and reduce human errors. Electronic work packages (eWPs), studied by the Electric Power Research Institute (EPRI), are work packages that rely to various extent on electronic data processingmore » and presentation. AWPs are the future of eWPs. They are envisioned to incorporate the advanced technologies of the future, and thus address the unresolved deficiencies associated with the eWPs in a nuclear power plant. In order to define the AWP, it is necessary to develop an ideal envisioned scenario of the future work process without any current technology restriction. The approach followed to develop this scenario is specific to every stage of the work process execution. The scenario development resulted in fifty advanced functionalities that can be part of the AWP. To rank the importance of these functionalities, a survey was conducted involving several U.S. nuclear utilities. The survey aimed at determining the current need of the nuclear industry with respect to the current work process, i.e. what the industry is satisfied with, and where the industry envisions potential for improvement. The survey evaluated the most promising functionalities resulting from the scenario development. The results demonstrated a significant desire to adopt the majority of these functionalities. The results of the survey are expected to drive the Idaho National Laboratory (INL) AWP research and development (R&D). In order to facilitate this mission, a prototype AWP is needed. Since the vast majority of earlier efforts focused on the frontend aspects of the AWP, the backend data architecture was researched and developed in this effort. The backend design involved data architecture aspects. It was realized through this effort that the key aspects of this design are hierarchy, data configuration and live information, data templates and instances, the flow of work package execution, the introduction of properties, and the means to interface the backend to the frontend. After the backend design was developed, a data structure was built to reflect the developed data architecture. The data structure was developed to accommodate the fifty functionalities identified by the envisioned scenario development. The data structure was evaluated by incorporating an example work order from the nuclear power industry. The implementation resulted in several optimization iterations of the data structure. In addition, the rearrangement of the work order information to fit the data structure highlighted several possibilities for improvement in the current work order design, and significantly reduced the size of the work order.« less
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Weaving networks of responsibility: community work in development programs in rural Malawi.
Rosenthal, Anat
2012-01-01
The need to cope with the impact of the AIDS epidemic on communities in Africa has resulted in the emergence of numerous community health and development programs. Initiated by governments, international nongovernmental organizations (NGOs), and local organizations, such programs target local communities with the goal of building care and support mechanisms in the local level. Based on ethnographic field research in rural Malawi, and drawing from the cross-disciplinary debate on development work, the article explores the work of an NGO offering health and care programs to orphans and vulnerable children. Through analyzing the organization's scope of work, the article demonstrates how the NGO acts to structure local social networks as instruments of care and offers a new reading of the role of NGOs in which the limitations of development work and the work of NGOs are understood within their local context and not only in the context of broad cultural critique.
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Working Memory Maturation: Can We Get at the Essence of Cognitive Growth?
Cowan, Nelson
2016-03-01
The theoretical and practical understanding of cognitive development depends on working memory, the limited information temporarily accessible for such daily activities as language processing and problem solving. In this article, I assess many possible reasons that working memory performance improves with development. A first glance at the literature leads to the weird impression that working memory capacity reaches adult levels during infancy but then regresses during childhood. In place of that unlikely explanation, I consider how infant studies may lead to overestimates of capacity if one neglects supports that the tasks provide, compared with adult-level tasks. Further development of working memory during the school years is also considered. Many investigators have come to suspect that working memory capacity may be constant after infancy because of various factors such as developmental increases in knowledge, filtering out of irrelevant distractions, encoding and rehearsal strategies, and pattern formation. With each of these factors controlled, though, working memory still improves during the school years. Suggestions are made for research to bridge the gap between infant and child developmental research, to understand the focus and control of attention in working memory and how these skills develop, and to pinpoint the nature of capacity and its development from infancy forward. © The Author(s) 2016.
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Working Memory Maturation: Can We Get At the Essence of Cognitive Growth?
Cowan, Nelson
2015-01-01
Our theoretical and practical understanding of cognitive development depends on working memory, the limited information temporarily accessible for such daily activities as language processing and problem-solving. Here I assess many possible reasons why working memory performance improves with development. A first glance at the literature leads to the weird impression that working memory capacity reaches adult-like levels during infancy but then regresses during childhood. In place of that unlikely surmise, I consider how infant studies may lead to overestimates of capacity if one neglects supports that the tasks provide, compared to adult-like tasks. Further development of working memory during the school years is also considered. Various confounding factors have led many investigators to suspect that working memory capacity may be constant after infancy; the factors include developmental increases in knowledge, filtering out of irrelevant distractions, encoding and rehearsal strategies, and pattern formation. With each of these factors controlled, though, working memory still improves during the school years. Suggestions are made for research to bridge the gap between infant and child developmental research, to understand the focus and control of attention in working memory and how they develop, and to pinpoint the nature of capacity and its development from infancy on. PMID:26993277
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Fjell, Anders M.; Tamnes, Christian K.; Grydeland, Håkon; Due-Tønnessen, Paulina; Bjørnerud, Atle; Sampaio-Baptista, Cassandra; Andersson, Jesper; Johansen-Berg, Heidi; Walhovd, Kristine B.
2018-01-01
Working memory capacity is pivotal for a broad specter of cognitive tasks and develops throughout childhood. This must in part rely on development of neural connections and white matter microstructure maturation, but there is scarce knowledge of specific relations between this and different aspects of working memory. Diffusion tensor imaging (DTI) enables us to study development of brain white matter microstructure. In a longitudinal DTI study of 148 healthy children between 4 and 11 years scanned twice with an on average 1.6 years interval, we characterized change in fractional anisotropy (FA), mean (MD), radial (RD) and axial diffusivity (AD) in 10 major white matter tracts hypothesized to be of importance for working memory. The results showed relationships between change in several tracts and change in visuospatial working memory. Specifically, improvement in visuospatial working memory capacity was significantly associated with decreased MD, RD and AD in inferior longitudinal fasciculus (ILF), inferior fronto-occipital fasciculus (IFOF) and uncinate fasciculus (UF) in the right hemisphere, as well as forceps major (FMaj). No significant relationships were found between change in DTI metrics and change in verbal working memory capacity. These findings yield new knowledge about brain development and corresponding working memory improvements in childhood. PMID:29689058
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Joining Others for Community Economic Development.
ERIC Educational Resources Information Center
Borgen, Joseph A.; Shade, William B.
1984-01-01
Examines the basic principles of economic development and provides a case study of the Communitywide Work Force Development Project, which was designed to involve the community in solving the economic development and work force problems of Terre Haute, Indiana. (DMM)
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Harcourt, C; Donovan, B
2005-06-01
To compile a global typography of commercial sex work. A Medline search and review of 681 "prostitution" articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work. At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely. Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.
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24 CFR 983.154 - Conduct of development work.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Conduct of development work. 983.154 Section 983.154 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND...
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Schnabel, Claus
Kick-off of the Bosch scope of work for the REGIS project started in October 2012. The primary work-packages included in the Bosch scope of work were the following: overall project management, development of the EGR sensor (design of sensor element, design of protection tube, and design of mounting orientation), development of EGR system control strategy, build-up of prototype sensors, evaluation of system performance with the new sensor and the new control strategy, long-term durability testing, and development of a 2nd generation sensor concept for continued technology development after the REGIS project. The University of Clemson was a partner with Boschmore » in the REGIS project. The Clemson scope of work for the REGIS project started in June 2013. The primary work-packages included in the Clemson scope of work were the following: development of EGR system control strategy, and evaluation of system performance with the new sensor and new control strategy. This project was split into phase I, phase II and phase III. Phase I work was completed by the end of June 2014 and included the following primary work packages: development of sensor technical requirements, assembly of engine testbench at Clemson, design concept for sensor housing, connector, and mounting orientation, build-up of EGR flow test benches at Bosch, and build-up of first sensor prototypes. Phase II work was completed by the end of June 2015 and included the following primary work pack ages: development of an optimizing function and demonstration of robustness of sensor, system control strategy implementation and initial validation, completion of engine in the loop testing of developed control algorithm, completion of sensor testing including characteristic line, synthetic gas test stand, and pressure dependency characterization, demonstration of benefits of control w/o sensing via simulation, development of 2nd generation sensor concept. Notable technical achievements from phase II were the following: publication of two new technical papers by Clemson detailing the control strategies used for the EGR system control. The two papers was published in the 2016 SAE World Congress in April 2016. The titles of each paper are, “Physics-Based Exhaust Pressure and Temperature Estimation for Low Pressure EGR Control in Turbocharged Gasoline Engines,” by K. Siokos, and “A Control Algorithm for Low Pressure – EGR Systems using a Smith Predictor with Intake Oxygen Sensor Feedback”, by R. Koli. All phase III work packages have been completed. The primary work packages in phase III were the following: completion of long-term sensor durability testing, final demonstration of benefits of EGR control w/o sensing, final decision of the second generation sensor development path.« less
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McAuley, Tara; White, Desirée
2010-01-01
The present study addressed three related aims: (1) to replicate and extend previous work regarding the non-unitary nature of processing speed, response inhibition, and working memory during development, (2) to quantify the rate at which processing speed, response inhibition, and working memory develop and the extent to which the development of these latter abilities reflect general changes in processing speed, and (3) to evaluate whether commonly used tasks of processing speed, response inhibition, and working memory are valid and reliable when used with a developmentally diverse group. To address these aims, a latent variables approach was used to analyze data from 147 participants 6 to 24 years of age. Results showed that processing speed, response inhibition, and working memory were separable abilities and that the extent of this separability was stable cross the age range of participants. All three constructs improved as a function of age; however, only the effect of age on working memory remained significant after processing speed was controlled. The psychometric properties of tasks used to assess the constructs were age invariant, thus validating their use in studies of executive development. PMID:20888572
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From the past to the future: Integrating work experience into the design process.
Bittencourt, João Marcos; Duarte, Francisco; Béguin, Pascal
2017-01-01
Integrating work activity issues into design process is a broadly discussed theme in ergonomics. Participation is presented as the main means for such integration. However, a late participation can limit the development of both project solutions and future work activity. This article presents the concept of construction of experience aiming at the articulated development of future activities and project solutions. It is a non-teleological approach where the initial concepts will be transformed by the experience built up throughout the design process. The method applied was a case study of an ergonomic participation during the design of a new laboratory complex for biotechnology research. Data was obtained through analysis of records in a simulation process using a Lego scale model and interviews with project participants. The simulation process allowed for developing new ways of working and generating changes in the initial design solutions, which enable workers to adopt their own developed strategies for conducting work more safely and efficiently in the future work system. Each project decision either opens or closes a window of opportunities for developing a future activity. Construction of experience in a non-teleological design process allows for understanding the consequences of project solutions for future work.
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Diemer, Matthew A; Wang, Qiu; Moore, Traymanesha; Gregory, Shannon R; Hatcher, Keisha M; Voight, Adam M
2010-05-01
Structural barriers constrain marginalized youths' development of work salience and vocational expectations. Sociopolitical development (SPD), the consciousness of, and motivation to reduce, sociopolitical inequality, may facilitate the negotiation of structural constraints. A structural model of SPD's impact on work salience and vocational expectations was proposed and its generalizability tested among samples of low-socioeconomic-status African American, Latin American, and Asian American youth, with Educational Longitudinal Study data. Measurement and temporal invariance of these constructs was first established before testing the proposed model across the samples. Across the three samples, 10th-grade SPD had significant effects on 10th-grade work salience and vocational expectations; 12th-grade SPD had a significant effect on 12th-grade work salience. Tenth-grade SPD had significant indirect effects on 12th-grade work salience and on 12th-grade vocational expectations for all three samples. These results suggest that SPD facilitates the agentic negotiation of constraints on the development of work salience and vocational expectations. Given the impact of adolescent career development on adult occupational attainment, SPD may also foster social mobility among youth constrained by an inequitable opportunity structure. 2010 APA, all rights reserved
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The Current Working Conditions in Ugandan Apparel Assembly Plants.
Tebyetekerwa, Mike; Akankwasa, Nicholus Tayari; Marriam, Ifra
2017-12-01
The present rapid shift of industrialization from developed to developing countries requires developing countries to understand issues related to work organization, management, and working conditions. There are many factors slackening production, of which working conditions is part. A complete inquiry into the workers' working conditions can enable managements to reduce risks in the workplaces and improve productivity. Understanding and awareness of the benefits of workplace research and a probe into the working conditions in the Ugandan apparel assembly plants are urgently required. A total of 103 (70 women and 33 men) workers from five different plants were interviewed. Together with the top management of various plants, questionnaires about the workers' opinions of their physical working conditions were prepared. Data was collected using two methods: (1) questionnaire; and (2) observation of the workers during their work. The results indicated that poor plant working conditions were mainly contributed by the workers' social factors and the management policies. The government, together with the management, should work to improve the working conditions in the apparel assembly plants, as it greatly affects both.
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ERIC Educational Resources Information Center
Bierema, Laura L.
2001-01-01
Outlines causes of women's disadvantage in the workplace and the inadequacies of career development models for women. Addresses themes related to women's learning at work: hidden curriculum in the work context, identity development, relationships and connection, and mentoring. (Contains 38 references.) (SK)
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ERIC Educational Resources Information Center
Natoli, Riccardo; Jackling, Beverley; Seelanatha, Lalith
2014-01-01
This paper examines the influence of two distinct group work management strategies on finance students' attitudes towards group work and their perceptions of generic skill development. Using quantitative and qualitative data, comparisons are made between students who experienced a supportive group work environment and students who experienced an…
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The Dynamic between Work Values and Part-Time Work Experiences across the High School Years
ERIC Educational Resources Information Center
Porfeli, Erik J.
2008-01-01
The work value system, its development, and its relationship with work experiences can be modeled as an adaptive control system [Ford, D. H., & Lerner, R. M. (1992). "Developmental systems theory: An integrative approach". Newbury Park, CA: Sage Publications]. This study employed longitudinal data from 1000 participants (Youth Development Study;…
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A Standards-Based Inventory of Foundation Competencies in Social Work with Groups
ERIC Educational Resources Information Center
Macgowan, Mark J.
2012-01-01
Objective: This article describes the development of a measure of foundation competencies in group work derived from the Standards for Social Work Practice with Groups. Developed by the Association for the Advancement of Social Work with Groups, the Standards have not been widely used. An instrument based on the Standards can help advance…
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Development and Validation of a Short Form of the Occupational Work Ethic Inventory
ERIC Educational Resources Information Center
Park, HwaChoon; Hill, Roger B.
2017-01-01
The Occupational Work Ethic Inventory (OWEI) has been widely used to measure work ethic constructs by professionals in the fields of Career and Technical Education (CTE) and Human Resource Development (HRD). However, there are circumstances when a shorter instrument would have advantages, especially when a measure of work ethic is needed along…
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The Development of a Proposed Global Work-Integrated Learning Framework
ERIC Educational Resources Information Center
McRae, Norah; Johnston, Nancy
2016-01-01
Building on the work completed in BC that resulted in the development of a WIL Matrix for comparing and contrasting various forms of WIL with the Canadian co-op model, this paper proposes a Global Work-Integrated Learning Framework that allows for the comparison of a variety of models of work-integrated learning found in the international…
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ERIC Educational Resources Information Center
Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael
2014-01-01
Background: Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The "Getting Practical" CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of…
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ERIC Educational Resources Information Center
Campana, Joe
2014-01-01
Informal learning networks play a key role in the skill and professional development of professionals, working in micro-businesses within Australia's digital media industry, as they do not have access to learning and development or human resources sections that can assist in mapping their learning pathway. Professionals working in this environment…
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ERIC Educational Resources Information Center
Coers, Natalie; Williams, Jennifer
2010-01-01
This study explored the impact of emphasis on the group development process on the perceived importance of and confidence in group work skills and students' perception of group work use in the collegiate classroom as developed by Tuckman and Jensen (1977). The purposive sample utilized in this study included 33 undergraduate students enrolled in…
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ERIC Educational Resources Information Center
Campbell, Robert E.; And Others
This instructor's handbook is part of a career development unit on coping in the world of work, designed to assist students in developing coping strategies to deal with work-entry and job adjustment problems. (Other components of the unit--student guide, handout/transparency masters, and filmstrip/sound cassette programs--are available…
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Assessment of Work Performance (AWP)--development of an instrument.
Sandqvist, Jan L; Törnquist, Kristina B; Henriksson, Chris M
2006-01-01
Adequate work assessments are a matter of importance both for individuals and society [5,29,31,38,40,46,52]. However, there is a lack of adequate and reliable instruments for use in work rehabilitation [14,15,20,21,31,44]. The purpose of this study was to develop and evaluate an observation instrument for assessing work performance, the AWP (Assessment of Work Performance). The purpose of the 14-item instrument is to assess the individual's observable working skills in three different areas: motor skills, process skills, and communication and interaction skills. This article describes the development and results of preliminary testing of the AWP. The testing indicates a satisfactory face validity and utility for the AWP and supports further research and testing of the instrument.
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NASA Work Breakdown Structure (WBS) Handbook
NASA Technical Reports Server (NTRS)
Terrell, Stefanie M.
2018-01-01
The purpose of this document is to provide program/project teams necessary instruction and guidance in the best practices for Work Breakdown Structure (WBS) and WBS dictionary development and use for project implementation and management control. This handbook can be used for all types of NASA projects and work activities including research, development, construction, test and evaluation, and operations. The products of these work efforts may be hardware, software, data, or service elements (alone or in combination). The aim of this document is to assist project teams in the development of effective work breakdown structures that provide a framework of common reference for all project elements.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Spencer, Benjamin; Zhang, Yongfeng; Chakraborty, Pritam
2014-09-01
This report summarizes work during FY 2014 to develop capabilities to predict embrittlement of reactor pressure vessel steel, and to assess the response of embrittled reactor pressure vessels to postulated accident conditions. This work has been conducted a three length scales. At the engineering scale, 3D fracture mechanics capabilities have been developed to calculate stress intensities and fracture toughnesses, to perform a deterministic assessment of whether a crack would propagate at the location of an existing flaw. This capability has been demonstrated on several types of flaws in a generic reactor pressure vessel model. Models have been developed at themore » scale of fracture specimens to develop a capability to determine how irradiation affects the fracture toughness of material. Verification work has been performed on a previously-developed model to determine the sensitivity of the model to specimen geometry and size effects. The effects of irradiation on the parameters of this model has been investigated. At lower length scales, work has continued in an ongoing to understand how irradiation and thermal aging affect the microstructure and mechanical properties of reactor pressure vessel steel. Previously-developed atomistic kinetic monte carlo models have been further developed and benchmarked against experimental data. Initial work has been performed to develop models of nucleation in a phase field model. Additional modeling work has also been performed to improve the fundamental understanding of the formation mechanisms and stability of matrix defects caused.« less
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48 CFR 27.405-1 - Special works.
Code of Federal Regulations, 2014 CFR
2014-10-01
..., books, studies, surveys, or similar documents that do not involve research, development, or experimental...; (3) Surveys of Government establishments; (4) Works pertaining to the instruction or guidance of... that resulting from research, development, or experimental work performed by the contractor), the early...
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48 CFR 27.405-1 - Special works.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., books, studies, surveys, or similar documents that do not involve research, development, or experimental...; (3) Surveys of Government establishments; (4) Works pertaining to the instruction or guidance of... that resulting from research, development, or experimental work performed by the contractor), the early...
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48 CFR 27.405-1 - Special works.
Code of Federal Regulations, 2013 CFR
2013-10-01
..., books, studies, surveys, or similar documents that do not involve research, development, or experimental...; (3) Surveys of Government establishments; (4) Works pertaining to the instruction or guidance of... that resulting from research, development, or experimental work performed by the contractor), the early...
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48 CFR 27.405-1 - Special works.
Code of Federal Regulations, 2012 CFR
2012-10-01
..., books, studies, surveys, or similar documents that do not involve research, development, or experimental...; (3) Surveys of Government establishments; (4) Works pertaining to the instruction or guidance of... that resulting from research, development, or experimental work performed by the contractor), the early...
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48 CFR 27.405-1 - Special works.
Code of Federal Regulations, 2011 CFR
2011-10-01
..., books, studies, surveys, or similar documents that do not involve research, development, or experimental...; (3) Surveys of Government establishments; (4) Works pertaining to the instruction or guidance of... that resulting from research, development, or experimental work performed by the contractor), the early...
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Converging Work-Talk Patterns in Online Task-Oriented Communities.
Xuan, Qi; Devanbu, Premkumar; Filkov, Vladimir
2016-01-01
Much of what we do is accomplished by working collaboratively with others, and a large portion of our lives are spent working and talking; the patterns embodied in the alternation of working and talking can provide much useful insight into task-oriented social behaviors. The available electronic traces of the different kinds of human activities in online communities are an empirical goldmine that can enable the holistic study and understanding of these social systems. Open Source Software (OSS) projects are prototypical examples of collaborative, task-oriented communities, depending on volunteers for high-quality work. Here, we use sequence analysis methods to identify the work-talk patterns of software developers in online communities of Open Source Software projects. We find that software developers prefer to persist in same kinds of activities, i.e., a string of work activities followed by a string of talk activities and so forth, rather than switch them frequently; this tendency strengthens with time, suggesting that developers become more efficient, and can work longer with fewer interruptions. This process is accompanied by the formation of community culture: developers' patterns in the same communities get closer with time while different communities get relatively more different. The emergence of community culture is apparently driven by both "talk" and "work". Finally, we also find that workers with good balance between "work" and "talk" tend to produce just as much work as those that focus strongly on "work"; however, the former appear to be more likely to continue to be active contributors in the communities.
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Women's work and development in Latin America.
Draper, E
1985-01-01
The discussion explores the problem of women's employment patterns under capitalist development in Latin America, first by analyzing the way in which women's work has been conceptualized within modernization theory. It then goes on to examine the 2 types of work in which most Latin American women are engaged -- domestic service and informal work such as selling produce and taking in laundry -- to provide evidence for challenging modernization theory and for developing a more useful approach. Subsequently, the discussion considers women's domestic and informal work within the context of capitalist development, which provides some insight into the broader structures shaping women's employment. Finally, the discussion proposes some reconceptualizations of women's work and development. Modernization theorists analyze women's work in the cities within a variety of constructs, interpreting it as a backward manifestation of traditional society, a reflection of women's inadequate training for the modern sector, an indication of women's primary orientation to the family, or as a phenomenon that is too tangential to warrant examination. The primary assumption is that modernization improves women's status and the conditions of their lives as it brings greater productivity, more advanced technology, and more highly differentiated institutions. Assumptions concerning women's absorption into the modern sector and the equalization of work roles between men and women are not borne out by actual employment trends, which reveal the persistent concentration of women in domestic work, informal jobs, and the lower-paying service jobs. Despite their predominance, domestic service and informal jobs are infrequently included in employment statistics and are virtually ignored in studies of development, yet these 2 types of work are the primary forms of work for Latin American women. Even when modernization theorists recognize the proliferation of informal and domestic service jobs, they see it as part of a progressive development stage, with displaced rural laborers becoming incorporated into the modern sector by way of informal jobs. In most Latin American countries, rural women become a permanent part of the services and the informal labor market when they move to the cities. There is little sign of their transition to industrial employment. In general, capitalist development marginalizes Latin American women, who in several important ways lose status. The range of pursuits considered women's work should include their activities within the infromal labor sector. Informal work is still virtually unexplored, especially as it relates to wage work in underdeveloped countries. Informal labor is not registered in the census, nor is it included in the gross national product. Yet, it is a major component of women's work. Domestic service and infromal jobs should be seen in relation to other forms of labor and to total social production.
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Suwazono, Y; Okubo, Y; Kobayashi, E; Kido, T; Nogawa, K
2003-10-01
This study investigated the association of working conditions and lifestyle with mental health in Japanese workers. A follow-up study was carried out in the Kanto district of Japan of workers in a telecommunications enterprise who received their first annual health check-up between 1992 and 1996 and were between 20 and 54 years old. Workers who reported mental symptoms, had a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 23 837 workers. The association between working conditions and lifestyle and the development of mental symptoms was investigated by pooled logistic regression analyses. Working long hours and part-time work, as opposed to normal daytime hours of work, were factors associated with the development of mental symptoms in males, as were smoking, short sleeping hours, little physical exercise, rarely taking three meals a day, frequently eating within 1 h before sleep, much preference for salty meals and little preference for vegetables. Consumption of alcohol was negatively associated with the development of mental symptoms in males. Overall, the results suggested that the lower the Healthy Work and Lifestyle Score, the higher the risk of developing mental symptoms. Working conditions and lifestyle, especially food preferences, have an apparent influence on the mental health of Japanese workers. Moreover, the Healthy Work and Lifestyle Score indicates that working conditions and lifestyle appear to have a cumulative influence upon the mental health of Japanese workers.
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The development and initial validation of the Decent Work Scale.
Duffy, Ryan D; Allan, Blake A; England, Jessica W; Blustein, David L; Autin, Kelsey L; Douglass, Richard P; Ferreira, Joaquim; Santos, Eduardo J R
2017-03-01
Decent work is positioned as the centerpiece of the recently developed Psychology of Working Theory (PWT; Duffy, Blustein, Diemer, & Autin, 2016). However, to date, no instrument exists which assesses all 5 components of decent work from a psychological perspective. In the current study, we developed the Decent Work Scale (DWS) and demonstrated several aspects of validity with 2 samples of working adults. In Study 1 (N = 275), a large pool of items were developed and exploratory factor analysis was conducted resulting in a final 15-item scale with 5 factors/subscales corresponding to the 5 components of decent work: (a) physically and interpersonally safe working conditions, (b) access to health care, (c) adequate compensation, (d) hours that allow for free time and rest, and (e) organizational values that complement family and social values. In Study 2 (N = 589), confirmatory factor analysis demonstrated that a 5-factor, bifactor model offered the strongest and most parsimonious fit to the data. Configural, metric, and scalar invariance models were tested demonstrating that the structure of the instrument did not differ across gender, income, social class, and majority/minority racial/ethnic groups. Finally, the overall scale score and 5 subscale scores correlated in the expected directions with similar constructs supporting convergent and discriminant evidence of validity, and subscale scores evidenced predictive validity in the prediction of job satisfaction, work meaning, and withdrawal intentions. The development of this scale provides a useful tool for researchers and practitioners seeking to assess the attainment of decent work among employed adults. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Frone, Michael R; Tidwell, Marie-Cecile O
2015-07-01
Although work fatigue represents an important construct in several substantive areas, prior conceptual definitions and measures have been inadequate in a number of ways. The goals of the present study were to develop a conceptual definition and outline the desirable characteristics of a work fatigue measure, briefly examine several prior measures of work fatigue-related constructs, and develop and evaluate a new measure of work fatigue. The Three-Dimensional Work Fatigue Inventory (3D-WFI) provides separate and commensurate assessments of physical, mental, and emotional work fatigue. Results from a pilot study (n = 207) and a broader evaluative study of U.S. wage and salary workers (n = 2,477) suggest that the 3D-WFI is psychometrically sound and evinces a meaningful pattern of relations with variables that comprise the nomological network of work fatigue. As with all new measures, additional research is required to evaluate fully the utility of the 3D-WFI in research on work fatigue. (c) 2015 APA, all rights reserved).
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2013-07-30
more about STEM. From museums, to gardens, to planetariums and more, Places to Go mobilizes people to explore the STEM resources offered by their...Works website was developed utilizing a phased approach. This approach allowed for informed, periodic updates to the structure, design, and backend ...our web development team, throughout this phase. A significant amount of backend development work on the website, as well as design work was completed
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ERIC Educational Resources Information Center
Stanley-Clarke, Nicky; English, Awhina; Yeung, Polly
2018-01-01
The development of new e-technologies and an increased focus on developing distance social work education programs has created the impetus for social work educators to consider the tools they can employ in delivering distance courses. This article reflects on an action learning research project involving the development of an online toolbox of…
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ERIC Educational Resources Information Center
Ohio State Univ., Columbus. Center for Vocational Education.
Master handouts and transparencies needed for activities and instruction are contained in this document, which is part of a career development unit on coping in the world of work designed to assist students in developing coping strategies to deal with work entry and job adjustment problems. (Other components of the unit--instructor's handbook,…
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ERIC Educational Resources Information Center
Young, Susan; McKenzie, Margaret; Schjelderup, Liv; Omre, Cecilie; Walker, Shayne
2014-01-01
Working from practice experiences, Social Work educators from Aotearoa/New Zealand, Norway and Western Australia have developed a framework for child welfare work . The framework brings together the Rights of the Child, Community Development and Child Protection. This article describes the principles and theoretical underpinnings of this…
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Development of a guideline for work zone diversion rate and capacity reduction.
DOT National Transportation Integrated Search
2016-03-01
This study develops a comprehensive guideline to estimate the traffic diversion rates and capacity reduction for : work zones. The analysis of the traffic diversion patterns with data from past work zones in the metro freeway : network in Minnesota r...
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ERIC Educational Resources Information Center
1999
This document contains four symposium papers on work force development. "Effects of Two Different Learning Paths on School-to-Work Transition" (Esther Van Der Schoot) discusses a Dutch study documenting that the following items make a difference in the school-to-work transition: learning path, curriculum characteristics, individual…
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ERIC Educational Resources Information Center
Howell, Sharon L.; Carter, Vicki K.; Schied, Fred M.
2002-01-01
Analysis of data from 8 female manufacturing workers, 13 professionals, and 10 clerical workers, two themes emerged: (1) women and organizational change; and (2) disappearing boundaries of work and family. The assumptions of human resource development about why and how women work and definitions of productive work were found to be flawed and…
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ERIC Educational Resources Information Center
Nevo, Einat; Breznitz, Zvia
2013-01-01
This study investigated the development of working memory ability (measured by tasks assessing all four working memory components) from the end of kindergarten to the end of first grade--the first year reading is taught in school--and the relationship between working memory abilities in kindergarten and first grade and reading skills in first…
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ERIC Educational Resources Information Center
Vock, Miriam; Holling, Heinz
2008-01-01
The objective of this study is to explore the potential for developing IRT-based working memory scales for assessing specific working memory components in children (8-13 years). These working memory scales should measure cognitive abilities reliably in the upper range of ability distribution as well as in the normal range, and provide a…
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Group Selection Methods and Contribution to the West Point Leadership Development System (WPLDS)
2015-08-01
Government. 14. ABSTRACT Group work in an academic setting can consist of projects or problems students can work on collaboratively. Although pedagogical ...ABSTRACT Group work in an academic setting can consist of projects or problems students can work on collaboratively. Although pedagogical studies...helping students develop intangibles like communication, time management, organization, leadership, interpersonal, and relationship skills. Supporting
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ERIC Educational Resources Information Center
Cortes Pascual, M. P. Alejandra
2009-01-01
Work values are linked with other relevant variables in career development, such as professional interests or vocational personality, are formed in a specific work context and influence the orientation intervention designed, for example, as an element of the professional portfolio or the development of transversal participatory and personal…
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Hughes, Roger
2006-01-01
This article uses a socioecological analytical approach to assess the capacity of the public health nutrition work force in Australia as a prelude to work force development strategy planning. It demonstrates how the socioecological model can be used to assess and inform the development of the infrastructure required for effective public health nutrition effort. An interpretive case study method was used involving triangular analysis of quantitative and qualitative data from multiple sources including semistructured interviews with advanced-level practitioners, literature review, a cross-sectional national work force survey, and position description audit and consensus development using a Delphi study. The findings of this analysis indicate that the Australian public health nutrition work force's capacity to effectively address priority nutrition issues is limited by determinants that can be categorized as relating to human resource infrastructure, organizational and policy environments, intelligence access and use, practice improvement and learning systems, and work force preparation. This socioecological analysis supports an intelligence-based focus for work force development effort in Australia and a conceptual framework for work force capacity assessment with potential applications in other countries.
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Managing multiple roles: development of the Work-Family Conciliation Strategies Scale.
Matias, Marisa; Fontaine, Anne Marie
2014-07-17
Juggling the demands of work and family is becoming increasingly difficult in today's world. As dual-earners are now a majority and men and women's roles in both the workplace and at home have changed, questions have been raised regarding how individuals and couples can balance family and work. Nevertheless, research addressing work-family conciliation strategies is limited to a conflict-driven approach and context-specific instruments are scarce. This study develops an instrument for assessing how dual-earners manage their multiple roles detaching from a conflict point of view highlighting the work-family conciliation strategies put forward by these couples. Through qualitative and quantitative procedures the Work-Family Conciliation Strategies Scales was developed and is composed by 5 factors: Couple Coping; Positive Attitude Towards Multiple Roles, Planning and Management Skills, Professional Adjustments and Institutional Support; with good adjustment [χ2/df = 1.22; CFI = .90, RMSEA = .04, SRMR = .08.] and good reliability coefficients [from .67 to .87]. The developed scale contributes to research because of its specificity to the work-family framework and its focus on the proactive nature of balancing work and family roles. The results support further use of this instrument.
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Chakrabarti, Debkumar; Bhattachheriya, Nandita
2012-01-01
Strategy for finding the appropriate strategy for work tool development has become a crucial issue in occupational wellness of varied nature of women workforce of Northeast India. This paper deals with ergonomics intervention through sustainable work tool design development process. Workers who frequently shift to different activities quite often in unorganised small-scale fruit processing units where productivity is directly related to the harvesting season require different work tools relevant to specific tasks and mostly workers themselves manage work tools of their own with available local resources. Whereas in contrast the tea-leaf pluckers are engaged in a single task throughout the year, and the work schedule and work equipment is decided and supplied to them based on the corporate decision where the workers do not have any individual control. Observations confirm the need for organising participatory workshops specific to trade based occupational well-being and different work tools for different tasks in mostly private owned unorganised sector. Implementation of single variety work tool development that supports a crucial component in tea-leaf plucking for which they are engaged in full time employment; and through a corporate decision a single design with its number of users makes a good effect.
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Working memory predicts children's analogical reasoning.
Simms, Nina K; Frausel, Rebecca R; Richland, Lindsey E
2018-02-01
Analogical reasoning is the cognitive skill of drawing relationships between representations, often between prior knowledge and new representations, that allows for bootstrapping cognitive and language development. Analogical reasoning proficiency develops substantially during childhood, although the mechanisms underlying this development have been debated, with developing cognitive resources as one proposed mechanism. We explored the role of executive function (EF) in supporting children's analogical reasoning development, with the goal of determining whether predicted aspects of EF were related to analogical development at the level of individual differences. We assessed 5- to 11-year-old children's working memory, inhibitory control, and cognitive flexibility using measures from the National Institutes of Health Toolbox Cognition battery. Individual differences in children's working memory best predicted performance on an analogical mapping task, even when controlling for age, suggesting a fundamental interrelationship between analogical reasoning and working memory development. These findings underscore the need to consider cognitive capacities in comprehensive theories of children's reasoning development. Copyright © 2017 Elsevier Inc. All rights reserved.
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The Development of Attention Systems and Working Memory in Infancy
Reynolds, Greg D.; Romano, Alexandra C.
2016-01-01
In this article, we review research and theory on the development of attention and working memory in infancy using a developmental cognitive neuroscience framework. We begin with a review of studies examining the influence of attention on neural and behavioral correlates of an earlier developing and closely related form of memory (i.e., recognition memory). Findings from studies measuring attention utilizing looking measures, heart rate, and event-related potentials (ERPs) indicate significant developmental change in sustained and selective attention across the infancy period. For example, infants show gains in the magnitude of the attention related response and spend a greater proportion of time engaged in attention with increasing age (Richards and Turner, 2001). Throughout infancy, attention has a significant impact on infant performance on a variety of tasks tapping into recognition memory; however, this approach to examining the influence of infant attention on memory performance has yet to be utilized in research on working memory. In the second half of the article, we review research on working memory in infancy focusing on studies that provide insight into the developmental timing of significant gains in working memory as well as research and theory related to neural systems potentially involved in working memory in early development. We also examine issues related to measuring and distinguishing between working memory and recognition memory in infancy. To conclude, we discuss relations between the development of attention systems and working memory. PMID:26973473
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The Development of Attention Systems and Working Memory in Infancy.
Reynolds, Greg D; Romano, Alexandra C
2016-01-01
In this article, we review research and theory on the development of attention and working memory in infancy using a developmental cognitive neuroscience framework. We begin with a review of studies examining the influence of attention on neural and behavioral correlates of an earlier developing and closely related form of memory (i.e., recognition memory). Findings from studies measuring attention utilizing looking measures, heart rate, and event-related potentials (ERPs) indicate significant developmental change in sustained and selective attention across the infancy period. For example, infants show gains in the magnitude of the attention related response and spend a greater proportion of time engaged in attention with increasing age (Richards and Turner, 2001). Throughout infancy, attention has a significant impact on infant performance on a variety of tasks tapping into recognition memory; however, this approach to examining the influence of infant attention on memory performance has yet to be utilized in research on working memory. In the second half of the article, we review research on working memory in infancy focusing on studies that provide insight into the developmental timing of significant gains in working memory as well as research and theory related to neural systems potentially involved in working memory in early development. We also examine issues related to measuring and distinguishing between working memory and recognition memory in infancy. To conclude, we discuss relations between the development of attention systems and working memory.
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Applied Meteorology Unit Quarterly Report, Second Quarter FY-13
NASA Technical Reports Server (NTRS)
Bauman, William; Crawford, Winifred; Watson, Leela; Shafer, Jaclyn; Huddleston, Lisa
2013-01-01
The AMU team worked on six tasks for their customers: (1) Ms. Crawford continued work on the objective lightning forecast task for airports in east-central Florida, and began work on developing a dual-Doppler analysis with local Doppler radars, (2) Ms. Shafer continued work for Vandenberg Air Force Base on an automated tool to relate pressure gradients to peak winds, (3) Dr. Huddleston continued work to develop a lightning timing forecast tool for the Kennedy Space Center/Cape Canaveral Air Force Station area, (4) Dr. Bauman continued work on a severe weather forecast tool focused on east-central Florida, (5) Mr. Decker began developing a wind pairs database for the Launch Services Program to use when evaluating upper-level winds for launch vehicles, and (6) Dr. Watson began work to assimilate observational data into the high-resolution model configurations, she created for Wallops Flight Facility and the Eastern Range.
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Using scenarios to capture work processes in shared home care.
Hägglund, Maria; Scandurra, Isabella; Koch, Sabine
2007-01-01
Shared home care is increasingly common, and in order to develop ICT that support such complex cooperative work it is crucial obtain an understanding of the work routines, information demands, and other central preconditions at the clinical level before the development is initiated. Scenarios are proposed as a technique that can be useful for capturing work processes in shared home care and experiences from the Old@Home project are presented. The scenarios are useful not only in the initial phases of the development project but throughout the development process, improving the accessibility of end user requirements and usability issues for the design team, and as a basis for use cases and further design.
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Bragadóttir, Helga; Gunnarsdóttir, Sigrún; Ingason, Helgi T
2013-05-01
This paper describes the development and piloting of electronic standardized measures on nursing work (e-SMNW) for rich data gathering on the work and work environment of registered nurses (RNs) and practical nurses (PNs). Efficient and valid methods are needed to measure nursing work to enhance the optimal use of the nursing workforce for safe patient care. The study combined human factors engineering (HFE) and nursing knowledge to develop electronic standardized measures for observational studies on nursing work in acute care. The work and work environment of RNs and PNs in acute care medical and surgical inpatient units was successfully measured using e-SMNW. With predetermined items of work activities and influencing factors in the work of nurses, and full use of computer technology, multi-layered rich standardized data were gathered, analysed and displayed. The combination of nursing knowledge, HFE and computer technology enables observational data collection for a rich picture of the complex work of nursing. Information collected by standardized and multi-layered measures makes it easier to identify potential improvements, with regard to influencing factors and management of the work and work environment of nurses. Further use of computer technology in health services research is encouraged. © 2012 Blackwell Publishing Ltd.
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Native Employment in a Frontier Region.
ERIC Educational Resources Information Center
Farnsworth, J. M.
By employing southern strategies and preconceptions to develop the north, southern Canadians have complicated northern Canadian development problems. Assuming that the only recognizable work is "paid" work and that welfare recipients do not want to work, southern Canadians have failed to recognize the inherent relationship between…
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Statements of work handbook. [technical writing for NASA programs
NASA Technical Reports Server (NTRS)
1975-01-01
Guidelines are presented for preparing statements of work (SOW) to assure a consistent approach throughout NASA. Statements of work for study and preliminary definition contracts, for definition and development of major systems, for support services, and for small research and development contracts are discussed.
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Developing energy and momentum conceptual survey (EMCS) with four-tier diagnostic test items
NASA Astrophysics Data System (ADS)
Afif, Nur Faadhilah; Nugraha, Muhammad Gina; Samsudin, Achmad
2017-05-01
Students' conceptions of work and energy are important to support the learning process in the classroom. For that reason, a diagnostic test instrument is needed to diagnose students' conception of work and energy. As a result, the researcher decided to develop Energy and Momentum Conceptual Survey (EMCS) instrument test into four-tier test diagnostic items. The purpose of this research is organized as the first step of four-tier test-formatted EMCS development as one of diagnostic test instruments on work and Energy. The research method used the 4D model (Defining, Designing, Developing and Disseminating). The instrument developed has been tested to 39 students in one of Senior High Schools. The resulting research showed that four-tier test-formatted EMCS is able to diagnose students' conception level of work and energy concept. It can be concluded that the development of four-tier test-formatted EMCS is one of potential diagnostic test instruments that able to obtain the category of students who understand concepts, misconceptions and do not understand about Work and Energy concept at all.
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ERIC Educational Resources Information Center
Manathunga, Catherine
2006-01-01
Post-colonial theories about liminality, hybridity, unhomeliness, and identity form a novel lens through which to re-theorise educational development work. Applying these conceptual frameworks allows practitioners and the academics they work with the opportunity to problematise some of educational development's colonial underpinnings and…
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ERIC Educational Resources Information Center
Yuen, Mantak; Gysbers, Norman C.; Chan, Raymond M. C.; Lau, Patrick S. Y.; Shea, Peter M. K.
2010-01-01
This article describes the development of an instrument--the "Career and Talent Development Self-Efficacy Scale (CTD-SES)"--for assessing students' self-efficacy in applying life skills essential for personal talent development, acquisition of positive work habits, and career exploration. In Study 1, data were obtained from a large…
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Rego, Arménio; Pina E Cunha, Miguel
2009-07-01
The study shows how the perceptions of opportunities for learning and personal development predict five dimensions of affective well-being (AWB: pleasure, comfort, placidity, enthusiasm, and vigor), and how this relationship is moderated by the perceptions of work-family conciliation. A sample comprising 404 individuals was collected. The findings show the following: (1) both the perceptions of opportunities for learning and personal development and perceptions of work-family conciliation predict AWB, the happier individuals being those who have high perceptions on both variables; (2) both variables interact in predicting AWB, in such a way that perceptions of high opportunities for learning and personal development may not lead to higher AWB if work-family conciliation is low. Post hoc analysis also suggests that the relationship between the perceptions of opportunities for learning and personal development and AWB tends to be nonlinear for individuals with perceptions of low work-family conciliation. (c) 2009 APA, all rights reserved.
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Technology development for lunar base water recycling
NASA Technical Reports Server (NTRS)
Schultz, John R.; Sauer, Richard L.
1992-01-01
This paper will review previous and ongoing work in aerospace water recycling and identify research activities required to support development of a lunar base. The development of a water recycle system for use in the life support systems envisioned for a lunar base will require considerable research work. A review of previous work on aerospace water recycle systems indicates that more efficient physical and chemical processes are needed to reduce expendable and power requirements. Development work on biological processes that can be applied to microgravity and lunar environments also needs to be initiated. Biological processes are inherently more efficient than physical and chemical processes and may be used to minimize resupply and waste disposal requirements. Processes for recovering and recycling nutrients such as nitrogen, phosphorus, and sulfur also need to be developed to support plant growth units. The development of efficient water quality monitors to be used for process control and environmental monitoring also needs to be initiated.
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Harcourt, C; Donovan, B
2005-01-01
Objective: To compile a global typography of commercial sex work. Methods: A Medline search and review of 681 "prostitution" articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work. Results: At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely. Conclusion: Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes. PMID:15923285
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Developing nursing practice through work-based learning.
Clarke, David J; Copeland, Lisa
2003-12-01
Developing nursing practice in any area demands skills, knowledge, support and a long term commitment to the achievement of best practice. It is easy to become overwhelmed by the competing demands for client care and service delivery. It is not always easy to see how good ideas, clinical concerns and professionally led objectives, can be realised in practice. Ongoing professional development activities, including formal educational programmes can contribute to individual staff members' ability to take on practice development projects. Too often however, educational programmes are seen as making little real difference to clinical practice. Work-based learning, a relatively new approach in higher education in the United Kingdom, presents opportunities for Universities and healthcare providers to work in partnership to realise the shared aims of developing nursing practice. Specific examples, drawn from the personal experiences of one of the authors, will examine the contribution of a work-based learning approach to integrating learning and developing practice in the field of cancer care. The work-based learning approach can bring about tangible benefits for patients, practitioners and organisations, but only if the organisational and contextual factors which impact on practice and its development are properly considered and managed through effective partnerships.
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Krajnak, Kristine M
2014-01-01
Two of the major causes of death worldwide are cardiovascular disease and Type II diabetes. Although death due to these diseases is assessed separately, the physiological process that is attributed to the development of cardiovascular disease can be linked to the development of Type II diabetes and the impact that this disease has on the cardiovascular system. Physiological, genetic, and personal factors contribute to the development of both these disorders. It has also been hypothesized that work-related stress may contribute to the development of Type II diabetes and cardiovascular disease. This review summarizes some of the studies examining the role of work-related stress on the development of these chronic disorders. Because women may be more susceptible to the physiological effects of work-related stress, the papers cited in this review focus on studies that examined the difference in responses of men or women to work-related stress or on studies that focused on the effects of stress on women alone. Based on the papers summarized, it is concluded that (1) work-related stress may directly contribute to the development of cardiovascular disease by inducing increases in blood pressure and changes in heart rate that have negative consequences on functioning of the cardiovascular system; (2) workers reporting increased levels of stress may display an increased risk of Type II diabetes because they adopt poor health habits (ie, increased level of smoking, inactivity etc), which in turn contribute to the development of cardiovascular problems; and (3) women in high demand and low-control occupations report an increased level of stress at work, and thus may be at a greater risk of negative health consequences.
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Ada Software Design Methods Formulation.
1982-10-01
cycle organization is also appropriate for another reason. The source material for the case studies is the work of the two contractors who participated in... working version of the system exist. The integration phase takes the pieces developed and combines them into a single working system. Interfaces...hardware, developed separately from the software, is united with the software, and further testing is performed until the system is a working whole
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ERIC Educational Resources Information Center
Trenberth, Linda
2005-01-01
This paper serves as an introduction to this issue focused on the importance of work-life balance. Developments at work, in organizations and in society at large are drawing attention to the importance of work-life balance. Work-life balance cannot be understood unless we continue to understand the role that leisure plays in this relationship.…
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Supervised Fieldwork and the Development of Counseling Skills.
ERIC Educational Resources Information Center
Lutwak, Nita; Scheffler, Linda W.
1991-01-01
Examines the relationship between field work and counseling skill development for 73 trainees from 2 master's level counseling programs with different field-work requirements. Trainees with field-work experience respond differently than do inexperienced trainees, with greater empathy, better formulation of clinical impressions, and the ability to…
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7 CFR 1781.3 - Authorities, responsibilities, and delegation of authority.
Code of Federal Regulations, 2011 CFR
2011-01-01
... AND WATERSHED (WS) LOANS AND ADVANCES § 1781.3 Authorities, responsibilities, and delegation of... developing WS and RCD area plans and for individual RCD measures or projects and watershed works of improvement. The watershed work plan for developing, operating, and maintaining watershed works of improvement...
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7 CFR 1781.3 - Authorities, responsibilities, and delegation of authority.
Code of Federal Regulations, 2013 CFR
2013-01-01
... AND WATERSHED (WS) LOANS AND ADVANCES § 1781.3 Authorities, responsibilities, and delegation of... developing WS and RCD area plans and for individual RCD measures or projects and watershed works of improvement. The watershed work plan for developing, operating, and maintaining watershed works of improvement...
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7 CFR 1781.3 - Authorities, responsibilities, and delegation of authority.
Code of Federal Regulations, 2012 CFR
2012-01-01
... AND WATERSHED (WS) LOANS AND ADVANCES § 1781.3 Authorities, responsibilities, and delegation of... developing WS and RCD area plans and for individual RCD measures or projects and watershed works of improvement. The watershed work plan for developing, operating, and maintaining watershed works of improvement...
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7 CFR 1781.3 - Authorities, responsibilities, and delegation of authority.
Code of Federal Regulations, 2014 CFR
2014-01-01
... AND WATERSHED (WS) LOANS AND ADVANCES § 1781.3 Authorities, responsibilities, and delegation of... developing WS and RCD area plans and for individual RCD measures or projects and watershed works of improvement. The watershed work plan for developing, operating, and maintaining watershed works of improvement...
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Development of the Competitive Work Environment Scale: A Multidimensional Climate Construct
ERIC Educational Resources Information Center
Fletcher, Thomas D.; Nusbaum, David N.
2010-01-01
Recent research suggests that competitive work environments may influence individual's attitudes, behaviors, stress, and performance. Unfortunately, adequate measures of competitive environments are lacking. This article traces the development of a new multidimensional competitive work environment scale. An initial 59-item pool covering five…
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ERIC Educational Resources Information Center
Walker, Karen
2010-01-01
According to Johnson and Johnson, group work helps increase student retention and satisfaction, develops strong oral communication and social skills, as well as higher self-esteem (University of Minnesota, n.d.). Group work, when planned and implemented deliberately and thoughtfully helps students develop cognitive and leadership skills as well as…
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Critically Reflective Work Behavior of Health Care Professionals
ERIC Educational Resources Information Center
de Groot, Esther; Jaarsma, Debbie; Endedijk, Maaike; Mainhard, Tim; Lam, Ineke; Simons, Robert-Jan; van Beukelen, Peter
2012-01-01
Introduction: Better understanding of critically reflective work behavior (CRWB), an approach for work-related informal learning, is important in order to gain more profound insight in the continuing development of health care professionals. Methods: A survey, developed to measure CRWB and its predictors, was distributed to veterinary…
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-06-18
... improve professional development for personnel working with infants, toddlers, and preschool children with... development system so that all personnel providing services to infants, toddlers, and preschool children with... professional development system for personnel working with infants, toddlers, and preschool children with...
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Young, Pat; Moule, Pam; Evans, David; Simmons, Sue; Crack, Meg; Mayo, Gillian
2012-07-01
This article describes an innovative initiative to support partnership working between trade unions and management in three National Health Service Trusts, by means of shared participation in a series of learning and development days. Although there is existing evidence, within the literature on partnership, of the benefits of partnership working for employees and employers, there is little discussion of processes by which effective partnership is developed. More specifically, there is no current academic literature on the role of education in enabling improved partnership working between trade unions and managers. The findings of the evaluation suggest that the pilot provided a successful learning experience as well as a number of pointers for improving future developments of this nature. The recommendations include embedding of partnership work within existing staff development processes. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Development and Evaluation of the Method with an Affective Interface for Promoting Employees' Morale
NASA Astrophysics Data System (ADS)
Fujino, Hidenori; Ishii, Hirotake; Shimoda, Hiroshi; Yoshikawa, Hidekazu
For the sustainable society, organization management not based on the mass production and mass consumption but having the flexibility to meet to various social needs precisely is required. For realizing such management, the emploees' work morale is required. Recently, however, the emploees' work morale is tend to decrease. Therefore, in this study, the authors developed the model of the method for promoting and keeping employees' work morale effectively and efficiently. Especially the authors thought “work morale” of “attitude to the work”. Based on this idea, it could be considered that the theory of the persuasion psychology and various persuasion techniques. Therefore, the model of the method applying the character agent was developed based on the forced compliance which is one of persuasion techniques based on the theory of the cognitive dissonance. By the evaluation experiment using human subjects, it was confirmed that developed method could improve workers' work morle effectively.
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Neonatal nurses' perceptions of a work-based learning approach.
Stanley, Helen; Simmons, Susanne
2011-09-01
To examine how senior neonatal nurses perceive their experience of a continuing professional development module on their practice. A qualitative approach was used. Focus group interviews were held with five senior neonatal nurses at band 6 and 7. Discussions were taped and transcribed verbatim and field notes captured non-verbal communication. Four themes emerged: work-based learning as a new way of learning; barriers to learning at work; professional role development; and complexities of evaluating such learning. Work-based learning emerged as an active form of learning that can develop personal and professional skills required in the neonatal workforce.
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Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.
Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C
2015-08-01
This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.
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Tong, Lian; Shinohara, Ryoji; Sugisawa, Yuka; Tanaka, Emiko; Maruyama, Akiko; Sawada, Yuko; Ishi, Yukiko; Anme, Tokie
2009-10-01
This paper is a report of a longitudinal study of the relationship of working mothers' parenting style to their children's social competence and vocabulary/ motor/intellectual development. With an increasing number of women choosing to remain in the workforce after starting a family, there has been a concomitant increase in use of non-parental childcare facilities to help look after the child while the mother is at work. This increase in non-parental care has led to a dramatic change in the traditional child-rearing environment. Long-term investigations were conducted over a period of 2 years in 41 Japanese government-licensed childcare facilities. Child development was evaluated by childcare professionals and parenting style was assessed by questionnaire. A total of 504 children and their mothers participated in the study. Data collection was carried out in 2004 and 2006. We found that the changes in parenting style were statistically significantly related to children's development after 2 years. For instance, changes in the parent-child playing routine contributed to the child's social competence (odds ratio = 11.088). Variation in working mothers' disciplinary practices was also associated with children's vocabulary development after 2 years (odds ratio = 2246). Working mothers should increase interactions with their children in their free time to reduce the risk of developmental delay. Daily childcare support provided by family members or social organizations for long-term working mothers is helpful in mediating the negative relationship of mothers' working with children's development.
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Luo, Shi-Xiang; Liu, Jun-E; Cheng, Andy S K; Xiao, Shu-Qin; Su, Ya-Li; Feuerstein, Michael
2018-02-14
Aim To determine whether breast cancer survivors (BCS) at work following the diagnosis and/or treatment of breast cancer, in a rapidly developing country such as China experience similar to return to work challenges as reported in nations with established return to work (RTW) policy and procedures for employees with cancer. Methods Semi-structured interviews were conducted with 16 BCS who returned to work following diagnosis and/or primary cancer treatment. An Interpretative Phenomenological Analysis was used to investigate responses. Results Three recurring themes emerged: (1) challenges at work related to residual effects of diagnosis and/or primary treatment; (2) positive and negative responses from employers and/or supervisors; and (3) positive and negative responses from co-workers/colleagues. Although several participants experienced a high level of workplace support, there was a subgroup that did report challenges related to symptom burden, cognitive limitations, and both positive and negative responses by employers and co-workers were reported. Conclusions Findings indicate similar challenges in BCS who RTW during and/or following cancer treatment in both rapidly developing and developed nations. Results suggest that regardless of the existence of workplace policies and practices related to RTW for workers with a history of cancer, a subgroup of BCS experience similar challenges when returning to work. These findings highlight the international nature of RTW challenges and suggest the need for more global efforts to develop and evaluate workplace interventions to assist with these similarities.
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[Quality of psychological strain in police work--development of a taxonomy of sources of stress].
Reinecke, Stefan; Runde, Bernd; Bastians, Frauke; Weiss, Udo; Heuft, Gereon; Bär, Olaf
2007-01-01
Police officers frequently face traumatic stressors of different origins and thus bear an increased risk of developing a post-traumatic stress disorder. The most mentally burdening situations range from shootings, death of fellow officers, dealing with dead bodies in general, the effects of shift work, time pressure or discontent with management due to mobbing. Part of the present study examines the quality of stress in police work with the goal of developing a taxonomy of the origins of stress. A stratified sample of 109 police officers participated in the study. They were interviewed about stressful situations in their work life. In the interviews participants generated incidents describing stressful or straining situations. These incidents were used to develop a taxonomy of stressful situations in everyday police work. A further 22 interviews with officers of the federal police were carried out to examine the transferability of the developed taxonomy to other occupational groups. The taxonomy distinguishes between five sources of strain. Strain can arise from (1.) the task itself, (2.) the organization and structure of work, (3.) the temporal conditions and (4.) the social conditions. The fifth category describes the source of strain based on other conditions. The results also show that the taxonomy is transferable to other occupational groups. This taxonomy leads to the systematisation of the differences among the stress phenomena which occur in police work. The results can help in the development of practical prevention, counselling and therapeutic programs.
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Finding a Fit or Developing It: Implicit Theories About Achieving Passion for Work.
Chen, Patricia; Ellsworth, Phoebe C; Schwarz, Norbert
2015-10-01
"Passion for work" has become a widespread phrase in popular discourse. Two contradictory lay perspectives have emerged on how passion for work is attained, which we distill into the fit and develop implicit theories. Fit theorists believe that passion for work is achieved through finding the right fit with a line of work; develop theorists believe that passion is cultivated over time. Four studies examined the expectations, priorities, and outcomes that characterize these implicit theories. Our results show that these beliefs elicit different motivational patterns, but both can facilitate vocational well-being and success. This research extends implicit theory scholarship to the work domain and provides a framework that can fruitfully inform career advising, life coaching, mentorship, and employment policies. © 2015 by the Society for Personality and Social Psychology, Inc.
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Collaborative Online Teaching: A Model for Gerontological Social Work Education
ERIC Educational Resources Information Center
Fulton, Amy E.; Walsh, Christine A.; Azulai, Anna; Gulbrandsen, Cari; Tong, Hongmei
2015-01-01
Social work students and faculty are increasingly embracing online education and collaborative teaching. Yet models to support these activities have not been adequately developed. This paper describes how a team of instructors developed, delivered, and evaluated an undergraduate gerontological social work course using a collaborative online…
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Learning and Language: Supporting Group Work so Group Work Supports Learning
ERIC Educational Resources Information Center
Mylett, Terri; Gluck, Russell
2005-01-01
This paper reports on developments in teaching and learning for first year employment relations students at the University of Wollongong based on creating conditions of learning informed by Vygotsky's "zone of proximal development" theory. Essentially, this meant emphasising collaborative learning (group work) in the lecture theatre and…
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Education and Training for Work. Volume 1--Planning Programs.
ERIC Educational Resources Information Center
Campbell, Clifton P., Ed.
This book, which is intended for practicing or aspiring instructors, curriculum developers, and others engaged in work force development at the secondary and postsecondary levels, contains eight papers explaining how to plan education and training for work. The following papers are included: "Determining the Market Demand for Skilled Workers"…
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ERIC Educational Resources Information Center
Bosch, Gerhard
1990-01-01
Reviews developments in the shortened work week in the Federal Republic of Germany. Discusses collective agreements and examines the methods used to implement the shorter working week at enterprise level and possible developments in the reunited Germany. (JOW)
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Working Memory Underpins Cognitive Development, Learning, and Education
ERIC Educational Resources Information Center
Cowan, Nelson
2014-01-01
Working memory is the retention of a small amount of information in a readily accessible form. It facilitates planning, comprehension, reasoning, and problem solving. I examine the historical roots and conceptual development of the concept and the theoretical and practical implications of current debates about working memory mechanisms. Then, I…
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Teachers' Working Conditions. Findings from "The Condition of Education, 1996," No. 7.
ERIC Educational Resources Information Center
Choy, Susan P.
Working conditions play an important role in a school's ability to attract, develop, and retain effective teachers. Data presented here describe a number of aspects of teachers' working conditions, including workload, compensation, school and district support for teachers' professional development, school decision making, school safety, student…
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Guidelines on Pregnancy and Work. Research Report.
ERIC Educational Resources Information Center
American Coll. of Obstetricians and Gynecologists, Chicago, IL.
Presented in seven sections, these guidelines developed largely by physicians are designed to protect the pregnant worker's health. As defined in section I, the guidelines seek to aid the pregnant worker's physician to develop recommendations for job placement, work continuation during pregnancy, and return to work following delivery. In section…
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Work-Engaged Learning: Towards a Paradigm Shift in Assessment
ERIC Educational Resources Information Center
Yorke, Mantz
2011-01-01
Student engagement with the world of work or voluntary service has become increasingly prominent in higher education curricula as nations and states seek competitive advantage for their economies. Developments in assessment have lagged behind developments in curricula. It is argued that the incorporation of work-engaged learning into curricula…
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Teaching Pragmatic Psychodynamic Psychotherapy to Graduate Social Work Students
ERIC Educational Resources Information Center
Duncan-Daston, Rana; Schneller, Debora
2016-01-01
Evolving developments in psychodynamic theory have strengthened it as an evidence-based approach and have made it concordant with social work's strengths-based, multicultural perspective. An elective focused on teaching fundamental concepts of psychodynamic psychotherapy was developed for graduate social work students based on Kolb's theory of…
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The Significance of Government-Education Partnerships in China's Social Work Education
ERIC Educational Resources Information Center
Fengzhi, Ma
2013-01-01
The author traces the history of government role in the development of social work education in China. She analyzes the nature and significance of government-education partnership in the development of social work education and professionalization, and points to the future direction of such collaboration.
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Development of the Student Affairs Officers Work Environment Perception Scale
ERIC Educational Resources Information Center
Haynes, Derrick E.
2010-01-01
The qualitative and quantitative study developed and validated a questionnaire to measure Student Affairs Officers' (SAO) perceptions of the work environment. A review of the literature identified five major categories and 25 elements having an impact on SAOs' perceptions of the work environment. The test instrument (questionnaire) was developed…
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Manned remote work station development article, executive summary
NASA Technical Reports Server (NTRS)
1979-01-01
The mission requirements for the manned remote work station (MRWS) flight article and the manned remote work station open cherry picker development test article is defined. Considerations are given for the near, mid, and far term use of the MRWS with emphasis on its ultimate application: constructing the Solar Power Satellite.
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Developing a Postgraduate Work-Based Curriculum Using an Intervention Mapping Approach
ERIC Educational Resources Information Center
Stewart, Victoria; Campbell, Matthew; Wheeler, Amanda J.
2016-01-01
Advanced practitioner skill development has become an important focus in health service delivery as increasingly complex consumer needs, practice environments and national professional registration requirements impact on professional work practices. Increasingly, work-based or workplace learning experiences are being seen as an effective means for…
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The Contribution of Work-Integrated Learning to Undergraduate Employability Skill Outcomes
ERIC Educational Resources Information Center
Jackson, Denise
2013-01-01
WIL has attracted considerable attention as an instrument for enhancing professional practice and developing work-readiness in new graduates. It is widely considered as a point of difference in developing graduate employability by enhancing skill outcomes, such as team-work, communication, self-management and problem solving, employment prospects…
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Combining Education and Work; Experiences in Asia and Oceania: Malaysia.
ERIC Educational Resources Information Center
Murugasu, V.
Work oriented education has been tied to national development in Malaysia since the 1960's. Increasing population, unemployment, and shortages of skilled manpower led the government to relate education more closely to work and develop technical and vocational education. Malaysia extended basic education to lower secondary manpower needs; and…
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ERIC Educational Resources Information Center
Creed, Peter A.; Patton, Wendy; Hood, Michelle
2010-01-01
We surveyed 506 Australian high school students on career development (exploration, planning, job-knowledge, decision-making, indecision), personal functioning (well-being, self-esteem, life satisfaction, school satisfaction) and control variables (parent education, school achievement), and tested differences among work-bound, college-bound and…