Effort-based cost-benefit valuation and the human brain

PubMed Central

Croxson, Paula L; Walton, Mark E; O'Reilly, Jill X; Behrens, Timothy EJ; Rushworth, Matthew FS

2010-01-01

In both the wild and the laboratory, animals' preferences for one course of action over another reflect not just reward expectations but also the cost in terms of effort that must be invested in pursuing the course of action. The ventral striatum and dorsal anterior cingulate cortex (ACCd) are implicated in the making of cost-benefit decisions in the rat but there is little information about how effort costs are processed and influence calculations of expected net value in other mammals including the human. We carried out a functional magnetic resonance imaging (fMRI) study to determine whether and where activity in the human brain was available to guide effort-based cost-benefit valuation. Subjects were scanned while they performed a series of effortful actions to obtain secondary reinforcers. At the beginning of each trial, subjects were presented with one of eight different visual cues which they had learned indicated how much effort the course of action would entail and how much reward could be expected at its completion. Cue-locked activity in the ventral striatum and midbrain reflected the net value of the course of action, signaling the expected amount of reward discounted by the amount of effort to be invested. Activity in ACCd also reflected the interaction of both expected reward and effort costs. Posterior orbitofrontal and insular activity, however, only reflected the expected reward magnitude. The ventral striatum and anterior cingulate cortex may be the substrate of effort-based cost-benefit valuation in primates as well as in rats. PMID:19357278

Expected net benefit of vaccinating rangeland sheep against bluetongue virus using a modified-live versus killed virus vaccine

USDA-ARS?s Scientific Manuscript database

Recurring outbreaks of bluetongue virus in large rangeland sheep flocks in the Intermountain West of the United States have prompted questions about the economic benefits and costs of vaccinating individual flocks against bluetongue disease. We use enterprise budgets and stochastic simulation to est...

Cost-benefit analysis of hospital based postpartum vaccination with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap).

PubMed

Ding, Yao; Yeh, Sylvia H; Mink, Chris Anna M; Zangwill, Kenneth M; Allred, Norma J; Hay, Joel W

2013-05-24

To assess the economic benefits associated with hospital-based postpartum Tdap (combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination. A decision tree model was constructed to calculate the potential cost-benefit of this strategy from both a health care system and a societal perspective. Probabilities and costs were derived from published literature, data reported to Centers for Disease Control and Prevention, and recommendations from expert panels. The maternal vaccination protection period for infants was defined as 7 months, and 10 years of waning immunity following Tdap for birth mothers was estimated in the model. All cost estimates were inflated to year 2012 US dollars and discounted at a 3% annual discount rate. In the base case from a societal perspective, the expected costs per vaccinated and unvaccinated mother were estimated at $129.27 and $187.97, respectively, suggesting an expected net benefit of $58.70 per vaccinated mother. The overall societal benefits in the cohort of 3.6 million U.S. birth mothers ranged from $52.8-126.8 million, depending on the vaccination coverage level. If including direct medical costs only, the strategy would not generate net savings from a health care system perspective. Annual incidence of pertussis in birth mothers and Tdap efficacy exhibited substantial impact on the model as shown in one-way and two-way sensitivity analyses. Although postpartum Tdap vaccination is not cost-beneficial from a health care system perspective in the base case, this strategy is likely to generate net benefits from a societal perspective. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cost Benefit of Comprehensive Primary and Preventive School-Based Health Care.

PubMed

Padula, William V; Connor, Katherine A; Mueller, Josiah M; Hong, Jonathan C; Velazquez, Gabriela Calderon; Johnson, Sara B

2018-01-01

The Rales Health Center is a comprehensive school-based health center at an urban elementary/middle school. Rales Health Center provides a full range of pediatric services using an enriched staffing model consisting of pediatrician, nurse practitioner, registered nurses, and medical office assistant. This staffing model provides greater care but costs more than traditional school-based health centers staffed by part-time nurses. The objective was to analyze the cost benefit of Rales Health Center enhanced staffing model compared with a traditional school-based health center (standard care), focusing on asthma care, which is among the most prevalent chronic conditions of childhood. In 2016, cost-benefit analysis using a decision tree determined the net social benefit of Rales Health Center compared with standard care from the U.S. societal perspective based on the 2015-2016 academic year. It was assumed that Rales Health Center could handle greater patient throughput related to asthma, decreased prescription costs, reduced parental resources in terms of missed work time, and improved student attendance. Univariate and multivariate probabilistic sensitivity analyses were conducted. The expected cost to operate Rales Health Center was $409,120, compared with standard care cost of $172,643. Total monetized incremental benefits of Rales Health Center were estimated to be $993,414. The expected net social benefit for Rales Health Center was $756,937, which demonstrated substantial societal benefit at a return of $4.20 for every dollar invested. This net social benefit estimate was robust to sensitivity analyses. Despite the greater cost associated with the Rales Health Center's enhanced staffing model, the results of this analysis highlight the cost benefit of providing comprehensive, high-quality pediatric care in schools, particularly schools with a large proportion of underserved students. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The Use of Economic Evaluation to Inform Newborn Screening Policy Decisions: The Washington State Experience.

PubMed

Grosse, Scott D; Thompson, John D; Ding, Yao; Glass, Michael

2016-06-01

Newborn screening not only saves lives but can also yield net societal economic benefit, in addition to benefits such as improved quality of life to affected individuals and families. Calculations of net economic benefit from newborn screening include the monetary equivalent of avoided deaths and reductions in costs of care for complications associated with late-diagnosed individuals minus the additional costs of screening, diagnosis, and treatment associated with prompt diagnosis. Since 2001 the Washington State Department of Health has successfully implemented an approach to conducting evidence-based economic evaluations of disorders proposed for addition to the state-mandated newborn screening panel. Economic evaluations can inform policy decisions on the expansion of newborn screening panels. This article documents the use of cost-benefit models in Washington State as part of the rule-making process that resulted in the implementation of screening for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and 4 other metabolic disorders in 2004, cystic fibrosis (CF) in 2006, 15 other metabolic disorders in 2008, and severe combined immune deficiency (SCID) in 2014. We reviewed Washington State Department of Health internal reports and spreadsheet models of expected net societal benefit of adding disorders to the state newborn screening panel. We summarize the assumptions and findings for 2 models (MCAD and CF) and discuss them in relation to findings in the peer-reviewed literature. The MCAD model projected a benefit-cost ratio of 3.4 to 1 based on assumptions of a 20.0 percentage point reduction in infant mortality and a 13.9 percentage point reduction in serious developmental disability. The CF model projected a benefit-cost ratio of 4.0-5.4 to 1 for a discount rate of 3%-4% and a plausible range of 1-2 percentage point reductions in deaths up to age 10 years. The Washington State cost-benefit models of newborn screening were broadly consistent with peer-reviewed literature, and their findings of net benefit appear to be robust to uncertainty in parameters. Public health newborn screening programs can develop their own capacity to project expected costs and benefits of expansion of newborn screening panels, although it would be most efficient if this capacity were shared among programs. © 2016 Milbank Memorial Fund.

Potential benefits from a successful solar thermal program

NASA Technical Reports Server (NTRS)

Terasawa, K. L.; Gates, W. R.

1982-01-01

Solar energy systems were investigated which complement nuclear and coal technologies as a means of reducing the U.S. dependence on imported petroleum. Solar Thermal Energy Systems (STES) represents an important category of solar energy technologies. STES can be utilized in a broad range of applications servicing a variety of economic sectors, and they can be deployed in both near-term and long-term markets. The net present value of the energy cost savings attributable to electric utility and IPH applications of STES were estimated for a variety of future energy cost scenarios and levels of R&D success. This analysis indicated that the expected net benefits of developing an STES option are significantly greater than the expected costs of completing the required R&D. In addition, transportable fuels and chemical feedstocks represent a substantial future potential market for STES. Due to the basic nature of this R&D activity, however, it is currently impossible to estimate the value of STES in these markets. Despite this fact, private investment in STES R&D is not anticipated due to the high level of uncertainty characterizing the expected payoffs.

Wildfire effects on hiking and biking demand in New Mexico: a travel cost study.

PubMed

Hesseln, Hayley; Loomis, John B; González-Cabán, Armando; Alexander, Susan

2003-12-01

We use a travel cost model to test the effects of wild and prescribed fire on visitation by hikers and mountain bikers in New Mexico. Our results indicate that net benefits for mountain bikers is $150 per trip and that they take an average of 6.2 trips per year. Hikers take 2.8 trips per year with individual net benefits per trip of $130. Both hikers' and mountain bikers' demand functions react adversely to prescribed burning. Net benefits for both groups fall as areas recover from prescribed burns. Because both visitation and annual recreation benefits decrease to these two types of visitors, this gives rise to multiple use costs associated with prescribed burning. With respect to wildfire, hikers and mountain bikers both exhibit decreased visitation as areas recover from wildfires, however, only hikers indicate an increase in per trip net benefits. Bikers' demand effectively drops to zero. These results differ from previous findings in the literature and have implications for efficient implementation of the National Fire Plan and whether prescribed burning is a cost effective tool for multiple use management of National Forests. Specifically, that fire and recreation managers cannot expect recreation users to react similarly to fire across recreation activities, or different geographic regions. What is cost effective in one region may not be so in another.

The potential benefits of a new poliovirus vaccine for long-term poliovirus risk management.

PubMed

Duintjer Tebbens, Radboud J; Thompson, Kimberly M

2016-12-01

To estimate the incremental net benefits (INBs) of a hypothetical ideal vaccine with all of the advantages and no disadvantages of existing oral and inactivated poliovirus vaccines compared with current vaccines available for future outbreak response. INB estimates based on expected costs and polio cases from an existing global model of long-term poliovirus risk management. Excluding the development costs, an ideal poliovirus vaccine could offer expected INBs of US$1.6 billion. The ideal vaccine yields small benefits in most realizations of long-term risks, but great benefits in low-probability-high-consequence realizations. New poliovirus vaccines may offer valuable insurance against long-term poliovirus risks and new vaccine development efforts should continue as the world gathers more evidence about polio endgame risks.

The Use of Economic Evaluation to Inform Newborn Screening Policy Decisions: The Washington State Experience

PubMed Central

THOMPSON, JOHN D.; DING, YAO; GLASS, MICHAEL

2016-01-01

Policy Points: Newborn screening not only saves lives but can also yield net societal economic benefit, in addition to benefits such as improved quality of life to affected individuals and families.Calculations of net economic benefit from newborn screening include the monetary equivalent of avoided deaths and reductions in costs of care for complications associated with late‐diagnosed individuals minus the additional costs of screening, diagnosis, and treatment associated with prompt diagnosis.Since 2001 the Washington State Department of Health has successfully implemented an approach to conducting evidence‐based economic evaluations of disorders proposed for addition to the state‐mandated newborn screening panel. Context Economic evaluations can inform policy decisions on the expansion of newborn screening panels. This article documents the use of cost‐benefit models in Washington State as part of the rule‐making process that resulted in the implementation of screening for medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency and 4 other metabolic disorders in 2004, cystic fibrosis (CF) in 2006, 15 other metabolic disorders in 2008, and severe combined immune deficiency (SCID) in 2014. Methods We reviewed Washington State Department of Health internal reports and spreadsheet models of expected net societal benefit of adding disorders to the state newborn screening panel. We summarize the assumptions and findings for 2 models (MCAD and CF) and discuss them in relation to findings in the peer‐reviewed literature. Findings The MCAD model projected a benefit‐cost ratio of 3.4 to 1 based on assumptions of a 20.0 percentage point reduction in infant mortality and a 13.9 percentage point reduction in serious developmental disability. The CF model projected a benefit‐cost ratio of 4.0‐5.4 to 1 for a discount rate of 3%‐4% and a plausible range of 1‐2 percentage point reductions in deaths up to age 10 years. Conclusions The Washington State cost‐benefit models of newborn screening were broadly consistent with peer‐reviewed literature, and their findings of net benefit appear to be robust to uncertainty in parameters. Public health newborn screening programs can develop their own capacity to project expected costs and benefits of expansion of newborn screening panels, although it would be most efficient if this capacity were shared among programs. PMID:27265561

Solar thermal technologies - Potential benefits to U.S. utilities and industry

NASA Technical Reports Server (NTRS)

Terasawa, K. L.; Gates, W. R.

1983-01-01

Solar energy systems were investigated which complement nuclear and coal technologies as a means of reducing the U.S. dependence on imported petroleum. Solar Thermal Energy Systems (STES) represents an important category of solar energy technologies. STES can be utilized in a broad range of applications servicing a variety of economic sectors, and they can be deployed in both near-term and long-term markets. The net present value of the energy cost savings attributable to electric utility and IPH applications of STES were estimated for a variety of future energy cost scenarios and levels of R&D success. This analysis indicated that the expected net benefits of developing an STES option are significantly greater than the expected costs of completing the required R&D. In addition, transportable fuels and chemical feedstocks represent a substantial future potential market for STES. Due to the basic nature of this R&D activity, however, it is currently impossible to estimate the value of STES in these markets. Despite this fact, private investment in STES R&D is not anticipated due to the high level of uncertainty characterizing the expected payoffs. Previously announced in STAR as N83-10547

Cost-Effectiveness/Cost-Benefit Analysis of Newborn Screening for Severe Combined Immune Deficiency in Washington State.

PubMed

Ding, Yao; Thompson, John D; Kobrynski, Lisa; Ojodu, Jelili; Zarbalian, Guisou; Grosse, Scott D

2016-05-01

To evaluate the expected cost-effectiveness and net benefit of the recent implementation of newborn screening (NBS) for severe combined immunodeficiency (SCID) in Washington State. We constructed a decision analysis model to estimate the costs and benefits of NBS in an annual birth cohort of 86 600 infants based on projections of avoided infant deaths. Point estimates and ranges for input variables, including the birth prevalence of SCID, proportion detected asymptomatically without screening through family history, screening test characteristics, survival rates, and costs of screening, diagnosis, and treatment were derived from published estimates, expert opinion, and the Washington NBS program. We estimated treatment costs stratified by age of identification and SCID type (with or without adenosine deaminase deficiency). Economic benefit was estimated using values of $4.2 and $9.0 million per death averted. We performed sensitivity analyses to evaluate the influence of key variables on the incremental cost-effectiveness ratio (ICER) of net direct cost per life-year saved. Our model predicts an additional 1.19 newborn infants with SCID detected preclinically through screening, in addition to those who would have been detected early through family history, and 0.40 deaths averted annually. Our base-case model suggests an ICER of $35 311 per life-year saved, and a benefit-cost ratio of either 5.31 or 2.71. Sensitivity analyses found ICER values <$100 000 and positive net benefit for plausible assumptions on all variables. Our model suggests that NBS for SCID in Washington is likely to be cost-effective and to show positive net economic benefit. Published by Elsevier Inc.

Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force.

PubMed

Dehmer, Steven P; Maciosek, Michael V; Flottemesch, Thomas J; LaFrance, Amy B; Whitlock, Evelyn P

2016-06-21

Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages. To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups. Decision analysis using a microsimulation model. 3 systematic evidence reviews. Men and women aged 40 to 79 years with a 10-year CVD risk of 20% or less, and no history of CVD and without elevated risk for GI or cerebral hemorrhages that would contraindicate aspirin use. Lifetime, 20 years, and 10 years. Clinical. Low-dose aspirin (≤100 mg/d). Primary outcomes are length and quality of life measured in net life-years and quality-adjusted life-years. Benefits include reduced nonfatal myocardial infarction, nonfatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increased fatal and nonfatal GI bleeding and hemorrhagic stroke. Lifetime net quality-adjusted life-years are positive for most adults initiating aspirin at ages 40 to 69 years, and life expectancy gains are expected for most men and women initiating aspirin at ages 40 to 59 years and 60 to 69 years with higher CVD risk. Harms may exceed benefits for persons starting aspirin in their 70s and for many during the first 10 to 20 years of use. Results are most sensitive to the relative risk for hemorrhagic stroke and CVD mortality but are affected by all relative risk estimates, baseline GI bleeding incidence and case-fatality rates, and disutilities associated with aspirin use. Aspirin effects by age are uncertain. Stroke benefits are conservatively estimated. Gastrointestinal bleeding incidence and case-fatality rates account only for age and sex. Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit. Agency for Healthcare Research and Quality.

Supporting Dynamic Spectrum Access in Heterogeneous LTE+ Networks

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

Luiz A. DaSilva; Ryan E. Irwin; Mike Benonis

As early as 2014, mobile network operators’ spectral capac- ity is expected to be overwhelmed by the demand brought on by new devices and applications. With Long Term Evo- lution Advanced (LTE+) networks likely as the future one world 4G standard, network operators may need to deploy a Dynamic Spectrum Access (DSA) overlay in Heterogeneous Networks (HetNets) to extend coverage, increase spectrum efficiency, and increase the capacity of these networks. In this paper, we propose three new management frameworks for DSA in an LTE+ HetNet: Spectrum Accountability Client, Cell Spectrum Management, and Domain Spectrum Man- agement. For these spectrum managementmore » frameworks, we define protocol interfaces and operational signaling scenar- ios to support cooperative sensing, spectrum lease manage- ment, and alarm scenarios for rule adjustment. We also quan- tify, through integer programs, the benefits of using DSA in an LTE+ HetNet, that can opportunistically reuse vacant TV and GSM spectrum. Using integer programs, we consider a topology using Geographic Information System data from the Blacksburg, VA metro area to assess the realistic benefits of DSA in an LTE+ HetNet.« less

The cost-benefit of genomic testing of heifers and using sexed semen in pasture-based dairy herds.

PubMed

Newton, J E; Hayes, B J; Pryce, J E

2018-07-01

Recent improvements in dairy cow fertility and female reproductive technologies offer an opportunity to apply greater selection pressure to females. This means there may be greater incentive to obtain genomic breeding values for females. We modeled the impact of changes to key parameters on the net benefit from genomic testing of heifer calves with and without usage of sexed semen. This paper builds on earlier cost-benefit studies but uses parameters relevant to pasture-based systems. A deterministic model was used to evaluate the effect on net benefit due to changes in (1) reproduction rate, (2) genomic test costs, (3) availability of parent-derived breeding values (EBV PA ), and (4) replacement rate. When the use of sexed semen was included, we also considered (1) the proportion of heifers and cows mated to sexed semen, (2) decreases in conception rate in inseminations with sexed semen, and (3) the marginal return for surplus heifers. Scenarios with lower replacement rates and no availability of EBV PA had the largest net benefits. Under current Australian parameters, the net benefit of genomic testing realized over the lifetime of genotyped heifers is expected to range from A$204 to A$1,124 per 100 cows for a herd with median reproductive performance. The cost of a genomic test, a perceived barrier to many farmers, had only a small effect on net benefit. Genomic testing alone was always more profitable than using sexed semen and genomic testing together if the only benefit considered was increased genetic gain in heifer replacements. When other benefits (i.e., the higher sale price of a surplus heifer compared with a male calf) were considered, there were combinations of parameters where net benefit from using sexed semen and genomic testing was higher than the equivalent scenario with genomic testing only. Using sexed semen alongside genomic testing is most likely to be profitable when (1) used in heifers, (2) the marginal return for selling surplus heifers (sale price minus rearing costs) is greater than A$400, and (3) conception rates of no more than 10 percentage points lower than those achieved using conventional semen can be realized. Net benefit was highly dependent on the marginal return. Demonstrating that the initial investment in genomic testing can be recouped within the lifetime of the heifers tested may assist in the development of extension messages to explain the value of genomic testing females at the herd level. The Authors. Published by FASS Inc. and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services--A Cost Benefit Analysis.

PubMed

De Gruyter, Elaine; Ford, Greg; Stavreski, Bill

2016-02-01

Cardiac rehabilitation can reduce mortality, improve cardiac risk factor profile and reduce readmissions; yet uptake remains low at 30%. This research aims to investigate the social and economic impact of increasing the uptake of cardiac rehabilitation in Victoria, Australia using cost benefit analysis (CBA). Cost benefit analysis has been undertaken over a 10-year period to analyse three scenarios: (1) Base Case: 30% uptake; (2) Scenario 1: 50% uptake; and (3) Scenario 2: 65% uptake. Impacts considered include cardiac rehabilitation program costs, direct inpatient costs, other healthcare costs, burden of disease, productivity losses, informal care costs and net deadweight loss. There is a net financial saving of $46.7-$86.7 million under the scenarios. Compared to the Base Case, an additional net benefit of $138.9-$227.2 million is expected. This results in a Benefit Cost Ratio of 5.6 and 6.8 for Scenarios 1 and 2 respectively. Disability Adjusted Life Years were 21,117-37,565 years lower than the Base Case. Greater uptake of cardiac rehabilitation can reduce the burden of disease, directly translating to benefits for society and the economy. This research supports the need for greater promotion, routine referral to be made standard practice and implementation of reforms to boost uptake. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Decision theory and the evaluation of risks and benefits of clinical trials.

PubMed

Bernabe, Rosemarie D C; van Thiel, Ghislaine J M W; Raaijmakers, Jan A M; van Delden, Johannes J M

2012-12-01

Research ethics committees (RECs) are tasked to assess the risks and the benefits of a clinical trial. In previous studies, it was shown that RECs find this task difficult, if not impossible, to do. The current approaches to benefit-risk assessment (i.e. Component Analysis and the Net Risk Test) confound the various risk-benefit tasks, and as such, make balancing impossible. In this article, we show that decision theory, specifically through the expected utility theory and multiattribute utility theory, enable for an explicit and ethically weighted risk-benefit evaluation. This makes a balanced ethical justification possible, and thus a more rationally defensible decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

Strategies for Efficient Computation of the Expected Value of Partial Perfect Information

PubMed Central

Madan, Jason; Ades, Anthony E.; Price, Malcolm; Maitland, Kathryn; Jemutai, Julie; Revill, Paul; Welton, Nicky J.

2014-01-01

Expected value of information methods evaluate the potential health benefits that can be obtained from conducting new research to reduce uncertainty in the parameters of a cost-effectiveness analysis model, hence reducing decision uncertainty. Expected value of partial perfect information (EVPPI) provides an upper limit to the health gains that can be obtained from conducting a new study on a subset of parameters in the cost-effectiveness analysis and can therefore be used as a sensitivity analysis to identify parameters that most contribute to decision uncertainty and to help guide decisions around which types of study are of most value to prioritize for funding. A common general approach is to use nested Monte Carlo simulation to obtain an estimate of EVPPI. This approach is computationally intensive, can lead to significant sampling bias if an inadequate number of inner samples are obtained, and incorrect results can be obtained if correlations between parameters are not dealt with appropriately. In this article, we set out a range of methods for estimating EVPPI that avoid the need for nested simulation: reparameterization of the net benefit function, Taylor series approximations, and restricted cubic spline estimation of conditional expectations. For each method, we set out the generalized functional form that net benefit must take for the method to be valid. By specifying this functional form, our methods are able to focus on components of the model in which approximation is required, avoiding the complexities involved in developing statistical approximations for the model as a whole. Our methods also allow for any correlations that might exist between model parameters. We illustrate the methods using an example of fluid resuscitation in African children with severe malaria. PMID:24449434

Net reclassification index at event rate: properties and relationships.

PubMed

Pencina, Michael J; Steyerberg, Ewout W; D'Agostino, Ralph B

2017-12-10

The net reclassification improvement (NRI) is an attractively simple summary measure quantifying improvement in performance because of addition of new risk marker(s) to a prediction model. Originally proposed for settings with well-established classification thresholds, it quickly extended into applications with no thresholds in common use. Here we aim to explore properties of the NRI at event rate. We express this NRI as a difference in performance measures for the new versus old model and show that the quantity underlying this difference is related to several global as well as decision analytic measures of model performance. It maximizes the relative utility (standardized net benefit) across all classification thresholds and can be viewed as the Kolmogorov-Smirnov distance between the distributions of risk among events and non-events. It can be expressed as a special case of the continuous NRI, measuring reclassification from the 'null' model with no predictors. It is also a criterion based on the value of information and quantifies the reduction in expected regret for a given regret function, casting the NRI at event rate as a measure of incremental reduction in expected regret. More generally, we find it informative to present plots of standardized net benefit/relative utility for the new versus old model across the domain of classification thresholds. Then, these plots can be summarized with their maximum values, and the increment in model performance can be described by the NRI at event rate. We provide theoretical examples and a clinical application on the evaluation of prognostic biomarkers for atrial fibrillation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

What Influences Young Canadians to Pursue Post-Secondary Studies? Final Report

ERIC Educational Resources Information Center

Dubois, Julie

2002-01-01

This paper uses the theory of human capital to model post-secondary education enrolment decisions. The model is based on the assumption that high school graduates assess the costs and benefits associated with various levels of post-secondary education (college or university) and select the option that maximizes the expected net present value.…

Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise.

PubMed

Mewes, Janne C; Steuten, Lotte M G; IJsbrandy, Charlotte; IJzerman, Maarten J; van Harten, Wim H

2017-12-01

To increase the adherence of health professionals and cancer survivors to evidence-based physical exercise, effective implementation strategies (ISTs) are required. To examine to what extent these ISTs provide value for money and which IST has the highest expected value. The net benefit framework of health economic evaluations is used to conduct a value-of-implementation analysis of nine ISTs. Seven are directed to health professionals and two to cancer survivors. The analysis consists of four steps: 1) analyzing the expected value of perfect implementation (EVPIM); 2) assessing the estimated costs of the various ISTs; 3) comparing the ISTs' costs with the EVPIM; and 4) assessing the total net benefit (TNB) of the ISTs. These steps are followed to identify which strategy has the greatest value. The EVPIM for physical exercise in the Netherlands is €293 million. The total costs for the ISTs range from €34,000 for printed educational materials for professionals to €120 million for financial incentives for patients, and thus all are cost-effective. The TNB of the ISTs that are directed to professionals ranges from €5.7 million for printed educational materials to €30.9 million for reminder systems. Of the strategies that are directed to patients, only the motivational program had a positive net benefit of €100.4 million. All the ISTs for cancer survivors, except for financial incentives, had a positive TNB. The largest improvements in adherence were created by a motivational program for patients, followed by a reminder system for professionals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Expected Net Present Value of Developing Weight Management Drugs in the Context of Drug Safety Litigation.

PubMed

Chawla, Anita; Carls, Ginger; Deng, Edmund; Tuttle, Edward

2015-07-01

Following withdrawals, failures, and significant litigation settlements, drug product launches in the anti-obesity category slowed despite a large and growing unmet need. Litigation concerns, a more risk-averse regulatory policy, and the difficulty of developing a product with a compelling risk-benefit profile in this category may have limited innovators' expected return on investment and restricted investment in this therapeutic area. The objective of the study was to estimate perceived manufacturer risk associated with product safety litigation and increased development costs vs. revenue expectations on anticipated return on investment and to determine which scenarios might change a manufacturer's investment decision. Expected net present value of a weight-management drug entering pre-clinical trials was calculated for a range of scenarios representing evolving expectations of development costs, revenue, and litigation risk over the past 25 years. These three factors were based on published estimates, historical data, and analogs from other therapeutic areas. The main driver in expected net present value calculations is expected revenue, particularly if one assumes that litigation risk and demand are positively correlated. Changes in development costs associated with increased regulatory concern with potential safety issues for the past 25 years likely did not impact investment decisions. Regulatory policy and litigation risk both played a role in anti-obesity drug development; however, product revenue-reflecting efficacy at acceptable levels of safety-was by far the most important factor. To date, relatively modest sales associated with recent product introductions suggest that developing a product that is sufficiently efficacious with an acceptable level of safety continues to be the primary challenge in this market.

The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis

PubMed Central

Manca, Andrea; Claxton, Karl; Sculpher, Mark J.

2014-01-01

This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. PMID:24944196

The value of heterogeneity for cost-effectiveness subgroup analysis: conceptual framework and application.

PubMed

Espinoza, Manuel A; Manca, Andrea; Claxton, Karl; Sculpher, Mark J

2014-11-01

This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. © The Author(s) 2014.

Long-term economic benefits attributed to IVF-conceived children: a lifetime tax calculation.

PubMed

Connolly, Mark P; Pollard, Michael S; Hoorens, Stijn; Kaplan, Brian R; Oskowitz, Selwyn P; Silber, Sherman J

2008-09-01

To evaluate whether lifetime future net tax revenues from an in vitro fertilization (IVF)-conceived child are substantial enough to warrant public subsidy relative to the mean IVF treatment costs required to obtain 1 live birth. Mathematical generational accounting model. The model estimates direct financial interactions between the IVF-conceived child and the government during the child's projected lifetime. In the model, we accrue IVF costs required to conceive the child to the government, and then we estimate future net tax revenue to the federal and state governments from this individual, offset by direct financial transfers from the government (eg, child allowances, education, Medicare, and Social Security). We discount lifetime costs and gross tax payments at Treasury Department rates to establish the present value of investing in IVF. We applied US Congressional Budget Office projected changes in tax rates over the course of the model. An IVF-conceived child, average in every respect (eg, future earnings, healthcare consumption, and life expectancy), represents a net positive return to the government. Based on an average employed individual born in 2005, the projected net lifetime tax contribution is US $606,200. Taking into consideration IVF costs and all direct financial interactions, the net present value is US $155,870. Lifetime net taxes paid from a child relative to the child's initial IVF investment represent a 700% net return to the government in discounted US dollars from fully employed individuals. This suggests that removing barriers to IVF would have positive tax benefits for the government, notwithstanding its beneficial effect on overall economic growth.

Lifetime distributional effects of Social Security retirement benefits.

PubMed

Smith, Karen; Toder, Eric; Iams, Howard

This article presents three measures of the distribution of actual and projected net benefits (benefits minus payroll taxes) from Social Security's Old-Age and Survivors Insurance (OASI) for people born between 1931 and 1960. The results are based on simulations with the Social Security Administration's Model of Income in the Near Term (MINT), which projects retirement income through 2020. The base sample for MINT is the U.S. Census Bureau's Survey of Income and Program Participation panels for 1990 to 1993, matched with Social Security administrative records. The study population is grouped into 5-year birth cohorts and then ranked by economic status in three ways. First, the population is divided into five groups on the basis of individual lifetime covered earnings, and their lifetime present values of OASI benefits received and payroll taxes paid are calculated. By this measure, OASI provides much higher benefits to the lowest quintile of earners than to other groups, but it becomes less redistributive toward lower earners in more recent birth cohorts. Second, people are ranked by shared lifetime covered earnings, and the values of shared benefits received and payroll taxes paid are computed. Individuals are assumed to split covered earnings, benefits, and payroll taxes with their spouses in the years they are married. By the shared covered earnings measure, OASI is still much more favorable to persons in the lower income quintiles, although to a lesser degree than when people are ranked by individual covered earnings. OASI becomes more progressive among recent cohorts, even as net lifetime benefits decline for the entire population. Finally, individuals are ranked on the basis of their shared permanent income from age 62, when they become eligible for early retirement benefits, until death. Their annual Social Security benefits are compared with the benefits they would have received if they had saved their payroll taxes in individual accounts and used the proceeds to buy either of two annuities that provide level payments from age 62 until death: a unisex annuity that is based on the average life expectancy of the birth cohort or an age-adjusted annuity that is based on the worker's own life expectancy. On the permanent income measure, OASI is generally more favorable to people in higher income quintiles. Moreover, it is particularly unfavorable to those in the lowest quintile. Because people in the lowest quintile have a shorter life expectancy, they receive OASI benefits for a shorter period. This group would receive greater benefits in retirement if they invested their payroll taxes in the age-adjusted annuity. OASI is more favorable to them than the unisex annuity, however, OASI is becoming more progressive in that the net benefits it provides drop more rapidly among higher income quintiles than lower ones. This article also examines how OASI affects individuals by educational attainment, race, and sex. On both the lifetime covered earnings and the permanent income measures, OASI is more favorable to workers with less education and more favorable to women. The results by race and ethnicity are mixed. When people are ranked by the present value of their shared lifetime covered earnings, OASI appears more favorable to non-Hispanic blacks and Hispanics than to non-Hispanic whites. When people are ranked by shared permanent income in retirement, however, OASI produces negative returns for both non-Hispanic blacks and non-Hispanic whites in the most recent birth cohorts, with non-Hispanic blacks faring relatively worse. The changes across cohorts occur partly because of changes in tax rates and benefits, but more importantly because of changing demographics and earnings patterns of the workforce. Of particular importance is the increasing share of beneficiaries who receive worker benefits instead of auxiliary benefits as wives or widows. OASI benefits are based on the lifetime covered earnings of current or former married couples, as well as on earned retirement benefits of individuals. The reduced importance of auxiliary benefits (due to the higher lifetime covered earnings of women) and the increased proportion of divorced retirees make OASI more progressive--even as net benefits decline--for current and future cohorts than for cohorts who retired in the 1990s. Analysis of these findings suggests that simulations of policy changes in Social Security must take into account the decreasing importance of auxiliary benefits across birth cohorts and the complex changes in individuals' marital histories.

Must research benefit human subjects if it is to be permissible?

PubMed Central

Wikler, Daniel

2017-01-01

Must medical experiments with human subjects offer them a ‘favourable risk-benefit ratio’, that is, more expectation of benefit than harm or burden, if they are to be judged as ethically justified? Ethical justification is easier for experiments that do offer net benefit to subjects, but ethical justification is possible also for some experiments that do not. Basic science experiments with healthy volunteers and ‘Phase I’ drug trials that seek to determine tolerable dosage levels are routinely approved by ethical review committees; moreover, guidance they receive from government funding agencies specifically asks them to weigh risks to subjects against benefits to subjects and also benefits to those who may benefit from the knowledge gained in the experiment. If a puzzle remains, it is why there remains any assumption that research ethics requires a ‘favourable risk-benefit ratio’ for the individual research subject. PMID:27573151

2018 Military Retirement Options: An Expected Net Present Value Decision Analysis Model

DTIC Science & Technology

2017-03-23

Decision Analysis Model Bret N. Witham Follow this and additional works at: https://scholar.afit.edu/etd Part of the Benefits and Compensation Commons...FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DISTRIBUTION STATEMENT A. APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED...Science in Operations Research Bret N. Witham, BS Captain, USAF March 2017 DISTRIBUTION STATEMENT A. APPROVED FOR PUBLIC RELEASE; DISTRIBUTION

Comparing diagnostic tests on benefit-risk.

PubMed

Pennello, Gene; Pantoja-Galicia, Norberto; Evans, Scott

2016-01-01

Comparing diagnostic tests on accuracy alone can be inconclusive. For example, a test may have better sensitivity than another test yet worse specificity. Comparing tests on benefit risk may be more conclusive because clinical consequences of diagnostic error are considered. For benefit-risk evaluation, we propose diagnostic yield, the expected distribution of subjects with true positive, false positive, true negative, and false negative test results in a hypothetical population. We construct a table of diagnostic yield that includes the number of false positive subjects experiencing adverse consequences from unnecessary work-up. We then develop a decision theory for evaluating tests. The theory provides additional interpretation to quantities in the diagnostic yield table. It also indicates that the expected utility of a test relative to a perfect test is a weighted accuracy measure, the average of sensitivity and specificity weighted for prevalence and relative importance of false positive and false negative testing errors, also interpretable as the cost-benefit ratio of treating non-diseased and diseased subjects. We propose plots of diagnostic yield, weighted accuracy, and relative net benefit of tests as functions of prevalence or cost-benefit ratio. Concepts are illustrated with hypothetical screening tests for colorectal cancer with test positive subjects being referred to colonoscopy.

Estimating the Economic Value of Information for Screening in Disseminating and Targeting Effective School-based Preventive Interventions: An Illustrative Example.

PubMed

Johnston, Stephen S; Salkever, David S; Ialongo, Nicholas S; Slade, Eric P; Stuart, Elizabeth A

2017-11-01

When candidates for school-based preventive interventions are heterogeneous in their risk of poor outcomes, an intervention's expected economic net benefits may be maximized by targeting candidates for whom the intervention is most likely to yield benefits, such as those at high risk of poor outcomes. Although increasing amounts of information about candidates may facilitate more accurate targeting, collecting information can be costly. We present an illustrative example to show how cost-benefit analysis results from effective intervention demonstrations can help us to assess whether improved targeting accuracy justifies the cost of collecting additional information needed to make this improvement.

Economic Effects of Introducing Alternative Salmonella Control Strategies in Sweden

PubMed Central

Sundström, Kristian; Wahlström, Helene; Ivarsson, Sofie; Sternberg Lewerin, Susanna

2014-01-01

The objective of the study was to analyse the economic effects of introducing alternative Salmonella control strategies in Sweden. Current control strategies in Denmark and the Netherlands were used as benchmarks. The true number of human Salmonella cases was estimated by reconstructing the reporting pyramids for the various scenarios. Costs were calculated for expected changes in human morbidity (Salmonella and two of its sequelae), for differences in the control programmes and for changes in cattle morbidity. The net effects (benefits minus costs) were negative in all scenarios (€ −5 to −105 million), implying that it would not be cost-effective to introduce alternative control strategies in Sweden. This result was mainly due to an expected increase in the incidence of Salmonella in humans (6035–57108 reported and unreported new cases/year), with expected additional costs of € 5–55 million. Other increased costs were due to expected higher incidences of sequelae (€ 3–49 million) and a higher cattle morbidity (€ 4–8 million). Benefits in terms of lower control costs amounted to € 4–7 million. PMID:24831797

The choice of sample size: a mixed Bayesian / frequentist approach.

PubMed

Pezeshk, Hamid; Nematollahi, Nader; Maroufy, Vahed; Gittins, John

2009-04-01

Sample size computations are largely based on frequentist or classical methods. In the Bayesian approach the prior information on the unknown parameters is taken into account. In this work we consider a fully Bayesian approach to the sample size determination problem which was introduced by Grundy et al. and developed by Lindley. This approach treats the problem as a decision problem and employs a utility function to find the optimal sample size of a trial. Furthermore, we assume that a regulatory authority, which is deciding on whether or not to grant a licence to a new treatment, uses a frequentist approach. We then find the optimal sample size for the trial by maximising the expected net benefit, which is the expected benefit of subsequent use of the new treatment minus the cost of the trial.

Use of net present value analysis to evaluate a publicly funded biomass-to-ethanol research, development, and demonstration program and valuate expected private sector participation.

PubMed

Hinman, N D; Yancey, M A

1998-01-01

One of the functions of government is to invest tax dollars in programs, projects, and properties that will result in greater public benefit than would have resulted from leaving the tax dollars in the private sector or using them to pay off the public debt. This paper describes the use of Net Present Value (NPV) as an approach to analyze and select investment opportunities for government money in public research, development, and demonstration (RD&D) programs and to evaluate potential private sector participation in the programs. This approach is then applied to a specific biomass-to-ethanol opportunity in California.

Individual and Population Benefits of Daily Aspirin Therapy: A Proposal for Personalizing National Guidelines

PubMed Central

Sussman, Jeremy B.; Johnson, Robert Wood; Vijan, Sandeep; Choi, HwaJung; Hayward, Rodney A.

2014-01-01

Background Clinical practice guidelines that help clinicians and patients understand the magnitude of expected individual risks and benefits would help patient-centered decision-making and prioritization of care. We assessed the net benefit from daily aspirin in individuals to estimate the individual and public health implications of a more individualized decision-making approach. Methods and Results We use data from the National Health and Nutrition Examination Survey (NHANES) representing all U.S. persons aged 30 to 85 years with no history of myocardial infarction and applied a Markov Model based on randomized evidence and published literature to estimate lifetime effects of aspirin treatment in quality adjusted life years (QALYs). We show that treatment benefit varies greatly by an individual's cardiovascular disease (CVD) risk. Almost all adults have fewer major clinical events on aspirin, but for most, events prevented would be so rare that even a very small distaste for aspirin use would make treatment inappropriate. With minimal dislike of aspirin use (disutility = 0.005 QALY per year), only those with a 10-year cardiac event risk greater than 6.1% would have a net benefit. A disutility of 0.01 QALY moves this benefit cut-point to 10.6%. Multiple factors altered the absolute benefit of aspirin, but the strong relationship between CVD risk and magnitude of benefit was robust. Conclusions The benefits of aspirin therapy depend substantially on an individual's risk of CVD and adverse treatment effects. Understanding who benefits from aspirin use and how much can help clinicians and patients develop a more patient-centered approach to preventive therapy. PMID:21487091

Net Efficacy Adjusted for Risk (NEAR): A Simple Procedure for Measuring Risk:Benefit Balance

PubMed Central

Boada, José N.; Boada, Carlos; García-Sáiz, Mar; García, Marcelino; Fernández, Eduardo; Gómez, Eugenio

2008-01-01

Background Although several mathematical models have been proposed to assess the risk:benefit of drugs in one measure, their use in practice has been rather limited. Our objective was to design a simple, easily applicable model. In this respect, measuring the proportion of patients who respond favorably to treatment without being affected by adverse drug reactions (ADR) could be a suitable endpoint. However, remarkably few published clinical trials report the data required to calculate this proportion. As an approach to the problem, we calculated the expected proportion of this type of patients. Methodology/Principal Findings Theoretically, responders without ADR may be obtained by multiplying the total number of responders by the total number of subjects that did not suffer ADR, and dividing the product by the total number of subjects studied. When two drugs are studied, the same calculation may be repeated for the second drug. Then, by constructing a 2×2 table with the expected frequencies of responders with and without ADR, and non-responders with and without ADR, the odds ratio and relative risk with their confidence intervals may be easily calculated and graphically represented on a logarithmic scale. Such measures represent “net efficacy adjusted for risk” (NEAR). We assayed the model with results extracted from several published clinical trials or meta-analyses. On comparing our results with those originally reported by the authors, marked differences were found in some cases, with ADR arising as a relevant factor to balance the clinical benefit obtained. The particular features of the adverse reaction that must be weighed against benefit is discussed in the paper. Conclusion NEAR representing overall risk-benefit may contribute to improving knowledge of drug clinical usefulness. As most published clinical trials tend to overestimate benefits and underestimate toxicity, our measure represents an effort to change this trend. PMID:18974868

Economic value of in vitro fertilization in Ukraine, Belarus, and Kazakhstan.

PubMed

Mandrik, Olena; Knies, Saskia; Severens, Johan L

2015-01-01

An economic value calculation was performed to estimate the lifetime net present value of in vitro fertilization (IVF) in Ukraine, Belarus, and Kazakhstan. Net lifetime tax revenues were used to represent governmental benefits accruing from a hypothetical cohort of an IVF population born in 2009 using the methodology of generational accounting. Governmental expenses related to this population included social benefits, education and health care, unemployment support, and pensions. Where available, country-specific data referencing official sources were applied. The average health care cost needed to achieve one additional birth from the governmental perspective varied from $2,599 in Ukraine to $5,509 in Belarus. The net present value from the population born using IVF was positive in all countries: for Ukraine ($9,839), Belarus ($21,702), and Kazakhstan ($2,295). The break-even costs of drugs and supplies per IVF procedure is expected to be $3,870, $8,530, and $1,780, respectively. Probabilistic sensitivity analyses based on 5,000 simulations show that the average net present value per person remains positive: $1,894±$7,619, $27,925±$12,407, and $17,229±$24,637 in Ukraine, Belarus, and Kazakhstan, respectively. Financing IVF may represent a good investment in terms of governmental financial returns, even in lower-income countries with state-financed health care systems such as Ukraine, Belarus, and Kazakhstan.

Economic value of in vitro fertilization in Ukraine, Belarus, and Kazakhstan

PubMed Central

Mandrik, Olena; Knies, Saskia; Severens, Johan L

2015-01-01

Background An economic value calculation was performed to estimate the lifetime net present value of in vitro fertilization (IVF) in Ukraine, Belarus, and Kazakhstan. Methods Net lifetime tax revenues were used to represent governmental benefits accruing from a hypothetical cohort of an IVF population born in 2009 using the methodology of generational accounting. Governmental expenses related to this population included social benefits, education and health care, unemployment support, and pensions. Where available, country-specific data referencing official sources were applied. Results The average health care cost needed to achieve one additional birth from the governmental perspective varied from $2,599 in Ukraine to $5,509 in Belarus. The net present value from the population born using IVF was positive in all countries: for Ukraine ($9,839), Belarus ($21,702), and Kazakhstan ($2,295). The break-even costs of drugs and supplies per IVF procedure is expected to be $3,870, $8,530, and $1,780, respectively. Probabilistic sensitivity analyses based on 5,000 simulations show that the average net present value per person remains positive: $1,894±$7,619, $27,925±$12,407, and $17,229±$24,637 in Ukraine, Belarus, and Kazakhstan, respectively. Conclusion Financing IVF may represent a good investment in terms of governmental financial returns, even in lower-income countries with state-financed health care systems such as Ukraine, Belarus, and Kazakhstan. PMID:26109873

Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space

PubMed Central

McCaffrey, Nikki; Agar, Meera; Harlum, Janeane; Karnon, Jonathon; Currow, David; Eckermann, Simon

2015-01-01

Introduction Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses—where outcomes are considered separately, with their joint relationship under uncertainty ignored—lead to incorrect inference regarding preferred strategies. Objective The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Methods Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. Results Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home ( 1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Conclusion Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and multiple effects under uncertainty across potential threshold values for effect, better informing net benefit assessment and related reimbursement and research decisions. PMID:25751629

Net Effects of Ecotourism on Threatened Species Survival

PubMed Central

Buckley, Ralf C.; Morrison, Clare; Castley, J. Guy

2016-01-01

Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data. PMID:26886876

Net Effects of Ecotourism on Threatened Species Survival.

PubMed

Buckley, Ralf C; Morrison, Clare; Castley, J Guy

2016-01-01

Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data.

Public reporting and pay-for-performance: safety-net hospital executives' concerns and policy suggestions.

PubMed

Goldman, L Elizabeth; Henderson, Stuart; Dohan, Daniel P; Talavera, Jason A; Dudley, R Adams

2007-01-01

Safety-net hospitals (SNHs) may gain little financial benefit from the rapidly spreading adoption of public reporting and pay-for-performance, but may feel compelled to participate (and bear the costs of data collection) to meet public expectations of transparency and accountability. To better understand the concerns that SNH administrators have regarding public reporting and pay-for-performance, we interviewed 37 executives at randomly selected California SNHs. The main concerns noted by SNH executives were that human and financial resource constraints made it difficult for SNHs to accurately measure their performance. Additionally, some executives felt that market-driven public reporting and pay-for-performance may focus on clinical areas and incentive structures that may not be high-priority clinical areas for SNHs. Executives at SNHs suggested several policy responses to these concerns-such as offering training programs for SNH data collectors-that could be relatively inexpensive and might improve the cost-benefit ratio of public reporting and pay-for-performance programs.

Assessing long-run economic benefits attributed to an IVF-conceived singleton based on projected lifetime net tax contributions in the UK.

PubMed

Connolly, M; Gallo, F; Hoorens, S; Ledger, W

2009-03-01

Over the past decade, demand for fertility treatments has increased as a result of delaying time to first pregnancy and growing awareness and acceptance of available treatment options. Despite increasing demand, health authorities often view infertility as a low health priority and consequently limit access to treatments by rationing and limiting funds. To assess the long-term economic benefits attributed to in vitro fertilization (IVF)-conceived children, we developed a health investment model to evaluate whether state-funded IVF programmes in the UK represent sound fiscal policies. Based on the average investment cost to conceive an IVF singleton, we describe the present value of net taxes derived from gross taxes paid minus direct government transfers received (e.g. education, health, pension) over the lifetime of the child. To establish the present value of investing in IVF, we have discounted all costs from benefits (i.e. lifetime taxes paid) using UK Treasury department rates based on a singleton delivery with similar characteristics for education, earnings, health and life expectancy to a naturally conceived child. The lifetime discounted value of net taxes from an IVF-conceived child with mother aged 35 is pound 109,939 compared with pound 122,127 for a naturally conceived child. The lifetime undiscounted net tax contribution for the IVF-conceived child and naturally conceived child are pound 603,000 and pound 616,000, respectively. An investment of pound 12,931 to achieve an IVF singleton is actually worth 8.5-times this amount to the UK Treasury in discounted future tax revenue. The analysis underscores that costs to the health sector are actually investments when a broader government perspective is considered over a longer period of time.

A cost-effectiveness analysis of hormone replacement therapy in the menopause.

PubMed

Cheung, A P; Wren, B G

1992-03-02

To evaluate the cost-effectiveness of hormone replacement therapy in the menopause with particular reference to osteoporotic fracture and myocardial infarction. The multiple-decrement form of the life table was the mathematical model used to follow women of age 50 through their lifetime under the "no hormone replacement" and "hormone replacement" assumptions. Standard demographic and health economic techniques were used to calculate the corresponding lifetime differences in direct health care costs (net costs in dollars) and health effects ("net effectiveness" in terms of life expectancy and quality, in "quality-adjusted life-years"). This was then expressed as a cost-effectiveness ratio or the cost ($) per quality-adjusted life-year (QALY) for each of the chosen hormone replacement regimens. All women of age 50 in New South Wales, Australia (n = 27,021). The analysis showed that the lifetime net increments in direct medical care costs were largely contributed by hormone drug and consultation costs. Hormone replacement was associated with increased quality-adjusted life expectancy, a large percentage of which was attributed to a relief of menopausal symptoms. Cost-effectiveness ratios ranged from under 10,000 to over a million dollars per QALY. Factors associated with improved cost-effectiveness were prolonged treatment duration, the presence of menopausal symptoms, minimum progestogen side effects (in the case of oestrogen with progestogen regimens), oestrogen use after hysterectomy and the inclusion of cardiac benefits in addition to fracture prevention. Hormone replacement therapy for symptomatic women is cost-effective when factors that enhance its efficiency are considered. Short-term treatment of asymptomatic women for prevention of osteoporotic fractures and myocardial infarction is an inefficient use of health resources. Cost-effectiveness of hormone replacement in asymptomatic women is dependent on the magnitude of cardiac benefits associated with hormone use and the treatment duration.

A Safe Zone for Veterans: Developing the VET NET Ally Program to Increase Faculty and Staff Awareness and Sensitivity to the Needs of Military Veterans in Higher Education

ERIC Educational Resources Information Center

Thomas, Marshall W.

2010-01-01

Given the increased educational benefits of the Post 9/11 G. I. Bill for veterans, and as the current conflicts in Iraq and Afghanistan wind down and the troops come home, the number of military veterans entering colleges and universities is expected to increase. As non-traditional students with significant life experience, often including combat,…

Survival Benefit of Lung Transplantation in the Modern Era of Lung Allocation.

PubMed

Vock, David M; Durheim, Michael T; Tsuang, Wayne M; Finlen Copeland, C Ashley; Tsiatis, Anastasios A; Davidian, Marie; Neely, Megan L; Lederer, David J; Palmer, Scott M

2017-02-01

Lung transplantation is an accepted and increasingly employed treatment for advanced lung diseases, but the anticipated survival benefit of lung transplantation is poorly understood. To determine whether and for which patients lung transplantation confers a survival benefit in the modern era of U.S. lung allocation. Data on 13,040 adults listed for lung transplantation between May 2005 and September 2011 were obtained from the United Network for Organ Sharing. A structural nested accelerated failure time model was used to model the survival benefit of lung transplantation over time. The effects of patient, donor, and transplant center characteristics on the relative survival benefit of transplantation were examined. Overall, 73.8% of transplant recipients were predicted to achieve a 2-year survival benefit with lung transplantation. The survival benefit of transplantation varied by native disease group (P = 0.062), with 2-year expected benefit in 39.2 and 98.9% of transplants occurring in those with obstructive lung disease and cystic fibrosis, respectively, and by lung allocation score at the time of transplantation (P < 0.001), with net 2-year benefit in only 6.8% of transplants occurring for lung allocation score less than 32.5 and in 99.9% of transplants for lung allocation score exceeding 40. A majority of adults undergoing transplantation experience a survival benefit, with the greatest potential benefit in those with higher lung allocation scores or restrictive native lung disease or cystic fibrosis. These results provide novel information to assess the expected benefit of lung transplantation at an individual level and to enhance lung allocation policy.

Green roof adoption in atlanta, georgia: the effects of building characteristics and subsidies on net private, public, and social benefits.

PubMed

Mullen, Jeffrey D; Lamsal, Madhur; Colson, Greg

2013-10-01

This research draws on and expands previous studies that have quantified the costs and benefits associated with conventional roofs versus green roofs. Using parameters from those studies to define alternative scenarios, we estimate from a private, public, and social perspective the costs and benefits of installing and maintaining an extensive green roof in Atlanta, GA. Results indicate net private benefits are a decreasing function of roof size and vary considerably across scenarios. In contrast, net public benefits are highly stable across scenarios, ranging from $32.49 to $32.90 m(-2). In addition, we evaluate two alternative subsidy regimes: (i) a general subsidy provided to every building that adopts a green roof and (ii) a targeted subsidy provided only to buildings for which net private benefits are negative but net public benefits are positive. In 6 of the 12 general subsidy scenarios the optimal public policy is not to offer a subsidy; in 5 scenarios the optimal subsidy rate is between $20 and $27 m(-2); and in 1 scenario the optimal rate is $5 m(-2). The optimal rate with a targeted subsidy is between $20 and $27 m(-2) in 11 scenarios and no subsidy is optimal in the twelfth. In most scenarios, a significant portion of net public benefits are generated by buildings for which net private benefits are positive. This suggests a policy focused on information dissemination and technical assistance may be more cost-effective than direct subsidy payments.

A cost-benefit analysis of the outpatient smoking cessation services in Taiwan from a societal viewpoint.

PubMed

Chen, Pei-Ching; Lee, Yue-Chune; Tsai, Shih-Tzu; Lai, Chih-Kuan

2012-05-01

This study applied a cost-benefit analysis from a societal viewpoint to evaluate the Outpatient Smoking Cessation Services (OSCS) program. The costs measured in this study include the cost to the health sector, non-health sectors, the patients and their family, as well as the loss of productivity as a result of smoking. The benefits measured the medical costs savings and the earnings due to the increased life expectancy of a person that has stopped smoking for 15 years. Data were obtained from the primary data of a telephone survey, the literatures and reports from the Outpatient Smoking Cessation Management Center and government. Sensitivity analyses were conducted to verify the robustness of the results. There were 169,761 cases that participated in the outpatient smoking cessation program in the years 2007 and 2008, of those cases, 8,282 successfully stopped smoking. The total cost of the OSCS program was 18 million USD. The total benefits of the program were 215 million USD with a 3% discount rate; the net benefit to society was 196 million USD. After conducting sensitivity analyses on the different abstinence, relapse, and discount rates, from a societal perspective, the benefits still far exceeded the costs, while from a health care perspective, there was only a net benefit when the respondent's abstinence rate was used. From a societal perspective, the OSCS program in Taiwan is cost-beneficial. This study provides partial support for the policy makers to increase the budget and expand the OSCS program.

A cost-benefit analysis of The National Map

USGS Publications Warehouse

Halsing, David L.; Theissen, Kevin; Bernknopf, Richard

2003-01-01

The Geography Discipline of the U.S. Geological Survey (USGS) has conducted this cost-benefit analysis (CBA) of The National Map. This analysis is an evaluation of the proposed Geography Discipline initiative to provide the Nation with a mechanism to access current and consistent digital geospatial data. This CBA is a supporting document to accompany the Exhibit 300 Capital Asset Plan and Business Case of The National Map Reengineering Program. The framework for estimating the benefits is based on expected improvements in processing information to perform any of the possible applications of spatial data. This analysis does not attempt to determine the benefits and costs of performing geospatial-data applications. Rather, it estimates the change in the differences between those benefits and costs with The National Map and the current situation without it. The estimates of total costs and benefits of The National Map were based on the projected implementation time, development and maintenance costs, rates of data inclusion and integration, expected usage levels over time, and a benefits estimation model. The National Map provides data that are current, integrated, consistent, complete, and more accessible in order to decrease the cost of implementing spatial-data applications and (or) improve the outcome of those applications. The efficiency gains in per-application improvements are greater than the cost to develop and maintain The National Map, meaning that the program would bring a positive net benefit to the Nation. The average improvement in the net benefit of performing a spatial data application was multiplied by a simulated number of application implementations across the country. The numbers of users, existing applications, and rates of application implementation increase over time as The National Map is developed and accessed by spatial data users around the country. Results from the 'most likely' estimates of model parameters and data inputs indicate that, over its 30-year projected lifespan, The National Map will bring a net present value (NPV) of benefits of $2.05 billion in 2001 dollars. The average time until the initial investments (the break-even period) are recovered is 14 years. Table ES-1 shows a running total of NPV in each year of the simulation model. In year 14, The National Map first shows a positive NPV, and so the table is highlighted in gray after that point. Figure ES-1 is a graph of the total benefit and total cost curves of a single model run over time. The curves cross in year 14, when the project breaks even. A sensitivity analysis of the input variables illustrated that these results of the NPV of The National Map are quite robust. Figure ES-2 plots the mean NPV results from 60 different scenarios, each consisting of fifty 30-year runs. The error bars represent a two-standard-deviation range around each mean. The analysis that follows contains the details of the cost-benefit analysis, the framework for evaluating economic benefits, a computational simulation tool, and a sensitivity analysis of model variables and values.

76 FR 16657 - Demand Response Compensation in Organized Wholesale Energy Markets

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-24

... demand response resource is cost-effective as determined by the net benefits test described in this rule... Net Benefits Test..... 38 (c) Standardization or Regional Variations in 43 Compensation 3. Commission Determination 45 B. Implementation of a Net Benefits Test 68 1. Comments 68 2. Commission Determination 78 C...

Cost Of Compliance On Munitions Consolidation From Lualualei To West Loch

DTIC Science & Technology

2017-12-01

from the perspective of the Department of Defense in order to capture all costs and benefits associated with the Army and Navy, the main stakeholders...weaknesses of the available alternative options. The model identifies tangible costs and benefits to estimate a net present value for each option. To...the robustness of the average net present value and to show the probability of net costs exceeding the net benefits . The analysis conducted in this

Prioritizing health system and disease burden factors: an evaluation of the net benefit of transferring health technology interventions to different districts in Zimbabwe.

PubMed

Shamu, Shepherd; Rusakaniko, Simbarashe; Hongoro, Charles

2016-01-01

Health-care technologies (HCTs) play an important role in any country's health-care system. Zimbabwe's health-care system uses a lot of HCTs developed in other countries. However, a number of local factors have affected the absorption and use of these technologies. We therefore set out to test the hypothesis that the net benefit regression framework (NBRF) could be a helpful benefit testing model that enables assessment of intra-national variables in HCT transfer. We used an NBRF model to assess the benefits of transferring cost-effective technologies to different jurisdictions. We used the country's 57 administrative districts to proxy different jurisdictions. For the dependent variable, we combined the cost and effectiveness ratios with the districts' per capita health expenditure. The cost and effectiveness ratios were obtained from HIV/AIDS and malaria randomized controlled trials, which did either a prospective or retrospective cost-effectiveness analysis. The independent variables were district demographic and socioeconomic determinants of health. The study showed that intra-national variation resulted in different net benefits of the same health technology intervention if implemented in different districts in Zimbabwe. The study showed that population data, health data, infrastructure, demographic and health-seeking behavior had significant effects on the net margin benefit for the different districts. The net benefits also differed in terms of magnitude as a result of the local factors. Net benefit testing using local data is a very useful tool for assessing the transferability and further adoption of HCTs developed elsewhere. However, adopting interventions with a positive net benefit should also not be an end in itself. Information on positive or negative net benefit could also be used to ascertain either the level of future savings that a technology can realize or the level of investment needed for the particular technology to become beneficial.

Climate change impacts on US agriculture and forestry: benefits of global climate stabilization

NASA Astrophysics Data System (ADS)

Beach, Robert H.; Cai, Yongxia; Thomson, Allison; Zhang, Xuesong; Jones, Russell; McCarl, Bruce A.; Crimmins, Allison; Martinich, Jeremy; Cole, Jefferson; Ohrel, Sara; DeAngelo, Benjamin; McFarland, James; Strzepek, Kenneth; Boehlert, Brent

2015-09-01

Increasing atmospheric carbon dioxide levels, higher temperatures, altered precipitation patterns, and other climate change impacts have already begun to affect US agriculture and forestry, with impacts expected to become more substantial in the future. There have been numerous studies of climate change impacts on agriculture or forestry, but relatively little research examining the long-term net impacts of a stabilization scenario relative to a case with unabated climate change. We provide an analysis of the potential benefits of global climate change mitigation for US agriculture and forestry through 2100, accounting for landowner decisions regarding land use, crop mix, and management practices. The analytic approach involves a combination of climate models, a crop process model (EPIC), a dynamic vegetation model used for forests (MC1), and an economic model of the US forestry and agricultural sector (FASOM-GHG). We find substantial impacts on productivity, commodity markets, and consumer and producer welfare for the stabilization scenario relative to unabated climate change, though the magnitude and direction of impacts vary across regions and commodities. Although there is variability in welfare impacts across climate simulations, we find positive net benefits from stabilization in all cases, with cumulative impacts ranging from 32.7 billion to 54.5 billion over the period 2015-2100. Our estimates contribute to the literature on potential benefits of GHG mitigation and can help inform policy decisions weighing alternative mitigation and adaptation actions.

"It is about how the net looks": a qualitative study of perceptions and practices related to mosquito net care and repair in two districts in eastern Uganda.

PubMed

Scandurra, Leah; Acosta, Angela; Koenker, Hannah; Kibuuka, Daniel Musoke; Harvey, Steven

2014-12-17

Prolonging net durability has important implications for reducing both malaria transmission and the frequency of net replacement. Protective behaviour, such as net care and repair, offers promise for improving net integrity and durability. Given the potential cost-savings and public health benefit associated with extending the useful life of long-lasting insecticidal nets (LLINs), prevention and mitigation of damage will become ever more critical to ensuring adequate net coverage at the population level. A qualitative assessment was conducted in two districts in central eastern Uganda in September 2013. Data on household net care and repair behaviour, attitudes and practices were collected from 30 respondents through in-depth interviews (IDIs), observations, photos, and video to gather an in-depth understanding of these behaviours. Net damage was common and the most cited causes were children and rodents. Responses revealed strong social norms about net cleanliness and aesthetics, and strong expectations that others should care for and repair their own nets. Respondents were receptive and able to repair nets, though longer-term repair methods, such as sewing and patching, were not as commonly reported or observed. Self-reported behaviour was not always consistent with observed or demonstrated behaviour, revealing potential misconceptions and the need for clear and consistent net care and repair messaging. Respondents considered both aesthetics and malaria protection important when deciding whether, when, and how to care for and repair nets. BCC should continue to emphasize the importance of maintaining net integrity for malaria prevention purposes as well as for maintaining aesthetic appeal. Additional research is needed, particularly surrounding washing, drying, daily storage routines, and gender roles in care and repair, in order to understand the complexity of these behaviours, and refine existing or develop new behaviour change communication (BCC) messages for net care and repair.

Must research benefit human subjects if it is to be permissible?

PubMed

Wikler, Daniel

2017-02-01

Must medical experiments with human subjects offer them a 'favourable risk-benefit ratio', that is, more expectation of benefit than harm or burden, if they are to be judged as ethically justified? Ethical justification is easier for experiments that do offer net benefit to subjects, but ethical justification is possible also for some experiments that do not. Basic science experiments with healthy volunteers and 'Phase I' drug trials that seek to determine tolerable dosage levels are routinely approved by ethical review committees; moreover, guidance they receive from government funding agencies specifically asks them to weigh risks to subjects against benefits to subjects and also benefits to those who may benefit from the knowledge gained in the experiment. If a puzzle remains, it is why there remains any assumption that research ethics requires a 'favourable risk-benefit ratio' for the individual research subject. 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/.

Estimating the Expected Value of Sample Information Using the Probabilistic Sensitivity Analysis Sample

PubMed Central

Oakley, Jeremy E.; Brennan, Alan; Breeze, Penny

2015-01-01

Health economic decision-analytic models are used to estimate the expected net benefits of competing decision options. The true values of the input parameters of such models are rarely known with certainty, and it is often useful to quantify the value to the decision maker of reducing uncertainty through collecting new data. In the context of a particular decision problem, the value of a proposed research design can be quantified by its expected value of sample information (EVSI). EVSI is commonly estimated via a 2-level Monte Carlo procedure in which plausible data sets are generated in an outer loop, and then, conditional on these, the parameters of the decision model are updated via Bayes rule and sampled in an inner loop. At each iteration of the inner loop, the decision model is evaluated. This is computationally demanding and may be difficult if the posterior distribution of the model parameters conditional on sampled data is hard to sample from. We describe a fast nonparametric regression-based method for estimating per-patient EVSI that requires only the probabilistic sensitivity analysis sample (i.e., the set of samples drawn from the joint distribution of the parameters and the corresponding net benefits). The method avoids the need to sample from the posterior distributions of the parameters and avoids the need to rerun the model. The only requirement is that sample data sets can be generated. The method is applicable with a model of any complexity and with any specification of model parameter distribution. We demonstrate in a case study the superior efficiency of the regression method over the 2-level Monte Carlo method. PMID:25810269

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

PubMed

Eckermann, Simon; Willan, Andrew R

2013-05-01

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

Reserpine-induced Reduction in Norepinephrine Transporter Function Requires Catecholamine Storage Vesicles

PubMed Central

Mandela, Prashant; Chandley, Michelle; Xu, Yao-Yu; Zhu, Meng-Yang; Ordway, Gregory A.

2010-01-01

Treatment of rats with reserpine, an inhibitor of the vesicular monoamine transporter (VMAT), depletes norepinephrine (NE) and regulates NE transporter (NET) expression. The present study examined the molecular mechanisms involved in regulation of the NET by reserpine using cultured cells. Exposure of rat PC12 cells to reserpine for a period as short as 5 min decreased [3H]NE uptake capacity, an effect characterized by a robust decrease in the Vmax of the transport of [3H]NE. As expected, reserpine did not displace the binding of [3H]nisoxetine from the NET in membrane homogenates. The potency of reserpine for reducing [3H]NE uptake was dramatically lower in SK-N-SH cells that have reduced storage capacity for catecholamines. Reserpine had no effect on [3H]NE uptake in HEK-293 cells transfected with the rat NET (293-hNET), cells that lack catecholamine storage vesicles. NET regulation by reserpine was independent of trafficking of the NET from the cell surface. Pre-exposure of cells to inhibitors of several intracellular signaling cascades known to regulate the NET, including Ca2+/Ca2+-calmodulin dependent kinase and protein kinases A, C and G, did not affect the ability of reserpine to reduce [3H]NE uptake. Treatment of PC12 cells with the catecholamine depleting agent, α-methyl-p-tyrosine, increased [3H]NE uptake and eliminated the inhibitory effects of reserpine on [3H]NE uptake. Reserpine non-competitively inhibits NET activity through a Ca2+-independent process that requires catecholamine storage vesicles, revealing a novel pharmacological method to modify NET function. Further characterization of the molecular nature of reserpine's action could lead to the development of alternative therapeutic strategies for treating disorders known to be benefitted by treatment with traditional competitive NET inhibitors. PMID:20176067

Cost-Benefit Analysis of a Support Program for Nursing Staff.

PubMed

Moran, Dane; Wu, Albert W; Connors, Cheryl; Chappidi, Meera R; Sreedhara, Sushama K; Selter, Jessica H; Padula, William V

2017-04-27

A peer-support program called Resilience In Stressful Events (RISE) was designed to help hospital staff cope with stressful patient-related events. The aim of this study was to evaluate the impact of the RISE program by conducting an economic evaluation of its cost benefit. A Markov model with a 1-year time horizon was developed to compare the cost benefit with and without the RISE program from a provider (hospital) perspective. Nursing staff who used the RISE program between 2015 and 2016 at a 1000-bed, private hospital in the United States were included in the analysis. The cost of running the RISE program, nurse turnover, and nurse time off were modeled. Data on costs were obtained from literature review and hospital data. Probabilities of quitting or taking time off with or without the RISE program were estimated using survey data. Net monetary benefit (NMB) and budget impact of having the RISE program were computed to determine cost benefit to the hospital. Expected model results of the RISE program found a net monetary benefit savings of US $22,576.05 per nurse who initiated a RISE call. These savings were determined to be 99.9% consistent on the basis of a probabilistic sensitivity analysis. The budget impact analysis revealed that a hospital could save US $1.81 million each year because of the RISE program. The RISE program resulted in substantial cost savings to the hospital. Hospitals should be encouraged by these findings to implement institution-wide support programs for medical staff, based on a high demand for this type of service and the potential for cost savings.

Using the weighted area under the net benefit curve for decision curve analysis.

PubMed

Talluri, Rajesh; Shete, Sanjay

2016-07-18

Risk prediction models have been proposed for various diseases and are being improved as new predictors are identified. A major challenge is to determine whether the newly discovered predictors improve risk prediction. Decision curve analysis has been proposed as an alternative to the area under the curve and net reclassification index to evaluate the performance of prediction models in clinical scenarios. The decision curve computed using the net benefit can evaluate the predictive performance of risk models at a given or range of threshold probabilities. However, when the decision curves for 2 competing models cross in the range of interest, it is difficult to identify the best model as there is no readily available summary measure for evaluating the predictive performance. The key deterrent for using simple measures such as the area under the net benefit curve is the assumption that the threshold probabilities are uniformly distributed among patients. We propose a novel measure for performing decision curve analysis. The approach estimates the distribution of threshold probabilities without the need of additional data. Using the estimated distribution of threshold probabilities, the weighted area under the net benefit curve serves as the summary measure to compare risk prediction models in a range of interest. We compared 3 different approaches, the standard method, the area under the net benefit curve, and the weighted area under the net benefit curve. Type 1 error and power comparisons demonstrate that the weighted area under the net benefit curve has higher power compared to the other methods. Several simulation studies are presented to demonstrate the improvement in model comparison using the weighted area under the net benefit curve compared to the standard method. The proposed measure improves decision curve analysis by using the weighted area under the curve and thereby improves the power of the decision curve analysis to compare risk prediction models in a clinical scenario.

Survival Benefit of Lung Transplantation in the Modern Era of Lung Allocation

PubMed Central

Tsuang, Wayne M.; Copeland, C. Ashley Finlen; Tsiatis, Anastasios A.; Davidian, Marie; Neely, Megan L.; Lederer, David J.; Palmer, Scott M.

2017-01-01

Rationale: Lung transplantation is an accepted and increasingly employed treatment for advanced lung diseases, but the anticipated survival benefit of lung transplantation is poorly understood. Objectives: To determine whether and for which patients lung transplantation confers a survival benefit in the modern era of U.S. lung allocation. Methods: Data on 13,040 adults listed for lung transplantation between May 2005 and September 2011 were obtained from the United Network for Organ Sharing. A structural nested accelerated failure time model was used to model the survival benefit of lung transplantation over time. The effects of patient, donor, and transplant center characteristics on the relative survival benefit of transplantation were examined. Measurements and Main Results: Overall, 73.8% of transplant recipients were predicted to achieve a 2-year survival benefit with lung transplantation. The survival benefit of transplantation varied by native disease group (P = 0.062), with 2-year expected benefit in 39.2 and 98.9% of transplants occurring in those with obstructive lung disease and cystic fibrosis, respectively, and by lung allocation score at the time of transplantation (P < 0.001), with net 2-year benefit in only 6.8% of transplants occurring for lung allocation score less than 32.5 and in 99.9% of transplants for lung allocation score exceeding 40. Conclusions: A majority of adults undergoing transplantation experience a survival benefit, with the greatest potential benefit in those with higher lung allocation scores or restrictive native lung disease or cystic fibrosis. These results provide novel information to assess the expected benefit of lung transplantation at an individual level and to enhance lung allocation policy. PMID:27779905

Joint distribution approaches to simultaneously quantifying benefit and risk.

PubMed

Shaffer, Michele L; Watterberg, Kristi L

2006-10-12

The benefit-risk ratio has been proposed to measure the tradeoff between benefits and risks of two therapies for a single binary measure of efficacy and a single adverse event. The ratio is calculated from the difference in risk and difference in benefit between therapies. Small sample sizes or expected differences in benefit or risk can lead to no solution or problematic solutions for confidence intervals. Alternatively, using the joint distribution of benefit and risk, confidence regions for the differences in risk and benefit can be constructed in the benefit-risk plane. The information in the joint distribution can be summarized by choosing regions of interest in this plane. Using Bayesian methodology provides a very flexible framework for summarizing information in the joint distribution. Data from a National Institute of Child Health & Human Development trial of hydrocortisone illustrate the construction of confidence regions and regions of interest in the benefit-risk plane, where benefit is survival without supplemental oxygen at 36 weeks postmenstrual age, and risk is gastrointestinal perforation. For the subgroup of infants exposed to chorioamnionitis the confidence interval based on the benefit-risk ratio is wide (Benefit-risk ratio: 1.52; 90% confidence interval: 0.23 to 5.25). Choosing regions of appreciable risk and acceptable risk in the benefit-risk plane confirms the uncertainty seen in the wide confidence interval for the benefit-risk ratio--there is a greater than 50% chance of falling into the region of acceptable risk--while visually allowing the uncertainty in risk and benefit to be shown separately. Applying Bayesian methodology, an incremental net health benefit analysis shows there is a 72% chance of having a positive incremental net benefit if hydrocortisone is used in place of placebo if one is willing to incur at most one gastrointestinal perforation for each additional infant that survives without supplemental oxygen. If the benefit-risk ratio is presented, the joint distribution of benefit and risk also should be shown. These regions avoid the ambiguity associated with collapsing benefit and risk to a single dimension. Bayesian methods allow even greater flexibility in simultaneously quantifying benefit and risk.

Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study.

PubMed

Banerjee, Amitava; Lane, Deirdre A; Torp-Pedersen, Christian; Lip, Gregory Y H

2012-03-01

The concept of net clinical benefit has been used to quantify the balance between risk of ischaemic stroke (IS) and risk of intracranial haemorrhage (ICH) with the use oral anticoagulant therapy (OAC) in the setting of non-valvular atrial fibrillation (AF), and has shown that patients at highest risk of stroke and thromboembolism gain the greatest benefit from OAC with warfarin. There are no data for the new OACs, that is, dabigatran, rivaroxaban and apixaban, as yet. We calculated the net clinical benefit balancing IS against ICH using data from the Danish National Patient Registry on patients with non-valvular AF between 1997-2008, for dabigatran, rivaroxaban and apixaban on the basis of recent clinical trial outcome data for these new OACs. In patients with CHADS(2)=0 but at high bleeding risk, apixaban and dabigatran 110 mg bid had a positive net clinical benefit. At CHA(2)DS(2)-VASc=1, apixaban and both doses of dabigatran (110 mg and 150 mg bid) had a positive net clinical benefit. In patients with CHADS(2) score≥1 or CHA(2)DS(2)-VASc≥2, the three new OACs (dabigatran, rivaroxaban and apixaban) appear superior to warfarin for net clinical benefit, regardless of risk of bleeding. When risk of bleeding and stroke are both high, all three new drugs appear to have a greater net clinical benefit than warfarin. In the absence of head-to-head trials for these new OACs, our analysis may help inform decision making processes when all these new OACs become available to clinicians for stroke prevention in AF. Using 'real world' data, our modelling analysis has shown that when the risk of bleeding and stroke are both high, all three new drugs appear to have a greater net clinical benefit compared to warfarin.

The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs.

PubMed

Eisenhauer, Philipp; Heckman, James J; Vytlacil, Edward

2015-04-01

The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college.

The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs*

PubMed Central

Eisenhauer, Philipp; Heckman, James J.; Vytlacil, Edward

2015-01-01

The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college. PMID:26709315

Evaluating Expected Costs and Benefits of Granting Access to New Treatments on the Basis of Progression-Free Survival in Non-Small-Cell Lung Cancer.

PubMed

Lakdawalla, Darius N; Chou, Jacquelyn W; Linthicum, Mark T; MacEwan, Joanna P; Zhang, Jie; Goldman, Dana P

2015-05-01

Surrogate end points may be used as proxy for more robust clinical end points. One prominent example is the use of progression-free survival (PFS) as a surrogate for overall survival (OS) in trials for oncologic treatments. Decisions based on surrogate end points may expedite regulatory approval but may not accurately reflect drug efficacy. Payers and clinicians must balance the potential benefits of earlier treatment access based on surrogate end points against the risks of clinical uncertainty. To present a framework for evaluating the expected net benefit or cost of providing early access to new treatments on the basis of evidence of PFS benefits before OS results are available, using non-small-cell lung cancer (NSCLC) as an example. A probabilistic decision model was used to estimate expected incremental social value of the decision to grant access to a new treatment on the basis of PFS evidence. The model analyzed a hypothetical population of patients with NSCLC who could be treated during the period between PFS and OS evidence publication. Estimates for delay in publication of OS evidence following publication of PFS evidence, expected OS benefit given PFS benefit, incremental cost of new treatment, and other parameters were drawn from the literature on treatment of NSCLC. Incremental social value of early access for each additional patient per month (in 2014 US dollars). For "medium-value" model parameters, early reimbursement of drugs with any PFS benefit yields an incremental social cost of more than $170,000 per newly treated patient per month. In contrast, granting early access on the basis of PFS benefit between 1 and 3.5 months produces more than $73,000 in incremental social value. Across the full range of model parameter values, granting access for drugs with PFS benefit between 3 and 3.5 months is robustly beneficial, generating incremental social value ranging from $38,000 to more than $1 million per newly treated patient per month, whereas access for all drugs with any PFS benefit is usually not beneficial. The value of providing access to new treatments on the basis of surrogate end points, and PFS in particular, likely varies considerably. Payers and clinicians should carefully consider how to use PFS data in balancing potential benefits against costs in each particular disease.

Risk assessment for invasive species produces net bioeconomic benefits

PubMed Central

Keller, Reuben P.; Lodge, David M.; Finnoff, David C.

2007-01-01

International commerce in live organisms presents a policy challenge for trade globalization; sales of live organisms create wealth, but some nonindigenous species cause harm. To reduce damage, some countries have implemented species screening to limit the introduction of damaging species. Adoption of new risk assessment (RA) technologies has been slowed, however, by concerns that RA accuracy remains insufficient to produce positive net economic benefits. This concern arises because only a small proportion of all introduced species escape, spread, and cause harm (i.e., become invasive), so a RA will exclude many noninvasive species (which provide a net economic benefit) for every invasive species correctly identified. Here, we develop a simple cost:benefit bioeconomic framework to quantify the net benefits from applying species prescreening. Because invasive species are rarely eradicated, and their damages must therefore be borne for long periods, we have projected the value of RA over a suitable range of policy time horizons (10–500 years). We apply the model to the Australian plant quarantine program and show that this RA program produces positive net economic benefits over the range of reasonable assumptions. Because we use low estimates of the financial damage caused by invasive species and high estimates of the value of species in the ornamental trade, our results underestimate the net benefit of the Australian plant quarantine program. In addition, because plants have relatively low rates of invasion, applying screening protocols to animals would likely demonstrate even greater benefits. PMID:17190819

Risk assessment for invasive species produces net bioeconomic benefits.

PubMed

Keller, Reuben P; Lodge, David M; Finnoff, David C

2007-01-02

International commerce in live organisms presents a policy challenge for trade globalization; sales of live organisms create wealth, but some nonindigenous species cause harm. To reduce damage, some countries have implemented species screening to limit the introduction of damaging species. Adoption of new risk assessment (RA) technologies has been slowed, however, by concerns that RA accuracy remains insufficient to produce positive net economic benefits. This concern arises because only a small proportion of all introduced species escape, spread, and cause harm (i.e., become invasive), so a RA will exclude many noninvasive species (which provide a net economic benefit) for every invasive species correctly identified. Here, we develop a simple cost:benefit bioeconomic framework to quantify the net benefits from applying species prescreening. Because invasive species are rarely eradicated, and their damages must therefore be borne for long periods, we have projected the value of RA over a suitable range of policy time horizons (10-500 years). We apply the model to the Australian plant quarantine program and show that this RA program produces positive net economic benefits over the range of reasonable assumptions. Because we use low estimates of the financial damage caused by invasive species and high estimates of the value of species in the ornamental trade, our results underestimate the net benefit of the Australian plant quarantine program. In addition, because plants have relatively low rates of invasion, applying screening protocols to animals would likely demonstrate even greater benefits.

Construction and Deciphering of Human Phosphorylation-Mediated Signaling Transduction Networks.

PubMed

Zhang, Menghuan; Li, Hong; He, Ying; Sun, Han; Xia, Li; Wang, Lishun; Sun, Bo; Ma, Liangxiao; Zhang, Guoqing; Li, Jing; Li, Yixue; Xie, Lu

2015-07-02

Protein phosphorylation is the most abundant reversible covalent modification. Human protein kinases participate in almost all biological pathways, and approximately half of the kinases are associated with disease. PhoSigNet was designed to store and display human phosphorylation-mediated signal transduction networks, with additional information related to cancer. It contains 11 976 experimentally validated directed edges and 216 871 phosphorylation sites. Moreover, 3491 differentially expressed proteins in human cancer from dbDEPC, 18 907 human cancer variation sites from CanProVar, and 388 hyperphosphorylation sites from PhosphoSitePlus were collected as annotation information. Compared with other phosphorylation-related databases, PhoSigNet not only takes the kinase-substrate regulatory relationship pairs into account, but also extends regulatory relationships up- and downstream (e.g., from ligand to receptor, from G protein to kinase, and from transcription factor to targets). Furthermore, PhoSigNet allows the user to investigate the impact of phosphorylation modifications on cancer. By using one set of in-house time series phosphoproteomics data, the reconstruction of a conditional and dynamic phosphorylation-mediated signaling network was exemplified. We expect PhoSigNet to be a useful database and analysis platform benefiting both proteomics and cancer studies.

Financial analysis of cardiovascular wellness program provided to self-insured company from pharmaceutical care provider's perspective.

PubMed

Wilson, Justin B; Osterhaus, Matt C; Farris, Karen B; Doucette, William R; Currie, Jay D; Bullock, Tammy; Kumbera, Patty

2005-01-01

To perform a retrospective financial analysis on the implementation of a self-insured company's wellness program from the pharmaceutical care provider's perspective and conduct sensitivity analyses to estimate costs versus revenues for pharmacies without resident pharmacists, program implementation for a second employer, the second year of the program, and a range of pharmacist wages. Cost-benefit and sensitivity analyses. Self-insured employer with headquarters in Canton, N.C. 36 employees at facility in Clinton, Iowa. Pharmacist-provided cardiovascular wellness program. Costs and revenues collected from pharmacy records, including pharmacy purchasing records, billing records, and pharmacists' time estimates. All costs and revenues were calculated for the development and first year of the intervention program. Costs included initial and follow-up screening supplies, office supplies, screening/group presentation time, service provision time, documentation/preparation time, travel expenses, claims submission time, and administrative fees. Revenues included initial screening revenues, follow-up screening revenues, group session revenues, and Heart Smart program revenues. For the development and first year of Heart Smart, net benefit to the pharmacy (revenues minus costs) amounted to dollars 2,413. All sensitivity analyses showed a net benefit. For pharmacies without a resident pharmacist, the net benefit was dollars 106; for Heart Smart in a second employer, the net benefit was dollars 6,024; for the second year, the projected net benefit was dollars 6,844; factoring in a lower pharmacist salary, the net benefit was dollars 2,905; and for a higher pharmacist salary, the net benefit was dollars 1,265. For the development and first year of Heart Smart, the revenues of the wellness program in a self-insured company outweighed the costs.

The costs of prevention.

PubMed

Weinstein, M C

1990-01-01

A prevention program is cost-effective if it yields more health benefits than do alternative uses of health care resources. Some prevention programs meet this standard: either they actually save more health care resources than they utilize, or their net costs per healthy year of life gained are lower than those of alternatives such as curative or palliative medicine. Other prevention programs, however, are less cost-effective than are medical treatments for the same disease. One lesson for public policy is that generalizations about the cost-effectiveness of "prevention" are unwise. Another lesson is that prevention programs should not be subjected to a higher standard than other health programs: they should not be expected to save money, but they should be expected to yield improved health at a reasonable price.

Climate change impacts on US agriculture and forestry: benefits of global climate stabilization

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

Beach, Robert H.; Cai, Yongxia; Thomson, Allison

Increasing atmospheric carbon dioxide levels, higher temperatures, altered precipitation patterns, and other climate change impacts have already begun to affect US agriculture and forestry, with impacts expected to become more substantial in the future. There have been numerous studies of climate change impacts on agriculture or forestry, but relatively little research examining the long-term net impacts of a stabilization scenario relative to a case with unabated climate change. We provide an analysis of the potential benefits of global climate change mitigation for US agriculture and forestry through 2100, accounting for landowner decisions regarding land use, crop mix, and management practices.more » The analytic approach involves a combination of climate models, a crop process model (EPIC), a dynamic vegetation model used for forests (MC1), and an economic model of the US forestry and agricultural sector (FASOM-GHG). We find substantial impacts on productivity, commodity markets, and consumer and producer welfare for the stabilization scenario relative to unabated climate change, though the magnitude and direction of impacts vary across regions and commodities. Although there is variability in welfare impacts across climate simulations, we find positive net benefits from stabilization in all cases, with cumulative impacts ranging from $32.7 billion to $54.5 billion over the period 2015-2100. Our estimates contribute to the literature on potential benefits of GHG mitigation and can help inform policy decisions weighing alternative mitigation and adaptation actions.« less

A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program.

PubMed

Wingate, La'Marcus T; Coleman, Margaret S; de la Motte Hurst, Christopher; Semple, Marie; Zhou, Weigong; Cetron, Martin S; Painter, John A

2015-12-01

This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.

High efficiency SPS klystron design

NASA Technical Reports Server (NTRS)

Nalos, E. J.

1980-01-01

The most likely compact configuration to realize both high efficiency and high gain (approx. 40 dB) is a 5-6 cavity design focused by an electromagnet. The basic klystron efficiency cannot be expected to exceed 70-75% without collector depression. It was estimated that the net benefit of a 5 stage collector over a 2 stage collector is between 1.5 and 3.5 kW per tube. A modulating anode is incorporated in the design to enable rapid shutoff of the beam current in case the r.f. drive should be removed.

Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders.

PubMed

Hoch, Jeffrey S; Dewa, Carolyn S

2014-04-01

Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known. To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations. Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges. Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

Decision curve analysis revisited: overall net benefit, relationships to ROC curve analysis, and application to case-control studies.

PubMed

Rousson, Valentin; Zumbrunn, Thomas

2011-06-22

Decision curve analysis has been introduced as a method to evaluate prediction models in terms of their clinical consequences if used for a binary classification of subjects into a group who should and into a group who should not be treated. The key concept for this type of evaluation is the "net benefit", a concept borrowed from utility theory. We recall the foundations of decision curve analysis and discuss some new aspects. First, we stress the formal distinction between the net benefit for the treated and for the untreated and define the concept of the "overall net benefit". Next, we revisit the important distinction between the concept of accuracy, as typically assessed using the Youden index and a receiver operating characteristic (ROC) analysis, and the concept of utility of a prediction model, as assessed using decision curve analysis. Finally, we provide an explicit implementation of decision curve analysis to be applied in the context of case-control studies. We show that the overall net benefit, which combines the net benefit for the treated and the untreated, is a natural alternative to the benefit achieved by a model, being invariant with respect to the coding of the outcome, and conveying a more comprehensive picture of the situation. Further, within the framework of decision curve analysis, we illustrate the important difference between the accuracy and the utility of a model, demonstrating how poor an accurate model may be in terms of its net benefit. Eventually, we expose that the application of decision curve analysis to case-control studies, where an accurate estimate of the true prevalence of a disease cannot be obtained from the data, is achieved with a few modifications to the original calculation procedure. We present several interrelated extensions to decision curve analysis that will both facilitate its interpretation and broaden its potential area of application.

Decision curve analysis revisited: overall net benefit, relationships to ROC curve analysis, and application to case-control studies

PubMed Central

2011-01-01

Background Decision curve analysis has been introduced as a method to evaluate prediction models in terms of their clinical consequences if used for a binary classification of subjects into a group who should and into a group who should not be treated. The key concept for this type of evaluation is the "net benefit", a concept borrowed from utility theory. Methods We recall the foundations of decision curve analysis and discuss some new aspects. First, we stress the formal distinction between the net benefit for the treated and for the untreated and define the concept of the "overall net benefit". Next, we revisit the important distinction between the concept of accuracy, as typically assessed using the Youden index and a receiver operating characteristic (ROC) analysis, and the concept of utility of a prediction model, as assessed using decision curve analysis. Finally, we provide an explicit implementation of decision curve analysis to be applied in the context of case-control studies. Results We show that the overall net benefit, which combines the net benefit for the treated and the untreated, is a natural alternative to the benefit achieved by a model, being invariant with respect to the coding of the outcome, and conveying a more comprehensive picture of the situation. Further, within the framework of decision curve analysis, we illustrate the important difference between the accuracy and the utility of a model, demonstrating how poor an accurate model may be in terms of its net benefit. Eventually, we expose that the application of decision curve analysis to case-control studies, where an accurate estimate of the true prevalence of a disease cannot be obtained from the data, is achieved with a few modifications to the original calculation procedure. Conclusions We present several interrelated extensions to decision curve analysis that will both facilitate its interpretation and broaden its potential area of application. PMID:21696604

Benefit-cost assessment of the commercial vehicle information systems and networks (CVISN) in Maryland

DOT National Transportation Integrated Search

1998-11-01

The objective of this study is to answer questions regarding the net benefits of CVISN deployment by the State of Maryland. The hypothesis is that the net benefits of CVISN deployment are positive and large but vary among system components and betwee...

Reserpine-induced reduction in norepinephrine transporter function requires catecholamine storage vesicles.

PubMed

Mandela, Prashant; Chandley, Michelle; Xu, Yao-Yu; Zhu, Meng-Yang; Ordway, Gregory A

2010-01-01

Treatment of rats with reserpine, an inhibitor of the vesicular monoamine transporter (VMAT), depletes norepinephrine (NE) and regulates NE transporter (NET) expression. The present study examined the molecular mechanisms involved in regulation of the NET by reserpine using cultured cells. Exposure of rat PC12 cells to reserpine for a period as short as 5min decreased [(3)H]NE uptake capacity, an effect characterized by a robust decrease in the V(max) of the transport of [(3)H]NE. As expected, reserpine did not displace the binding of [(3)H]nisoxetine from the NET in membrane homogenates. The potency of reserpine for reducing [(3)H]NE uptake was dramatically lower in SK-N-SH cells that have reduced storage capacity for catecholamines. Reserpine had no effect on [(3)H]NE uptake in HEK-293 cells transfected with the rat NET (293-hNET), cells that lack catecholamine storage vesicles. NET regulation by reserpine was independent of trafficking of the NET from the cell surface. Pre-exposure of cells to inhibitors of several intracellular signaling cascades known to regulate the NET, including Ca(2+)/Ca(2+)-calmodulin dependent kinase and protein kinases A, C and G, did not affect the ability of reserpine to reduce [(3)H]NE uptake. Treatment of PC12 cells with the catecholamine depleting agent, alpha-methyl-p-tyrosine, increased [(3)H]NE uptake and eliminated the inhibitory effects of reserpine on [(3)H]NE uptake. Reserpine non-competitively inhibits NET activity through a Ca(2+)-independent process that requires catecholamine storage vesicles, revealing a novel pharmacological method to modify NET function. Further characterization of the molecular nature of reserpine's action could lead to the development of alternative therapeutic strategies for treating disorders known to be benefitted by treatment with traditional competitive NET inhibitors. Copyright 2010 Elsevier Ltd. All rights reserved.

A Model Based Approach to Sample Size Estimation in Recent Onset Type 1 Diabetes

PubMed Central

Bundy, Brian; Krischer, Jeffrey P.

2016-01-01

The area under the curve C-peptide following a 2-hour mixed meal tolerance test from 481 individuals enrolled on 5 prior TrialNet studies of recent onset type 1 diabetes from baseline to 12 months after enrollment were modelled to produce estimates of its rate of loss and variance. Age at diagnosis and baseline C-peptide were found to be significant predictors and adjusting for these in an ANCOVA resulted in estimates with lower variance. Using these results as planning parameters for new studies results in a nearly 50% reduction in the target sample size. The modelling also produces an expected C-peptide that can be used in Observed vs. Expected calculations to estimate the presumption of benefit in ongoing trials. PMID:26991448

Application of Green Net Metropolitan Product to Measure ...

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (USEPA) has been increasingly incorporating the concept of sustainability in its research programs. One facet of this research is the quantitative assessment of the sustainability of urban systems in light of several multidisciplinary sustainability metrics. In this work, we explore the estimation of economic measure of sustainability for Chicago Metropolitan Area (CMA) based on Green Net Metropolitan Product (GNMP), by adapting the economic models of sustainability at the macroeconomic level to regional sustainability. GNMP aims at amending the limitations of Net Domestic Product (NDP), a classical indicator of economic wellbeing, which fails to account for the degradation of environmental and natural resources caused by economic activities. We collect data for computing GNMP from publicly available secondary sources on variables such as gross metropolitan product, net income, emissions, solid waste, etc. In estimating GNMP for CMA, we have accounted for the damage costs associated with pollution emissions based on marginal damage values obtained from the literature using benefit transfers method. In addition, we attempt at accounting for the marginal value of depletion of natural resources in the CMA in terms of water depletion and changes in urban ecosystems such as green spaces. We account for the marginal damage cost associated with solid waste generation. It is expected the preliminary results of this exploration se

Studies in the extensively automatic construction of large odds-based inference networks from structured data. Examples from medical, bioinformatics, and health insurance claims data.

PubMed

Robson, B; Boray, S

2018-04-01

Theoretical and methodological principles are presented for the construction of very large inference nets for odds calculations, composed of hundreds or many thousands or more of elements, in this paper generated by structured data mining. It is argued that the usual small inference nets can sometimes represent rather simple, arbitrary estimates. Examples of applications in clinical and public health data analysis, medical claims data and detection of irregular entries, and bioinformatics data, are presented. Construction of large nets benefits from application of a theory of expected information for sparse data and the Dirac notation and algebra. The extent to which these are important here is briefly discussed. Purposes of the study include (a) exploration of the properties of large inference nets and a perturbation and tacit conditionality models, (b) using these to propose simpler models including one that a physician could use routinely, analogous to a "risk score", (c) examination of the merit of describing optimal performance in a single measure that combines accuracy, specificity, and sensitivity in place of a ROC curve, and (d) relationship to methods for detecting anomalous and potentially fraudulent data. Copyright © 2018 Elsevier Ltd. All rights reserved.

45 CFR 149.100 - Amount of reimbursement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... reimbursement in the amount of 80 percent of the costs for health benefits (net of negotiated price concessions... costs for health benefits net of negotiated price concessions, within the applicable plan year for each... threshold and above the cost limit for any given early retiree, all costs for health benefits paid by the...

The Implications of the Net Fiscal Benefits Criterion for Cost Sharing in Flood Control Projects.

DTIC Science & Technology

controversial areas. First, it is concluded that the net fiscal benefits criterion has important advantages in the determination of what local governments...would be willing to contribute to the cost of flood control projects, but somewhat less applicability to the analysis of economic efficiency benefits and

The net effects of the Project NetWork return-to-work case management experiment on participant earnings, benefit receipt, and other outcomes.

PubMed

Kornfeld, R; Rupp, K

2000-01-01

The Social Security Administration (SSA) initiated Project NetWork in 1991 to test case management as a means of promoting employment among persons with disabilities. The demonstration, which targeted Social Security Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants and recipients, offered intensive outreach, work-incentive waivers, and case management/referral services. Participation in Project NetWork was voluntary. Volunteers were randomly assigned to the "treatment" group or the "control" group. Those assigned to the treatment group met individually with a case or referral manager who arranged for rehabilitation and employment services, helped clients develop an individual employment plan, and provided direct employment counseling services. Volunteers assigned to the control group could not receive services from Project NetWork but remained eligible for any employment assistance already available in their communities. For both treatment and control groups, the demonstration waived specific DI and SSI program rules considered to be work disincentives. The experimental impact study thus measures the incremental effects of case and referral management services. The eight demonstration sites were successful in implementing the experimental design roughly as planned. Project NetWork staff were able to recruit large numbers of participants and to provide rehabilitation and employment services on a substantial scale. Most of the sites easily reached their enrollment targets and were able to attract volunteers with demographic characteristics similar to those of the entire SSI and DI caseload and a broad range of moderate and severe disabilities. However, by many measures, volunteers were generally more "work-ready" than project eligible in the demonstration areas who did not volunteer to receive NetWork services. Project NetWork case management increased average annual earnings by $220 per year over the first 2 years following random assignment. This statistically significant impact, an approximate 11-percent increase in earnings, is based on administrative data on earnings. For about 70 percent of sample members, a third year of followup data was available. For this limited sample, the estimated effect of Project NetWork on annual earnings declined to roughly zero in the third followup year. The findings suggest that the increase in earnings may have been short-lived and may have disappeared by the time Project NetWork services ended. Project NetWork did not reduce reliance on SSI or DI benefits by statistically significant amounts over the 30-42 month followup period. The services provided by Project NetWork thus did not reduce overall SSI and DI caseloads or benefits by substantial amounts, especially given that only about 5 percent of the eligible caseload volunteered to participate in Project NetWork. Project NetWork produced modest net benefits to persons with disabilities and net costs to taxpayers. Persons with disabilities gained mainly because the increases in their earnings easily outweighed the small (if any) reduction in average SSI and DI benefits. For SSA and the federal government as a whole, the costs of Project NetWork were not sufficiently offset by increases in tax receipts resulting from increased earnings or reductions in average SSI and DI benefits. The modest net benefits of Project NetWork to persons with disabilities are encouraging. How such benefits of an experimental intervention should be weighed against costs of taxpayers depends on value judgments of policymakers. Because different case management projects involve different kinds of services, these results cannot be directly generalized to other case management interventions. They are nevertheless instructive for planning new initiatives. Combining case and referral management services with various other interventions, such as longer term financial support for work or altered provider incentives, could produc

A model of the health and economic impact of posttransfusion hepatitis C: application to cost-effectiveness analysis of further expansion of HCV screening protocols.

PubMed

Pereira, A; Sanz, C

2000-10-01

Cost-effectiveness analyses are needed to decide the value of further expansion of the screening protocols for HCV in blood donors. However, such analyses are hampered by imperfect knowledge of the health and economic repercussions of posttransfusion hepatitis C (PTHC). A Monte Carlo simulation of a Markov model representing the outcomes of patients transfused with HCV-infective blood was used to estimate the health and economic impact of PTHC and to calculate the cost-effectiveness ratio of various HCV screening methods. Median survival for hypothetical patients with PTHC and for controls without hepatitis was 11.25 and 11.75 years, respectively. Overall, 12.3 percent of patients receiving HCV-infective blood will develop chronic hepatitis, 9.3 percent will progress to liver failure, and 9. 25 percent will eventually die of liver disease after a median time of 20.75 years (range, 6-70). Ninety-one percent of the infected blood recipients had no reduction in life expectancy due to PTHC, and the average loss per patient was 0.754 years. The present value of the lifetime health costs incurred by patients with PTHC is $6330 per case. HCV antibody testing increases the patients' life expectancy by 20.4 hours per blood collection tested, and it results in net savings by decreasing the number of patients that will require treatment for liver disease in the future. Adding HCV NAT increases the patients' life expectancy by 0.08 hours per blood collection tested, at a cost-effectiveness ratio of $1,829,611 per QALY gained. PTHC has low health benefits because of the advanced age of many blood recipients. Testing donors for HCV antibodies results in net savings for the health care system, despite low health benefits. Adding HCV NAT would produce little additional gain at a very high cost.

The cost-effectiveness of hospital-based telephone coaching for people with type 2 diabetes: a 10 year modelling analysis.

PubMed

Varney, J E; Liew, D; Weiland, T J; Inder, W J; Jelinek, G A

2016-09-27

Type 2 diabetes (T2DM) is a burdensome condition for individuals to live with and an increasingly costly condition for health services to treat. Cost-effective treatment strategies are required to delay the onset and slow the progression of diabetes related complications. The Diabetes Telephone Coaching Study (DTCS) demonstrated that telephone coaching is an intervention that may improve the risk factor status and diabetes management practices of people with T2DM. Measuring the cost effectiveness of this intervention is important to inform funding decisions that may facilitate the translation of this research into clinical practice. The purpose of this study is to assess the cost-effectiveness of telephone coaching, compared to usual diabetes care, in participants with poorly controlled T2DM. A cost utility analysis was undertaken using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model to extrapolate outcomes collected at 6 months in the DTCS over a 10 year time horizon. The intervention's impact on life expectancy, quality-adjusted life expectancy (QALE) and costs was estimated. Costs were reported from a health system perspective. A 5 % discount rate was applied to all future costs and effects. One-way sensitivity analyses were conducted to reflect uncertainty surrounding key input parameters. The intervention dominated the control condition in the base-case analysis, contributing to cost savings of $3327 per participant, along with non-significant improvements in QALE (0.2 QALE) and life expectancy (0.3 years). The cost of delivering the telephone coaching intervention continuously, for 10 years, was fully recovered through cost savings and a trend towards net health benefits. Findings of cost savings and net health benefits are rare and should prove attractive to decision makers who will determine whether this intervention is implemented into clinical practice. ACTRN12609000075280.

Population dynamics and the ecological stability of obligate pollination mutualisms

USGS Publications Warehouse

Holland, J. Nathaniel; DeAngelis, Donald L.

2001-01-01

Mutualistic interactions almost always produce both costs and benefits for each of the interacting species. It is the difference between gross benefits and costs that determines the net benefit and the per-capita effect on each of the interacting populations. For example, the net benefit of obligate pollinators, such as yucca and senita moths, to plants is determined by the difference between the number of ovules fertilized from moth pollination and the number of ovules eaten by the pollinator's larvae. It is clear that if pollinator populations are large, then, because many eggs are laid, costs to plants are large, whereas, if pollinator populations are small, gross benefits are low due to lack of pollination. Even though the size and dynamics of the pollinator population are likely to be crucial, their importance has been neglected in the investigation of mechanisms, such as selective fruit abortion, that can limit costs and increase net benefits. Here, we suggest that both the population size and dynamics of pollinators are important in determining the net benefits to plants, and that fruit abortion can significantly affect these. We develop a model of mutualism between populations of plants and their pollinating seed-predators to explore the ecological consequences of fruit abortion on pollinator population dynamics and the net effect on plants. We demonstrate that the benefit to a plant population is unimodal as a function of pollinator abundance, relative to the abundance of flowers. Both selective abortion of fruit with eggs and random abortion of fruit, without reference to whether they have eggs or not, can limit pollinator population size. This can increase the net benefits to the plant population by limiting the number of eggs laid, if the pollination rate remains high. However, fruit abortion can possibly destabilize the pollinator population, with negative consequences for the plant population.

Cost-effectiveness of population-based, community, workplace and individual policies for diabetes prevention in the UK.

PubMed

Breeze, P R; Thomas, C; Squires, H; Brennan, A; Greaves, C; Diggle, P; Brunner, E; Tabak, A; Preston, L; Chilcott, J

2017-08-01

To analyse the cost-effectiveness of different interventions for Type 2 diabetes prevention within a common framework. A micro-simulation model was developed to evaluate the cost-effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workplace intervention; (4) community-based intervention; and (5) screening and intensive lifestyle intervention in individuals with high diabetes risk. Within the model, individuals follow metabolic trajectories (for BMI, cholesterol, systolic blood pressure and glycaemia); individuals may develop diabetes, and some may exhibit complications of diabetes and related disorders, including cardiovascular disease, and eventually die. Lifetime healthcare costs, employment costs and quality-adjusted life-years are collected for each person. All interventions generate more life-years and lifetime quality-adjusted life-years and reduce healthcare spending compared with doing nothing. Screening and intensive lifestyle intervention generates greatest lifetime net benefit (£37) but is costly to implement. In comparison, soft drinks taxation or retail policy generate lower net benefit (£11 and £11) but are cost-saving in a shorter time period, preferentially benefit individuals from deprived backgrounds and reduce employer costs. The model enables a wide range of diabetes prevention interventions to be evaluated according to cost-effectiveness, employment and equity impacts over the short and long term, allowing decision-makers to prioritize policies that maximize the expected benefits, as well as fulfilling other policy targets, such as addressing social inequalities. © 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Necessary conditions for morally responsible animal research.

PubMed

DeGrazia, David; Sebo, Jeff

2015-10-01

In this article, we present three necessary conditions for morally responsible animal research that we believe people on both sides of this debate can accept. Specifically, we argue that, even if human beings have higher moral status than nonhuman animals, animal research is morally permissible only if it satisfies (1) an expectation of sufficient net benefit, (2) a worthwhile-life condition, and (3) a no-unnecessary-harm/qualified-basic-needs condition. We then claim that, whether or not these necessary conditions are jointly sufficient for justified animal research, they are relatively demanding, with the consequence that many animal experiments may fail to satisfy them.

Benefit-Cost Analysis of a Randomized Evaluation of Communities That Care: Monetizing Intervention Effects on the Initiation of Delinquency and Substance Use Through Grade 12.

PubMed

Kuklinski, Margaret R; Fagan, Abigail A; Hawkins, J David; Briney, John S; Catalano, Richard F

2015-06-01

To determine whether the Communities That Care (CTC) prevention system is a cost-beneficial intervention. Data were from a longitudinal panel of 4,407 youth participating in a randomized controlled trial including 24 towns in 7 states, matched in pairs within state and randomly assigned to condition. Significant differences favoring intervention youth in sustained abstinence from delinquency, alcohol use, and tobacco use through Grade 12 were monetized and compared to economic investment in CTC. CTC was estimated to produce $4,477 in benefits per youth (discounted 2011 dollars). It cost $556 per youth to implement CTC for 5 years. The net present benefit was $3,920. The benefit-cost ratio was $8.22 per dollar invested. The internal rate of return was 21%. Risk that investment would exceed benefits was minimal. Investment was expected to be recouped within 9 years. Sensitivity analyses in which effects were halved yielded positive cost-beneficial results. CTC is a cost-beneficial, community-based approach to preventing initiation of delinquency, alcohol use, and tobacco use. CTC is estimated to generate economic benefits that exceed implementation costs when disseminated with fidelity in communities.

Changes in Spending and Labor Supply in Response to a Social Security Benefit Cut: Evidence from Stated Choice Data.

PubMed

Delavande, Adeline; Rohwedder, Susann

2017-12-01

We investigate how individuals in the U.S. expect to adjust their labor force participation and savings if Social Security benefits were cut by 30 percent. Respondents were asked directly what they would do under this scenario. Using the resulting stated choice data we find that respondents would on average reduce spending by 18.2 percent before retirement and 20.4 percent after retirement. About 34.1% of respondents state they would definitely work longer and they would postpone claiming Social Security by 1.1 years. We investigate how working longer and claiming Social Security later would compensate partially for the loss in benefits among the individuals who are currently working, under the assumption that individuals retire and claim at the same time. Individuals would increase their Social Security benefits from the post-reform level due to additional earnings entering the benefit calculation and a smaller early claiming penalty (or higher delayed claiming credit). As a result, the Social Security benefit people would receive would drop on average by 21 rather than 30 percent. Still, the net financial loss, even after accounting for additional earnings, is sizeable for individuals in the lowest wealth tertile.

20 CFR 404.452 - Reports to Social Security Administration of earnings; wages; net earnings from self-employment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Reports to Social Security Administration of earnings; wages; net earnings from self-employment. 404.452 Section 404.452 Employees' Benefits SOCIAL...; and Nonpayments of Benefits § 404.452 Reports to Social Security Administration of earnings; wages...

20 CFR 404.452 - Reports to Social Security Administration of earnings; wages; net earnings from self-employment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Reports to Social Security Administration of earnings; wages; net earnings from self-employment. 404.452 Section 404.452 Employees' Benefits SOCIAL...; and Nonpayments of Benefits § 404.452 Reports to Social Security Administration of earnings; wages...

20 CFR 404.452 - Reports to Social Security Administration of earnings; wages; net earnings from self-employment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Reports to Social Security Administration of earnings; wages; net earnings from self-employment. 404.452 Section 404.452 Employees' Benefits SOCIAL...; and Nonpayments of Benefits § 404.452 Reports to Social Security Administration of earnings; wages...

20 CFR 404.452 - Reports to Social Security Administration of earnings; wages; net earnings from self-employment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Reports to Social Security Administration of earnings; wages; net earnings from self-employment. 404.452 Section 404.452 Employees' Benefits SOCIAL...; and Nonpayments of Benefits § 404.452 Reports to Social Security Administration of earnings; wages...

An Analysis of Costs and Health Co-Benefits for a U.S. Power Plant Carbon Standard.

PubMed

Buonocore, Jonathan J; Lambert, Kathleen F; Burtraw, Dallas; Sekar, Samantha; Driscoll, Charles T

2016-01-01

Reducing carbon dioxide (CO2) emissions from power plants can have important "co-benefits" for public health by reducing emissions of air pollutants. Here, we examine the costs and health co-benefits, in monetary terms, for a policy that resembles the U.S. Environmental Protection Agency's Clean Power Plan. We then examine the spatial distribution of the co-benefits and costs, and the implications of a range of cost assumptions in the implementation year of 2020. Nationwide, the total health co-benefits were $29 billion 2010 USD (95% CI: $2.3 to $68 billion), and net co-benefits under our central cost case were $12 billion (95% CI: -$15 billion to $51 billion). Net co-benefits for this case in the implementation year were positive in 10 of the 14 regions studied. The results for our central case suggest that all but one region should experience positive net benefits within 5 years after implementation.

A model-based approach to sample size estimation in recent onset type 1 diabetes.

PubMed

Bundy, Brian N; Krischer, Jeffrey P

2016-11-01

The area under the curve C-peptide following a 2-h mixed meal tolerance test from 498 individuals enrolled on five prior TrialNet studies of recent onset type 1 diabetes from baseline to 12 months after enrolment were modelled to produce estimates of its rate of loss and variance. Age at diagnosis and baseline C-peptide were found to be significant predictors, and adjusting for these in an ANCOVA resulted in estimates with lower variance. Using these results as planning parameters for new studies results in a nearly 50% reduction in the target sample size. The modelling also produces an expected C-peptide that can be used in observed versus expected calculations to estimate the presumption of benefit in ongoing trials. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Estimating the Size and Cost of the STD Prevention Services Safety Net.

PubMed

Gift, Thomas L; Haderxhanaj, Laura T; Torrone, Elizabeth A; Behl, Ajay S; Romaguera, Raul A; Leichliter, Jami S

2015-01-01

The Patient Protection and Affordable Care Act is expected to reduce the number of uninsured people in the United States during the next eight years, but more than 10% are expected to remain uninsured. Uninsured people are one of the main populations using publicly funded safety net sexually transmitted disease (STD) prevention services. Estimating the proportion of the uninsured population expected to need STD services could help identify the potential demand for safety net STD services and improve program planning. In 2013, an estimated 8.27 million people met the criteria for being in need of STD services. In 2023, 4.70 million uninsured people are expected to meet the criteria for being in need of STD services. As an example, the cost in 2014 U.S. dollars of providing chlamydia screening to these people was an estimated $271.1 million in 2013 and is estimated to be $153.8 million in 2023. A substantial need will continue to exist for safety net STD prevention services in coming years.

Estimating the Size and Cost of the STD Prevention Services Safety Net

PubMed Central

Haderxhanaj, Laura T.; Torrone, Elizabeth A.; Behl, Ajay S.; Romaguera, Raul A.; Leichliter, Jami S.

2015-01-01

The Patient Protection and Affordable Care Act is expected to reduce the number of uninsured people in the United States during the next eight years, but more than 10% are expected to remain uninsured. Uninsured people are one of the main populations using publicly funded safety net sexually transmitted disease (STD) prevention services. Estimating the proportion of the uninsured population expected to need STD services could help identify the potential demand for safety net STD services and improve program planning. In 2013, an estimated 8.27 million people met the criteria for being in need of STD services. In 2023, 4.70 million uninsured people are expected to meet the criteria for being in need of STD services. As an example, the cost in 2014 U.S. dollars of providing chlamydia screening to these people was an estimated $271.1 million in 2013 and is estimated to be $153.8 million in 2023. A substantial need will continue to exist for safety net STD prevention services in coming years. PMID:26556931

The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.

PubMed

Agus, David B; Gaudette, Étienne; Goldman, Dana P; Messali, Andrew

2016-01-01

The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease. We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50) and would add 900,000 people (95% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975) in net health benefits over that period. Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.

The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older

PubMed Central

Agus, David B.; Gaudette, Étienne; Goldman, Dana P.; Messali, Andrew

2016-01-01

Background The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease. Methods and Findings We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011–2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08–0.50) and would add 900,000 people (95% CI 300,000–1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345–975) in net health benefits over that period. Conclusions Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively. PMID:27902693

An Analysis of Costs and Health Co-Benefits for a U.S. Power Plant Carbon Standard

PubMed Central

Buonocore, Jonathan J.; Lambert, Kathleen F.; Burtraw, Dallas; Sekar, Samantha; Driscoll, Charles T.

2016-01-01

Reducing carbon dioxide (CO2) emissions from power plants can have important “co-benefits” for public health by reducing emissions of air pollutants. Here, we examine the costs and health co-benefits, in monetary terms, for a policy that resembles the U.S. Environmental Protection Agency’s Clean Power Plan. We then examine the spatial distribution of the co-benefits and costs, and the implications of a range of cost assumptions in the implementation year of 2020. Nationwide, the total health co-benefits were $29 billion 2010 USD (95% CI: $2.3 to $68 billion), and net co-benefits under our central cost case were $12 billion (95% CI: -$15 billion to $51 billion). Net co-benefits for this case in the implementation year were positive in 10 of the 14 regions studied. The results for our central case suggest that all but one region should experience positive net benefits within 5 years after implementation. PMID:27270222

The net return from animal activity in agro-ecosystems: trading off benefits from ecosystem services against costs from crop damage.

PubMed

Luck, Gary W

2013-01-01

Animals provide benefits to agriculture through the provision of ecosystem services, but also inflict costs such as damaging crops. These benefits and costs are mostly examined independently, rather than comparing the trade-offs of animal activity in the same system and quantifying the net return from beneficial minus detrimental activities. Here, I examine the net return associated with the activity of seed-eating birds in almond orchards by quantifying the economic costs and benefits of bird consumption of almonds. Pre-harvest, the consumption of harvestable almonds by birds cost growers AUD$57.50 ha (-1) when averaged across the entire plantation. Post-harvest, the same bird species provide an ecosystem service by removing mummified nuts from trees that growers otherwise need to remove to reduce threats from fungal infection or insect pest infestations. The value of this ecosystem service ranged from AUD$82.50 ha (-1)-$332.50 ha (-1) based on the replacement costs of mechanical or manual removal of mummified nuts, respectively. Hence, bird consumption of almonds yielded a positive net return of AUD$25-$275 ha (-1) averaged across the entire plantation. However, bird activity varied spatially resulting in positive net returns occurring primarily at the edges of crops where activity was higher, compared to negative net returns in crop interiors. Moreover, partial mummy nut removal by birds meant that bird activity may only reduce costs to growers rather than replace these costs completely. Similar cost-benefit trade-offs exist across nature, and quantifying net returns can better inform land management decisions such as when to control pests or promote ecosystem service provision.

The net return from animal activity in agro-ecosystems: trading off benefits from ecosystem services against costs from crop damage

PubMed Central

Luck, Gary W

2014-01-01

Animals provide benefits to agriculture through the provision of ecosystem services, but also inflict costs such as damaging crops. These benefits and costs are mostly examined independently, rather than comparing the trade-offs of animal activity in the same system and quantifying the net return from beneficial minus detrimental activities. Here, I examine the net return associated with the activity of seed-eating birds in almond orchards by quantifying the economic costs and benefits of bird consumption of almonds. Pre-harvest, the consumption of harvestable almonds by birds cost growers AUD$57.50 ha -1 when averaged across the entire plantation. Post-harvest, the same bird species provide an ecosystem service by removing mummified nuts from trees that growers otherwise need to remove to reduce threats from fungal infection or insect pest infestations. The value of this ecosystem service ranged from AUD$82.50 ha -1–$332.50 ha -1 based on the replacement costs of mechanical or manual removal of mummified nuts, respectively. Hence, bird consumption of almonds yielded a positive net return of AUD$25–$275 ha -1 averaged across the entire plantation. However, bird activity varied spatially resulting in positive net returns occurring primarily at the edges of crops where activity was higher, compared to negative net returns in crop interiors. Moreover, partial mummy nut removal by birds meant that bird activity may only reduce costs to growers rather than replace these costs completely. Similar cost-benefit trade-offs exist across nature, and quantifying net returns can better inform land management decisions such as when to control pests or promote ecosystem service provision. PMID:25285202

Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability

PubMed Central

Wang, Xu; McCarty, Perry L.; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

2015-01-01

Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries. PMID:25605884

Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability.

PubMed

Wang, Xu; McCarty, Perry L; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

2015-02-03

Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries.

Placental alpha-microglobulin-1 and combined traditional diagnostic test: a cost-benefit analysis.

PubMed

Echebiri, Nelson C; McDoom, M Maya; Pullen, Jessica A; Aalto, Meaghan M; Patel, Natasha N; Doyle, Nora M

2015-01-01

We sought to evaluate if the placental alpha-microglobulin (PAMG)-1 test vs the combined traditional diagnostic test (CTDT) of pooling, nitrazine, and ferning would be a cost-beneficial screening strategy in the setting of potential preterm premature rupture of membranes. A decision analysis model was used to estimate the economic impact of PAMG-1 test vs the CTDT on preterm delivery costs from a societal perspective. Our primary outcome was the annual net cost-benefit per person tested. Baseline probabilities and costs assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2013 US dollars. Annual net benefit from PAMG-1 was $20,014 per person tested, while CTDT had a net benefit of $15,757 per person tested. If the probability of rupture is <38%, PAMG-1 will be cost-beneficial with an annual net benefit of $16,000-37,000 per person tested, while CTDT will have an annual net benefit of $16,000-19,500 per person tested. If the probability of rupture is >38%, CTDT is more cost-beneficial. Monte Carlo simulations of 1 million trials selected PAMG-1 as the optimal strategy with a frequency of 89%, while CTDT was only selected as the optimal strategy with a frequency of 11%. Sensitivity analyses were robust. Our cost-benefit analysis provides the economic evidence for the adoption of PAMG-1 in diagnosing preterm premature rupture of membranes in uncertain presentations and when CTDT is equivocal at 34 to <37 weeks' gestation. Copyright © 2015 Elsevier Inc. All rights reserved.

A regret theory approach to decision curve analysis: a novel method for eliciting decision makers' preferences and decision-making.

PubMed

Tsalatsanis, Athanasios; Hozo, Iztok; Vickers, Andrew; Djulbegovic, Benjamin

2010-09-16

Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker. We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease. We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc).

A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making

PubMed Central

2010-01-01

Background Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. Methods First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker. Results We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease. Conclusions We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc). PMID:20846413

Quantifying the net social benefits of vehicle trip reductions : guidance for customizing the TRIMMS(c) model.

DOT National Transportation Integrated Search

2009-04-01

This study details the development of a series of enhancements to the Trip Reduction Impacts of : Mobility Management Strategies (TRIMMS) model. TRIMMS allows quantifying the net social : benefits of a wide range of transportation demand management...

Petri Nets as Modeling Tool for Emergent Agents

NASA Technical Reports Server (NTRS)

Bergman, Marto

2004-01-01

Emergent agents, those agents whose local interactions can cause unexpected global results, require a method of modeling that is both dynamic and structured Petri Nets, a modeling tool developed for dynamic discrete event system of mainly functional agents, provide this, and have the benefit of being an established tool. We present here the details of the modeling method here and discuss how to implement its use for modeling agent-based systems. Petri Nets have been used extensively in the modeling of functional agents, those agents who have defined purposes and whose actions should result in a know outcome. However, emergent agents, those agents who have a defined structure but whose interaction causes outcomes that are unpredictable, have not yet found a modeling style that suits them. A problem with formally modeling emergent agents that any formal modeling style usually expects to show the results of a problem and the results of problems studied using emergent agents are not apparent from the initial construction. However, the study of emergent agents still requires a method to analyze the agents themselves, and have sensible conversation about the differences and similarities between types of emergent agents. We attempt to correct this problem by applying Petri Nets to the characterization of emergent agents. In doing so, the emergent properties of these agents can be highlighted, and conversation about the nature and compatibility of the differing methods of agent creation can begin.

The ‘W’ Prawn-Trawl with Emphasised Drag-Force Transfer to Its Centre Line to Reduce Overall System Drag

PubMed Central

Balash, Cheslav; Sterling, David; Binns, Jonathan; Thomas, Giles; Bose, Neil

2015-01-01

For prawn trawling systems, drag reduction is a high priority as the trawling process is energy intensive. Large benefits have occurred through the use of multiple-net rigs and thin twine in the netting. An additional positive effect of these successful twine-area reduction strategies is the reduced amount of otter board area required to spread the trawl systems, which leads to further drag reduction. The present work investigated the potential of redirecting the drag-strain within a prawn trawl away from the wings and the otter boards to the centre line of the trawl, where top and bottom tongues have been installed, with an aim to minimise the loading/size of the otter boards required to spread the trawl. In the system containing the new ‘W’ trawl, the drag redirected to the centre-line tongues is transferred forward through a connected sled and towing wires to the trawler. To establish the extent of drag redirection to the centre-line tongues and the relative drag benefits of the new trawl system, conventional and ‘W’ trawls of 3.65 m headline length were tested firstly over a range of spread ratios in the flume tank, and subsequently at optimum spread ratio in the field. The developed ‘W’ trawl effectively directed 64% of netting-drag off the wings and onto the centre tongues, which resulted in drag savings in the field of ∼20% for the associated ‘W’ trawl/otter-board/sled system compared to the traditional trawl/otter-board arrangement in a single trawl or twin rig configuration. Furthermore, based on previously published data, the new trawl when used in a twin rig system is expected to provide approximately 12% drag reduction compared to quad rig. The twin ‘W’ trawl system also has benefits over quad rig in that a reduced number of cod-end/By-catch Reduction Device units need to be installed and attended each tow. PMID:25751251

Spatially resolved air-water emissions tradeoffs improve regulatory impact analyses for electricity generation.

PubMed

Gingerich, Daniel B; Sun, Xiaodi; Behrer, A Patrick; Azevedo, Inês L; Mauter, Meagan S

2017-02-21

Coal-fired power plants (CFPPs) generate air, water, and solids emissions that impose substantial human health, environmental, and climate change (HEC) damages. This work demonstrates the importance of accounting for cross-media emissions tradeoffs, plant and regional emissions factors, and spatially variation in the marginal damages of air emissions when performing regulatory impact analyses for electric power generation. As a case study, we assess the benefits and costs of treating wet flue gas desulfurization (FGD) wastewater at US CFPPs using the two best available treatment technology options specified in the 2015 Effluent Limitation Guidelines (ELGs). We perform a life-cycle inventory of electricity and chemical inputs to FGD wastewater treatment processes and quantify the marginal HEC damages of associated air emissions. We combine these spatially resolved damage estimates with Environmental Protection Agency estimates of water quality benefits, fuel-switching benefits, and regulatory compliance costs. We estimate that the ELGs will impose average net costs of $3.01 per cubic meter for chemical precipitation and biological wastewater treatment and $11.26 per cubic meter for zero-liquid discharge wastewater treatment (expected cost-benefit ratios of 1.8 and 1.7, respectively), with damages concentrated in regions containing a high fraction of coal generation or a large chemical manufacturing industry. Findings of net cost for FGD wastewater treatment are robust to uncertainty in auxiliary power source, location of chemical manufacturing, and binding air emissions limits in noncompliant regions, among other variables. Future regulatory design will minimize compliance costs and HEC tradeoffs by regulating air, water, and solids emissions simultaneously and performing regulatory assessments that account for spatial variation in emissions impacts.

Spatially resolved air-water emissions tradeoffs improve regulatory impact analyses for electricity generation

PubMed Central

Gingerich, Daniel B.; Behrer, A. Patrick; Azevedo, Inês L.

2017-01-01

Coal-fired power plants (CFPPs) generate air, water, and solids emissions that impose substantial human health, environmental, and climate change (HEC) damages. This work demonstrates the importance of accounting for cross-media emissions tradeoffs, plant and regional emissions factors, and spatially variation in the marginal damages of air emissions when performing regulatory impact analyses for electric power generation. As a case study, we assess the benefits and costs of treating wet flue gas desulfurization (FGD) wastewater at US CFPPs using the two best available treatment technology options specified in the 2015 Effluent Limitation Guidelines (ELGs). We perform a life-cycle inventory of electricity and chemical inputs to FGD wastewater treatment processes and quantify the marginal HEC damages of associated air emissions. We combine these spatially resolved damage estimates with Environmental Protection Agency estimates of water quality benefits, fuel-switching benefits, and regulatory compliance costs. We estimate that the ELGs will impose average net costs of $3.01 per cubic meter for chemical precipitation and biological wastewater treatment and $11.26 per cubic meter for zero-liquid discharge wastewater treatment (expected cost-benefit ratios of 1.8 and 1.7, respectively), with damages concentrated in regions containing a high fraction of coal generation or a large chemical manufacturing industry. Findings of net cost for FGD wastewater treatment are robust to uncertainty in auxiliary power source, location of chemical manufacturing, and binding air emissions limits in noncompliant regions, among other variables. Future regulatory design will minimize compliance costs and HEC tradeoffs by regulating air, water, and solids emissions simultaneously and performing regulatory assessments that account for spatial variation in emissions impacts. PMID:28167772

Net Resource Assessment (NetRA): A Collaborative Effort Between USGS Science and Decisions Center, the Science Impact Laboratory for Policy and Economics (University of New Mexico) and Sandia National Laboratory

NASA Astrophysics Data System (ADS)

Brookshire, D.; Bernknopf, R.; Adhikari, D. R.; Babis, C.; Broadbent, C. D.; Tidwell, V. C.

2015-12-01

Department of Interior Secretarial Order No. 3330, "… establishes a Department-wide mitigation strategy that will ensure consistency and efficiency in the review and permitting of infrastructure development projects and in conserving our Nation's valuable natural and cultural resources." The USGS Organic Act authorizes resource assessments to estimate the in-place potential capacity of energy, mineral, hydrologic, and biologic resources (20 Stat. 394; 43 U.S.C. 31) and later amendments. These two statements form the basis for the development of the Net Resources Assessment (NetRA) framework. NetRA is a policy-relevant, interdisciplinary approach to assessing natural resources availability in examining the regional-scale interrelationships between energy or mineral extraction and impact on ecosystem services. The systems dynamics approach (SD) emphasizes the interdependence of natural resource development and its effect on collocated ecosystem services over space and time. The example of the NetRA that will be presented focuses on tradeoffs associated with land management decisions in the West. The Piceance Basin, CO example that will be discussed involves development of a continuous gas deposit and its impact on Mule Deer and water quality. The SD is the hub for generating a range of simulated landscape outcomes. The probabilistic model provides an economic indicator as to the expected net societal benefit of economic development and biophysical indicators for ecosystem services affected in the region. Both natural and economic indicators are associated with each outcome via a tradeoff analysis the can be used for risk analysis. The NetRA also retains map attributes for before and after map comparisons to specific alternatives for an existing baseline. The model has three stages: map-based scenario development with slider bars (choice variables), side-by-side extraction and ecosystem services sub-models, and integrated multiple resource trade-off outcomes.

Estimating the net benefit of a specialized return-to-work program for workers on short-term disability related to a mental disorder: an example exploring investment in collaborative care.

PubMed

Dewa, Carolyn S; Hoch, Jeffrey S

2014-06-01

This article estimates the net benefit for a company incorporating a collaborative care model into its return-to-work program for workers on short-term disability related to a mental disorder. Employing a simple decision model, the net benefit and uncertainty were explored. The breakeven point occurs when the average short-term disability episode is reduced by at least 7 days. In addition, 85% of the time, benefits could outweigh costs. Model results and sensitivity analyses indicate that organizational benefits can be greater than the costs of incorporating a collaborative care model into a return-to-work program for workers on short-term disability related to a mental disorder. The results also demonstrate how the probability of a program's effectiveness and the magnitude of its effectiveness are key factors that determine whether the benefits of a program outweigh its costs.

The Economic Impact of Adaptive Responses to Future Scenarios of Socio-Economic and Ecological Change in the Tonle Sap Ecosystem, Cambodia

NASA Astrophysics Data System (ADS)

Teh, L.; Bond, N.; KC, K. B.; Fraser, E. D. G.; Seng, R.; Sumaila, R.

2016-12-01

The livelihoods of people dependent on the Tonle Sap floodplain ecosystem in Cambodia are expected to be affected by future socio-economic, policy, ecological, and climate change. To investigate the economic impact of these changes on fishing dependent communities, we compare the net income from individuals' current livelihoods to that derived from reallocating their livelihood activities under 4 different scenarios depicting future change. Under current conditions, we find that the group of individuals who do not participate in fishing had the lowest net income. In contrast, individuals who participated in fishing only had comparatively higher average net income than those with multiple livelihoods, suggesting that there may be current gains from livelihood specialisation. When presented with scenarios of future ecological and socio-economic change, the majority of respondents chose to retain their current livelihood strategy under all future scenarios. Of those who did change their livelihood allocation, less than 10% actually experienced a gain in economic benefits. Overall, a loss in net income was expected under all future scenarios, with those engaged in single livelihoods being the most vulnerable because they were likely to experience the largest losses (7 - 29% loss vs. 1 - 17% for multi-livelihoods) across all 4 scenarios while having the least capacity to adapt. Respondents' choices generated the best economic outcome under the scenario depicting the status quo, indicating that they were capable of coping with current conditions, but were unlikely to make appropriate decisions when faced with future scenarios that they were unfamiliar with. By quantifying the consequences of low adaptive capacity in terms of income loss, this study provides an economic argument for addressing the social and economic factors that currently inhibit the capacity of Tonle Sap inhabitants to adapt to future change. It also emphasises the need for sustainable management of fish and water resources upon which inhabitants are currently heavily dependent upon.

Defining Appropriate Use of Proton-Pump Inhibitors Among Medical Inpatients.

PubMed

Pappas, Matt; Jolly, Sanjay; Vijan, Sandeep

2016-04-01

Proton-pump inhibitors (PPIs) are commonly used among medical inpatients, both for prophylaxis against upper gastrointestinal bleeding (UGIB) and continuation of outpatient use. While PPIs reduce the risk of UGIB, they also appear to increase the risk of hospital-acquired pneumonia (HAP) and Clostridium difficile infection (CDI). Depending upon the underlying risks of these conditions and the changes in those risks with PPIs, use of proton-pump inhibitors may lead to a net benefit or net harm among medical inpatients. We aimed to determine the net impact of PPIs on hospital mortality among medical inpatients. A microsimulation model, using literature-derived estimates of the risks of UGIB, HAP, and CDI among medical inpatients, along with the changes in risk associated with PPI use for each of these outcomes. The primary outcome was change in inpatient mortality. Simulated general medical inpatients outside the intensive care unit (ICU). Change in overall mortality during hospitalization. New initiation of PPI therapy led to an increase in hospital mortality in about 90% of simulated patients. Continuation of outpatient PPI therapy on admission led to net increase in hospital mortality in 79% of simulated patients. Results were robust to both one-way and multivariate sensitivity analyses, with net harm occurring in at least two-thirds of patients in all scenarios. For the majority of medical inpatients outside the ICU, use of PPIs likely leads to a net increase in hospital mortality. Even in patients at particularly high risk of UGIB, only those at the very lowest risk of HCAP and CDI should be considered for prophylactic PPI use. Continuation of outpatient PPIs may also increase expected hospital mortality. Apart from patients with active UGIB, use of PPIs in hospitalized patients should be discouraged.

Using insurance to enhance nitrogen fertilizer application to reduce nitrogen losses to the environment.

PubMed

Huang, W Y; Heifner, R G; Taylor, H; Uri, N D

2001-05-01

The advantage of using insurance to help a farmer adopt a best nitrogen management plan (BNMP) that reduces the impact of agricultural production on the environment is analytically and empirically demonstrated. Using an expected value analysis, it is shown that an insurance program can be structured so as to reduce a farmer's cost of bearing the adoption risk associated with changing production practices and, thus, to improve the farmer's certainty equivalent net return thereby promoting the adoption of a BNMP. Using the adoption of growing-season only N fertilizer application in Iowa as a case study, it is illustrated how insurance may be used to promote the adoption of this practice to reduce N fertilizer use. It is shown that it is possible for a farmer and an insurance company both to have an incentive to develop an insurance adoption program that will benefit both the farmer and the insurance company, increasing net social welfare and improving environmental quality in Iowa.

Quantifying the net social benefits of vehicle trip reductions : guidance for customizing the TRIMMS model, final draft report, June 2009.

DOT National Transportation Integrated Search

2009-04-01

This study details the development of a series of enhancements to the Trip Reduction Impacts of : Mobility Management Strategies (TRIMMS) model. TRIMMS allows quantifying the net social : benefits of a wide range of transportation demand management...

75 FR 26702 - Fisheries off West Coast States; Pacific Coast Groundfish Fishery Management Plan; Amendments 20...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... increase net economic benefits, create individual economic stability, provide full utilization of the trawl... (Amendments 20 and 21) is intended to increase net economic benefits, create individual economic stability... licenses, quota share accounts, vessel accounts, further tracking and monitoring components, and economic...

44 CFR 1.4 - Policy and procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... chosen to maximize the net benefits to society; (4) Among alternative approaches to any given regulatory... regulatory priorities with the aim of maximizing the aggregate net benefits to society, taking into account... economy, and other regulatory actions contemplated for the future. (b) It is the policy of FEMA to provide...

44 CFR 1.4 - Policy and procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... chosen to maximize the net benefits to society; (4) Among alternative approaches to any given regulatory... regulatory priorities with the aim of maximizing the aggregate net benefits to society, taking into account... economy, and other regulatory actions contemplated for the future. (b) It is the policy of FEMA to provide...

75 FR 56491 - Technical Amendments for Marine Spark-Ignition Engines and Vessels

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-16

... spillage, incorporating safe recommended practices will result in a net benefit to the environment and lead... spillage, incorporating safe recommended practices will result in a net benefit to the environment and lead... portable fuel tanks to these new requirements, manufacturers working together on systems integration...

Estimating the benefits of public health policies that reduce harmful consumption.

PubMed

Ashley, Elizabeth M; Nardinelli, Clark; Lavaty, Rosemarie A

2015-05-01

For products such as tobacco and junk food, where policy interventions are often designed to decrease consumption, affected consumers gain utility from improvements in lifetime health and longevity but also lose utility associated with the activity of consuming the product. In the case of anti-smoking policies, even though published estimates of gross health and longevity benefits are up to 900 times higher than the net consumer benefits suggested by a more direct willingness-to-pay estimation approach, there is little recognition in the cost-benefit and cost-effectiveness literature that gross estimates will overstate intrapersonal welfare improvements when utility losses are not netted out. This paper presents a general framework for analyzing policies that are designed to reduce inefficiently high consumption and provides a rule of thumb for the relationship between net and gross consumer welfare effects: where there exists a plausible estimate of the tax that would allow consumers to fully internalize health costs, the ratio of the tax to the per-unit long-term cost can provide an upper bound on the ratio of net to gross benefits. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Benefit-Cost Analysis of a Randomized Evaluation of Communities That Care: Monetizing Intervention Effects on the Initiation of Delinquency and Substance Use Through Grade 12

PubMed Central

Kuklinski, Margaret R.; Fagan, Abigail A.; Hawkins, J. David; Briney, John S.; Catalano, Richard F.

2015-01-01

Objective To determine whether the Communities That Care (CTC) prevention system is a cost-beneficial intervention. Methods Data were from a longitudinal panel of 4,407 youth participating in a randomized controlled trial including 24 towns in 7 states, matched in pairs within state and randomly assigned to condition. Significant differences favoring intervention youth in sustained abstinence from delinquency, alcohol use, and tobacco use through Grade 12 were monetized and compared to economic investment in CTC. Results CTC was estimated to produce $4,477 in benefits per youth (discounted 2011 dollars). It cost $556 per youth to implement CTC for 5 years. The net present benefit was $3,920. The benefit-cost ratio was $8.22 per dollar invested. The internal rate of return was 21%. Risk that investment would exceed benefits was minimal. Investment was expected to be recouped within 9 years. Sensitivity analyses in which effects were halved yielded positive cost-beneficial results. Conclusions CTC is a cost-beneficial, community-based approach to preventing initiation of delinquency, alcohol use, and tobacco use. CTC is estimated to generate economic benefits that exceed implementation costs when disseminated with fidelity in communities. PMID:26213527

Recent Advances in Near-Net-Shape Fabrication of Al-Li Alloy 2195 for Launch Vehicles

NASA Technical Reports Server (NTRS)

Wagner, John; Domack, Marcia; Hoffman, Eric

2007-01-01

Recent applications in launch vehicles use 2195 processed to Super Lightweight Tank specifications. Potential benefits exist by tailoring heat treatment and other processing parameters to the application. Assess the potential benefits and advocate application of Al-Li near-net-shape technologies for other launch vehicle structural components. Work with manufacturing and material producers to optimize Al-Li ingot shape and size for enhanced near-net-shape processing. Examine time dependent properties of 2195 critical for reusable applications.

Cost-benefit analysis of comprehensive mental health prevention programs in Japanese workplaces: a pilot study.

PubMed

Iijima, Sachiko; Yokoyama, Kazuhito; Kitamura, Fumihiko; Fukuda, Takashi; Inaba, Ryoichi

2013-01-01

We examined the implementation of mental health prevention programs in Japanese workplaces and the costs and benefits. A cross-sectional survey targeting mental health program staff at 11 major companies was conducted. Questionnaires explored program implementation based on the guidelines of the Japanese Ministry of Health, Labor and Welfare. Labor, materials, outsourcing costs, overheads, employee mental discomfort, and absentee numbers, and work attendance were examined. Cost-benefit analyses were conducted from company perspectives assessing net benefits per employee and returns on investment. The surveyed companies employ an average of 1,169 workers. The implementation rate of the mental health prevention programs was 66% for primary, 51% for secondary, and 60% for tertiary programs. The program's average cost was 12,608 yen per employee and the total benefit was 19,530 yen per employee. The net benefit per employee was 6,921 yen and the return on investment was in the range of 0.27-16.85. Seven of the 11 companies gained a net benefit from the mental health programs.

Cost-benefit Analysis of Comprehensive Mental Health Prevention Programs in Japanese Workplaces: A Pilot Study

PubMed Central

IIJIMA, Sachiko; YOKOYAMA, Kazuhito; KITAMURA, Fumihiko; FUKUDA, Takashi; INABA, Ryoichi

2013-01-01

We examined the implementation of mental health prevention programs in Japanese workplaces and the costs and benefits. A cross-sectional survey targeting mental health program staff at 11 major companies was conducted. Questionnaires explored program implementation based on the guidelines of the Japanese Ministry of Health, Labor and Welfare. Labor, materials, outsourcing costs, overheads, employee mental discomfort, and absentee numbers, and work attendance were examined. Cost-benefit analyses were conducted from company perspectives assessing net benefits per employee and returns on investment. The surveyed companies employ an average of 1,169 workers. The implementation rate of the mental health prevention programs was 66% for primary, 51% for secondary, and 60% for tertiary programs. The program’s average cost was 12,608 yen per employee and the total benefit was 19,530 yen per employee. The net benefit per employee was 6,921 yen and the return on investment was in the range of 0.27–16.85. Seven of the 11 companies gained a net benefit from the mental health programs. PMID:24077445

The Anterior Cingulate Gyrus Signals the Net Value of Others' Rewards

PubMed Central

Ramnani, Narender

2014-01-01

Evaluating the costs and benefits of our own choices is central to most forms of decision-making and its mechanisms in the brain are becoming increasingly well understood. To interact successfully in social environments, it is also essential to monitor the rewards that others receive. Previous studies in nonhuman primates have found neurons in the anterior cingulate cortex (ACC) that signal the net value (benefit minus cost) of rewards that will be received oneself and also neurons that signal when a reward will be received by someone else. However, little is understood about the way in which the human brain engages in cost–benefit analyses during social interactions. Does the ACC signal the net value (the benefits minus the costs) of rewards that others will receive? Here, using fMRI, we examined activity time locked to cues that signaled the anticipated reward magnitude (benefit) to be gained and the level of effort (cost) to be incurred either by a subject themselves or by a social confederate. We investigated whether activity in the ACC covaries with the net value of rewards that someone else will receive when that person is required to exert effort for the reward. We show that, although activation in the sulcus of the ACC signaled the costs on all trials, gyral ACC (ACCg) activity varied parametrically only with the net value of rewards gained by others. These results suggest that the ACCg plays an important role in signaling cost–benefit information by signaling the value of others' rewards during social interactions. PMID:24790190

20 CFR 404.1080 - Net earnings from self-employment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1080 Net earnings from self-employment. (a) Definition of net earnings from self-employment... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Net earnings from self-employment. 404.1080...

20 CFR 404.1080 - Net earnings from self-employment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1080 Net earnings from self-employment. (a) Definition of net earnings from self-employment... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Net earnings from self-employment. 404.1080...

20 CFR 404.1080 - Net earnings from self-employment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1080 Net earnings from self-employment. (a) Definition of net earnings from self-employment... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Net earnings from self-employment. 404.1080...

20 CFR 404.1080 - Net earnings from self-employment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1080 Net earnings from self-employment. (a) Definition of net earnings from self-employment... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Net earnings from self-employment. 404.1080...

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

PubMed

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

2016-10-01

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

Optimal allocation of bulk water supplies to competing use sectors based on economic criterion - An application to the Chao Phraya River Basin, Thailand

NASA Astrophysics Data System (ADS)

Divakar, L.; Babel, M. S.; Perret, S. R.; Gupta, A. Das

2011-04-01

SummaryThe study develops a model for optimal bulk allocations of limited available water based on an economic criterion to competing use sectors such as agriculture, domestic, industry and hydropower. The model comprises a reservoir operation module (ROM) and a water allocation module (WAM). ROM determines the amount of water available for allocation, which is used as an input to WAM with an objective function to maximize the net economic benefits of bulk allocations to different use sectors. The total net benefit functions for agriculture and hydropower sectors and the marginal net benefit from domestic and industrial sectors are established and are categorically taken as fixed in the present study. The developed model is applied to the Chao Phraya basin in Thailand. The case study results indicate that the WAM can improve net economic returns compared to the current water allocation practices.

Stated Preference Economic Development Model

DTIC Science & Technology

2015-02-01

calculated the public benefit associated with Petroglyph by extracting the value for day hikes from the first study, the added value of rock art from the...2002. There are a lack of data and methods to determine the net social benefit of this aid. Additionally, currently available data are insufficient to...properly prioritize the usage and award of this aid. SPED involved the creation of tools that estimate the net social benefit of projects using

Shaking up the dental safety-net: elimination of optional adult dental Medicaid benefits in California.

PubMed

Wides, Cynthia; Alam, Sonia Rab; Mertz, Elizabeth

2014-02-01

In July 2009, California eliminated funding for most adult non-emergency Medicaid dental benefits (Denti-Cal). This paper presents the findings from a qualitative assessment of the impacts of the Denti-Cal cuts on California's oral health safety-net. Interviews were conducted with dental safety-net providers throughout the state, including public health departments, community health centers, dental schools, Native American health clinics, and private providers, and were coded thematically using Atlas.ti. Safety-net providers reported decreased utilization by Denti-Cal-eligible adults, who now primarily seek emergency dental services, and reported shifting to focus on pediatric and privately-insured patients. Significant changes were reported in safety-net clinic finances, operations, and ability to refer. The impact of the Denti-Cal cuts has been distributed unevenly across the safety-net, with private providers and County Health Departments bearing the highest burden.

THE COMPETITION BETWEEN METHYLMERCURY RISKS AND OMEGA-3 POLYUNSATURATED FATTY ACID BENEFITS: A REVIEW OF CONFLICTING EVIDENCE ON FISH CONSUMPTION AND CARDIOVASCULAR HEALTH.

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

LIPFERT, F.W.; SULLIVAN, T.M.

2006-10-31

The health concerns of methylmercury (MeHg) contamination of seafood have recently been extended to include cardiovascular effects, especially premature mortality. Although the fatty acids (fish oils) found in most species are thought to confer a wide range of health benefits, especially to the cardiovascular system, some epidemiological studies have suggested that such benefits may be offset by adverse effects of MeHg. This comprehensive review is based on searches of the NIH MEDLINE database and compares and contrasts 145 published studies involving cardiovascular effects and exposures to mercury and other fish contaminants, intake of fatty acids including dietary supplements of fishmore » oils, and rates of seafood consumption. Since few of these studies include adequate simultaneous measurements of all of these potential predictor variables, we summarized their effects separately, across the available studies of each, and then drew conclusions based on the aggregated findings. It is important to realize that studies of seafood consumption encompass the net effects of all of these predictor variables, but that seafood intake studies are rarely supported by human biomarker measurements that reflect the actual uptake of harmful as well as beneficial fish ingredients. As a result, exposure measurement error is an issue when comparing studies and predictor variables. It is also possible that the observed benefits of eating fish may relate more to the characteristics of the consumers than to those of the fish. We found the evidence for adverse cardiovascular effects of MeHg to be sparse and unconvincing. Studies of cardiovascular mortality show net benefits, and the findings of adverse effects are mainly limited to studies Finland at high mercury exposure levels. By contrast, a very consistent picture of beneficial effects is seen for fatty acids, after recognizing the effects of exposure uncertainties and the presence of threshold effects. Studies based on measured biomarker levels are seen to be the most reliable and present a convincing picture of strong beneficial effects, especially for those causes of death involving cardiac arrhythmia. This conclusion also extends to studies of fish-oil supplementation. Studies based on fish consumption show mainly benefits from increased consumption. This finding is supported by an ecological study at the national population level, for which the lifestyle effects that might be correlated with fish consumption within a given population would be expected to ''average out'' across nations. Finally, the net survival benefits resulting from eating fish are consistent with studies involving complete diets, although benefits are also seen to accrue from reduced consumption of red meat and saturated fats.« less

One principle and a fourth fallacy of disability studies

PubMed Central

Harris, J.

2002-01-01

This brief paper shows that the idea of benefits to the subject compensating for the harms of disability is at best self defeating and at worst sinister. Equally benefits to third parties while real are dubious as compensating factors. This shows that disabilities are just that, a net loss and not a net gain.

Benefit-Risk Monitoring of Vaccines Using an Interactive Dashboard: A Methodological Proposal from the ADVANCE Project.

PubMed

Bollaerts, Kaatje; De Smedt, Tom; Donegan, Katherine; Titievsky, Lina; Bauchau, Vincent

2018-03-26

New vaccines are launched based on their benefit-risk (B/R) profile anticipated from clinical development. Proactive post-marketing surveillance is necessary to assess whether the vaccination uptake and the B/R profile are as expected and, ultimately, whether further public health or regulatory actions are needed. There are several, typically not integrated, facets of post-marketing vaccine surveillance: the surveillance of vaccination coverage, vaccine safety, effectiveness and impact. With this work, we aim to assess the feasibility and added value of using an interactive dashboard as a potential methodology for near real-time monitoring of vaccine coverage and pre-specified health benefits and risks of vaccines. We developed a web application with an interactive dashboard for B/R monitoring. The dashboard is demonstrated using simulated electronic healthcare record data mimicking the introduction of rotavirus vaccination in the UK. The interactive dashboard allows end users to select certain parameters, including expected vaccine effectiveness, age groups, and time periods and allows calculation of the incremental net health benefit (INHB) as well as the incremental benefit-risk ratio (IBRR) for different sets of preference weights. We assessed the potential added value of the dashboard by user testing amongst a range of stakeholders experienced in the post-marketing monitoring of vaccines. The dashboard was successfully implemented and demonstrated. The feedback from the potential end users was generally positive, although reluctance to using composite B/R measures was expressed. The use of interactive dashboards for B/R monitoring is promising and received support from various stakeholders. In future research, the use of such an interactive dashboard will be further tested with real-life data as opposed to simulated data.

Economic analysis of the global polio eradication initiative.

PubMed

Duintjer Tebbens, Radboud J; Pallansch, Mark A; Cochi, Stephen L; Wassilak, Steven G F; Linkins, Jennifer; Sutter, Roland W; Aylward, R Bruce; Thompson, Kimberly M

2010-12-16

The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40-50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains robust over a wide range of assumptions, and that consideration of the additional net benefits of externalities that occurred during polio campaigns to date, such as the mortality reduction associated with delivery of Vitamin A supplements, significantly increases the net benefits. This study finds a strong economic justification for the GPEI despite the rising costs of the initiative. Copyright © 2010 Elsevier Ltd. All rights reserved.

PCSK9 Inhibitors Show Value for Patients and the US Health Care System.

PubMed

Cheng, Wei-Han; Gaudette, Étienne; Goldman, Dana P

2017-12-01

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were approved by the US Food and Drug Administration (FDA) as cholesterol-lowering therapies for patients with familial hypercholesterolemia or atherosclerotic cardiovascular disease. To estimate the long-term health and economic value of PCSK9 inhibitors for Americans (51 years and older). We conducted simulations using the Future Elderly Model, an established dynamic microsimulation model to project the lifetime outcomes for the US population aged 51 years and older. Health effects estimates and confidence intervals from published meta-analysis studies were used to project changes in life expectancy, quality-adjusted life-years, and lifetime medical spending resulting from the use of PCSK9 inhibitors. We considered two treatment scenarios: 1) current FDA eligibility and 2) an extended eligibility scenario that includes patients with no pre-existing cardiovascular disease but at high risk. We assumed that the price of PCSK9 inhibitors was discounted by 35% in the first 12 years and by 57% thereafter, with gradual uptake of the drug in eligible populations. Use of PCSK9 inhibitors by individuals covered by current FDA approval would extend life expectancy at the age of 51 years by an estimated 1.1 years and would yield a lifetime net value of $5800 per person. If use was extended to those at high risk for cardiovascular disease, PCSK9 inhibitors would generate a lifetime net benefit of $14,100 per person. Expanded access to PCSK9 inhibitors would offer positive long-term net value for patients and the US health care system at the current discounted prices. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Derivation of Optimal Cropping Pattern in Part of Hirakud Command using Cuckoo Search

NASA Astrophysics Data System (ADS)

Rath, Ashutosh; Biswal, Sudarsan; Samantaray, Sandeep; Swain, Prakash Chandra, PROF.

2017-08-01

The economicgrowth of a Nation depends on agriculture which relies on the obtainable water resources, available land and crops. The contribution of water in an appropriate quantity at appropriate time plays avitalrole to increase the agricultural production. Optimal utilization of available resources can be achieved by proper planning and management of water resources projects and adoption of appropriate technology. In the present work, the command area of Sambalpur distribrutary System is taken up for investigation. Further, adoption of a fixed cropping pattern causes the reduction of yield. The present study aims at developing different crop planning strategies to increase the net benefit from the command area with minimum investment. Optimization models are developed for Kharif season using LINDO and Cuckoo Search (CS) algorithm for maximization of the net benefits. In process of development of Optimization model the factors such as cultivable land, seeds, fertilizers, man power, water cost, etc. are taken as constraints. The irrigation water needs of major crops and the total available water through canals in the command of Sambalpur Distributary are estimated. LINDO and Cuckoo Search models are formulated and used to derive the optimal cropping pattern yielding maximum net benefits. The net benefits of Rs.585.0 lakhs in Kharif Season are obtained by adopting LINGO and 596.07 lakhs from Cuckoo Search, respectively, whereas the net benefits of 447.0 lakhs is received by the farmers of the locality with the adopting present cropping pattern.

The utility of hand transplantation in hand amputee patients.

PubMed

Alolabi, Noor; Chuback, Jennifer; Grad, Sharon; Thoma, Achilles

2015-01-01

To measure the desirable health outcome, termed utility, and the expected quality-adjusted life years (QALYs) gained with hand composite tissue allotransplantation (CTA) using hand amputee patients and the general public. Using the standard gamble (SG) and time trade-off (TTO) techniques, utilities were obtained from 30 general public participants and 12 amputee patients. The health utility and net QALYs gained or lost with transplantation were computed. A sensitivity analysis was conducted to account for the effects of lifelong immunosuppression on the life expectancy of transplant recipients. Higher scores represent greater utility. Hand amputation mean health utility as measured by the SG and TTO methods, respectively, was 0.72 and 0.80 for the general public and 0.69 and 0.70 for hand amputees. In comparison, hand CTA mean health utility was 0.74 and 0.82 for the general public and 0.83 and 0.86 for amputees. Hand CTA imparted an expected gain of 0.9 QALYs (SG and TTO) in the general public and 7.0 (TTO) and 7.8 (SG) QALYs in hand amputees. A loss of at least 1.7 QALYs was demonstrated when decreasing the life expectancy in the sensitivity analysis in the hand amputee group. Hand amputee patients did not show a preference toward hand CTA with its inherent risks. With this procedure being increasingly adopted worldwide, the benefits must be carefully weighed against the risks of lifelong immunosuppressive therapy. This study does not show clear benefit to advocate hand CTA. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Sulfadoxine-Pyrimethamine–Based Intermittent Preventive Treatment, Bed Net Use, and Antenatal Care during Pregnancy: Demographic Trends and Impact on the Health of Newborns in the Kassena Nankana District, Northeastern Ghana

PubMed Central

Oduro, Abraham R.; Fryauff, David J.; Koram, Kwadwo A.; Rogers, William O.; Anto, Francis; Atuguba, Frank; Anyorigiya, Thomas; Adjuik, Martin; Ansah, Patrick; Hodgson, Abraham; Nkrumah, Francis

2010-01-01

Demographics and health practices of 2,232 pregnant women in rural northeastern Ghana and characteristics of their 2,279 newborns were analyzed to determine benefits associated with intermittent preventive treatment (IPTp), antenatal care, and/or bed net use during pregnancy. More than half reported bed net use, 90% reported at least two antenatal care visits, and > 82% took at least one IPTp dose of sulfadoxine-pyrimethamine. Most used a bed net and IPTp (45%) or IPTp alone (38%). Low birth weight (< 2,500 grams) characterized 18.3% of the newborns and was significantly associated with female sex, Nankam ethnicity, first-born status, and multiple births. Among newborns of primigravidae, IPTp was associated with a significantly greater birth weight, significantly fewer low birth weight newborns, improved hemoglobin levels, and less anemia. Babies of multigravidae derived no benefit to birth weight or hemoglobin level from single or multiple doses of sulfadoxine-pyrimethamine during pregnancy. No differences or benefits were seen when a bed net was the only protective factor. PMID:20595482

Clinical benefit of systemic treatment in patients with advanced pancreatic and gastrointestinal neuroendocrine tumours according to ESMO-MCBS and ASCO framework.

PubMed

de Hosson, L D; van Veenendaal, L M; Schuller, Y; Zandee, W T; de Herder, W W; Tesselaar, M E T; Klümpen, H J; Walenkamp, A M E

2017-12-01

Assessment of clinical benefit of systemic treatments of rare diseases including gastroenteropancreatic neuroendocrine tumours (GEP-NET) is challenging. Recently several tools have been developed to grade the clinical benefit of cancer drugs. The European Society for Medical Oncology (ESMO) has developed the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS). The American Society of Clinical Oncology (ASCO) has developed and revised the ASCO framework consisting of the Net Health Benefit (NHB) score juxtaposed against the costs of the treatment. In this review, we graded systemic treatments for GEP-NET patients with both frameworks. The electronic databases (PubMed and EMBASE) were searched for papers reporting comparative trials, conducted in adult GEP-NET patients in the English language. Papers were assessed according to the ESMO-MCBS and the NHB part of the ASCO revised Framework (NHB-ASCO-F) by four independent assessors, and discrepancies were discussed. The search yielded 32 trials of which 6 were eligible for grading with the ESMO-MCBS resulting in scores of 2 or 3. Eight trials were eligible for grading with the NHB-ASCO-F, resulting in scores between 37.6 and 57.4. Trials that were not primary assessable by the tools were analysed separately. Consensus between assessors was reached in 68% of trials with the ESMO-MCBS and in 23% of trials with the NHB-ASCO-F. The currently used systemic treatments for GEP-NET patients had low scores according to the NHB-ASCO-F and none could be graded as meaningful clinical beneficial according to the ESMO-MCBS. Despite the low incidence, the heterogeneous patient population and relatively long natural course of NET, future studies on new treatment modalities should aim for high clinical benefit outcomes. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice.

PubMed

Eckermann, Simon; Coelli, Tim

2013-01-01

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care. In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied. Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Quantitative approach for incorporating methylmercury risks and omega-3 fatty acid benefits in developing species-specific fish consumption advice.

PubMed

Ginsberg, Gary L; Toal, Brian F

2009-02-01

Despite general agreement about the toxicity of methylmercury (MeHg), fish consumption advice remains controversial. Concerns have been raised that negative messages will steer people away from fish and omega-3 fatty acid (FA) benefits. One approach is to provide advice for individual species that highlights beneficial fish while cautioning against riskier fish. Our goal in this study was to develop a method to quantitatively analyze the net risk/benefit of individual fish species based on their MeHg and omega-3 FA content. We identified dose-response relationships for MeHg and omega-3 FA effects on coronary heart disease (CHD) and neurodevelopment. We used the MeHg and omega-3 FA content of 16 commonly consumed species to calculate the net risk/benefit for each species. Estimated omega-3 FA benefits outweigh MeHg risks for some species (e.g., farmed salmon, herring, trout); however, the opposite was true for others (swordfish, shark). Other species were associated with a small net benefit (e.g., flounder, canned light tuna) or a small net risk (e.g., canned white tuna, halibut). These results were used to place fish into one of four meal frequency categories, with the advice tentative because of limitations in the underlying dose-response information. Separate advice appears warranted for the neurodevelopmental risk group versus the cardiovascular risk group because we found a greater net benefit from fish consumption for the cardiovascular risk group. This research illustrates a framework for risk/benefit analysis that can be used to develop categories of consumption advice ranging from "do not eat" to "unlimited," with the caveat that unlimited may need to be tempered for certain fish (e.g., farm-raised salmon) because of other contaminants and end points (e.g., cancer risk). Uncertainties exist in the underlying dose-response relationships, pointing in particular to the need for more research on the adverse effects of MeHg on cardiovascular end points.

A physical framework for evaluating net effects of wet meadow restoration on late summer streamflow

NASA Astrophysics Data System (ADS)

Grant, G.; Nash, C.; Selker, J. S.; Lewis, S.; Noël, P.

2017-12-01

Restoration of degraded wet meadows that develop on upland valley floors is intended to achieve a range of ecological benefits. A widely cited benefit is the potential for meadow restoration to augment late-season streamflow; however, there has been little field data demonstrating increased summer flows following restoration. Instead, the hydrologic consequences of restoration have typically been explored using coupled groundwater and surface water flow models at instrumented sites. The expected magnitude and direction of change provided by models has, however, been inconclusive. Here, we assess the streamflow benefit that can be obtained by wet meadow restoration using a parsimonious, physically-based approach. We use a one-dimensional linearized Boussinesq equation with a superimposed solution for changes in storage due to groundwater upwelling and and explicitly calculate evapotranspiration using the White Method. The model accurately predicts water table elevations from field data in the Middle Fork John Day watershed in Oregon, USA. The full solution shows that while raising channel beds can increase total water storage via increases in water table elevation in upland valley bottoms, the contributions of both lateral and longitudinal drainage from restored floodplains to late summer streamflow are undetectably small, while losses in streamflow due to greater transpiration, lower hydraulic gradients, and less drainable pore volume are substantial. Although late-summer streamflow increases should not be expected as a direct result of wet meadow restoration, these approaches offer benefits for improving the quality and health of riparian and meadow vegetation that would warrant considering such measures, even at the cost of increased water demand and reduced streamflow.

Assessing task-technology fit in a PACS upgrade: do users' and developers' appraisals converge?

PubMed

Lepanto, Luigi; Sicotte, Claude; Lehoux, Pascale

2011-12-01

The purpose of this study was to measure users' perceived benefits of a picture archiving and communication system (PACS) upgrade, and compare their responses to those predicted by developers. The Task-Technology Fit (TTF) model served as the theoretical framework to study the relation between TTF, utilization, and perceived benefits. A self-administered survey was distributed to radiologists working in a university hospital undergoing a PACS upgrade. Four variables were measured: impact, utilization, TTF, and perceived net benefits. The radiologists were divided into subgroups according to their utilization profiles. Analysis of variance was performed and the hypotheses were tested with regression analysis. Interviews were conducted with developers involved in the PACS upgrade who were asked to predict impact and TTF. Users identified only a moderate fit between the PACS enhancements and their tasks, while developers predicted a high level of TTF. The combination of a moderate fit and an underestimation of the potential impact of changes in the PACS led to a low score for perceived net benefits. Results varied significantly among user subgroups. Globally, the data support the hypotheses that TTF predicts utilization and perceived net benefits, but not that utilization predicts perceived net benefits. TTF is a valid tool to assess perceived benefits, but it is important to take into account the characteristics of users. In the context of a technology that is rapidly evolving, there needs to be an alignment of what users perceive as a good fit and the functionality developers incorporate into their products.

When Is Spillover from Marine Reserves Likely to Benefit Fisheries?

PubMed Central

Buxton, Colin D.; Hartmann, Klaas; Kearney, Robert; Gardner, Caleb

2014-01-01

The net movement of individuals from marine reserves (also known as no-take marine protected areas) to the remaining fishing grounds is known as spillover and is frequently used to promote reserves to fishers on the grounds that it will benefit fisheries. Here we consider how mismanaged a fishery must be before spillover from a reserve is able to provide a net benefit for a fishery. For our model fishery, density of the species being harvested becomes higher in the reserve than in the fished area but the reduction in the density and yield of the fished area was such that the net effect of the closure was negative, except when the fishery was mismanaged. The extent to which effort had to exceed traditional management targets before reserves led to a spillover benefit varied with rates of growth and movement of the model species. In general, for well-managed fisheries, the loss of yield from the use of reserves was less for species with greater movement and slower growth. The spillover benefit became more pronounced with increasing mis-management of the stocks remaining available to the fishery. This model-based result is consistent with the literature of field-based research where a spillover benefit from reserves has only been detected when the fishery is highly depleted, often where traditional fisheries management controls are absent. We conclude that reserves in jurisdictions with well-managed fisheries are unlikely to provide a net spillover benefit. PMID:25188380

Assessment of the Incremental Benefit of Computer-Aided Detection (CAD) for Interpretation of CT Colonography by Experienced and Inexperienced Readers

PubMed Central

Boone, Darren; Mallett, Susan; McQuillan, Justine; Taylor, Stuart A.; Altman, Douglas G.; Halligan, Steve

2015-01-01

Objectives To quantify the incremental benefit of computer-assisted-detection (CAD) for polyps, for inexperienced readers versus experienced readers of CT colonography. Methods 10 inexperienced and 16 experienced radiologists interpreted 102 colonography studies unassisted and with CAD utilised in a concurrent paradigm. They indicated any polyps detected on a study sheet. Readers’ interpretations were compared against a ground-truth reference standard: 46 studies were normal and 56 had at least one polyp (132 polyps in total). The primary study outcome was the difference in CAD net benefit (a combination of change in sensitivity and change in specificity with CAD, weighted towards sensitivity) for detection of patients with polyps. Results Inexperienced readers’ per-patient sensitivity rose from 39.1% to 53.2% with CAD and specificity fell from 94.1% to 88.0%, both statistically significant. Experienced readers’ sensitivity rose from 57.5% to 62.1% and specificity fell from 91.0% to 88.3%, both non-significant. Net benefit with CAD assistance was significant for inexperienced readers but not for experienced readers: 11.2% (95%CI 3.1% to 18.9%) versus 3.2% (95%CI -1.9% to 8.3%) respectively. Conclusions Concurrent CAD resulted in a significant net benefit when used by inexperienced readers to identify patients with polyps by CT colonography. The net benefit was nearly four times the magnitude of that observed for experienced readers. Experienced readers did not benefit significantly from concurrent CAD. PMID:26355745

When is spillover from marine reserves likely to benefit fisheries?

PubMed

Buxton, Colin D; Hartmann, Klaas; Kearney, Robert; Gardner, Caleb

2014-01-01

The net movement of individuals from marine reserves (also known as no-take marine protected areas) to the remaining fishing grounds is known as spillover and is frequently used to promote reserves to fishers on the grounds that it will benefit fisheries. Here we consider how mismanaged a fishery must be before spillover from a reserve is able to provide a net benefit for a fishery. For our model fishery, density of the species being harvested becomes higher in the reserve than in the fished area but the reduction in the density and yield of the fished area was such that the net effect of the closure was negative, except when the fishery was mismanaged. The extent to which effort had to exceed traditional management targets before reserves led to a spillover benefit varied with rates of growth and movement of the model species. In general, for well-managed fisheries, the loss of yield from the use of reserves was less for species with greater movement and slower growth. The spillover benefit became more pronounced with increasing mis-management of the stocks remaining available to the fishery. This model-based result is consistent with the literature of field-based research where a spillover benefit from reserves has only been detected when the fishery is highly depleted, often where traditional fisheries management controls are absent. We conclude that reserves in jurisdictions with well-managed fisheries are unlikely to provide a net spillover benefit.

Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later.

PubMed

Tuffaha, Haitham W; Roberts, Shelley; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A

2015-04-01

Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritional support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition. To evaluate the cost-effectiveness of nutritional support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information analysis (VOI). The analysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-analysis. Resources were valued using 2014 prices and the time horizon of the analysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures. Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million. Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.

Cost Benefit Analysis of a Utility Scale Waste-to-Energy/Concentrating Solar Power Hybrid Facility at Fort Bliss

DTIC Science & Technology

2012-06-01

installations for Energy, Waste, and Water. This means Fort Bliss will strive to become Net Zero Energy, Net Zero Waste , and Net Zero Water in the coming...years. Net Zero Energy requires Fort Bliss to produce as much energy on-installation as it consumes annually. Net Zero Waste aims to reduce, reuse...become Net Zero Energy and Net Zero Waste by 2020. A WtE facility actually goes well beyond Fort Bliss’ Net Zero Energy mission. That mission

A good night's sleep and the habit of net use: perceptions of risk and reasons for bed net use in Bukoba and Zanzibar.

PubMed

Koenker, Hannah M; Loll, Dana; Rweyemamu, Datius; Ali, Abdullah S

2013-06-13

Intensive malaria control interventions in the United Republic of Tanzania have contributed to reductions in malaria prevalence. Given that malaria control remains reliant upon continued use of long-lasting insecticidal bed nets (LLINs) even when the threat of malaria has been reduced, this qualitative study sought to understand how changes in perceived risk influence LLIN usage, and to explore in more detail the benefits of net use that are unrelated to malaria. Eleven focus group discussions were conducted in Bukoba Rural district and in Zanzibar Urban West district in late 2011. Participants were males aged 18 and over, females between the ages of 18 and 49, and females at least 50 years old. The perceived risk of malaria had decreased among the respondents, and malaria control interventions were credited for the decline. Participants cited reductions in both the severity of malaria and in their perceived susceptibility to malaria. However, malaria was still considered a significant threat. Participants' conceptualization of risk appeared to be an important consideration for net use. At the same time, comfort and aspects of comfort (getting a good night's sleep, avoiding biting pests) appeared to play a large role in personal decisions to use nets consistently or not. Barriers to comfort (feeling uncomfortable or trapped; perceived difficulty breathing, or itching/rashes) were frequently cited as reasons not to use a net consistently. While it was apparent that participants acknowledged the malaria-prevention benefits of net use, the exploration of the risk and comfort determinants of net use provides a richer understanding of net use behaviours, particularly in a setting where transmission has fallen and yet consistent net use is still crucial to maintaining those gains. Future behaviour change communication campaigns should capitalize on the non-malaria benefits of net use that provide a long-term rationale for consistent use even when the immediate threat of malaria transmission has been reduced.

The good, the bad and the ugly of marine reserves for fishery yields

PubMed Central

De Leo, Giulio A.; Micheli, Fiorenza

2015-01-01

Marine reserves (MRs) are used worldwide as a means of conserving biodiversity and protecting depleted populations. Despite major investments in MRs, their environmental and social benefits have proven difficult to demonstrate and are still debated. Clear expectations of the possible outcomes of MR establishment are needed to guide and strengthen empirical assessments. Previous models show that reserve establishment in overcapitalized, quota-based fisheries can reduce both catch and population abundance, thereby negating fisheries and even conservation benefits. By using a stage-structured, spatially explicit stochastic model, we show that catches under quota-based fisheries that include a network of MRs can exceed maximum sustainable yield (MSY) under conventional quota management if reserves provide protection to old, large spawners that disproportionally contribute to recruitment outside the reserves. Modelling results predict that the net fishery benefit of MRs is lost when gains in fecundity of old, large individuals are small, is highest in the case of sedentary adults with high larval dispersal, and decreases with adult mobility. We also show that environmental variability may mask fishery benefits of reserve implementation and that MRs may buffer against collapse when sustainable catch quotas are exceeded owing to stock overestimation or systematic overfishing. PMID:26460129

Simulation of quitting smoking in the military shows higher lifetime medical spending more than offset by productivity gains.

PubMed

Yang, Wenya; Dall, Timothy M; Zhang, Yiduo; Zhang, Shiping; Arday, David R; Dorn, Patricia W; Jain, Anjali

2012-12-01

Despite the documented benefits of quitting smoking, studies have found that smokers who quit may have higher lifetime medical costs, in part because of increased risk for medical conditions, such as type 2 diabetes, brought on by associated weight gain. Using a simulation model and data on 612,332 adult smokers in the US Department of Defense's TRICARE Prime health plan in 2008, we estimated that cessation accompanied by weight gain would increase average life expectancy by 3.7 years, and that the average lifetime reduction in medical expenditures from improved health ($5,600) would be offset by additional expenditures resulting from prolonged life ($7,300). Results varied by age and sex: For females ages 18-44 at time of cessation, there would be net savings of $1,200 despite additional medical expenditures from prolonged life. Avoidance of weight gain after quitting smoking would increase average life expectancy by four additional months and reduce mean extra spending resulting from prolonged life by $700. Overall, the average net lifetime health care cost increase of $1,700 or less per ex-smoker would be modest and, for employed people, more than offset by even one year's worth of productivity gains. These results boost the case for smoking cessation programs in the military in particular, along with not selling cigarettes in commissaries or at reduced prices.

A mathematical model of the impact of present and future malaria vaccines.

PubMed

Wenger, Edward A; Eckhoff, Philip A

2013-04-15

With the encouraging advent of new malaria vaccine candidates, mathematical modelling of expected impacts of present and future vaccines as part of multi-intervention strategies is especially relevant. The impact of potential malaria vaccines is presented utilizing the EMOD model, a comprehensive model of the vector life cycle coupled to a detailed mechanistic representation of intra-host parasite and immune dynamics. Values of baseline transmission and vector feeding behaviour parameters are identified, for which local elimination is enabled by layering pre-erythrocytic vaccines of various efficacies on top of high and sustained insecticide-treated net coverage. The expected reduction in clinical cases is further explored in a scenario that targets children by adding a pre-erythrocytic vaccine to the EPI programme for newborns. At high transmission, there is a minimal reduction in clinical disease cases, as the time to infection is only slightly delayed. At lower transmission, there is an accelerating community-level protection that has subtle dependences on heterogeneities in vector behaviour, ecology, and intervention coverage. At very low transmission, the trend reverses as many children are vaccinated to prevent few cases. The maximum-impact setting is one in which the impact of increasing bed net coverage has saturated, vector feeding is primarily outdoors, and transmission is just above the threshold where small perturbations from a vaccine intervention result in large community benefits.

Cost-benefit analysis of establishing and operating radiation oncology services in Fiji.

PubMed

Kim, Eunkyoung; Cho, Yoon-Min; Kwon, Soonman; Park, Kunhee

2017-10-01

Rising demand for services of cancer patients has been recognised by the Government of Fiji as a national health priority. Increasing attention has been paid to the lack of service of radiation therapy or radiotherapy in Fiji. This study aims to estimate and compare the costs and benefits of introducing radiation oncology services in Fiji from the societal perspective. Time horizon for cost-benefit analysis (CBA) was 15 years from 2021 to 2035. The benefits and costs were converted to the present values of 2016. Estimates for the CBA model were taken from previous studies and expert opinions and data obtained from field visits to Fiji in January 2016. Sensitivity analyses with changing assumptions were undertaken. The estimated net benefit, applying the national minimum wage (NMW) to measure monetary value for life-year gained, was -31,624,421 FJD with 0.69 of benefit-cost (B/C) ratio. If gross national income (GNI) per capita was used for the value of life years, net benefit was 3,975,684 FJD (B/C ratio: 1.04). With a pessimistic scenario, establishing the center appeared to be not cost-beneficial, and the net benefit was -53,634,682 FJD (B/C ratio: 0.46); net benefit with an optimistic scenario was estimated 23,178,189 FJD (B/C ratio: 1.20). Based on the CBA results from using GNI per capita instead of the NMW, this project would be cost-beneficial. Introducing a radiation oncology center in Fiji would have potential impacts on financial sustainability, financial protection, and accessibility and equity of the health system. Copyright © 2017 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

Benefit-cost analysis of spruce budworm (Choristoneura fumiferana Clem.) control: incorporating market and non-market values.

PubMed

Chang, Wei-Yew; Lantz, Van A; Hennigar, Chris R; MacLean, David A

2012-01-01

This study employs a benefit-cost analysis framework to estimate market and non-market benefits and costs of controlling future spruce budworm (Choristoneura fumiferana) outbreaks on Crown forest lands in New Brunswick, Canada. We used: (i) an advanced timber supply model to project potential timber volume saved, timber value benefits, and costs of pest control efforts; and (ii) a recent contingent valuation method analysis that evaluated non-market benefits (i.e., changes in recreation opportunities and existence values) of controlling future spruce budworm outbreaks in the Province. A total of six alternative scenarios were evaluated, including two uncontrolled future budworm outbreak severities (moderate vs. severe) and, for each severity, three control program levels (protecting 10%, 20%, or 40% of the susceptible Crown land forest area). The economic criteria used to evaluate each scenario included benefit-cost ratios and net present values. Under severe outbreak conditions, results indicated that the highest benefit-cost ratio (4.04) occurred when protecting 10% (284,000 ha) of the susceptible area, and the highest net present value ($111 M) occurred when protecting 20% (568,000 ha) of the susceptible area. Under moderate outbreak conditions, the highest benefit-cost ratio (3.24) and net present value ($58.7 M) occurred when protecting 10% (284,000 ha) of the susceptible area. Inclusion of non-market values generally increased the benefit-cost ratios and net present values of the control programs, and in some cases, led to higher levels of control being supported. Results of this study highlight the importance of including non-market values into the decision making process of forest pest management. Copyright © 2011 Elsevier Ltd. All rights reserved.

An Expanded Study of Net Generation Perceptions on Privacy and Security on Social Networking Sites (SNS)

ERIC Educational Resources Information Center

Lawler, James P.; Molluzzo, John C.; Doshi, Vijal

2012-01-01

Social networking on the Internet continues to be a frequent avenue of communication, especially among Net Generation consumers, giving benefits both personal and professional. The benefits may be eventually hindered by issues in information gathering and sharing on social networking sites. This study evaluates the perceptions of students taking a…

Supported Employment's Cost-Efficiency to Taxpayers: 2002 to 2007

ERIC Educational Resources Information Center

Cimera, Robert Evert

2009-01-01

This study explored the cost-efficiency of all 231,204 supported employees funded by vocational rehabilitation throughout the entire United States from 2002 to 2007. Results found that supported employees returned an average monthly net benefit to taxpayers of $251.34 (i.e., an annual net benefit of $3,016.08 per supported employee) and generated…

Cost-utility of universal hepatitis A vaccination in Canada.

PubMed

Bauch, C T; Anonychuk, A M; Pham, B Z; Gilca, V; Duval, B; Krahn, M D

2007-12-12

Hepatitis A (HA) vaccination in Canada is currently targeted toward high-risk groups. The cost-effectiveness and expected health outcomes of universal vaccination relative to targeted vaccination in low-incidence countries such as Canada are currently unknown. Here, we conducted a cost-utility analysis for this situation, with Canada as the study population. We included vaccine costs, time costs, infection costs, and public health costs. We assessed a range of possible universal vaccination strategies over an 80-year time horizon using multiple cost perspectives. A dynamic model was used to account for herd immunity. Aggregate health gains from switching to universal vaccination are modest (10-30 QALYs per year). However, a "9+9" strategy that replaces two doses of monovalent hepatitis B (HB) vaccine at 9/10 years (universally administered in most provinces) with two doses of bivalent HA/HB vaccine is cost-saving from the societal perspective. At a willingness to pay threshold of $50,000/QALY, mean net benefit is +49.4 QALYs (S.D. 12.6) from the societal perspective and +3.8 QALYS (S.D. 3.0) from the payer perspective for the "9+9" strategy. Net benefit from the payer perspective is sensitive to the marginal cost of HA/HB vaccine relative to HB vaccine. Similar conclusions may apply in other countries with low incidence and a targeted vaccination policy.

Knowledge synthesis of benefits and adverse effects of measles vaccination: the Lasbela balance sheet.

PubMed

Ledogar, Robert J; Fleming, John; Andersson, Neil

2009-10-14

In preparation for a cluster-randomized controlled trial of a community intervention to increase the demand for measles vaccination in Lasbela district of Pakistan, a balance sheet summarized published evidence on benefits and possible adverse effects of measles vaccination. The balance sheet listed: 1) major health conditions associated with measles; 2) the risk among the unvaccinated who contract measles; 3) the risk among the vaccinated; 4) the risk difference between vaccinated and unvaccinated; and 5) the likely net gain from vaccination for each condition. Two models revealed very different projections of net gain from measles vaccine. A Lasbela-specific combination of low period prevalence of measles among the unvaccinated, medium vaccination coverage and low vaccine efficacy rate, as revealed by the baseline survey, resulted in less-than-expected gains attributable to vaccination. Modelled on estimates where the vaccine had greater efficacy, the gains from vaccination would be more substantial. Specific local conditions probably explain the low rates among the unvaccinated while the high vaccine failure rate is likely due to weaknesses in the vaccination delivery system. Community perception of these realities may have had some role in household decisions about whether to vaccinate, although the major discouraging factor was inadequate access. The balance sheet may be useful as a communication tool in other circumstances, applied to up-to-date local evidence.

The experience of mental health professionals using neuro emotional technique in psychotherapeutic practice

NASA Astrophysics Data System (ADS)

Marriage, Amanda Lynn

This study reviewed how Neuro Emotional Technique (NET) is used in psychotherapeutic practice, and how it is understood and experienced by the practitioners who use it. Participants included 18 mental health professionals who have obtained the certification-level of training in NET and have incorporated NET into their professional practice. A qualitative method was used to explore NET providers' experiences through an online survey. Data from these surveys was analyzed using the constant comparative method. Six categories containing 18 themes emerged as a result of this analysis. These categories included: (1) practitioners currently employing NET; (2) technique utilization; (3) participant estimation of the efficacy of NET; (4) talking about NET; (5) clients most likely to benefit from NET; and (6) clients least likely to benefit from NET. The 18 themes that emerged within these categories represent important components of the integration of NET into psychological treatment. These themes were compared with existing literature to serve as valuable information for psychologists and other mental health professionals seeking to incorporate NET into their professional practices. This study helps to fill the current void in the area of research on NET as a psychological intervention, or more specifically, as a holistic mind-body approach to self-betterment and the amelioration of symptoms for humans who are healing from a broad spectrum of traumatic and stressful experiences.

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

Mather, James

Atmospheric Radiation Measurement (ARM) Program standard data format is NetCDF 3 (Network Common Data Form). The object of this tutorial is to provide a basic introduction to NetCDF with an emphasis on aspects of the ARM application of NetCDF. The goal is to provide basic instructions for reading and visualizing ARM NetCDF data with the expectation that these examples can then be applied to more complex applications.

Assessing the value-adding impact of diagnostic-type tests on drug development and marketing.

PubMed

Blair, Edward D

2008-01-01

We explore the cash value of the companion diagnostics opportunity from the perspective of the pharmaceutical partner. Cashflow-based modeling is used to demonstrate the potential financial benefits of key relationships between the pharmaceutical and diagnostics industries. In four scenarios, the uplift in the net present value (NPV) of a proprietary medicine can exceed $US1.8 billion. By simple extrapolation, the uplifted NPV calculations allow realistic and plausible estimates of the companion diagnostic opportunity to be in the region of $US40 billion to $US90 billion. It is expected that such market valuation could drive a macroeconomic change that shifts healthcare practice from reactionary disease-treatment to proactive health maintenance.

Migration and pension.

PubMed

Razin, A; Sadka, E

1998-11-01

"Migration has important implications for the financial soundness of the pension system.... While it is common sense to expect that young migrants, even if low-skilled, can help society pay the benefits to the currently elderly, it may nevertheless be reasonable to argue that these migrants would adversely affect current young since, after all, the migrants are net beneficiaries of the welfare state. In contrast to the adverse effects of low skilled migration in a static model, [the authors] show that in a Samuelsonian overlapping generations model...migration is a Pareto-improving measure. All the existing income (low and high) and age (young and old) groups living at the time of the migrant's arrival would be better off." excerpt

Costs of children--benefit theory and population control.

PubMed

Tian, X

1989-01-01

In order to stem the rising fertility and growth rates in China, new theories and measures are needed. The author suggests new insights into the relationships between reproductive behavior and economic interests, regulation of individual reproductive behavior by such economic interests, and governmental performance with these interests in mind. Topics are devoted to the benefit theory about the costs of children, trends in Chinese children's costs and benefits, and family planning (FP) based on children's costs and benefits. Natural biological law governed people's reproductive behavior and the number of offspring until there was control over human reproduction. Factors which determine the desired number of children can be economic, cultural, political, historical, or geographical. In modern times and with the commercialism of society, children have been sometimes viewed as commodities and Western economists (Becker and Leibenstein) have theorized the cost benefit ratio to parents. Expected positive benefits are support, labor force contribution, and family happiness. Negative benefits are the direct and indirect costs in time and money raising children. Children are produced where benefits are positive, and where benefits and costs are equal, circumstances will determine the result. No children will be produced when costs exceed benefits. The concept of net costs is described. Chinese trends indicate a direction toward a market oriented economy. Instead of following Western theory, as economic development has advanced rapidly the value of children has grown. The reasons are explained as marginal children may still bring benefits in a market where the function of regulation of a labor market is limited, children still render better support for their parents without a developed social security system, and boys are expected to secure their families fortunes during the changing economic conditions. The author recognizes that other conditions such as the number of fertile women are also important. The State's population policy of rewards and penalties also affects the costs and benefits. Administrative intervention to implement the FP program have been effectively and adequately used in the past to control population growth, even though it is recognized that social and economic development is another way of affecting population growth. Parents still need to be guaranteed that 1 child will indeed be a benefit. Children's economic value has been accepted, and policy is moving in the direction of correcting the imbalances between children's costs and benefits, such as increasing fines along with improving education and income distribution.

Economic impact of providing workplace influenza vaccination. A model and case study application at a Brazilian pharma-chemical company.

PubMed

Burckel, E; Ashraf, T; de Sousa Filho, J P; Forleo Neto, E; Guarino, H; Yauti, C; Barreto F de, B; Champion, L

1999-11-01

To develop and apply a model to assess the economic value of a workplace influenza programme from the perspective of the employer. The model calculated the avoided costs of influenza, including treatment costs, lost productivity, lost worker added value and the cost of replacing workers. Subtracted from this benefit were the costs associated with a vaccination programme, including administrative costs, the time to give the vaccine, and lost productivity due to adverse reactions. The framework of the model can be applied to any company to estimate the cost-benefit of an influenza immunisation programme. The model developed was applied to 4030 workers in the core divisions of a Brazilian pharma-chemical company. The model determined a net benefit of $US121,441 [129,335 Brazilian reals ($Brz)], or $US35.45 ($Brz37.75) per vaccinated employee (1997 values). The cost-benefit ratio was 1:2.47. The calculations were subjected to a battery of 1-way and 2-way sensitivity analyses that determined that net benefit would be retained as long as the vaccine cost remained below $US45.40 ($Brz48.40) or the vaccine was at least 32.5% effective. Other alterations would retain a net benefit as well, including several combinations of incidence rate and vaccine effectiveness. The analysis suggests that providing an influenza vaccination programme can incur a substantial net benefit for an employer, although the size of the benefit will depend upon who normally absorbs the costs of treating influenza and compensating workers for lost work time due to illness, as well as the type of company in which the immunisation programme is applied.

The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies.

PubMed

Jensen, Henning Tarp; Keogh-Brown, Marcus R; Smith, Richard D; Chalabi, Zaid; Dangour, Alan D; Davies, Mike; Edwards, Phil; Garnett, Tara; Givoni, Moshe; Griffiths, Ulla; Hamilton, Ian; Jarrett, James; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Haines, Andy

We employ a single-country dynamically-recursive Computable General Equilibrium model to make health-focussed macroeconomic assessments of three contingent UK Greenhouse Gas (GHG) mitigation strategies, designed to achieve 2030 emission targets as suggested by the UK Committee on Climate Change. In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures are included; our household energy efficiency strategy is likely to breakeven only over the long term after the investment programme has ceased (beyond our 20 year time horizon). We conclude that UK policy makers will, most likely, have to adopt elements which involve initial net societal costs in order to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote internalization of externalities. Health co-benefits can play a crucial role in bringing down net costs, but our results also suggest the need for adopting holistic assessment methodologies which give proper consideration to welfare-improving health co-benefits with potentially negative economic repercussions (such as increased longevity).

24 CFR 401.461 - HUD-held second mortgage.

Code of Federal Regulations, 2012 CFR

2012-04-01

... net cash flow, trending assumptions, amortization provisions, and expected residual value of the...)(i) Principal and interest on the second mortgage is payable only out of net cash flow during its term. “Net cash flow” means that portion of project income that remains after the payment of all...

24 CFR 401.461 - HUD-held second mortgage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... net cash flow, trending assumptions, amortization provisions, and expected residual value of the...)(i) Principal and interest on the second mortgage is payable only out of net cash flow during its term. “Net cash flow” means that portion of project income that remains after the payment of all...

24 CFR 401.461 - HUD-held second mortgage.

Code of Federal Regulations, 2013 CFR

2013-04-01

... net cash flow, trending assumptions, amortization provisions, and expected residual value of the...)(i) Principal and interest on the second mortgage is payable only out of net cash flow during its term. “Net cash flow” means that portion of project income that remains after the payment of all...

24 CFR 401.461 - HUD-held second mortgage.

Code of Federal Regulations, 2011 CFR

2011-04-01

... net cash flow, trending assumptions, amortization provisions, and expected residual value of the...)(i) Principal and interest on the second mortgage is payable only out of net cash flow during its term. “Net cash flow” means that portion of project income that remains after the payment of all...

24 CFR 401.461 - HUD-held second mortgage.

Code of Federal Regulations, 2014 CFR

2014-04-01

... net cash flow, trending assumptions, amortization provisions, and expected residual value of the...)(i) Principal and interest on the second mortgage is payable only out of net cash flow during its term. “Net cash flow” means that portion of project income that remains after the payment of all...

Scaling Constraints in Junior Tennis: The Influence of Net Height on Skilled Players' Match-Play Performance

ERIC Educational Resources Information Center

Limpens, Vera; Buszard, Tim; Shoemaker, Emma; Savelsbergh, Geert J. P.; Reid, Machar

2018-01-01

Purpose: The net height in tennis (0.91 m) is approximately 50% of a professional tennis player's height. Children are also expected to play with this net height, even though it is approximately 70% of the average 10-year-old's height. This study examined the immediate effect of lowering net height on the performance characteristics of skilled…

Economic analysis of interventions to improve village chicken production in Myanmar.

PubMed

Henning, J; Morton, J; Pym, R; Hla, T; Sunn, K; Meers, J

2013-07-01

A cost-benefit analysis using deterministic and stochastic modelling was conducted to identify the net benefits for households that adopt (1) vaccination of individual birds against Newcastle disease (ND) or (2) improved management of chick rearing by providing coops for the protection of chicks from predation and chick starter feed inside a creep feeder to support chicks' nutrition in village chicken flocks in Myanmar. Partial budgeting was used to assess the additional costs and benefits associated with each of the two interventions tested relative to neither strategy. In the deterministic model, over the first 3 years after the introduction of the interventions, the cumulative sum of the net differences from neither strategy was 13,189Kyat for ND vaccination and 77,645Kyat for improved chick management (effective exchange rate in 2005: 1000Kyat=1$US). Both interventions were also profitable after discounting over a 10-year period; Net Present Values for ND vaccination and improved chick management were 30,791 and 167,825Kyat, respectively. The Benefit-Cost Ratio for ND vaccination was very high (28.8). This was lower for improved chick management, due to greater costs of the intervention, but still favourable at 4.7. Using both interventions concurrently yielded a Net Present Value of 470,543Kyat and a Benefit-Cost Ratio of 11.2 over the 10-year period in the deterministic model. Using the stochastic model, for the first 3 years following the introduction of the interventions, the mean cumulative sums of the net difference were similar to those values obtained from the deterministic model. Sensitivity analysis indicated that the cumulative net differences were strongly influenced by grower bird sale income, particularly under improved chick management. The effects of the strategies on odds of households selling and consuming birds after 7 months, and numbers of birds being sold or consumed after this period also influenced profitability. Cost variations for equipment used under improved chick management were not markedly associated with profitability. Net Present Values and Benefit-Cost Ratios discounted over a 10-year period were also similar to the deterministic model when mean values obtained through stochastic modelling were used. In summary, the study showed that ND vaccination and improved chick management can improve the viability and profitability of village chicken production in Myanmar. Copyright © 2013 Elsevier B.V. All rights reserved.

75 FR 39621 - Proposed Information Collection (Income-Net Worth and Employment Statement) Activity: Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-09

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0002] Proposed Information Collection (Income-Net Worth and Employment Statement) Activity: Comment Request AGENCY: Veterans Benefits Administration... techniques or the use of other forms of information technology. Title: Income-Net Worth and Employment...

Assessment of the effectiveness of participatory developed adaptation strategies for HCMC

NASA Astrophysics Data System (ADS)

Lasage, R.; Veldkamp, T. I. E.; de Moel, H.; Van, T. C.; Phi, H. L.; Vellinga, P.; Aerts, J. C. J. H.

2014-01-01

Coastal cities are vulnerable to flooding, and flood risk to coastal cities will increase due to sea-level rise. Moreover, especially Asian cities are subject to considerable population growth and associated urban developments, increasing this risk even more. Empirical data on vulnerability and the cost and benefits of flood risk reducing measures are therefore paramount for sustainable development of these cities. This paper presents an approach to explore the impacts of sea level rise and socio-economic developments on flood risk for the flood prone District 4 in Ho Chi Minh City, Vietnam, and to develop and evaluate the effects of different adaptation strategies (new levees, dry- and wet flood proofing of buildings). A flood damage model was developed to simulate current and future flood risk using the results from a household survey to establish stage-damage curves for residential buildings. the model has been used to assess the effects of several participatory developed adaptation strategies to reduce flood risk, expressed in Expected Annual Damage (EAD). Adaptation strategies were evaluated assuming combinations of both sea level scenarios and land use scenarios. Together with information on costs of these strategies, we calculated the benefit-cost ratio and net present value for the adaptation strategies until 2100, taking into account depreciation rates of 2.5% and 5%. The results of this modeling study indicate that the current flood risk in District 4 is 0.31 million USD yr-1, increasing up to 0.78 million USD yr-1 in 2100. The net present value and benefit-cost ratios using a discount rate of 5% range from USD -107 to -1.5 million, and from 0.086 to 0.796 for the different strategies. Using a discount rate of 2.5% leads to an increase in both net present value and benefit cost ratio. The adaptation strategies wet proofing and dry proofing generate the best results using these economic indicators. The information on different strategies will be used by the government of Ho Chi Minh City for selecting a new flood protection strategy. Future research should focus on gathering empirical data right after a flood on the occurring damage, as this appears to be the most uncertain factor in the risk assessment.

Assessment of the effectiveness of flood adaptation strategies for HCMC

NASA Astrophysics Data System (ADS)

Lasage, R.; Veldkamp, T. I. E.; de Moel, H.; Van, T. C.; Phi, H. L.; Vellinga, P.; Aerts, J. C. J. H.

2014-06-01

Coastal cities are vulnerable to flooding, and flood risk to coastal cities will increase due to sea-level rise. Moreover, Asian cities in particular are subject to considerable population growth and associated urban developments, increasing this risk even more. Empirical data on vulnerability and the cost and benefits of flood risk reduction measures are therefore paramount for sustainable development of these cities. This paper presents an approach to explore the impacts of sea-level rise and socio-economic developments on flood risk for the flood-prone District 4 in Ho Chi Minh City, Vietnam, and to develop and evaluate the effects of different adaptation strategies (new levees, dry- and wet proofing of buildings and elevating roads and buildings). A flood damage model was developed to simulate current and future flood risk using the results from a household survey to establish stage-damage curves for residential buildings. The model has been used to assess the effects of several participatory developed adaptation strategies to reduce flood risk, expressed in expected annual damage (EAD). Adaptation strategies were evaluated assuming combinations of both sea-level scenarios and land-use scenarios. Together with information on costs of these strategies, we calculated the benefit-cost ratio and net present value for the adaptation strategies until 2100, taking into account depreciation rates of 2.5% and 5%. The results of this modelling study indicate that the current flood risk in District 4 is USD 0.31 million per year, increasing up to USD 0.78 million per year in 2100. The net present value and benefit-cost ratios using a discount rate of 5 % range from USD -107 to -1.5 million, and from 0.086 to 0.796 for the different strategies. Using a discount rate of 2.5% leads to an increase in both net present value and benefit-cost ratio. The adaptation strategies wet-proofing and dry-proofing generate the best results using these economic indicators. The information on different strategies will be used by the government of Ho Chi Minh City to determine a new flood protection strategy. Future research should focus on gathering empirical data right after a flood on the occurring damage, as this appears to be the most uncertain factor in the risk assessment.

Revisiting the extended producer responsibility program for metal packaging in South Korea.

PubMed

Kim, Soyoung; Mori, Akihisa

2015-05-01

Recently, developed and emerging countries have increasingly adopted the principle of extended producer responsibility (EPR) to reduce waste. In 2003, South Korea replaced the waste deposit recycling (WDR) program with the EPR program. Previous comparative analyses between the WDR and EPR programs have been qualitative evaluations and have not yet quantitatively shown whether the change has increased benefits. The aim of this paper is to explore which program brings larger net benefits. Because of limited data availability, here we focus on metal packaging exclusively. We find that the recycling rate dropped from 59% in 2000 to 40% in 2011 and recycling volume dropped accordingly. Cost-benefit incidence analysis shows that net social benefits decreased by 2.8 billion won (2.5 million US dollars), while the net benefits to producers increased by 1.9 billion won (1.7 million US dollars) under the EPR program compared with the WDR program. The government of South Korea should set an ambitious recycling target and narrow the scope of the exemption from the mandatory recycling requirement. Copyright © 2015 Elsevier Ltd. All rights reserved.

Modeling Test and Treatment Strategies for Presymptomatic Alzheimer Disease

PubMed Central

Burke, James F.; Langa, Kenneth M.; Hayward, Rodney A.; Albin, Roger L.

2014-01-01

Objectives In this study, we developed a model of presymptomatic treatment of Alzheimer disease (AD) after a screening diagnostic evaluation and explored the circumstances required for an AD prevention treatment to produce aggregate net population benefit. Methods Monte Carlo simulation methods were used to estimate outcomes in a simulated population derived from data on AD incidence and mortality. A wide variety of treatment parameters were explored. Net population benefit was estimated in aggregated QALYs. Sensitivity analyses were performed by individually varying the primary parameters. Findings In the base-case scenario, treatment effects were uniformly positive, and net benefits increased with increasing age at screening. A highly efficacious treatment (i.e. relative risk 0.6) modeled in the base-case is estimated to save 20 QALYs per 1000 patients screened and 221 QALYs per 1000 patients treated. Conclusions Highly efficacious presymptomatic screen and treat strategies for AD are likely to produce substantial aggregate population benefits that are likely greater than the benefits of aspirin in primary prevention of moderate risk cardiovascular disease (28 QALYS per 1000 patients treated), even in the context of an imperfect treatment delivery environment. PMID:25474698

Quantitative Approach for Incorporating Methylmercury Risks and Omega-3 Fatty Acid Benefits in Developing Species-Specific Fish Consumption Advice

PubMed Central

Ginsberg, Gary L.; Toal, Brian F.

2009-01-01

Background Despite general agreement about the toxicity of methylmercury (MeHg), fish consumption advice remains controversial. Concerns have been raised that negative messages will steer people away from fish and omega-3 fatty acid (FA) benefits. One approach is to provide advice for individual species that highlights beneficial fish while cautioning against riskier fish. Objectives Our goal in this study was to develop a method to quantitatively analyze the net risk/benefit of individual fish species based on their MeHg and omega-3 FA content. Methods We identified dose–response relationships for MeHg and omega-3 FA effects on coronary heart disease (CHD) and neurodevelopment. We used the MeHg and omega-3 FA content of 16 commonly consumed species to calculate the net risk/benefit for each species. Results Estimated omega-3 FA benefits outweigh MeHg risks for some species (e.g., farmed salmon, herring, trout); however, the opposite was true for others (swordfish, shark). Other species were associated with a small net benefit (e.g., flounder, canned light tuna) or a small net risk (e.g., canned white tuna, halibut). These results were used to place fish into one of four meal frequency categories, with the advice tentative because of limitations in the underlying dose–response information. Separate advice appears warranted for the neurodevelopmental risk group versus the cardiovascular risk group because we found a greater net benefit from fish consumption for the cardiovascular risk group. Conclusions This research illustrates a framework for risk/benefit analysis that can be used to develop categories of consumption advice ranging from “do not eat” to “unlimited,” with the caveat that unlimited may need to be tempered for certain fish (e.g., farm-raised salmon) because of other contaminants and end points (e.g., cancer risk). Uncertainties exist in the underlying dose–response relationships, pointing in particular to the need for more research on the adverse effects of MeHg on cardiovascular end points. PMID:19270798

A mechanism for social selection and successful altruism.

PubMed

Simon, H A

1990-12-21

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

Why use of dienogest for the first contraceptive pill with estradiol?

PubMed

Mueck, Alfred O; Seeger, Harald; Bühling, Kai J

2010-02-01

Dienogest (DNG) has the essential properties of an effective progestogen for use in a new contraceptive pill using estradiol valerate as estrogenic component -- it inhibits ovulation and protects against endometrial proliferation. DNG is a derivative of norethisterone (NET), but has a cyanomethyl- instead of an ethinyl-group in C17 position which may offer a variety of benefits regarding hepatic effects. The similarity to NET is reflected in the high endometriotropy and in similar pharmacokinetics like short plasma half-live and high bioavailability. However, DNG also elicits properties of progesterone derivatives like neutrality in metabolic and cardiovascular system and considerable antiandrogenic activity, the latter increased by lack of binding to SHBG as specific property of DNG. It has no glucocorticoid and antimineralocorticoid activity and has no antiestrogenic activity with the consequence that possible beneficial estradiol effects should not be antagonized. This may be of special importance for the tolerability and safety of the first pill with estradiol valerate instead of ethinylestradiol, although well-designed postmarketing studies are still ongoing to demonstrate what can be expected on the basis of pharmacology.

Scaling-up treatment of depression and anxiety: a global return on investment analysis.

PubMed

Chisholm, Dan; Sweeny, Kim; Sheehan, Peter; Rasmussen, Bruce; Smit, Filip; Cuijpers, Pim; Saxena, Shekhar

2016-05-01

Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders. In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country. The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period. Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3-3·0 to 1 when economic benefits only are considered, and 3·3-5·7 to 1 when the value of health returns is also included. Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide. Grand Challenges Canada. Copyright © 2016 Chisholm et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Dynamic response of the thermometric net radiometer

Treesearch

J. D. Wilson; W. J. Massman; G. E. Swaters

2009-01-01

We computed the dynamic response of an idealized thermometric net radiometer, when driven by an oscillating net longwave radiation intended roughly to simulate rapid fluctuations of the radiative environment such as might be expected during field use of such devices. The study was motivated by curiosity as to whether non-linearity of the surface boundary conditions...

Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement.

PubMed

Nevin, Rick; Jacobs, David E; Berg, Michael; Cohen, Jonathan

2008-03-01

Previous estimates of childhood lead poisoning prevention benefits have quantified the present value of some health benefits, but not the costs of lead paint hazard control or the benefits associated with housing and energy markets. Because older housing with lead paint constitutes the main exposure source today in the US, we quantify health benefits, costs, market value benefits, energy savings, and net economic benefits of lead-safe window replacement (which includes paint stabilization and other measures). The benefit per resident child from improved lifetime earnings alone is $21,195 in pre-1940 housing and $8685 in 1940-59 housing (in 2005 dollars). Annual energy savings are $130-486 per housing unit, with or without young resident children, with an associated increase in housing market value of $5900-14,300 per housing unit, depending on home size and number of windows replaced. Net benefits are $4490-5,629 for each housing unit built before 1940, and $491-1629 for each unit built from 1940-1959, depending on home size and number of windows replaced. Lead-safe window replacement in all pre-1960 US housing would yield net benefits of at least $67 billion, which does not include many other benefits. These other benefits, which are shown in this paper, include avoided Attention Deficit Hyperactivity Disorder, other medical costs of childhood lead exposure, avoided special education, and reduced crime and juvenile delinquency in later life. In addition, such a window replacement effort would reduce peak demand for electricity, carbon emissions from power plants, and associated long-term costs of climate change.

The Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases.

PubMed

Redekop, William K; Lenk, Edeltraud J; Luyendijk, Marianne; Fitzpatrick, Christopher; Niessen, Louis; Stolk, Wilma A; Tediosi, Fabrizio; Rijnsburger, Adriana J; Bakker, Roel; Hontelez, Jan A C; Richardus, Jan H; Jacobson, Julie; de Vlas, Sake J; Severens, Johan L

2017-01-01

Lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH) and trachoma represent the five most prevalent neglected tropical diseases (NTDs). They can be controlled or eliminated by means of safe and cost-effective interventions delivered through programs of Mass Drug Administration (MDA)-also named Preventive Chemotherapy (PCT). The WHO defined targets for NTD control/elimination by 2020, reinforced by the 2012 London Declaration, which, if achieved, would result in dramatic health gains. We estimated the potential economic benefit of achieving these targets, focusing specifically on productivity and out-of-pocket payments. Productivity loss was calculated by combining disease frequency with productivity loss from the disease, from the perspective of affected individuals. Productivity gain was calculated by deducting the total loss expected in the target achievement scenario from the loss in a counterfactual scenario where it was assumed the pre-intervention situation in 1990 regarding NTDs would continue unabated until 2030. Economic benefits from out-of-pocket payments (OPPs) were calculated similarly. Benefits are reported in 2005 US$ (purchasing power parity-adjusted and discounted at 3% per annum from 2010). Sensitivity analyses were used to assess the influence of changes in input parameters. The economic benefit from productivity gain was estimated to be I$251 billion in 2011-2020 and I$313 billion in 2021-2030, considerably greater than the total OPPs averted of I$0.72 billion and I$0.96 billion in the same periods. The net benefit is expected to be US$ 27.4 and US$ 42.8 for every dollar invested during the same periods. Impact varies between NTDs and regions, since it is determined by disease prevalence and extent of disease-related productivity loss. Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large uncertainty, these benefits far exceed the investment required by governments and their development partners within all reasonable scenarios. Given the concentration of the NTDs among the poorest households, these investments represent good value for money in efforts to share the world's prosperity and reduce inequity.

The Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases

PubMed Central

Luyendijk, Marianne; Fitzpatrick, Christopher; Niessen, Louis; Stolk, Wilma A.; Tediosi, Fabrizio; Rijnsburger, Adriana J.; Bakker, Roel; Hontelez, Jan A. C.; Richardus, Jan H.; Jacobson, Julie; de Vlas, Sake J.; Severens, Johan L.

2017-01-01

Background Lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH) and trachoma represent the five most prevalent neglected tropical diseases (NTDs). They can be controlled or eliminated by means of safe and cost-effective interventions delivered through programs of Mass Drug Administration (MDA)—also named Preventive Chemotherapy (PCT). The WHO defined targets for NTD control/elimination by 2020, reinforced by the 2012 London Declaration, which, if achieved, would result in dramatic health gains. We estimated the potential economic benefit of achieving these targets, focusing specifically on productivity and out-of-pocket payments. Methods Productivity loss was calculated by combining disease frequency with productivity loss from the disease, from the perspective of affected individuals. Productivity gain was calculated by deducting the total loss expected in the target achievement scenario from the loss in a counterfactual scenario where it was assumed the pre-intervention situation in 1990 regarding NTDs would continue unabated until 2030. Economic benefits from out-of-pocket payments (OPPs) were calculated similarly. Benefits are reported in 2005 US$ (purchasing power parity-adjusted and discounted at 3% per annum from 2010). Sensitivity analyses were used to assess the influence of changes in input parameters. Results The economic benefit from productivity gain was estimated to be I$251 billion in 2011–2020 and I$313 billion in 2021–2030, considerably greater than the total OPPs averted of I$0.72 billion and I$0.96 billion in the same periods. The net benefit is expected to be US$ 27.4 and US$ 42.8 for every dollar invested during the same periods. Impact varies between NTDs and regions, since it is determined by disease prevalence and extent of disease-related productivity loss. Conclusion Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large uncertainty, these benefits far exceed the investment required by governments and their development partners within all reasonable scenarios. Given the concentration of the NTDs among the poorest households, these investments represent good value for money in efforts to share the world’s prosperity and reduce inequity. PMID:28103243

Are the poor differentially benefiting from provision of priority public health services? A benefit incidence analysis in Nigeria

PubMed Central

2012-01-01

Background The paper presents evidence about the distribution of the benefits of public expenditures on a subset of priority public health services that are supposed to be provided free of charge in the public sector, using the framework of benefit incidence analysis. Methods The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states, southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES), rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence was calculated by subtracting payments made for services from the value of benefits. Results The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and the poor compared to the urban residents, females and better-off quintiles. Conclusion It is concluded that coverage of all of these priority public health services fell well below target levels, but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for females. Payments for services that are supposed to be delivered free of charge suggests that there may have been illegal payments which probably hindered access to the public health services. PMID:23158434

Enabling implementation of the Global Vaccine Action Plan: developing investment cases to achieve targets for measles and rubella prevention.

PubMed

Thompson, Kimberly M; Strebel, Peter M; Dabbagh, Alya; Cherian, Thomas; Cochi, Stephen L

2013-04-18

Global prevention and control of infectious diseases requires significant investment of financial and human resources and well-functioning leadership and management structures. The reality of competing demands for limited resources leads to trade-offs and questions about the relative value of specific investments. Developing investment cases can help to provide stakeholders with information about the benefits, costs, and risks associated with available options, including examination of social, political, governance, and ethical issues. We describe the process of developing investment cases for globally coordinated management of action plans for measles and rubella as tools for enabling the implementation of the Global Vaccine Action Plan (GVAP). We focus on considerations related to the timing of efforts to achieve measles and rubella goals independently and within the context of ongoing polio eradication efforts, other immunization priorities, and other efforts to control communicable diseases or child survival initiatives. Our analysis suggests that the interactions between the availability and sustainability of financial support, sufficient supplies of vaccines, capacity of vaccine delivery systems, and commitments at all levels will impact the feasibility and timing of achieving national, regional, and global goals. The timing of investments and achievements will determine the net financial and health benefits obtained. The methodology, framing, and assumptions used to characterize net benefits and uncertainties in the investment cases will impact estimates and perceptions about the value of prevention achieved overall by the GVAP. We suggest that appropriately valuing the benefits of investments of measles and rubella prevention will require the use of integrated dynamic disease, economic, risk, and decision analytic models in combination with consideration of qualitative factors, and that synthesizing information in the form of investment cases may help stakeholders manage expectations as they chart the course ahead and navigate the decade of vaccines. Copyright © 2012 Elsevier Ltd. All rights reserved.

Coral reefs will transition to net dissolving before end of century

NASA Astrophysics Data System (ADS)

Eyre, Bradley D.; Cyronak, Tyler; Drupp, Patrick; De Carlo, Eric Heinen; Sachs, Julian P.; Andersson, Andreas J.

2018-02-01

Ocean acidification refers to the lowering of the ocean’s pH due to the uptake of anthropogenic CO2 from the atmosphere. Coral reef calcification is expected to decrease as the oceans become more acidic. Dissolving calcium carbonate (CaCO3) sands could greatly exacerbate reef loss associated with reduced calcification but is presently poorly constrained. Here we show that CaCO3 dissolution in reef sediments across five globally distributed sites is negatively correlated with the aragonite saturation state (Ωar) of overlying seawater and that CaCO3 sediment dissolution is 10-fold more sensitive to ocean acidification than coral calcification. Consequently, reef sediments globally will transition from net precipitation to net dissolution when seawater Ωar reaches 2.92 ± 0.16 (expected circa 2050 CE). Notably, some reefs are already experiencing net sediment dissolution.

Fire behavior modeling to assess net benefits of forest treatments on fire hazard mitigation and bioenergy production in Northeastern California

Treesearch

David J. Ganz; David S. Saah; Klaus Barber; Mark Nechodom

2007-01-01

The fire behavior modeling described here, conducted as part of the Biomass to Energy (B2E) life cycle assessment, is funded by the California Energy Commission to evaluate the potential net benefits associated with treating and utilizing forest biomass. The B2E project facilitates economic, environmental, energy, and effectiveness assessments of the potential public...

Acceptable regret in medical decision making.

PubMed

Djulbegovic, B; Hozo, I; Schwartz, A; McMasters, K M

1999-09-01

When faced with medical decisions involving uncertain outcomes, the principles of decision theory hold that we should select the option with the highest expected utility to maximize health over time. Whether a decision proves right or wrong can be learned only in retrospect, when it may become apparent that another course of action would have been preferable. This realization may bring a sense of loss, or regret. When anticipated regret is compelling, a decision maker may choose to violate expected utility theory to avoid regret. We formulate a concept of acceptable regret in medical decision making that explicitly introduces the patient's attitude toward loss of health due to a mistaken decision into decision making. In most cases, minimizing expected regret results in the same decision as maximizing expected utility. However, when acceptable regret is taken into consideration, the threshold probability below which we can comfortably withhold treatment is a function only of the net benefit of the treatment, and the threshold probability above which we can comfortably administer the treatment depends only on the magnitude of the risks associated with the therapy. By considering acceptable regret, we develop new conceptual relations that can help decide whether treatment should be withheld or administered, especially when the diagnosis is uncertain. This may be particularly beneficial in deciding what constitutes futile medical care.

The Design and Realization of Net Testing System on Campus Network

ERIC Educational Resources Information Center

Ren, Zhanying; Liu, Shijie

2005-01-01

According to the requirement of modern teaching theory and technology, based on software engineering, database theory, the technique of net information security and system integration, a net testing system on local network was designed and realized. The system benefits for dividing of testing & teaching and settles the problems of random…

Type 1 Diabetes TrialNet--an international collaborative clinical trials network.

PubMed

Skyler, Jay S; Greenbaum, Carla J; Lachin, John M; Leschek, Ellen; Rafkin-Mervis, Lisa; Savage, Peter; Spain, Lisa

2008-12-01

Type 1 Diabetes TrialNet is an international consortium of clinical research centers aimed at the prevention or delay of type 1 diabetes (T1D). The fundamental goal of TrialNet is to counter the T1D disease process by immune modulation and/or enhancement of beta cell proliferation and regeneration. To achieve this goal, TrialNet researchers are working to better understand the natural history of the disease, to identify persons at risk, and to clinically evaluate novel therapies that balance potential risks and benefits. The particular focus is on studies of preventive measures. In addition, TrialNet evaluates therapies in individuals with newly diagnosed T1D with preserved beta cell function to help determine the risk/benefit profile and gain an initial assessment of potential efficacy in preservation of beta cell function, so that promising agents can be studied in prevention trials. In addition, TrialNet evaluates methodologies that enhance the conduct of its clinical trials, which includes tests of outcome assessment methodology, the evaluation of surrogate markers, and mechanistic studies laying the foundation for future clinical trials.

The good, the bad and the ugly of marine reserves for fishery yields.

PubMed

De Leo, Giulio A; Micheli, Fiorenza

2015-11-05

Marine reserves (MRs) are used worldwide as a means of conserving biodiversity and protecting depleted populations. Despite major investments in MRs, their environmental and social benefits have proven difficult to demonstrate and are still debated. Clear expectations of the possible outcomes of MR establishment are needed to guide and strengthen empirical assessments. Previous models show that reserve establishment in overcapitalized, quota-based fisheries can reduce both catch and population abundance, thereby negating fisheries and even conservation benefits. By using a stage-structured, spatially explicit stochastic model, we show that catches under quota-based fisheries that include a network of MRs can exceed maximum sustainable yield (MSY) under conventional quota management if reserves provide protection to old, large spawners that disproportionally contribute to recruitment outside the reserves. Modelling results predict that the net fishery benefit of MRs is lost when gains in fecundity of old, large individuals are small, is highest in the case of sedentary adults with high larval dispersal, and decreases with adult mobility. We also show that environmental variability may mask fishery benefits of reserve implementation and that MRs may buffer against collapse when sustainable catch quotas are exceeded owing to stock overestimation or systematic overfishing. © 2015 The Author(s).

Costs of diarrhoea and acute respiratory infection attributable to not handwashing: the cases of India and China.

PubMed

Townsend, Joy; Greenland, Katie; Curtis, Val

2017-01-01

To estimate the national costs relating to diarrhoea and acute respiratory infections from not handwashing with soap after contact with excreta and the costs and benefits of handwashing behaviour change programmes in India and China. Data on the reduction in risk of diarrhoea and acute respiratory infection attributable to handwashing with soap were used, together with World Health Organization (WHO) estimates of disability-adjusted life years (DALYs) due to diarrhoea and acute respiratory infection, to estimate DALYs due to not handwashing in India and China. Costs and benefits of behaviour change handwashing programmes and the potential returns to investment are estimated valuing DALYs at per capita GDP for each country. Annual net costs to India from not handwashing are estimated at US$ 23 billion (16-35) and to China at US$ 12 billion (7-23). Expected net returns to national behaviour change handwashing programmes would be US$ 5.6 billion (3.4-8.6) for India at US$ 23 (16-35) per DALY avoided, which represents a 92-fold return to investment, and US$ 2.64 billion (2.08-5.57) for China at US$ 22 (14-31) per DALY avoided - a 35-fold return on investment. Our results suggest large economic gains relating to decreases in diarrhoea and acute respiratory infection for both India and China from behaviour change programmes to increase handwashing with soap in households. © 2016 John Wiley & Sons Ltd.

Building and evaluating an informatics tool to facilitate analysis of a biomedical literature search service in an academic medical center library.

PubMed

Hinton, Elizabeth G; Oelschlegel, Sandra; Vaughn, Cynthia J; Lindsay, J Michael; Hurst, Sachiko M; Earl, Martha

2013-01-01

This study utilizes an informatics tool to analyze a robust literature search service in an academic medical center library. Structured interviews with librarians were conducted focusing on the benefits of such a tool, expectations for performance, and visual layout preferences. The resulting application utilizes Microsoft SQL Server and .Net Framework 3.5 technologies, allowing for the use of a web interface. Customer tables and MeSH terms are included. The National Library of Medicine MeSH database and entry terms for each heading are incorporated, resulting in functionality similar to searching the MeSH database through PubMed. Data reports will facilitate analysis of the search service.

Determining the value of disease management programs.

PubMed

Selby, Joe V; Scanlon, Dennis; Lafata, Jennifer Elston; Villagra, Victor; Beich, Jeff; Salber, Patricia R

2003-09-01

Increasing prevalence, rising costs, and persisting deficiencies in quality of care for chronic diseases pose economic and policy challenges to providers and purchasers. Disease management (DM) programs may address these challenges, but neither purchasers nor providers can assess their value. The potpourri of current quality indicators provides limited insight into the actual clinical benefit achieved. A conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) and held in October 2002 explored new approaches to measuring and reporting the value of DM for diabetes mellitus. Quantifying the value of DM requires measuring clinical benefit and net impact on health care costs for the entire population with diabetes. If quality is measured with indicators that are clearly linked to outcomes, clinical benefit can be estimated. Natural history models combine the expected benefits of improvements in multiple indicators to yield a single, composite measure, the quality-adjusted life-year. Such metrics could fairly express, in terms of survival and complications prevention, relatively disparate DM programs' benefits. Measuring and comparing health care costs requires data validation and appropriate case-mix adjustment. Comparing value across programs may provide more accurate assessments of performance, enhance quality improvement efforts within systems, and contribute generalizable knowledge on the utility of DM approaches. Conference attendees recommended pilot projects to further explore use of natural history models for measuring and reporting the value of DM.

Net profit flow per country from 1980 to 2009: The long-term effects of foreign direct investment.

PubMed

Akkermans, Dirk H M

2017-01-01

The paper aims at describing and explaining net profit flows per country for the period 1980-2009. Net profit flows result from Foreign Direct Investment (FDI) stock and profit repatriation: inward stock creating a profit outflow and outward FDI stock a profit inflow. Profit flows, especially 'normal' ones are not commonly researched. According to world-system theory, countries are part of a system characterised by a core, semi-periphery and periphery, as shown by network analyses of trade relations. Network analyses based on ownership relations of TransNational Corporations (TNCs) show that the top 50 firms that control about 40% of the world economy are almost exclusively located in core countries. So, we may expect a hierarchy in net profit flows with core countries on top and the periphery at the bottom. FDI outflows from the core countries especially rose in the 1990s, so we may expect that the difference has grown in time. A dataset on 'net profit flow' per country is developed. There are diverging developments in net profit flows since the 1980s, as expected: ever more positive for core countries, negative and ever lower for semi-peripheral and peripheral countries, in particular from the 1990s onwards. A fixed effects quantile regression using publicly available data confirms the prediction that peripheral countries share a unique characteristic: their outward investments do not have a positive influence on net profit flow as is the case with semi-peripheral and core countries. The most probable explanation is that peripheral outward investments are indirectly owned by firms located in core and semi-peripheral countries, so all peripheral profit inflows end up in those countries.

Net profit flow per country from 1980 to 2009: The long-term effects of foreign direct investment

PubMed Central

2017-01-01

Aim of the paper The paper aims at describing and explaining net profit flows per country for the period 1980–2009. Net profit flows result from Foreign Direct Investment (FDI) stock and profit repatriation: inward stock creating a profit outflow and outward FDI stock a profit inflow. Profit flows, especially ‘normal’ ones are not commonly researched. Theoretical background According to world-system theory, countries are part of a system characterised by a core, semi-periphery and periphery, as shown by network analyses of trade relations. Network analyses based on ownership relations of TransNational Corporations (TNCs) show that the top 50 firms that control about 40% of the world economy are almost exclusively located in core countries. So, we may expect a hierarchy in net profit flows with core countries on top and the periphery at the bottom. FDI outflows from the core countries especially rose in the 1990s, so we may expect that the difference has grown in time. Data and results A dataset on 'net profit flow' per country is developed. There are diverging developments in net profit flows since the 1980s, as expected: ever more positive for core countries, negative and ever lower for semi-peripheral and peripheral countries, in particular from the 1990s onwards. A fixed effects quantile regression using publicly available data confirms the prediction that peripheral countries share a unique characteristic: their outward investments do not have a positive influence on net profit flow as is the case with semi-peripheral and core countries. The most probable explanation is that peripheral outward investments are indirectly owned by firms located in core and semi-peripheral countries, so all peripheral profit inflows end up in those countries. PMID:28654644

American College of Chest Physicians

MedlinePlus

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Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier

PubMed Central

Berger, Ariel; Inglese, Gary; Skountrianos, George; Karlsmark, Tonny; Oguz, Mustafa

2018-01-01

PURPOSE: To assess the cost-effectiveness of a ceramide-infused skin barrier (CIB) versus other skin barriers (standard of care) among patients who have undergone ostomy creation. DESIGN: Cost-effectiveness analysis, based on a decision-analytic model that was estimated using data from the ADVOCATE (A Study Determining Variances in Ostomy Skin Conditions And The Economic Impact) trial, which investigated stoma-related healthcare costs over 12 weeks among patients who recently underwent fecal ostomy, and from other sources. SUBJECTS AND SETTING: Analysis was based on a hypothetical cohort of 1000 patients who recently underwent fecal ostomy; over a 1-year period, 500 patients were assumed to use CIB and 500 were assumed to use standard of care. METHODS: We adapted a previous economic model to estimate expected 1-year costs and outcomes among persons with a new ostomy assumed to use CIB versus standard of care. Outcomes of interest included peristomal skin complications (PSCs) (up to 2 during the 1-year period of interest) and quality-adjusted life days (QALDs); QALDs vary from 1, indicating a day of perfect health to 0, indicating a day with the lowest possible health (deceased). Subjects were assigned QALDs on a daily basis, with the value of the QALD on any given day based on whether the patient was experiencing a PSC. Costs included those related to skin barriers, ostomy accessories, and care of PSCs. The incremental cost-effectiveness of CIB versus standard of care was estimated as the incremental cost per PSC averted and QALD gained, respectively; net monetary benefit of CIB was also estimated. All analyses were run using the perspective of an Australian payer. RESULTS: On a per-patient basis, use of CIB was expected over a 1-year period to result in 0.16 fewer PSCs, an additional 0.35 QALDs, and a savings of A$180 (Australian dollars, US $137) in healthcare costs all versus standard of care. Management with CIB provided a net monetary benefit (calculated as the product of maximum willingness to pay for 1 QALD times additional QALDs with CIB less the incremental cost of CIB) of A$228 (US $174). Probabilistic sensitivity analysis was also completed; it revealed that 97% of model runs resulted in fewer expected PSCs with CIB; 92% of these runs resulted in lower expected costs with CIB. CONCLUSIONS: Findings suggest that the CIB is a cost-effective skin barrier for persons living with an ostomy. PMID:29438140

Economics of a reduction in smoking: case study from Heartbeat Wales.

PubMed Central

Phillips, C J; Prowle, M J

1993-01-01

STUDY OBJECTIVE--This study aims to apply economic principles and techniques in evaluating a health promotion programme. DESIGN--This study is an economic appraisal of the Heartbeat Wales no smoking intervention programme. The costs incurred over the four year period 1985-89 have been identified and estimates have been made of the likely future impact of the reduced smoking prevalence within Wales in terms of reduced morbidity and displaced mortality in three disease groups--coronary heart disease, lung cancer, and chronic bronchitis. SETTING--Wales, UK. RESULTS--The net present value of benefits is considerably greater than costs in terms of both the NHS and the economy as a whole in Wales. In addition, the net costs per life year saved shows that the programme generates additional working life years at relatively low cost. Because not all the benefits can be fully attributed to the programme 'impact rates' ranging from 100 to 10% have been applied to the level of benefits. The evidence suggests that even if only 10% of the benefits could be attributed to the programme there is still a positive net present value of benefits. The relative efficiency of this programme has not been considered here. CONCLUSION--Large scale benefits to the NHS and the economy as a whole can be derived from reductions in smoking. PMID:8350035

A Case Study on the Failure of Management Controls around Expected Benefit Development

ERIC Educational Resources Information Center

Parsons, Earl H.

2013-01-01

Organization leaders manage change through projects to realize specific expected benefits. Under Expectation-Confirmation theory, expected benefits can be used to judge the ongoing viability and final success of the project. Organization leaders often develop management controls to ensure that the expected benefits are defined to allow their use…

A Value Chain Analysis of ghost nets in the Arafura Sea: identifying trans-boundary stakeholders, intervention points and livelihood trade-offs.

PubMed

Butler, J R A; Gunn, R; Berry, H L; Wagey, G A; Hardesty, B D; Wilcox, C

2013-07-15

Lost or discarded fishing nets are a significant component of marine debris which has trans-boundary impacts in large marine ecosystems. Such 'ghost nets' cause the by-catch of marine fauna and require retrieval from coastlines where they wash up. Identifying the causes of discarded nets and feasible intervention points requires analysis of a complex value chain and the stakeholders within it, yet no studies have attempted this. In this paper we combine Value Chain Analysis, commonly applied to understand value-adding for a commodity, with elements of Life Cycle Assessment and social network analysis to examine the drivers, stakeholders, economic, environmental and social costs and benefits in the life of a trawl net. We use the Arafura Sea as a case study, which is shared by Indonesia, Papua New Guinea and Australia, and is the focus of a Trans-boundary Diagnostic Assessment (TDA) within the Arafura-Timor Seas Ecosystem Action program (ATSEA). We follow a trawl net through four sub-systems: manufacture of webbing in South Korea, fishing and loss by an Indonesian vessel, retrieval as ghost net on the northern Australian coastline by Indigenous rangers, and disposal or re-cycling as 'GhostNet Art' by Indigenous artists. Primary stakeholders along the value chain incur economic and social benefits, and economic and environmental costs. There is an anomaly in the chain between Indonesian fishermen and Indigenous rangers, artists and communities due to the lack of market linkages between these primary stakeholders. The first 'nexus of influence' where reductions in net losses and environmental costs can be achieved is through interactions between GhostNets Australia, the World Wide Fund for Nature and the Australian Government, which can influence Indonesian fishery management institutions and fishing crews. The second nexus is via the international art market which by publicising GhostNet Art can raise awareness amongst fish consumers about the impacts of ghost nets, and hence influence Indonesian fishing companies. GhostNets Australia is a key bridging organisation in the network, linking stakeholders across scales and sub-systems. Feasible preventative interventions are discussed to rectify the anomaly in the value chain. The importance of GhostNets Australia and ATSEA in the evolving adaptive co-management and trans-boundary governance of fisheries is highlighted. However, the prevention of ghost nets will result in trade-offs in benefits for the livelihoods of primary stakeholders. The utility of the method for analysing marine debris in TDAs, and ATSEA in particular, is discussed. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Benefit and cost curves for typical pollination mutualisms.

PubMed

Morris, William F; Vázquez, Diego P; Chacoff, Natacha P

2010-05-01

Mutualisms provide benefits to interacting species, but they also involve costs. If costs come to exceed benefits as population density or the frequency of encounters between species increases, the interaction will no longer be mutualistic. Thus curves that represent benefits and costs as functions of interaction frequency are important tools for predicting when a mutualism will tip over into antagonism. Currently, most of what we know about benefit and cost curves in pollination mutualisms comes from highly specialized pollinating seed-consumer mutualisms, such as the yucca moth-yucca interaction. There, benefits to female reproduction saturate as the number of visits to a flower increases (because the amount of pollen needed to fertilize all the flower's ovules is finite), but costs continue to increase (because pollinator offspring consume developing seeds), leading to a peak in seed production at an intermediate number of visits. But for most plant-pollinator mutualisms, costs to the plant are more subtle than consumption of seeds, and how such costs scale with interaction frequency remains largely unknown. Here, we present reasonable benefit and cost curves that are appropriate for typical pollinator-plant interactions, and we show how they can result in a wide diversity of relationships between net benefit (benefit minus cost) and interaction frequency. We then use maximum-likelihood methods to fit net-benefit curves to measures of female reproductive success for three typical pollination mutualisms from two continents, and for each system we chose the most parsimonious model using information-criterion statistics. We discuss the implications of the shape of the net-benefit curve for the ecology and evolution of plant-pollinator mutualisms, as well as the challenges that lie ahead for disentangling the underlying benefit and cost curves for typical pollination mutualisms.

Population dynamics and mutualism: Functional responses of benefits and costs

USGS Publications Warehouse

Holland, J. Nathaniel; DeAngelis, Donald L.; Bronstein, Judith L.

2002-01-01

We develop an approach for studying population dynamics resulting from mutualism by employing functional responses based on density‐dependent benefits and costs. These functional responses express how the population growth rate of a mutualist is modified by the density of its partner. We present several possible dependencies of gross benefits and costs, and hence net effects, to a mutualist as functions of the density of its partner. Net effects to mutualists are likely a monotonically saturating or unimodal function of the density of their partner. We show that fundamental differences in the growth, limitation, and dynamics of a population can occur when net effects to that population change linearly, unimodally, or in a saturating fashion. We use the mutualism between senita cactus and its pollinating seed‐eating moth as an example to show the influence of different benefit and cost functional responses on population dynamics and stability of mutualisms. We investigated two mechanisms that may alter this mutualism's functional responses: distribution of eggs among flowers and fruit abortion. Differences in how benefits and costs vary with density can alter the stability of this mutualism. In particular, fruit abortion may allow for a stable equilibrium where none could otherwise exist.

How much habitat management is needed to meet mallard production objectives?

USGS Publications Warehouse

Cowardin, L.M.; Shaffer, T.L.; Kraft, K.M.

1995-01-01

We used results from simulation models to demonstrate the benefit-cost ratios of habitat management to increase the number of mallard (Anas platyrhynchos) recruits produced. The models were applied to hypothetical 2-habitat landscapes comprised of managed and unmanaged habitat. Managed habitats were predator barrier fencing and CRP cover; unmanaged habitat was grassland. As the amount of managed cover increased, the production curve rose rapidly and leveled off. If 2 managed habitats are added to a landscape, the cover can compete for available nesting hens, thus negating the benefits of 1 of the covers. After converting benefits and costs to dollars, we determined the point at which maximum net benefit occurs. We present an equation that can be used to determine the maximum net benefit of a management treatment given the size of the breeding population and the values of costs and benefits. Our examples demonstrate that, on local areas, it is inefficient to spend money for habitat management once maximum net benefit has been attained. If desired production can not be attained efficiently on an area, the manager can invest effort on alternative areas with greater management potential. If recruitment is inadequate to maintain a stable population, managers should manage to increase recruitment before attempting to attract additional breeding pairs. If recruitment more than maintains the breeding population, managers should attempt to attract additional breeding pairs to the area.

When to Wait for More Evidence? Real Options Analysis in Proton Therapy

PubMed Central

Abrams, Keith R.; de Ruysscher, Dirk; Pijls-Johannesma, Madelon; Peters, Hans J.M.; Beutner, Eric; Lambin, Philippe; Joore, Manuela A.

2011-01-01

Purpose. Trends suggest that cancer spending growth will accelerate. One method for controlling costs is to examine whether the benefits of new technologies are worth the extra costs. However, especially new and emerging technologies are often more costly, while limited clinical evidence of superiority is available. In that situation it is often unclear whether to adopt the new technology now, with the risk of investing in a suboptimal therapy, or to wait for more evidence, with the risk of withholding patients their optimal treatment. This trade-off is especially difficult when it is costly to reverse the decision to adopt a technology, as is the case for proton therapy. Real options analysis, a technique originating from financial economics, assists in making this trade-off. Methods. We examined whether to adopt proton therapy, as compared to stereotactic body radiotherapy, in the treatment of inoperable stage I non-small cell lung cancer. Three options are available: adopt without further research; adopt and undertake a trial; or delay adoption and undertake a trial. The decision depends on the expected net gain of each option, calculated by subtracting its total costs from its expected benefits. Results. In The Netherlands, adopt and trial was found to be the preferred option, with an optimal sample size of 200 patients. Increase of treatment costs abroad and costs of reversal altered the preferred option. Conclusion. We have shown that real options analysis provides a transparent method of weighing the costs and benefits of adopting and/or further researching new and expensive technologies. PMID:22147003

A cost benefit analysis of an enhanced seat belt enforcement program in South Africa.

PubMed

Harris, G T; Olukoga, I A

2005-04-01

To examine whether a program to increase the wearing of seat belts in a South African urban area would be worthwhile in societal terms. A cost benefit analysis of a one year enhanced seat belt enforcement program in eThekwini (Durban) Municipality. Data were drawn from two main sources--a 1998 study of the cost of road crashes in South Africa and, given the absence of other data, a meta-analysis of the effectiveness of various types of interventions to reduce road crash casualties in the United States--and were analyzed using cost benefit analysis. A program designed to enforce greater wearing of seat belts, estimated to cost 2 million rand in one year, could be reasonably expected to increase seat belt usage rates by 16 percentage points and reduce fatalities and injuries by 9.5%. This would result in saved social costs of 13.6 million rand in the following year or a net present value of 11.6 million rand. There would also be favorable consequences for municipal finances. Investment in a program to increase seat belt wearing rates is highly profitable in societal terms.

The business impact of an integrated continuous biomanufacturing platform for recombinant protein production.

PubMed

Walther, Jason; Godawat, Rahul; Hwang, Chris; Abe, Yuki; Sinclair, Andrew; Konstantinov, Konstantin

2015-11-10

The biotechnology industry primarily uses batch technologies to manufacture recombinant proteins. The natural evolution of other industries has shown that transitioning from batch to continuous processing can yield significant benefits. A quantitative understanding of these benefits is critical to guide the implementation of continuous processing. In this manuscript, we use process economic modeling and Monte Carlo simulations to evaluate an integrated continuous biomanufacturing (ICB) platform and conduct risk-based valuation to generate a probabilistic range of net-present values (NPVs). For a specific ten-year product portfolio, the ICB platform reduces average cost by 55% compared to conventional batch processing, considering both capital and operating expenses. The model predicts that these savings can further increase by an additional 25% in situations with higher-than-expected product demand showing the upward potential of the ICB platform. The ICB platform achieves these savings and corresponding flexibility mainly due to process intensification in both upstream and downstream unit operations. This study demonstrates the promise of continuous bioprocessing while also establishing a novel framework to quantify financial benefits of other platform process technologies. Copyright © 2015 Elsevier B.V. All rights reserved.

'Maternity clinic on the net service' and its introduction into practice: experiences of maternity-care professionals.

PubMed

Kouri, Pirkko; Turunen, Hannele; Palomäki, Tuula

2005-06-01

To describe the experiences of maternity-care professionals using an Internet-based network service, called Net Clinic, and the opportunities and obstacles they encountered in Net Clinic while organising their work and developing their know-how. Qualitative information gathered from semi-structured thematic interviews. Four maternity care units in Eastern Finland (one antenatal ward in a university hospital, one antenatal ward in a central hospital, two maternity clinics in the community). Five midwives, two public health nurses and three doctors. All participants considered adequate privacy protection a prerequisite for development. They anticipated that because of their computer skills, young people would be able to use information and communication technology (ICT) as part of maternity-care services naturally. Managerial support, such as allocation of time and equipment, was extremely important during the introductory phase. The participants were divided into three groups based on their experiences of implementing Net Clinic: (1) 'doubters' did not believe in their own ICT competence and were afraid of using Net Clinic. They also showed resistance to Net Clinic. Doubters wanted versatile and personal guidance in ICT skills; (2) 'accepters' agreed that progress in ICT would inevitably affect their work. Development was considered difficult without awareness of the benefits of ICT, and Net Clinic was expected to increase their workload. Accepters preferred to have one-to-one ICT training; (3) 'future confidents' saw ICT as a useful tool for developing maternity care. They recognised the opportunities implicit in network collaboration and wanted versatile user training in ICT. They wanted successful network service models and were eager to develop them. IMPLICATIONS FOR THE FUTURE: Families will increase their knowledge levels, as those who will be future parents are learning to use public network services at school. The increasing diversity of family structure will be a challenge to maternity care. Changes in maternity services can be accomplished with new e-Working models developed through diversified co-operation and with managerial support. The crucial question will be the attitude of maternity-care professionals towards Internet-based network service in their work.

Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement.

PubMed

Grossman, David C; Curry, Susan J; Owens, Douglas K; Barry, Michael J; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phipps, Maureen G; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen

2017-12-12

Menopause occurs at a median age of 51.3 years, and the average US woman who reaches menopause is expected to live another 30 years. The prevalence and incidence of most chronic conditions, such as coronary heart disease, dementia, stroke, fractures, and breast cancer, increase with age; however, the excess risk for these conditions that can be attributed to menopause alone is uncertain. Since the publication of findings from the Women's Health Initiative that hormone therapy use is associated with serious adverse health effects in postmenopausal women, use of menopausal hormone therapy has declined. To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the use of menopausal hormone therapy for the primary prevention of chronic conditions. The USPSTF reviewed the evidence on the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal women and whether outcomes vary among women in different subgroups or by timing of intervention after menopause. The review did not address hormone therapy for preventing or treating menopausal symptoms. Although the use of hormone therapy to prevent chronic conditions in postmenopausal women is associated with some benefits, there are also well-documented harms. The USPSTF determined that the magnitude of both the benefits and the harms of hormone therapy in postmenopausal women is small to moderate. Therefore, the USPSTF concluded with moderate certainty that combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions for most postmenopausal women with an intact uterus and that estrogen alone has no net benefit for the primary prevention of chronic conditions for most postmenopausal women who have had a hysterectomy. The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (D recommendation).

Conversational Scholarship in Cyberspace: The Evolution and Activities of H-Net, the Online Network for the Humanities.

ERIC Educational Resources Information Center

Turnbull, Paul

1996-01-01

The origins and current use of H-Net, an online humanities network on the World Wide Web, are examined. H-Net currently sponsors 73 electronic discussion lists that reach subscribers in 68 countries. Discussion groups have not met expectations for scholarly exchange, possibly because of plagiarism and copyright concerns. New ventures include book…

Efficacy of permethrin treated long-lasting insecticidal nets on malaria transmission and observations on the perceived side effects, collateral benefits and human safety in a hyperendemic tribal area of Orissa, India.

PubMed

Sharma, Surya K; Tyagi, Prajesh K; Upadhyay, Ashok K; Haque, Mohammed A; Mohanty, Suman S; Raghavendra, Kamaraju; Dash, Aditya P

2009-11-01

Studies were conducted on the efficacy of Olyset nets-a long-lasting insecticidal net (LLIN) factory treated with 2% (w/w) permethrin on malaria transmission in an area under the influence of pyrethroid susceptible vector species Anopheles culicifacies and A. fluviatilis in Sundargarh District, Orissa, India. The study area comprised 22 villages that were randomized into three clusters and designated as Olyset net, untreated net, and no net area. Malaria incidence in the study population was measured through longitudinal active surveillance at fortnightly intervals. There was a reduction of 65-70% in malaria incidence in Olyset net area as compared to the control areas. The attack rate of Plasmodium falciparum or number of episodes per person per year in different age groups also showed significant reduction in Olyset net area as compared to untreated net and no net areas. Cross-sectional point prevalence surveys showed 45.7% reduction of malaria prevalence in Olyset net users, whereas there was an increase of 33.3% and 51% in untreated net and no net villages respectively. The compliance rate of Olyset net usage in the study population was 80-98% during different months, whereas it was between 70% and 90% for untreated nets. There were minimal complains of skin irritation (4%), itching (8%) and eye irritation (1.2%). However, these effects were only transitory in nature lasting for few hours of the first usage. Olyset nets also provided collateral benefits in terms of relief not only from mosquitoes and malaria but also from other household pests such as head lice, bed bugs, cockroaches, ants and houseflies. The Olyset nets were found to be safe to humans as no adverse event was recorded in the net users that can be attributed to the use of net. The study showed that Olyset nets are effective personal protection tool that can be used in a community based intervention programme.

Handling value added tax (VAT) in economic evaluations: should prices include VAT?

PubMed

Bech, Mickael; Christiansen, Terkel; Gyrd-Hansen, Dorte

2006-01-01

In health economic evaluations, value added tax is commonly treated as a transfer payment. Following this argument, resources are valued equal to their net-of-tax prices in economic evaluations applying a societal perspective. In this article we argue that if there is the possibility that a new healthcare intervention may expand the healthcare budget, the social cost of input factors should be the gross-of-tax prices and not the net-of-tax prices. The rising interest in cost-benefit analysis and the use of absolute thresholds, net benefit estimates and acceptability curves in cost-effectiveness analysis makes this argument highly relevant for an appropriate use of these tools in prioritisation.

Response of appetite and potential appetite regulators following intake of high energy nutritional supplements.

PubMed

Fatima, Sadia; Gerasimidis, Konstantinos; Wright, Charlotte; Tsiountsioura, Melina; Arvanitidou, Eirini-Iro; Malkova, Dalia

2015-12-01

The net clinical benefit of high-energy nutritional supplements (HENSDs) consumption is lower than expected. To investigate the extent to which consumption of oral HENSD in the fasted state reduces energy intake in slim females during consecutive breakfast and lunch, and whether this relates to changes in appetite and metabolic appetite regulators. Twenty three females of 24.4 ± 2.8 years with BMI of 18.2 ± 0.8 kg/m(2) consumed HENSD (2.5 MJ) or PLACEBO (0.4 MJ) in fasted state in a single blind randomized cross-over study. Appetite and metabolic rate measurements and blood collection were conducted prior to and during 240 min after the intake of the supplements. Energy intake was recorded during ad libitum buffet breakfast and lunch served 60 min and 240 min post supplementation respectively. Energy intake during breakfast was significantly (P < 0.01) lower in the HENSD trial but the net cumulative effect on energy intake was 1.07 ± 0.34 MJ higher in the HENSD compared to PLACEBO. Plasma concentration of CCK and PYY and insulin and were significantly (P < 0.05) higher in the HENSD trial while appetite measures were not significantly different between HENSD and PLACEBO trials. Correlations for the within participant relations between the responses of plasma hormones and appetite scores were significant (P < 0.05) for PYY and insulin but not CCK. The energy expended above resting metabolic rate was significantly (P < 0.05) higher in the HENDS trial but relative increase in energy expenditure was not significantly different between the two trials. Oral high-energy nutritional supplements have a partial and relatively short lived suppressive action on energy intake and can be expected to increase net energy intake by approximately half the energy value of the supplement consumed. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Efficient Research Design: Using Value-of-Information Analysis to Estimate the Optimal Mix of Top-down and Bottom-up Costing Approaches in an Economic Evaluation alongside a Clinical Trial.

PubMed

Wilson, Edward C F; Mugford, Miranda; Barton, Garry; Shepstone, Lee

2016-04-01

In designing economic evaluations alongside clinical trials, analysts are frequently faced with alternative methods of collecting the same data, the extremes being top-down ("gross costing") and bottom-up ("micro-costing") approaches. A priori, bottom-up approaches may be considered superior to top-down approaches but are also more expensive to collect and analyze. In this article, we use value-of-information analysis to estimate the efficient mix of observations on each method in a proposed clinical trial. By assigning a prior bivariate distribution to the 2 data collection processes, the predicted posterior (i.e., preposterior) mean and variance of the superior process can be calculated from proposed samples using either process. This is then used to calculate the preposterior mean and variance of incremental net benefit and hence the expected net gain of sampling. We apply this method to a previously collected data set to estimate the value of conducting a further trial and identifying the optimal mix of observations on drug costs at 2 levels: by individual item (process A) and by drug class (process B). We find that substituting a number of observations on process A for process B leads to a modest £ 35,000 increase in expected net gain of sampling. Drivers of the results are the correlation between the 2 processes and their relative cost. This method has potential use following a pilot study to inform efficient data collection approaches for a subsequent full-scale trial. It provides a formal quantitative approach to inform trialists whether it is efficient to collect resource use data on all patients in a trial or on a subset of patients only or to collect limited data on most and detailed data on a subset. © The Author(s) 2016.

Benefits of investing in ecosystem restoration.

PubMed

DE Groot, Rudolf S; Blignaut, James; VAN DER Ploeg, Sander; Aronson, James; Elmqvist, Thomas; Farley, Joshua

2013-12-01

Measures aimed at conservation or restoration of ecosystems are often seen as net-cost projects by governments and businesses because they are based on incomplete and often faulty cost-benefit analyses. After screening over 200 studies, we examined the costs (94 studies) and benefits (225 studies) of ecosystem restoration projects that had sufficient reliable data in 9 different biomes ranging from coral reefs to tropical forests. Costs included capital investment and maintenance of the restoration project, and benefits were based on the monetary value of the total bundle of ecosystem services provided by the restored ecosystem. Assuming restoration is always imperfect and benefits attain only 75% of the maximum value of the reference systems over 20 years, we calculated the net present value at the social discount rates of 2% and 8%. We also conducted 2 threshold cum sensitivity analyses. Benefit-cost ratios ranged from about 0.05:1 (coral reefs and coastal systems, worst-case scenario) to as much as 35:1 (grasslands, best-case scenario). Our results provide only partial estimates of benefits at one point in time and reflect the lower limit of the welfare benefits of ecosystem restoration because both scarcity of and demand for ecosystem services is increasing and new benefits of natural ecosystems and biological diversity are being discovered. Nonetheless, when accounting for even the incomplete range of known benefits through the use of static estimates that fail to capture rising values, the majority of the restoration projects we analyzed provided net benefits and should be considered not only as profitable but also as high-yielding investments. Beneficios de Invertir en la Restauración de Ecosistemas. © 2013 Society for Conservation Biology.

Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands.

PubMed

Moolenaar, L M; Connolly, M; Huisman, B; Postma, M J; Hompes, P G A; van der Veen, F; Mol, B W J

2014-02-01

This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received from the government by an individual. All costs were discounted to their net present values and adjusted for survival. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective amounts for men and women were -€36,109 and -€112,195. The model was most sensitive to changes in the growth of healthcare costs, economic growth and the discount rate. Therefore, it is concluded that, similarly to naturally conceived individuals in the Netherlands, IVF-conceived individuals have negative discounted net tax revenue at the end of life. The analytic framework described here undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits. This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative those naturally conceived. A model based on the method of generational accounting to evaluate investments in IVF was used. Calculations were based on average investments paid and received from the government by an individual. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective amounts for men and women were -€36,109 and -€112,195. The model was most sensitive for changes in the growth in healthcare costs, economic growth and the discount rate. Just as naturally conceived individuals in the Netherlands, IVF-conceived individuals have negative discounted net tax revenue at the end of life. The analytic framework described here undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Unmet need for specialised rehabilitation following neurosurgery: can we maximise the potential cost-benefits?

PubMed

Singh, Rajiv; Sinha, Saurabh; Bill, Alan; Turner-Stokes, Lynne

2017-04-01

To identify the needs for specialised rehabilitation provision in a cohort of neurosurgical patients; to determine if these were met, and to estimate the potential cost implications and cost-benefits of meeting any unmet rehabilitation needs. A prospective study of in-patient admissions to a regional neurosurgical ward. Assessment of needs for specialised rehabilitation (Category A or B needs) was made with the Patient Categorisation Tool. The number of patients who were referred and admitted for specialised rehabilitation was calculated. Data from the unit's submission to the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database 2012-2015 were used to estimate the potential mean lifetime savings generated through reduction in the costs of on-going care in the community. Of 223 neurosurgical in-patients over 3 months, 156 (70%) had Category A or B needs. Out of the 105 patients who were eligible for admission to the local specialised rehabilitation service, only 20 (19%) were referred and just 11 (10%) were actually admitted. The mean transfer time was 70.2 (range 28-127) days, compared with the national standard of 42 days. In the 3-year sample, mean savings in the cost of on-going care were £568 per week. Assuming a 10-year reduction in life expectancy, the approximate net lifetime saving for post-neurosurgical patients was estimated as at least £600K per patient. We calculated that provision of additional bed capacity in the specialist rehabilitation unit could generate net savings of £3.6M/bed-year. This preliminary single-centre study identified a considerable gap in provision of specialised rehabilitation for neurosurgical patients, which must be addressed if patients are to fulfil their potential for recovery. A 5-fold increase in bed capacity would cost £9.3m/year, but could lead to potential net savings of £24m/year. Our findings now require confirmation on a wider scale through prospective multi-centre studies.

A framework for quantifying net benefits of alternative prognostic models.

PubMed

Rapsomaniki, Eleni; White, Ian R; Wood, Angela M; Thompson, Simon G

2012-01-30

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd.

A framework for quantifying net benefits of alternative prognostic models‡

PubMed Central

Rapsomaniki, Eleni; White, Ian R; Wood, Angela M; Thompson, Simon G

2012-01-01

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21905066

Tailoring the implementation of new biomarkers based on their added predictive value in subgroups of individuals.

PubMed

van Giessen, A; Moons, K G M; de Wit, G A; Verschuren, W M M; Boer, J M A; Koffijberg, H

2015-01-01

The value of new biomarkers or imaging tests, when added to a prediction model, is currently evaluated using reclassification measures, such as the net reclassification improvement (NRI). However, these measures only provide an estimate of improved reclassification at population level. We present a straightforward approach to characterize subgroups of reclassified individuals in order to tailor implementation of a new prediction model to individuals expected to benefit from it. In a large Dutch population cohort (n = 21,992) we classified individuals to low (< 5%) and high (≥ 5%) fatal cardiovascular disease risk by the Framingham risk score (FRS) and reclassified them based on the systematic coronary risk evaluation (SCORE). Subsequently, we characterized the reclassified individuals and, in case of heterogeneity, applied cluster analysis to identify and characterize subgroups. These characterizations were used to select individuals expected to benefit from implementation of SCORE. Reclassification after applying SCORE in all individuals resulted in an NRI of 5.00% (95% CI [-0.53%; 11.50%]) within the events, 0.06% (95% CI [-0.08%; 0.22%]) within the nonevents, and a total NRI of 0.051 (95% CI [-0.004; 0.116]). Among the correctly downward reclassified individuals cluster analysis identified three subgroups. Using the characterizations of the typically correctly reclassified individuals, implementing SCORE only in individuals expected to benefit (n = 2,707,12.3%) improved the NRI to 5.32% (95% CI [-0.13%; 12.06%]) within the events, 0.24% (95% CI [0.10%; 0.36%]) within the nonevents, and a total NRI of 0.055 (95% CI [0.001; 0.123]). Overall, the risk levels for individuals reclassified by tailored implementation of SCORE were more accurate. In our empirical example the presented approach successfully characterized subgroups of reclassified individuals that could be used to improve reclassification and reduce implementation burden. In particular when newly added biomarkers or imaging tests are costly or burdensome such a tailored implementation strategy may save resources and improve (cost-)effectiveness.

Value of information analysis for groundwater quality monitoring network design Case study: Eocene Aquifer, Palestine

NASA Astrophysics Data System (ADS)

Khader, A.; McKee, M.

2010-12-01

Value of information (VOI) analysis evaluates the benefit of collecting additional information to reduce or eliminate uncertainty in a specific decision-making context. It makes explicit any expected potential losses from errors in decision making due to uncertainty and identifies the “best” information collection strategy as one that leads to the greatest expected net benefit to the decision-maker. This study investigates the willingness to pay for groundwater quality monitoring in the Eocene Aquifer, Palestine, which is an unconfined aquifer located in the northern part of the West Bank. The aquifer is being used by 128,000 Palestinians to fulfill domestic and agricultural demands. The study takes into account the consequences of pollution and the options the decision maker might face. Since nitrate is the major pollutant in the aquifer, the consequences of nitrate pollution were analyzed, which mainly consists of the possibility of methemoglobinemia (blue baby syndrome). In this case, the value of monitoring was compared to the costs of treating for methemoglobinemia or the costs of other options like water treatment, using bottled water or importing water from outside the aquifer. And finally, an optimal monitoring network that takes into account the uncertainties in recharge (climate), aquifer properties (hydraulic conductivity), pollutant chemical reaction (decay factor), and the value of monitoring is designed by utilizing a sparse Bayesian modeling algorithm called a relevance vector machine.

The value of personal health record (PHR) systems.

PubMed

Kaelber, David; Pan, Eric C

2008-11-06

Personal health records (PHRs) are a rapidly growing area of health information technology despite a lack of significant value-based assessment.Here we present an assessment of the potential value of PHR systems, looking at both costs and benefits.We examine provider-tethered, payer-tethered, and third-party PHRs, as well as idealized interoperable PHRs. An analytical model was developed that considered eight PHR application and infrastructure functions. Our analysis projects the initial and annual costs and annual benefits of PHRs to the entire US over the next 10 years.This PHR analysis shows that all forms of PHRs have initial net negative value. However, at the end of 10 years, steady state annual net value ranging from$13 billion to -$29 billion. Interoperable PHRs provide the most value, followed by third-party PHRs and payer-tethered PHRs also showing positive net value. Provider-tethered PHRs constantly demonstrating negative net value.

Cost-benefit analysis of electronic medical record system at a tertiary care hospital.

PubMed

Choi, Jong Soo; Lee, Woo Baik; Rhee, Poong-Lyul

2013-09-01

Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.

Cost and Economic Benefit of Clinical Decision Support Systems (CDSS) for Cardiovascular Disease Prevention: A Community Guide Systematic Review

PubMed Central

Jacob, Verughese; Thota, Anilkrishna B.; Chattopadhyay, Sajal K.; Njie, Gibril J.; Proia, Krista K.; Hopkins, David P.; Ross, Murray N.; Pronk, Nicolaas P.; Clymer, John M.

2017-01-01

Objective This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSS) to prevent cardiovascular disease (CVD). Materials and Methods Methods developed for The Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. Results It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSS to prevent CVD from the available studies (n=12) due to considerable heterogeneity. Several studies (n=11) indicated healthcare costs were averted by using CDSS but many were partial assessments that did not consider all components of healthcare. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSS based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. Discussion Intervention costs were not negligible but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted healthcare cost could not be determined with confidence because many studies did not fully account for all components of healthcare. Conclusion We were unable to conclude whether CDSS for CVD prevention is either cost-beneficial or cost effective. Several evidence gaps are identified, most prominently the lack of information about major drivers of cost and benefit; the lack of standard metrics for the cost of CDSS; and not allowing for useful life of CDSS that generally extends beyond one accounting period. PMID:28049635

Does the expectation or perception of noncontraceptive benefits lead to higher rates of short-acting reversible contraceptive continuation for adolescents and young adult women?

PubMed

Lazorwitz, Aaron; Sheeder, Jeanelle; Teal, Stephanie; Guiahi, Maryam

2015-05-01

Continuation rates of short-acting contraception among young women are low; we attempted to determine if continuation is higher when women expect noncontraceptive benefits at initiation or perceive benefits 6 months later. A total of 243 young women ages 13-24 years initiating short-acting methods in an adolescent-only family planning clinic completed post-visit surveys that included directed and open-ended questions about anticipated noncontraceptive benefits. The study participants were contacted 6 months later. We compared contraceptive continuation between those who expected noncontraceptive benefits and those who did not and between those who reported experiencing benefits and those who did not. We examined the concordance between expectations and reported experiences. Six months after initiation, 69.3% of women were using the same method. Baseline expectation of noncontraceptive benefits was not associated with 6-month continuation. The experience of any benefit listed by the patient (odds ratio=2.69, 95% confidence interval 1.1, 6.0) was associated with greater continuation. Concordance between expectation and perception of noncontraceptive benefits was low (Kappa=0.2). Women who experienced noncontraceptive benefits at 6 months of use were more likely to continue short-acting contraception. Women who expected benefits when initiating were not more likely to report experiencing them, and many women who did not expect benefits reported them and were more likely to continue. These findings imply that building expectations of noncontraceptive benefits, e.g., through counseling, may not improve continuation and that new contraceptive development should include consideration of tangible noncontraceptive benefits. Although adolescents and young women who perceive noncontraceptive benefits after 6 months of use are more likely to continue, the expectation of such benefits does not correlate with continuation. Copyright © 2015 Elsevier Inc. All rights reserved.

A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania

PubMed Central

2012-01-01

Background The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence. Methods Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM. Results Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets. Conclusions Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms. PMID:22863188

Effect of Dietary Types on Feed Intakes, Growth Performance and Economic Benefit in Tibetan sheep and Yaks on the Qinghai-Tibet Plateau during Cold Season

PubMed Central

Xu, Shixiao; Hu, Linyong; Zhao, Na; Liu, Zhe; Ma, Li; Liu, Hongjin; Zhao, Xinquan

2017-01-01

Pastoralists on the Tibetan alpine rangeland suffered great economic loss in cold season, due to serious live-weight loss of domestic livestock under traditional grazing management. This study aimed to evaluate the effect of dietary types (crude protein levels) on feed intakes, growth performance and economic returns of local Tibetan sheep and yaks during cold season. Twenty-four yearling Tibetan sheep (25.29±3.95 kg LW) and twenty two-year-old yaks (100.62±4.55 kg LW) with familiar body conditions were randomly assigned to four groups, fed oats hay (OH), oats silage (OS), total mixed ration (TMR) and traditionally grazed on the local cool-season pasture (TG), respectively, over a 135-day experiment. Daily dry matter intake was determined; all animals were weighed at the beginning and every 15 days of the 135-day experiment. Then, the total live-weight gain, average daily live-weight gain, gain rate, feed efficiency and net economic benefit were calculated. Results indicated that feed and nutrient intakes (DMI, DMI/kg LW, DMI/kg LW0.75 and CPI) of TMR, OH and OS were higher than TG (P < 0.05). Grazing animals suffered serious live-weight loss, while TMR, OS and OH significantly (P < 0.05) improved total live-weight gain and gain rate in both Tibetan sheep and yaks during the entire experiment. TMR worked better in animal performance and feed efficiency, obtained the highest breeding profit in both Tibetan sheep and yaks among four treatments (P < 0.05). When expressed on net economic benefit, TMR shared the highest net economic benefit in Tibetan sheep, OH shared the highest net economic benefit in yaks, but, no significant difference of net economic benefit in yaks fed TMR and OH diets was determined (P > 0.05). Results indicated that TMR was a reasonable diet in promoting feed intakes, animal performance, feed efficiency and economic returns in domestic livestock, which should be considered by local herdsmen to increase their breeding profit during cold season. PMID:28056054

Effect of Dietary Types on Feed Intakes, Growth Performance and Economic Benefit in Tibetan sheep and Yaks on the Qinghai-Tibet Plateau during Cold Season.

PubMed

Xu, Tianwei; Xu, Shixiao; Hu, Linyong; Zhao, Na; Liu, Zhe; Ma, Li; Liu, Hongjin; Zhao, Xinquan

2017-01-01

Pastoralists on the Tibetan alpine rangeland suffered great economic loss in cold season, due to serious live-weight loss of domestic livestock under traditional grazing management. This study aimed to evaluate the effect of dietary types (crude protein levels) on feed intakes, growth performance and economic returns of local Tibetan sheep and yaks during cold season. Twenty-four yearling Tibetan sheep (25.29±3.95 kg LW) and twenty two-year-old yaks (100.62±4.55 kg LW) with familiar body conditions were randomly assigned to four groups, fed oats hay (OH), oats silage (OS), total mixed ration (TMR) and traditionally grazed on the local cool-season pasture (TG), respectively, over a 135-day experiment. Daily dry matter intake was determined; all animals were weighed at the beginning and every 15 days of the 135-day experiment. Then, the total live-weight gain, average daily live-weight gain, gain rate, feed efficiency and net economic benefit were calculated. Results indicated that feed and nutrient intakes (DMI, DMI/kg LW, DMI/kg LW0.75 and CPI) of TMR, OH and OS were higher than TG (P < 0.05). Grazing animals suffered serious live-weight loss, while TMR, OS and OH significantly (P < 0.05) improved total live-weight gain and gain rate in both Tibetan sheep and yaks during the entire experiment. TMR worked better in animal performance and feed efficiency, obtained the highest breeding profit in both Tibetan sheep and yaks among four treatments (P < 0.05). When expressed on net economic benefit, TMR shared the highest net economic benefit in Tibetan sheep, OH shared the highest net economic benefit in yaks, but, no significant difference of net economic benefit in yaks fed TMR and OH diets was determined (P > 0.05). Results indicated that TMR was a reasonable diet in promoting feed intakes, animal performance, feed efficiency and economic returns in domestic livestock, which should be considered by local herdsmen to increase their breeding profit during cold season.

Phase 1 General Design Memorandum Dalton Lake Project, Conasauga River, Whitfield and Murray Counties, Georgia.

DTIC Science & Technology

1987-12-01

mg/l, and effluen: dissovled oxygen was 2.7 mg/l. In October 1986, these same parameters %.,re observed to be: 19 mg/l, 17 mg/l, and 3.6 mg/l...included analyses of three heights of da. tc determine the optirlur economJc ! cale of development (sizing that would provide the maximum annual net...benefits). 0 It was determined , through the above described analyses, that the annual net benefits at the Upper Jacks River and Coahulla Creek sites

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

PubMed

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

2005-01-01

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

Study to evaluate the effect of EVA on payload systems. Volume 1: Executive summary. [project planning of space missions employing extravehicular activity as a means of cost reduction

NASA Technical Reports Server (NTRS)

Patrick, J. W.; Kraly, E. F.

1975-01-01

Programmatic benefits to payloads are examined which can result from the routine use of extravehicular activity (EVA) during space missions. Design and operations costs were compared for 13 representative baseline payloads to the costs of those payloads adapted for EVA operations. The EVA-oriented concepts developed in the study were derived from these baseline concepts and maintained mission and program objectives as well as basic configurations. This permitted isolation of cost saving factors associated specifically with incorporation of EVA in a variety of payload designs and operations. The study results were extrapolated to a total of 74 payload programs. Using appropriate complexity and learning factors, net EVA savings were extrapolated to over $551M for NASA and U.S. civil payloads for routine operations. Adding DOD and ESRO payloads increases the net estimated savings of $776M. Planned maintenance by EVA indicated an estimated $168M savings due to elimination of automated service equipment. Contingency problems of payloads were also analyzed to establish expected failure rates for shuttle payloads. The failure information resulted in an estimated potential for EVA savings of $1.9 B.

Trait-based diversification shifts reflect differential extinction among fossil taxa.

PubMed

Wagner, Peter J; Estabrook, George F

2014-11-18

Evolution provides many cases of apparent shifts in diversification associated with particular anatomical traits. Three general models connect these patterns to anatomical evolution: (i) elevated net extinction of taxa bearing particular traits, (ii) elevated net speciation of taxa bearing particular traits, and (iii) elevated evolvability expanding the range of anatomies available to some species. Trait-based diversification shifts predict elevated hierarchical stratigraphic compatibility (i.e., primitive→derived→highly derived sequences) among pairs of anatomical characters. The three specific models further predict (i) early loss of diversity for taxa retaining primitive conditions (elevated net extinction), (ii) increased diversification among later members of a clade (elevated net speciation), and (iii) increased disparity among later members in a clade (elevated evolvability). Analyses of 319 anatomical and stratigraphic datasets for fossil species and genera show that hierarchical stratigraphic compatibility exceeds the expectations of trait-independent diversification in the vast majority of cases, which was expected if trait-dependent diversification shifts are common. Excess hierarchical stratigraphic compatibility correlates with early loss of diversity for groups retaining primitive conditions rather than delayed bursts of diversity or disparity across entire clades. Cambrian clades (predominantly trilobites) alone fit null expectations well. However, it is not clear whether evolution was unusual among Cambrian taxa or only early trilobites. At least among post-Cambrian taxa, these results implicate models, such as competition and extinction selectivity/resistance, as major drivers of trait-based diversification shifts at the species and genus levels while contradicting the predictions of elevated net speciation and elevated evolvability models.

Combined global change effects on ecosystem processesin nine U.S. topographically complex areas

USGS Publications Warehouse

Hartman, Melannie D.; Baron, Jill S.; Ewing, Holly A.; Weathers, Kathleen

2014-01-01

Concurrent changes in climate, atmospheric nitrogen (N) deposition, and increasing levels of atmospheric carbon dioxide (CO2) affect ecosystems in complex ways. The DayCent-Chem model was used to investigate the combined effects of these human-caused drivers of change over the period 1980–2075 at seven forested montane and two alpine watersheds in the United States. Net ecosystem production (NEP) increased linearly with increasing N deposition for six out of seven forested watersheds; warming directly increased NEP at only two of these sites. Warming reduced soil organic carbon storage at all sites by increasing heterotrophic respiration. At most sites, warming together with high N deposition increased nitrous oxide (N2O) emissions enough to negate the greenhouse benefit of soil carbon sequestration alone, though there was a net greenhouse gas sink across nearly all sites mainly due to the effect of CO2 fertilization and associated sequestration by plants. Over the simulation period, an increase in atmospheric CO2 from 350 to 600 ppm was the main driver of change in net ecosystem greenhouse gas sequestration at all forested sites and one of two alpine sites, but an additional increase in CO2 from 600 to 760 ppm produced smaller effects. Warming either increased or decreased net greenhouse gas sequestration, depending on the site. The N contribution to net ecosystem greenhouse gas sequestration averaged across forest sites was only 5–7 % and was negligible for the alpine. Stream nitrate (NO3−) fluxes increased sharply with N-loading, primarily at three watersheds where initial N deposition values were high relative to terrestrial N uptake capacity. The simulated results displayed fewer synergistic responses to warming, N-loading, and CO2 fertilization than expected. Overall, simulations with DayCent-Chem suggest individual site characteristics and historical patterns of N deposition are important determinants of forest or alpine ecosystem responses to global change.

Scraping by: Income and Program Participation After the Loss of Extended Unemployment Benefits.

PubMed

Rothstein, Jesse; Valletta, Robert G

Many Unemployment Insurance (UI) recipients do not find new jobs before exhausting their benefits, even when benefits are extended during recessions. Using Survey of Income and Program Participation (SIPP) panel data covering the 2001 and 2007 to 2009 recessions and their aftermaths, we identify individuals whose jobless spells outlasted their UI benefits (exhaustees) and examine household income, program participation, and health-related outcomes during the six months following UI exhaustion. For the average exhaustee, the loss of UI benefits is only slightly offset by increased participation in other safety net programs (e.g., food stamps), and family poverty rates rise substantially. Self-reported disability also rises following UI exhaustion. These patterns do not vary dramatically across household demographic groups, broad income level prior to job loss, or the two business cycles. The results highlight the unique, important role of UI in the U.S. social safety net.

Wetland habitats for wildlife of the Chesapeake Bay

USGS Publications Warehouse

Perry, M.C.; Majumdar, S.K.; Miller, E.W.; Brenner, Fred J.

1998-01-01

The wetlands of Chesapeake Bay have provided the vital habitats that have sustained the impressive wildlife populations that have brought international fame to the Bay. As these wetland habitats decrease in quantity and quality we will continue to see the decline in the wildlife populations that started when European settlers first came to this continent. These declines have accelerated significantly in this century. As the human population continues to increase in the Bay watershed, one can expect that wetland habitats will continue to decline, resulting in declines in species diversity and population numbers. Although federal, state, and local governments are striving for 'no net loss' of wetlands, the results to date are not encouraging. It is unrealistic to believe that human populations and associated development can continue to increase and not adversely affect the wetland resources of the Bay. Restrictions on human population growth in the Chesapeake area is clearly the best way to protect wetland habitats and the wildlife that are dependent on these habitats. In addition, there should be more aggressive approaches to protect wetland habitats from continued perturbations from humans. More sanctuary areas should be created and there should be greater use of enhancement and management techniques that will benefit the full complement of species that potentially exist in these wetlands. The present trend in wetland loss can be expected to continue as human populations increase with resultant increases in roads, shopping malls, and housing developments. Creation of habitat for mitigation of these losses will not result in 'no net loss'. More innovative approaches should be employed to reverse the long-term trend in wetland loss by humans.

Perception for Outdoor Navigation

DTIC Science & Technology

1990-11-01

without lane marktings. Our perception modules use a variety of techniques for video processing (clusering theory, symbolic feature detection, neural nets...on gravel and dirt roads, as expected. The most difficult case involved a dirt road in a forest, which was mainly distinguishable in the video images...in that estimate. u bIsrshigl Neural Nets. Under separate funding, we have driven the Naviab using neural nets to track the road in video iages. We ame

Science-based Framework for Environmental Benefits Assessment

DTIC Science & Technology

2013-03-01

ER D C/ EL T R -1 3 -4 Environmental Benefits Analysis Program Science-based Framework for Environmental Benefits Assessment E nv ir...acwc.sdp.sirsi.net/client/default. Environmental Benefits Analysis Program ERDC/EL TR-13-4 March 2013 Science-based Framework for Environmental Benefits ...evaluating ecosystem restoration benefits within the context of USACE Civil Works planning process. An emphasis is placed on knowledge gained from

Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature

PubMed Central

Ly, Angela; Latimer, Eric

2015-01-01

Objective: Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs. Method: A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted. Results: Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre–post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF. Conclusions: While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services. PMID:26720505

Economic impact of dental hygienists on solo dental practices.

PubMed

Lazar, Vickie F; Guay, Albert H; Beazoglou, Tryfon J

2012-08-01

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

A Framework for Assessing the Economic Benefits and Costs of Workplace Literacy Training.

ERIC Educational Resources Information Center

Hollenbeck, Kevin

The relative costs and benefits of workplace literacy training were analyzed. An analysis based on eight benefits/costs (training costs; higher productivity; high wages; nonwage compensation; less worker turnover; safer workplace; higher taxes; and improved self-esteem) established that workplace literacy training offers net benefits for workers,…

Education System Benefits of U.S. Metric Conversion.

ERIC Educational Resources Information Center

Phelps, Richard P.

1996-01-01

U.S. metric conversion efforts are reviewed as they have affected education. Education system benefits and costs are estimated for three possible system conversion plans. The soft-conversion-to-metric plan, which drops all inch-pound instruction, appears to provide the largest net benefits. The primary benefit is in class time saved. (SLD)

Present and future of cervical cancer prevention in Spain: a cost-effectiveness analysis.

PubMed

Georgalis, Leonidas; de Sanjosé, Silvia; Esnaola, Mikel; Bosch, F Xavier; Diaz, Mireia

2016-09-01

Human papillomavirus (HPV) vaccination within a nonorganized setting creates a poor cost-effectiveness scenario. However, framed within an organized screening including primary HPV DNA testing with lengthening intervals may provide the best health value for invested money. To compare the effectiveness and cost-effectiveness of different cervical cancer (CC) prevention strategies, including current status and new proposed screening practices, to inform health decision-makers in Spain, a Markov model was developed to simulate the natural history of HPV and CC. Outcomes included cases averted, life expectancy, reduction in the lifetime risk of CC, life years saved, quality-adjusted life years (QALYs), net health benefits, lifetime costs, and incremental cost-effectiveness ratios. The willingness-to-pay threshold is defined at 20 000&OV0556;/QALY. Both costs and health outcomes were discounted at an annual rate of 3%. A strategy of 5-year organized HPV testing has similar effectiveness, but higher efficiency than 3-year cytology. Screening alone and vaccination combined with cytology are dominated by vaccination followed by 5-year HPV testing with cytology triage (12 214&OV0556;/QALY). The optimal age for both ending screening and switching age from cytology to HPV testing in older women is 5 years later for unvaccinated than for vaccinated women. Net health benefits decrease faster with diminishing vaccination coverage than screening coverage. Primary HPV DNA testing is more effective and cost-effective than current cytological screening. Vaccination uptake improvements and a gradual change toward an organized screening practice are critical components for achieving higher effectiveness and efficiency in the prevention of CC in Spain.

Cost-benefit analysis as a part of sustainability assessment of remediation alternatives for contaminated land.

PubMed

Söderqvist, Tore; Brinkhoff, Petra; Norberg, Tommy; Rosén, Lars; Back, Pär-Erik; Norrman, Jenny

2015-07-01

There is an increasing demand amongst decision-makers and stakeholders for identifying sustainable remediation alternatives at contaminated sites, taking into account that remediation typically results in both positive and negative consequences. Multi-criteria analysis (MCA) is increasingly used for sustainability appraisal, and the Excel-based MCA tool Sustainable Choice Of REmediation (SCORE) has been developed to provide a relevant and transparent assessment of the sustainability of remediation alternatives relative to a reference alternative, considering key criteria in the economic, environmental and social sustainability domains, and taking uncertainty into explicit account through simulation. The focus of this paper is the use of cost-benefit analysis (CBA) as a part of SCORE for assessing the economic sustainability of remediation alternatives. An economic model is used for deriving a cost-benefit rule, which in turn motivates cost and benefit items in a CBA of remediation alternatives. The empirical part of the paper is a CBA application on remediation alternatives for the Hexion site, a former chemical industry area close to the city of Göteborg in SW Sweden. The impact of uncertainties in and correlations across benefit and cost items on CBA results is illustrated. For the Hexion site, the traditional excavation-and-disposal remediation alternative had the lowest expected net present value, which illustrates the importance of also considering other alternatives before deciding upon how a remediation should be carried out. Copyright © 2015 Elsevier Ltd. All rights reserved.

Coral reefs will transition to net dissolving before end of century.

PubMed

Eyre, Bradley D; Cyronak, Tyler; Drupp, Patrick; De Carlo, Eric Heinen; Sachs, Julian P; Andersson, Andreas J

2018-02-23

Ocean acidification refers to the lowering of the ocean's pH due to the uptake of anthropogenic CO 2 from the atmosphere. Coral reef calcification is expected to decrease as the oceans become more acidic. Dissolving calcium carbonate (CaCO 3 ) sands could greatly exacerbate reef loss associated with reduced calcification but is presently poorly constrained. Here we show that CaCO 3 dissolution in reef sediments across five globally distributed sites is negatively correlated with the aragonite saturation state (Ω ar ) of overlying seawater and that CaCO 3 sediment dissolution is 10-fold more sensitive to ocean acidification than coral calcification. Consequently, reef sediments globally will transition from net precipitation to net dissolution when seawater Ω ar reaches 2.92 ± 0.16 (expected circa 2050 CE). Notably, some reefs are already experiencing net sediment dissolution. Copyright © 2018 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

An economic model to evaluate the mitigation programme for bovine viral diarrhoea in Switzerland.

PubMed

Häsler, B; Howe, K S; Presi, P; Stärk, K D C

2012-09-15

Economic analyses are indispensable as sources of information to help policy makers make decisions about mitigation resource use. The aim of this study was to conduct an economic evaluation of the Swiss national mitigation programme for bovine viral diarrhoea virus (BVDV), which was implemented in 2008 and concludes in 2017. The eradication phase of the mitigation programme comprised testing and slaughtering of all persistently infected (PI) animals found. First, the whole population was antigen tested and all PI cattle removed. Since October 2008, all newborn calves have been subject to antigen testing to identify and slaughter PI calves. All mothers of PI calves were retested and slaughtered if the test was positive. Antigen testing in calves and elimination of virus-carriers was envisaged to be conducted until the end of 2011. Subsequently, a surveillance programme will document disease freedom or detect disease if it recurs. Four alternative surveillance strategies based on antibody testing in blood from newborn calves and/or milk from primiparous cows were proposed by Federal Veterinary Office servants in charge of the BVDV mitigation programme. A simple economic spreadsheet model was developed to estimate and compare the costs and benefits of the BVDV mitigation programme. In an independent project, the impact of the mitigation programme on the disease dynamics in the population was simulated using a stochastic compartment model. Mitigation costs accrued from materials, labour, and processes such as handling and testing samples, and recording results. Benefits were disease costs avoided by having the mitigation programme in place compared to a baseline of endemic disease equilibrium. Cumulative eradication costs and benefits were estimated to determine the break-even point for the eradication component of the programme. The margin over eradication cost therefore equalled the maximum expenditure potentially available for surveillance without the net benefit from the mitigation programme overall becoming zero. Costs of the four surveillance strategies and the net benefit of the mitigation programme were estimated. Simulations were run for the years 2008-2017 with 20,000 iterations in @Risk for Excel. The mean baseline disease costs were estimated to be 16.04 m CHF (1 Swiss Franc, CHF=0.73 € at the time of analysis) (90% central range, CR: 14.71-17.39 m CHF) in 2008 and 14.89 m CHF (90% CR: 13.72-16.08 m CHF) in 2009. The break-even point was estimated to be reached in 2012 and the margin over eradication cost 63.15m CHF (90% CR: 53.72-72.82 m CHF). The discounted cost for each surveillance strategy was found to be smaller than the margin, so the mitigation programme overall is expected to have a positive net economic benefit irrespective of the strategy adopted. For economic efficiency, the least cost surveillance alternative must be selected. Copyright © 2012 Elsevier B.V. All rights reserved.

Economic evaluation of gastric ulcer prophylaxis in patients with arthritis receiving non-steroidal anti-inflammatory drugs.

PubMed Central

Knill-Jones, R.; Drummond, M.; Kohli, H.; Davies, L.

1990-01-01

This study assesses the economic benefits of misoprostol in the prophylaxis of gastric ulcers larger than 0.3 cm in patients with osteoarthritis receiving non-steroidal anti-inflammatory drugs. Independent epidemiological data were obtained for patients in Scotland and the West Midlands. Co-diagnosis of arthritis with gastric ulcer recorded in the routine data was substantially less (4% Scotland, 10% West Midlands) than the 21% found at case review. These data were combined with cost and patient management data in a decision analysis model to explore whether prophylactic use of misoprostol altered substantially the average cost of managing gastric ulcer. Using conservative assumptions and a daily dose of 400 micrograms, cost savings per patient to the National Health Service of 5-8 pounds over a 3-month period are expected in the groups of patients studied, while at the 800 micrograms dose there would be a net cost of 23-25 pounds. Sensitivity analysis showed that under many assumptions misoprostol is expected to be cost saving or cost neutral. PMID:2120690

Modelling risk aversion to support decision-making for controlling zoonotic livestock diseases.

PubMed

van Asseldonk, M A P M; Bergevoet, R H M; Ge, L

2013-12-01

Zoonotic infectious livestock diseases are becoming a significant burden for both animal and human health and are rapidly gaining the attention of decision-makers who manage public health programmes. If control decisions have only monetary components, governments are generally regarded as being risk-neutral and the intervention strategy with the highest expected benefit (lowest expected net costs) should be preferred. However, preferences will differ and alternative intervention plans will prevail if (human) life and death outcomes are involved. A rational decision framework must therefore consider risk aversion in the decision-maker and controversial values related to public health. In the present study, risk aversion and its impact on both the utility for the monetary component and the utility for the non-monetary component is shown to be an important element when dealing with emerging zoonotic infectious livestock diseases and should not be ignored in the understanding and support of decision-making. The decision framework was applied to several control strategies for the reduction of human cases of brucellosis (Brucella melitensis) originating from sheep in Turkey.

Modeling the greenhouse gas budget of straw returning in China: feasibility of mitigation and countermeasures.

PubMed

Lu, Fei; Wang, Xiao-Ke; Han, Bing; Ouyang, Zhi-Yun; Zheng, Hua

2010-05-01

Straw returning is considered to be one of the most promising carbon sequestration measures in China's cropland. A compound model, namely "Straw Returning and Burning Model-Expansion" (SRBME), was built to estimate the net mitigation potential, economic benefits, and air pollutant reduction of straw returning. Three scenarios, that is, baseline, "full popularization of straw returning (FP)," and "full popularization of straw returning and precision fertilization (FP + P)," were set to reflect popularization of straw returning. The results of the SRBME indicated that (1) compared with the soil carbon sequestration of 13.37 Tg/yr, the net mitigation potentials, which were 6.328 Tg/yr for the FP scenario and 9.179 Tg/yr for the FP + P scenario, had different trends when the full budget of the greenhouse gases was considered; (2) when the feasibility in connection with greenhouse gas (GHG) mitigation, economic benefits, and environmental benefits was taken into consideration, straw returning was feasible in 15 provinces in the FP scenario, with a total net mitigation potential of 7.192 TgCe/yr and the total benefits of CNY 1.473 billion (USD 216.6 million); (3) in the FP + P scenario, with the implementation of precision fertilization, straw returning was feasible in 26 provinces with a total net mitigation potential of 10.39 TgCe/yr and the total benefits of CNY 5.466 billion (USD 803.8 million); (4) any extent of change in the treatment of straw from being burnt to being returned would contribute to air pollution reduction; (5) some countermeasures, such as CH(4) reduction in rice paddies, precision fertilization, financial support, education and propaganda, would promote the feasibility of straw returning as a mitigation measure.

Cost-effectiveness of a community-based physical activity programme for adults (Be Active) in the UK: an economic analysis within a natural experiment.

PubMed

Frew, Emma J; Bhatti, Mobeen; Win, Khine; Sitch, Alice; Lyon, Anna; Pallan, Miranda; Adab, Peymane

2014-02-01

To determine the cost-effectiveness of a physical activity programme (Be Active) aimed at city-dwelling adults living in Birmingham, UK. Very little is known about the cost-effectiveness of public health programmes to improve city-wide physical activity rates. This paper presents a cost-effectiveness analysis that compares a physical activity intervention (Be Active) with no intervention (usual care) using an economic model to quantify the reduction in disease risk over a lifetime. Metabolic equivalent minutes achieved per week, quality-adjusted life years (QALYs) gained and healthcare costs were all included as the main outcome measures in the model. A cost-benefit analysis was also conducted using 'willingness-to-pay' as a measure of value. Under base-case assumptions-that is, assuming that the benefits of increased physical activity are sustained over 5 years, participation in the Be Active programme increased quality-adjusted life expectancy by 0.06 years, at an expected discounted cost of £3552, and thus the cost-effectiveness of Be Active is £400 per QALY. When the start-up costs of the programme are removed from the economic model, the cost-effectiveness is further improved to £16 per QALY. The societal value placed on the Be Active programme was greater than the operation cost therefore the Be Active physical activity intervention results in a net benefit to society. Participation in Be Active appeared to be cost-effective and cost-beneficial. These results support the use of Be Active as part of a public health programme to improve physical activity levels within the Birmingham-wide population.

Understanding variation in ecosystem pulse responses to wetting: Benefits of data-model coupling

NASA Astrophysics Data System (ADS)

Jenerette, D.

2011-12-01

Metabolic pulses of activity are a common ecological response to intermittently available resources and in water-limited ecosystems these pulses often occur in response to wetting. Net ecosystem CO2 exchange (NEE) in response to episodic wetting events is hypothesized to have a complex trajectory reflecting the distinct responses, or "pulses", of respiration and photosynthesis. To help direct research activities a physiological-based model of whole ecosystem metabolic activity up- and down-regulation was developed to investigate ecosystem energy balance and gas exchange pulse responses following precipitation events. This model was to investigate pulse dynamics from a local network of sites in southern Arizona, a global network of eddy-covariance ecosystem monitoring sites, laboratory incubation studies, and field manipulations. Pulse responses were found to be ubiquitous across ecosystem types. These pulses had a highly variable influence on NEE following wetting, ranging from large net sinks to sources of CO2 to the atmosphere. Much of the variability in pulse responses of NEE could be described through a coupled up- and down-regulation pulse response model. Respiration pulses were hypothesized to occur through a reduction in whole ecosystem activation energy; this model was both useful and corroborated through laboratory incubation studies of soil respiration. Using the Fluxnet eddy-covariance measurement database event specific responses were combined with the pulse model into an event specific twenty-five day net flux calculation. Across all events observed a general net accumulation of CO2 following a precipitation event, with the largest net uptake within deciduous broadleaf forests and smallest within grasslands. NEE pulses favored greater uptake when pre-event ecosystem respiration rates and total precipitation were higher. While the latter was expected, the former adds to previous theory by suggesting a larger net uptake of CO2 when pre-event metabolic activity is higher. Scenario analyses of precipitation regimes suggested increased uptake with increasing total precipitation while more complex NEE responses to increasing number of events and interval between events. Pulse dynamics provides a general framework for understanding ecosystem responses to intermittent wetting projected to occur more frequently in future climates. Pulse dynamics also provides an opportunity to evaluate processes spanning cellular upregulation to global change.

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia.

PubMed

Doran, Christopher M; Ling, Rod; Byrnes, Joshua; Crane, Melanie; Shakeshaft, Anthony P; Searles, Andrew; Perez, Donna

2016-01-01

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006-2013. This analysis uses Australian dollars (AUD) and 2010-11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006-2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006-2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer.

Comparing the net cost of CSP-TES to PV deployed with battery storage

NASA Astrophysics Data System (ADS)

Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

2016-05-01

Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs provides a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.

Warmer temperatures reduce net carbon uptake, but not water use, in a mature southern Appalachian forest

EPA Science Inventory

Increasing air temperature is expected to extend growing season length in temperate, broadleaf forests, leading to potential increases in evapotranspiration and net carbon uptake. However, other key processes affecting water and carbon cycles are also highly temperature-dependent...

Expectations and illness perceptions as predictors of benefit recipiency among workers with common mental disorders: secondary analysis from a randomised controlled trial

PubMed Central

Løvvik, Camilla; Shaw, William; Øverland, Simon; Reme, Silje Endresen

2014-01-01

Objective Common mental disorders (CMDs) are among the leading causes of sick leave, and more knowledge on factors related to work participation and return-to-work (RTW) in CMDs is needed. The aim of this study was to investigate RTW-expectations and illness perceptions as predictors of benefit recipiency in CMDs. Design Study participants were enrolled in a randomised controlled trial and reported CMDs as a main obstacle for work participation. Three prespecified subgroups were included: people at risk of going on sick leave, people on sick leave (>3 weeks) or people on long-term benefits. Baseline questionnaire data and registry data at baseline and 6 months were used to investigate predictors of benefit recipiency at 6-month follow-up. Benefit recipiency included sickness benefits, disability pension, work assessment allowance and unemployment benefits. Results In this study, uncertain and negative RTW-expectations were strong predictors of benefit recipiency at 6 months follow-up. Illness perceptions predicted benefit recipiency in the unadjusted model, but not in the fully adjusted model. In the subgroup on sick leave, uncertain and negative RTW-expectations predicted benefit recipiency, while in the subgroup of people at risk of going on sick leave, negative RTW-expectations predicted benefit recipiency. In the subgroup on long-term benefits, only female gender predicted benefit recipiency. Conclusions For people with CMDs, uncertain and negative RTW-expectations predict later benefit recipiency, and expectations seem particularly important for those at risk of or on sick leave. For those at risk of sick leave, benefit recipiency at follow-up denoted a transition onto sick leave or long-term benefit, while those on sick leave had remained so or were receiving long-term benefits. Addressing RTW-expectations in occupational healthcare services or vocational rehabilitation might be beneficial in early stages or even prior to a sick leave episode. Trial registration http://www.clinicaltrials.gov, NCT01146730. PMID:24589824

Life Cycle Assessment Comparing the Use of Jatropha Biodiesel in the Indian Road and Rail Sectors

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

Whitaker, M.; Heath, G.

2010-05-01

This life cycle assessment of Jatropha biodiesel production and use evaluates the net greenhouse gas (GHG) emission (not considering land-use change), net energy value (NEV), and net petroleum consumption impacts of substituting Jatropha biodiesel for conventional petroleum diesel in India. Several blends of biodiesel with petroleum diesel are evaluated for the rail freight, rail passenger, road freight, and road-passenger transport sectors that currently rely heavily on petroleum diesel. For the base case, Jatropha cultivation, processing, and use conditions that were analyzed, the use of B20 results in a net reduction in GHG emissions and petroleum consumption of 14% and 17%,more » respectively, and a NEV increase of 58% compared with the use of 100% petroleum diesel. While the road-passenger transport sector provides the greatest sustainability benefits per 1000 gross tonne kilometers, the road freight sector eventually provides the greatest absolute benefits owing to substantially higher projected utilization by year 2020. Nevertheless, introduction of biodiesel to the rail sector might present the fewest logistic and capital expenditure challenges in the near term. Sensitivity analyses confirmed that the sustainability benefits are maintained under multiple plausible cultivation, processing, and distribution scenarios. However, the sustainability of any individual Jatropha plantation will depend on site-specific conditions.« less

Measuring the effect of fuel treatments on forest carbon using landscape risk analysis

NASA Astrophysics Data System (ADS)

Ager, A. A.; Finney, M. A.; McMahan, A.; Cathcart, J.

2010-12-01

Wildfire simulation modelling was used to examine whether fuel reduction treatments can potentially reduce future wildfire emissions and provide carbon benefits. In contrast to previous reports, the current study modelled landscape scale effects of fuel treatments on fire spread and intensity, and used a probabilistic framework to quantify wildfire effects on carbon pools to account for stochastic wildfire occurrence. The study area was a 68 474 ha watershed located on the Fremont-Winema National Forest in southeastern Oregon, USA. Fuel reduction treatments were simulated on 10% of the watershed (19% of federal forestland). We simulated 30 000 wildfires with random ignition locations under both treated and untreated landscapes to estimate the change in burn probability by flame length class resulting from the treatments. Carbon loss functions were then calculated with the Forest Vegetation Simulator for each stand in the study area to quantify change in carbon as a function of flame length. We then calculated the expected change in carbon from a random ignition and wildfire as the sum of the product of the carbon loss and the burn probabilities by flame length class. The expected carbon difference between the non-treatment and treatment scenarios was then calculated to quantify the effect of fuel treatments. Overall, the results show that the carbon loss from implementing fuel reduction treatments exceeded the expected carbon benefit associated with lowered burn probabilities and reduced fire severity on the treated landscape. Thus, fuel management activities resulted in an expected net loss of carbon immediately after treatment. However, the findings represent a point in time estimate (wildfire immediately after treatments), and a temporal analysis with a probabilistic framework used here is needed to model carbon dynamics over the life cycle of the fuel treatments. Of particular importance is the long-term balance between emissions from the decay of dead trees killed by fire and carbon sequestration by forest regeneration following wildfire.

Automatic milking systems, farm size, and milk production.

PubMed

Rotz, C A; Coiner, C U; Soder, K J

2003-12-01

Automatic milking systems (AMS) offer relief from the demanding routine of milking. Although many AMS are in use in Europe and a few are used in the United States, the potential benefit for American farms is uncertain. A farm-simulation model was used to determine the long-term, whole-farm effect of implementing AMS on farm sizes of 30 to 270 cows. Highest farm net return to management and unpaid factors was when AMS were used at maximal milking capacity. Adding stalls to increase milking frequency and possibly increase production generally did not improve net return. Compared with new traditional milking systems, the greatest potential economic benefit was a single-stall AMS on a farm size of 60 cows at a moderate milk production level (8600 kg/cow). On other farm sizes using single-stall type robotic units, losses in annual net return of 0 dollars to 300 dollars/cow were projected, with the greatest losses on larger farms and at high milk production (10,900 kg/cow). Systems with one robot serving multiple stalls provided a greater net return than single-stall systems, and this net return was competitive with traditional parlors for 50- to 130-cow farm sizes. The potential benefit of AMS was improved by 100 dollars/cow per year if the AMS increased production an additional 5%. A 20% reduction in initial equipment cost or doubling milking labor cost also improved annual net return of an AMS by up to 100 dollars/cow. Annual net return was reduced by 110 dollars/cow, though, if the economic life of the AMS was reduced by 3 yr for a more rapid depreciation than that normally used with traditional milking systems. Thus, under current assumptions, the economic return for an AMS was similar to that of new parlor systems on smaller farms when the milking capacity of the AMS was well matched to herd size and milk production level.

45 CFR 149.100 - Amount of reimbursement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... reimbursement in the amount of 80 percent of the costs for health benefits (net of negotiated price concessions for health benefits) for claims incurred during the plan year that are attributed to health benefits...

On the Economics of Space Colonisation

NASA Astrophysics Data System (ADS)

King, D. J.

An economic model of the future colonisation of Mars is developed, which, for simplicity, is assumed to be a one-off transplantation of capital and population to Mars. The model demonstrates that compound growth of output and population, and diminishing natural resources on Earth eventually create sufficiently intense economic pressures that the colonisation of Mars (and by implication of space generally) confers a net economic benefit on humanity. The model illustrates that the colonisation of space is likely to occur because economic forces will ultimately compel it to occur. The model is highly counter-intuitive because it has traditionally been believed by many that the colonisation of space could only be done at a net economic cost to humanity and would not result in a net economic benefit to mankind.

The Role of Labour Market Expectations and Admission Probabilities in Students' Application Decisions on Higher Education: The Case of Hungary

ERIC Educational Resources Information Center

Varga, Julia

2006-01-01

This paper analyses students' application strategies to higher education, the effects of labour market expectations and admission probabilities. The starting hypothesis of this study is that students consider the expected utility of their choices, a function of expected net lifetime earnings and the probability of admission. Based on a survey…

Policies with Varying Costs and Benefits: A Land Conservation Classroom Game

ERIC Educational Resources Information Center

Dissanayake, Sahan T. M.; Jacobson, Sarah A.

2016-01-01

Some policies try to maximize net benefits by targeting different individuals to participate. This is difficult when costs and benefits of participation vary independently, such as in land conservation. The authors share a classroom game that explores cases in which minimizing costs may not maximize benefits and vice versa. The game is a…

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention.

PubMed

Boyd, Matt; Baker, Michael G; Mansoor, Osman D; Kvizhinadze, Giorgi; Wilson, Nick

2017-01-01

Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, "Scenario A"), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of "Scenario A", or 2.75% of the country's population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for "Scenario A" times three for 26 weeks of border closure-but not for only 12 weeks of closure when it would still be beneficial). This "proof-of-concept" work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective.

Concept of Operations for Commercial and Business Aircraft Synthetic Vision Systems. 1.0

NASA Technical Reports Server (NTRS)

Williams Daniel M.; Waller, Marvin C.; Koelling, John H.; Burdette, Daniel W.; Capron, William R.; Barry, John S.; Gifford, Richard B.; Doyle, Thomas M.

2001-01-01

A concept of operations (CONOPS) for the Commercial and Business (CaB) aircraft synthetic vision systems (SVS) is described. The CaB SVS is expected to provide increased safety and operational benefits in normal and low visibility conditions. Providing operational benefits will promote SVS implementation in the Net, improve aviation safety, and assist in meeting the national aviation safety goal. SVS will enhance safety and enable consistent gate-to-gate aircraft operations in normal and low visibility conditions. The goal for developing SVS is to support operational minima as low as Category 3b in a variety of environments. For departure and ground operations, the SVS goal is to enable operations with a runway visual range of 300 feet. The system is an integrated display concept that provides a virtual visual environment. The SVS virtual visual environment is composed of three components: an enhanced intuitive view of the flight environment, hazard and obstacle defection and display, and precision navigation guidance. The virtual visual environment will support enhanced operations procedures during all phases of flight - ground operations, departure, en route, and arrival. The applications selected for emphasis in this document include low visibility departures and arrivals including parallel runway operations, and low visibility airport surface operations. These particular applications were selected because of significant potential benefits afforded by SVS.

An evaluation of the environmental and health effects of vehicle exhaust catalysts in the UK.

PubMed Central

Hutchinson, Emma J; Pearson, Peter J G

2004-01-01

Since 1993, all new gasoline-engine automobiles in the United Kingdom have been supplied with three-way vehicle exhaust catalytic converters (VECs) containing platinum, palladium, and rhodium, to comply with European Commission Stage I limits on emissions of regulated pollutants: carbon monoxide, hydrocarbons, and oxides of nitrogen. We conducted a physical and economic evaluation of the environmental and health benefits from a reduction in emissions through this mandated environmental technology against the costs, with reference to urban areas in Great Britain. We made both an ex post assessment--based on available data to 1998--and an ex ante assessment--projected to 2005, the year when full penetration of VECs into the fleet is expected. Substantial health benefits in excess of the costs of VECs were indicated: By 1998 the estimated net societal health benefits were approximately 500 million British pounds, and by 2005 they were estimated to rise to as much as 2 billion British pounds. We also found through environmental surveys that although lead in road dust has fallen by 50% in urban areas, platinum accumulations near roads have risen significantly, up to 90-fold higher than natural background levels. This rapid accumulation of platinum suggests further monitoring is warranted, although as yet there is no evidence of adverse health effects. PMID:14754566

The social benefits of private infectious disease-risk mitigation

PubMed Central

Perrings, Charles; Kinzig, Ann; Levin, Simon

2015-01-01

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

The social benefits of private infectious disease-risk mitigation.

PubMed

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

2015-11-01

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

An evaluation of the environmental and health effects of vehicle exhaust catalysts in the UK.

PubMed

Hutchinson, Emma J; Pearson, Peter J G

2004-02-01

Since 1993, all new gasoline-engine automobiles in the United Kingdom have been supplied with three-way vehicle exhaust catalytic converters (VECs) containing platinum, palladium, and rhodium, to comply with European Commission Stage I limits on emissions of regulated pollutants: carbon monoxide, hydrocarbons, and oxides of nitrogen. We conducted a physical and economic evaluation of the environmental and health benefits from a reduction in emissions through this mandated environmental technology against the costs, with reference to urban areas in Great Britain. We made both an ex post assessment--based on available data to 1998--and an ex ante assessment--projected to 2005, the year when full penetration of VECs into the fleet is expected. Substantial health benefits in excess of the costs of VECs were indicated: By 1998 the estimated net societal health benefits were approximately 500 million British pounds, and by 2005 they were estimated to rise to as much as 2 billion British pounds. We also found through environmental surveys that although lead in road dust has fallen by 50% in urban areas, platinum accumulations near roads have risen significantly, up to 90-fold higher than natural background levels. This rapid accumulation of platinum suggests further monitoring is warranted, although as yet there is no evidence of adverse health effects.

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

PubMed

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

2014-09-23

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

Aboveground net primary production responses to water availability in the Chihuhuan Desert: importance of legacy effects

USDA-ARS?s Scientific Manuscript database

In arid ecosystems, current year precipitation explains a small proportion of annual aboveground net primary production (ANPP). Precipitation that occurred in previous years may be responsible for the observed difference between actual and expected ANPP, a concept that we called legacy. Thus, previo...

Net merit as a measure of lifetime profit: 2018 revision

USDA-ARS?s Scientific Manuscript database

The lifetime net merit (NM$) index ranks dairy animals based on their combined genetic merit for economically important traits. Indexes are updated periodically to include new traits and to reflect prices expected in the next few years. The August 2018 update of NM$ includes genetic evaluations for ...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

Trait-based diversification shifts reflect differential extinction among fossil taxa

PubMed Central

Wagner, Peter J.; Estabrook, George F.

2014-01-01

Evolution provides many cases of apparent shifts in diversification associated with particular anatomical traits. Three general models connect these patterns to anatomical evolution: (i) elevated net extinction of taxa bearing particular traits, (ii) elevated net speciation of taxa bearing particular traits, and (iii) elevated evolvability expanding the range of anatomies available to some species. Trait-based diversification shifts predict elevated hierarchical stratigraphic compatibility (i.e., primitive→derived→highly derived sequences) among pairs of anatomical characters. The three specific models further predict (i) early loss of diversity for taxa retaining primitive conditions (elevated net extinction), (ii) increased diversification among later members of a clade (elevated net speciation), and (iii) increased disparity among later members in a clade (elevated evolvability). Analyses of 319 anatomical and stratigraphic datasets for fossil species and genera show that hierarchical stratigraphic compatibility exceeds the expectations of trait-independent diversification in the vast majority of cases, which was expected if trait-dependent diversification shifts are common. Excess hierarchical stratigraphic compatibility correlates with early loss of diversity for groups retaining primitive conditions rather than delayed bursts of diversity or disparity across entire clades. Cambrian clades (predominantly trilobites) alone fit null expectations well. However, it is not clear whether evolution was unusual among Cambrian taxa or only early trilobites. At least among post-Cambrian taxa, these results implicate models, such as competition and extinction selectivity/resistance, as major drivers of trait-based diversification shifts at the species and genus levels while contradicting the predictions of elevated net speciation and elevated evolvability models. PMID:25331898

Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review.

PubMed

Jacob, Verughese; Thota, Anilkrishna B; Chattopadhyay, Sajal K; Njie, Gibril J; Proia, Krista K; Hopkins, David P; Ross, Murray N; Pronk, Nicolaas P; Clymer, John M

2017-05-01

This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSSs) to prevent cardiovascular disease (CVD). Methods developed for the Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSSs to prevent CVD from the available studies ( n  = 12) due to considerable heterogeneity. Several studies ( n  = 11) indicated that health care costs were averted by using CDSSs but many were partial assessments that did not consider all components of health care. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSSs based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. Intervention costs were not negligible, but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted health care cost could not be determined with confidence because many studies did not fully account for all components of health care. We were unable to conclude whether CDSSs for CVD prevention is either cost-beneficial or cost-effective. Several evidence gaps are identified, most prominently a lack of information about major drivers of cost and benefit, a lack of standard metrics for the cost of CDSSs, and not allowing for useful life of a CDSS that generally extends beyond one accounting period. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the US.

20 CFR 404.1081 - General rules for figuring net earnings from self-employment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... self-employment. 404.1081 Section 404.1081 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1081 General rules for figuring net earnings from self...

20 CFR 404.1081 - General rules for figuring net earnings from self-employment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... self-employment. 404.1081 Section 404.1081 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1081 General rules for figuring net earnings from self...

20 CFR 404.1081 - General rules for figuring net earnings from self-employment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... self-employment. 404.1081 Section 404.1081 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1081 General rules for figuring net earnings from self...

20 CFR 404.1081 - General rules for figuring net earnings from self-employment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... self-employment. 404.1081 Section 404.1081 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1081 General rules for figuring net earnings from self...

20 CFR 404.1081 - General rules for figuring net earnings from self-employment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... self-employment. 404.1081 Section 404.1081 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Self-Employment Income § 404.1081 General rules for figuring net earnings from self...

29 CFR 4022.82 - Method of recoupment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... by the present value of the benefit payable with respect to the participant under title IV of ERISA. The PBGC will determine the present value of the benefit to which a participant or beneficiary is... Underpayments § 4022.82 Method of recoupment. (a) Future benefit reduction. The PBGC will recoup net...

Benefit-Cost Analysis of the Perry Preschool Program and Its Policy Implications.

ERIC Educational Resources Information Center

Barnett, W. Steven

1985-01-01

Benefit-cost analysis is applied to the Perry Preschool Program and its long-term follow-up in order to examine preschool education as a social investment. The net present value of benefits and costs is positive, indicating that the program was a profitable social investment. (Author/LMO)

Consortium Purchases: Case Study for a Cost-Benefit Analysis.

ERIC Educational Resources Information Center

Scigliano, Marisa

2002-01-01

Discusses library cooperation and academic library consortia and presents a case study of a Canadian consortia that conducted a cost-benefit analysis for purchasing an electronic resource. Reports on member library subscription costs, external economic factors, value of patron time saved, costs and benefits for patrons, and net savings. (LRW)

Capital investment analysis: three methods.

PubMed

Gapenski, L C

1993-08-01

Three cash flow/discount rate methods can be used when conducting capital budgeting financial analyses: the net operating cash flow method, the net cash flow to investors method, and the net cash flow to equity holders method. The three methods differ in how the financing mix and the benefits of debt financing are incorporated. This article explains the three methods, demonstrates that they are essentially equivalent, and recommends which method to use under specific circumstances.

Tax reform, population ageing and the changing labour supply behaviour of married women.

PubMed

Apps, P

1991-01-01

"The burden of financing retirement incomes in an ageing population is predicted to rise sharply in future decades. This paper investigates the effects of reforms to the Australian tax-benefit system involving a greater reliance on proportional taxation for raising revenue and a more targeted welfare system for cutting government expenditure, in order to reduce expected budget deficits. Estimates of changes in net incomes and hours of work suggest that reforms of this kind shift the tax burden to lower and middle income households with a second earner and that they can have counter-productive labour supply effects. The study explores the impact of projected increases in female work force participation and illustrates the importance of shifts in the labour supply of married women in predicting the fiscal effects of demographic change." excerpt

A multiple biomarker risk score for guiding clinical decisions using a decision curve approach.

PubMed

Hughes, Maria F; Saarela, Olli; Blankenberg, Stefan; Zeller, Tanja; Havulinna, Aki S; Kuulasmaa, Kari; Yarnell, John; Schnabel, Renate B; Tiret, Laurence; Salomaa, Veikko; Evans, Alun; Kee, Frank

2012-08-01

We assessed whether a cardiovascular risk model based on classic risk factors (e.g. cholesterol, blood pressure) could refine disease prediction if it included novel biomarkers (C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin I) using a decision curve approach which can incorporate clinical consequences. We evaluated whether a model including biomarkers and classic risk factors could improve prediction of 10 year risk of cardiovascular disease (CVD; chronic heart disease and ischaemic stroke) against a classic risk factor model using a decision curve approach in two prospective MORGAM cohorts. This included 7739 men and women with 457 CVD cases from the FINRISK97 cohort; and 2524 men with 259 CVD cases from PRIME Belfast. The biomarker model improved disease prediction in FINRISK across the high-risk group (20-40%) but not in the intermediate risk group, at the 23% risk threshold net benefit was 0.0033 (95% CI 0.0013-0.0052). However, in PRIME Belfast the net benefit of decisions guided by the decision curve was improved across intermediate risk thresholds (10-20%). At p(t) = 10% in PRIME, the net benefit was 0.0059 (95% CI 0.0007-0.0112) with a net increase in 6 true positive cases per 1000 people screened and net decrease of 53 false positive cases per 1000 potentially leading to 5% fewer treatments in patients not destined for an event. The biomarker model improves 10-year CVD prediction at intermediate and high-risk thresholds and in particular, could be clinically useful at advising middle-aged European males of their CVD risk.

Extending Value of Information Methods to Include the Co-Net Benefits of Earth Observations

NASA Astrophysics Data System (ADS)

Macauley, M.

2015-12-01

The widening relevance of Earth observations information across the spectrum of natural and environmental resources markedly enhances the value of these observations. An example is observations of forest extent, species composition, health, and change; this information can help in assessing carbon sequestration, biodiversity and habitat, watershed management, fuelwood potential, and other ecosystem services as well as inform the opportunity cost of forest removal for alternative land use such as agriculture, pasture, or development. These "stacked" indicators or co- net benefits add significant value to Earth observations. In part because of reliance on case studies, much previous research about the value of information from Earth observations has assessed individual applications rather than aggregate across applications, thus tending to undervalue the observations. Aggregating across applications is difficult, however, because it requires common units of measurement: controlling for spatial, spectral, and temporal attributes of the observations; and consistent application of value of information techniques. This paper will discuss general principles of co-net benefit aggregation and illustrate its application to attributing value to Earth observations.

The distribution over time of costs and social net benefits for pertussis immunization programs.

PubMed

Girard, Dorota Zdanowska

2010-03-01

The cost of a six-dose pertussis immunization programs for children and adolescents is investigated in relation to estimators of the price of acellular vaccine, the value of a child's life, levels of vaccination rate and discount rates. We compare the cost of the program maintained over time at 90% with three alternative strategies, each involving a decrease in vaccination coverage. Data from England and Wales, 1966-2005, is used to formalize a delay in occurrence of pertussis cases as a result of a fall in coverage. We first apply the criterion of minimization of the total social cost of pertussis to identify the best cost saving immunization strategy. The results are also discussed in form of the discounted present value of the total social net benefits. We find that the discounted present value of the total social net benefit is maximized when a stable vaccination program at 90% is compared to a gradual decrease in vaccination coverage leading to the lowest vaccination rate. The benefits to society of providing sustained immunization strategy, vaccinating the highest proportion of children and adolescents, are systematically proved on the basis of the second optimisation criterion, independently of the level of estimators applied during economic evaluation for the cost variables.

Impact of Tranexamic Acid in Total Knee and Total Hip Replacement.

PubMed

Boyle, Jaclyn A; Soric, Mate M

2017-02-01

To evaluate the net clinical benefit of tranexamic acid use in patients undergoing total knee or total hip replacement. This is a retrospective study of patients undergoing total knee or total hip replacement. The primary outcome was the net clinical benefit of tranexamic acid use. Secondary outcomes included length of stay, incidence of venous thromboembolism, change in hemoglobin, and number of units of blood transfused. Four hundred and six patients were screened for inclusion and 327 patients met inclusion criteria; 174 patients received tranexamic acid versus 153 patients who received usual care. Tranexamic acid demonstrated a positive net clinical benefit versus usual care (40.8% vs 13.7%, P < .01) but did not affect length of stay (3.39 vs 3.37 days, respectively, P = .76). Venous thromboembolism was comparable between groups (2.3% vs 0.7%, P = .38). Average change in hemoglobin and need for transfusion were lower in the treatment group versus the usual care group, respectively (3.46 vs 4.26 mg/dL, P < .01). Tranexamic acid demonstrated a significant benefit in decreasing change in hemoglobin as well as the need for blood transfusion with no increase in the risk of venous thromboembolism in patients undergoing total knee or total hip replacement.

39 CFR 3010.42 - Contents of notice of agreement in support of a negotiated service agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (b) A statement identifying all parties to the agreement and a description clearly explaining the operative components of the agreement. (c) Details regarding the expected improvements in the net financial position or operations of the Postal Service. The projection of change in net financial position as a...

Finance at the front line. The effects of financial slack on community health center clinical process quality.

PubMed

Beauvais, Brad; Wells, Rebecca; Vasey, Joseph; DelliFraine, Jami L

2007-01-01

As the number of health centers increases through a federal initiative, questions remain about these primary care providers' capacity to provide sufficient care to the underserved. In the current study, the authors hypothesize that health centers with greater financial latitude or "slack" will provide medically appropriate primary care to greater proportions of their patients. Annual data from all US federally funded community health centers between 1998 and 2004 provide unusually rich data through which to test this hypothesis. Multilevel model results indicate positive associations between higher levels of net revenue and percentages of patients receiving preventive health care at baseline, as well as between initial net revenue and increases over time in post partum care access. Contrary to expectation, higher net revenue was also negatively associated with percentages of women getting post partum care at baseline. Also contrary to expectation, higher baseline levels of net revenue were associated with decreasing preventive care access over time. These mixed results imply that organizations' financial slack can affect quality, but in ways that vary across outcomes and over time.

Expectations affect psychological and neurophysiological benefits even after a single bout of exercise.

PubMed

Mothes, Hendrik; Leukel, Christian; Jo, Han-Gue; Seelig, Harald; Schmidt, Stefan; Fuchs, Reinhard

2017-04-01

The study investigated whether typical psychological, physiological, and neurophysiological changes from a single exercise are affected by one's beliefs and expectations. Seventy-six participants were randomly assigned to four groups and saw different multimedia presentations suggesting that the subsequent exercise (moderate 30 min cycling) would result in more or less health benefits (induced expectations). Additionally, we assessed habitual expectations reflecting previous experience and beliefs regarding exercise benefits. Participants with more positive habitual expectations consistently demonstrated both greater psychological benefits (more enjoyment, mood increase, and anxiety reduction) and greater increase of alpha-2 power, assessed with electroencephalography. Manipulating participants' expectations also resulted in largely greater increases of alpha-2 power, but not in more psychological exercise benefits. On the physiological level, participants decreased their blood pressure after exercising, but this was independent of their expectations. These results indicate that habitual expectations in particular affect exercise-induced psychological and neurophysiological changes in a self-fulfilling manner.

A cost-benefit analysis of landfill mining and material recycling in China

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

Zhou, Chuanbin, E-mail: cbzhou@rcees.ac.cn; Gong, Zhe; Hu, Junsong

Highlights: • Assessing the economic feasibility of landfill mining. • We applied a cost-benefit analysis model for landfill mining. • Four material cycling and energy recovery scenarios were designed. • We used net present value to evaluate the cost-benefit efficiency. - Abstract: Landfill mining is an environmentally-friendly technology that combines the concepts of material recycling and sustainable waste management, and it has received a great deal of worldwide attention because of its significant environmental and economic potential in material recycling, energy recovery, land reclamation and pollution prevention. This work applied a cost-benefit analysis model for assessing the economic feasibility, whichmore » is important for promoting landfill mining. The model includes eight indicators of costs and nine indicators of benefits. Four landfill mining scenarios were designed and analyzed based on field data. The economic feasibility of landfill mining was then evaluated by the indicator of net present value (NPV). According to our case study of a typical old landfill mining project in China (Yingchun landfill), rental of excavation and hauling equipment, waste processing and material transportation were the top three costs of landfill mining, accounting for 88.2% of the total cost, and the average cost per unit of stored waste was 12.7 USD ton{sup −1}. The top three benefits of landfill mining were electricity generation by incineration, land reclamation and recycling soil-like materials. The NPV analysis of the four different scenarios indicated that the Yingchun landfill mining project could obtain a net positive benefit varying from 1.92 million USD to 16.63 million USD. However, the NPV was sensitive to the mode of land reuse, the availability of energy recovery facilities and the possibility of obtaining financial support by avoiding post-closure care.« less

Incremental Net Benefit of Early Intervention for Preschool-Aged Children with Emotional and Behavioral Problems in Foster Care.

PubMed

Lynch, Frances L; Dickerson, John F; Saldana, Lisa; Fisher, Phillip A

2014-01-01

Of 1 million cases of child maltreatment identified every year in the United States, one-fifth result in foster care. Many of these children suffer from significant emotional and behavioral conditions. Decision-makers must allocate highly constrained budgets to serve these children. Recent evidence suggests that Multidimensional Treatment Foster Care for Preschoolers can reduce negative outcomes for these children, but the relative benefits and costs of the program have not been evaluated. The objective of this study was to assess net benefit, over 24 months, of Multidimensional Treatment Foster Care for Preschoolers compared to regular foster care. Data were from a randomized controlled trial of 117 young children entering a new foster placement. A subsample exhibited placement instability (n = 52). Intervention services including parent training, lasted 9-12 months. Multidimensional Treatment Foster Care for Preschoolers significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for regular foster care (full sample: $27,204 vs. $30,090; P = .004; placement instability sample: $29,595 vs. $36,061; P = .045). Incremental average net benefit was positive at all levels of willingness to pay of zero or greater, indicating that the value of benefits exceeded costs. Multidimensional Treatment Foster Care for Preschoolers has significant benefit for preschool children in foster care with emotional and behavioral disorders compared to regular foster care services. At even modest levels of willingness to pay, benefits exceed costs indicating a strong likeliness that this program is an efficient choice for improving outcomes for young children with emotional and behavioral disorders in foster care.

Incremental Net Benefit of Early Intervention for Preschool-Aged Children with Emotional and Behavioral Problems in Foster Care

PubMed Central

Lynch, Frances L.; Dickerson, John F.; Saldana, Lisa; Fisher, Phillip A.

2017-01-01

Of 1 million cases of child maltreatment identified every year in the United States, one-fifth result in foster care. Many of these children suffer from significant emotional and behavioral conditions. Decision-makers must allocate highly constrained budgets to serve these children. Recent evidence suggests that Multidimensional Treatment Foster Care for Preschoolers can reduce negative outcomes for these children, but the relative benefits and costs of the program have not been evaluated. The objective of this study was to assess net benefit, over 24 months, of Multidimensional Treatment Foster Care for Preschoolers compared to regular foster care. Data were from a randomized controlled trial of 117 young children entering a new foster placement. A subsample exhibited placement instability (n = 52). Intervention services including parent training, lasted 9–12 months. Multidimensional Treatment Foster Care for Preschoolers significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for regular foster care (full sample: $27,204 vs. $30,090; P = .004; placement instability sample: $29,595 vs. $36,061; P = .045). Incremental average net benefit was positive at all levels of willingness to pay of zero or greater, indicating that the value of benefits exceeded costs. Multidimensional Treatment Foster Care for Preschoolers has significant benefit for preschool children in foster care with emotional and behavioral disorders compared to regular foster care services. At even modest levels of willingness to pay, benefits exceed costs indicating a strong likeliness that this program is an efficient choice for improving outcomes for young children with emotional and behavioral disorders in foster care. PMID:29097828

Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States.

PubMed

Miller, T R; Levy, D T

2000-06-01

The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

An agent-based model evaluation of economic control strategies for paratuberculosis in a dairy herd.

PubMed

Verteramo Chiu, Leslie J; Tauer, Loren W; Al-Mamun, Mohammad A; Kaniyamattam, Karun; Smith, Rebecca L; Grohn, Yrjo T

2018-04-25

This paper uses an agent-based simulation model to estimate the costs associated with Mycobacterium avium ssp. paratuberculosis (MAP), or Johne's disease, in a milking herd, and to determine the net benefits of implementing various control strategies. The net present value (NPV) of a 1,000-cow milking herd is calculated over 20 yr, parametrized to a representative US commercial herd. The revenues of the herd are generated from sales of milk and culled animals. The costs include all variable and fixed costs necessary to operate a representative 1,000-cow milking herd. We estimate the NPV of the herd with no MAP infection, under an expected endemic infection distribution with no controls, and under an expected endemic infection distribution with various controls. The initial number of cows in a herd with an endemic MAP infection is distributed as 75% susceptible, 13% latent, 9% low MAP shedding, and 3% high MAP shedding. Control strategies include testing using ELISA and fecal culture tests and culling of cows that test positive, and culling based on observable milk production decrease. Results show that culling cows based on test results does not increase the herd's NPV and in most cases decreases NPV due to test costs as well as false positives and negatives with their associated costs (e.g., culling healthy cows and keeping infected cows). Culling consistently low producing cows when MAP is believed to be present in the herd produces higher NPV over the strategy of testing and culling MAP infected animals, and over the case of no MAP control. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Evaluating a federated medical search engine: tailoring the methodology and reporting the evaluation outcomes.

PubMed

Saparova, D; Belden, J; Williams, J; Richardson, B; Schuster, K

2014-01-01

Federated medical search engines are health information systems that provide a single access point to different types of information. Their efficiency as clinical decision support tools has been demonstrated through numerous evaluations. Despite their rigor, very few of these studies report holistic evaluations of medical search engines and even fewer base their evaluations on existing evaluation frameworks. To evaluate a federated medical search engine, MedSocket, for its potential net benefits in an established clinical setting. This study applied the Human, Organization, and Technology (HOT-fit) evaluation framework in order to evaluate MedSocket. The hierarchical structure of the HOT-factors allowed for identification of a combination of efficiency metrics. Human fit was evaluated through user satisfaction and patterns of system use; technology fit was evaluated through the measurements of time-on-task and the accuracy of the found answers; and organization fit was evaluated from the perspective of system fit to the existing organizational structure. Evaluations produced mixed results and suggested several opportunities for system improvement. On average, participants were satisfied with MedSocket searches and confident in the accuracy of retrieved answers. However, MedSocket did not meet participants' expectations in terms of download speed, access to information, and relevance of the search results. These mixed results made it necessary to conclude that in the case of MedSocket, technology fit had a significant influence on the human and organization fit. Hence, improving technological capabilities of the system is critical before its net benefits can become noticeable. The HOT-fit evaluation framework was instrumental in tailoring the methodology for conducting a comprehensive evaluation of the search engine. Such multidimensional evaluation of the search engine resulted in recommendations for system improvement.

Evaluating a Federated Medical Search Engine

PubMed Central

Belden, J.; Williams, J.; Richardson, B.; Schuster, K.

2014-01-01

Summary Background Federated medical search engines are health information systems that provide a single access point to different types of information. Their efficiency as clinical decision support tools has been demonstrated through numerous evaluations. Despite their rigor, very few of these studies report holistic evaluations of medical search engines and even fewer base their evaluations on existing evaluation frameworks. Objectives To evaluate a federated medical search engine, MedSocket, for its potential net benefits in an established clinical setting. Methods This study applied the Human, Organization, and Technology (HOT-fit) evaluation framework in order to evaluate MedSocket. The hierarchical structure of the HOT-factors allowed for identification of a combination of efficiency metrics. Human fit was evaluated through user satisfaction and patterns of system use; technology fit was evaluated through the measurements of time-on-task and the accuracy of the found answers; and organization fit was evaluated from the perspective of system fit to the existing organizational structure. Results Evaluations produced mixed results and suggested several opportunities for system improvement. On average, participants were satisfied with MedSocket searches and confident in the accuracy of retrieved answers. However, MedSocket did not meet participants’ expectations in terms of download speed, access to information, and relevance of the search results. These mixed results made it necessary to conclude that in the case of MedSocket, technology fit had a significant influence on the human and organization fit. Hence, improving technological capabilities of the system is critical before its net benefits can become noticeable. Conclusions The HOT-fit evaluation framework was instrumental in tailoring the methodology for conducting a comprehensive evaluation of the search engine. Such multidimensional evaluation of the search engine resulted in recommendations for system improvement. PMID:25298813

Water resources planning and management : A stochastic dual dynamic programming approach

NASA Astrophysics Data System (ADS)

Goor, Q.; Pinte, D.; Tilmant, A.

2008-12-01

Allocating water between different users and uses, including the environment, is one of the most challenging task facing water resources managers and has always been at the heart of Integrated Water Resources Management (IWRM). As water scarcity is expected to increase over time, allocation decisions among the different uses will have to be found taking into account the complex interactions between water and the economy. Hydro-economic optimization models can capture those interactions while prescribing efficient allocation policies. Many hydro-economic models found in the literature are formulated as large-scale non linear optimization problems (NLP), seeking to maximize net benefits from the system operation while meeting operational and/or institutional constraints, and describing the main hydrological processes. However, those models rarely incorporate the uncertainty inherent to the availability of water, essentially because of the computational difficulties associated stochastic formulations. The purpose of this presentation is to present a stochastic programming model that can identify economically efficient allocation policies in large-scale multipurpose multireservoir systems. The model is based on stochastic dual dynamic programming (SDDP), an extension of traditional SDP that is not affected by the curse of dimensionality. SDDP identify efficient allocation policies while considering the hydrologic uncertainty. The objective function includes the net benefits from the hydropower and irrigation sectors, as well as penalties for not meeting operational and/or institutional constraints. To be able to implement the efficient decomposition scheme that remove the computational burden, the one-stage SDDP problem has to be a linear program. Recent developments improve the representation of the non-linear and mildly non- convex hydropower function through a convex hull approximation of the true hydropower function. This model is illustrated on a cascade of 14 reservoirs on the Nile river basin.

Benefit-cost analysis of Fort Collins' municipal forest

Treesearch

E.G. McPherson; J.R. Simpson; P.J. Peper; S.E. Maco; Q. Xiao

2003-01-01

The primary purpose of this report is to answer the question: Do the accrued benefits from Fort Collins’ urban forest justify an annual municipal budget that is nearly $1 million? Our results indicate that the 31,000 streets and park trees in Fort Collins produce substantial benefits. Net annual benefits total $1.17 million ($38/tree, $9/capita). For every $1 invested...

An enhancement of ROC curves made them clinically relevant for diagnostic-test comparison and optimal-threshold determination.

PubMed

Subtil, Fabien; Rabilloud, Muriel

2015-07-01

The receiver operating characteristic curves (ROC curves) are often used to compare continuous diagnostic tests or determine the optimal threshold of a test; however, they do not consider the costs of misclassifications or the disease prevalence. The ROC graph was extended to allow for these aspects. Two new lines are added to the ROC graph: a sensitivity line and a specificity line. Their slopes depend on the disease prevalence and on the ratio of the net benefit of treating a diseased subject to the net cost of treating a nondiseased one. First, these lines help researchers determine the range of specificities within which test comparisons of partial areas under the curves is clinically relevant. Second, the ROC curve point the farthest from the specificity line is shown to be the optimal threshold in terms of expected utility. This method was applied: (1) to determine the optimal threshold of ratio specific immunoglobulin G (IgG)/total IgG for the diagnosis of congenital toxoplasmosis and (2) to select, among two markers, the most accurate for the diagnosis of left ventricular hypertrophy in hypertensive subjects. The two additional lines transform the statistically valid ROC graph into a clinically relevant tool for test selection and threshold determination. Copyright © 2015 Elsevier Inc. All rights reserved.

Moisture rivals temperature in limiting photosynthesis by trees establishing beyond their cold-edge range limit under ambient and warmed conditions.

PubMed

Moyes, Andrew B; Germino, Matthew J; Kueppers, Lara M

2015-09-01

Climate change is altering plant species distributions globally, and warming is expected to promote uphill shifts in mountain trees. However, at many cold-edge range limits, such as alpine treelines in the western United States, tree establishment may be colimited by low temperature and low moisture, making recruitment patterns with warming difficult to predict. We measured response functions linking carbon (C) assimilation and temperature- and moisture-related microclimatic factors for limber pine (Pinus flexilis) seedlings growing in a heating × watering experiment within and above the alpine treeline. We then extrapolated these response functions using observed microclimate conditions to estimate the net effects of warming and associated soil drying on C assimilation across an entire growing season. Moisture and temperature limitations were each estimated to reduce potential growing season C gain from a theoretical upper limit by 15-30% (c. 50% combined). Warming above current treeline conditions provided relatively little benefit to modeled net assimilation, whereas assimilation was sensitive to either wetter or drier conditions. Summer precipitation may be at least as important as temperature in constraining C gain by establishing subalpine trees at and above current alpine treelines as seasonally dry subalpine and alpine ecosystems continue to warm. © 2015 The Authors. New Phytologist © 2015 New Phytologist Trust.

Hope, Quality of Life, and Benefit From Treatment in Women Having Chemotherapy for Platinum-Resistant/Refractory Recurrent Ovarian Cancer: The Gynecologic Cancer Intergroup Symptom Benefit Study

PubMed Central

Sjoquist, Katrin M.; Friedlander, Michael L.; O'Connell, Rachel L.; Voysey, Merryn; King, Madeleine T.; Stockler, Martin R.; Oza, Amit M.; Gillies, Kim; Martyn, Julie K.

2013-01-01

Purpose. Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12–16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio. Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r = 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r = −0.43) and depression (r = −0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49–0.96; p = .026). Conclusion. Trait hope and expectation of symptom benefit from chemotherapy appear to be distinct and independent of the aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefit from chemotherapy was not fulfilled were more likely to have scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy. PMID:24107972

Hope, quality of life, and benefit from treatment in women having chemotherapy for platinum-resistant/refractory recurrent ovarian cancer: the gynecologic cancer intergroup symptom benefit study.

PubMed

Sjoquist, Katrin M; Friedlander, Michael L; O'Connell, Rachel L; Voysey, Merryn; King, Madeleine T; Stockler, Martin R; Oza, Amit M; Gillies, Kim; Martyn, Julie K; Butow, Phyllis N

2013-01-01

Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12-16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio. Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r = 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r = -0.43) and depression (r = -0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49-0.96; p = .026). Conclusion. Trait hope and expectation of symptom benefit from chemotherapy appear to be distinct and independent of the aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefit from chemotherapy was not fulfilled were more likely to have scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy.

Foregone benefits of important food crop improvements in Sub-Saharan Africa

PubMed Central

2017-01-01

A number of new crops have been developed that address important traits of particular relevance for smallholder farmers in Africa. Scientists, policy makers, and other stakeholders have raised concerns that the approval process for these new crops causes delays that are often scientifically unjustified. This article develops a real option model for the optimal regulation of a risky technology that enhances economic welfare and reduces malnutrition. We consider gradual adoption of the technology and show that delaying approval reduces uncertainty about perceived risks of the technology. Optimal conditions for approval incorporate parameters of the stochastic processes governing the dynamics of risk. The model is applied to three cases of improved crops, which either are, or are expected to be, delayed by the regulatory process. The benefits and costs of the crops are presented in a partial equilibrium that considers changes in adoption over time and the foregone benefits caused by a delay in approval under irreversibility and uncertainty. We derive the equilibrium conditions where the net-benefits of the technology equal the costs that would justify a delay. The sooner information about the safety of the technology arrive, the lower the costs for justifying a delay need to be i.e. it pays more to delay. The costs of a delay can be substantial: e.g. a one year delay in approval of the pod-borer resistant cowpea in Nigeria will cost the country about 33 million USD to 46 million USD and between 100 and 3,000 lives. PMID:28749984

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia

PubMed Central

2016-01-01

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer. PMID:26824695

The Culture of Faith and Hope: Patients’ Justifications for Their High Estimations of Expected Therapeutic Benefit When Enrolling in Early-Phase Oncology Trials

PubMed Central

Sulmasy, Daniel P.; Astrow, Alan B.; He, M. Kai; Seils, Damon M.; Meropol, Neal J.; Micco, Ellyn; Weinfurt, Kevin P.

2013-01-01

Purpose Patients’ estimates of their chances of therapeutic benefit from participation in early-phase trials greatly exceed historical data. Ethicists worry that this “therapeutic misestimation” undermines the validity of informed consent. Patients and Methods We interviewed 45 patients enrolled in phase I or II oncology trials about their expectations of therapeutic benefit and their reasons for those expectations. We employed a phenomenological, qualitative approach with one primary coder to identify emergent themes, verified by 2 independent coders. Results Median expectations of therapeutic benefit varied from 50% to 80%, depending on how the question was asked. Justifications universally invoked hope and optimism, and 27/45 participants used one of these words. Three major themes emerged: (1) optimism as performative, that is, the notion that positive thoughts and expressions improve chances of benefit; (2) fighting cancer as a battle; and (3) faith in God, science, or both. Many participants described a culture in which optimism was encouraged and expected, such that trial enrollment became a way of reflecting this expectation. Many reported they had been told few patients would benefit and appeared to understand the uncertainties of clinical research, yet expressed high expected personal therapeutic benefit. More distressed participants were less likely to invoke performative justifications for their expectations (50% vs 84%; P = .04). Conclusion Expressions of high expected therapeutic benefit had little to do with reporting knowledge and more to do with expressing optimism. These results have implications for understanding how to obtain valid consent from participants in early-phase clinical trials. PMID:20564120

QuarkNet: Benefits for Teachers, Their Students and Physicists

NASA Astrophysics Data System (ADS)

Bardeen, Marjorie

2017-01-01

The QuarkNet Collaboration has forged nontraditional relationships among particle physicists, high school teachers and their students. QuarkNet centers are located at 50 + universities and labs across the U.S. and Puerto Rico. We provide professional development for teachers and create opportunities for teachers and students to engage in particle physics data investigations and join research teams. Students develop scientific knowledge and habits of mind by working alongside scientists to make sense of the world using authentic experimental data. Our program is based a classroom vision where teaching strategies emulate closely the way scientists build knowledge through inquiry. We look at how student engagement in research and masterclasses develops an understanding about the process of scientific discovery and science using current scientific data. We also look at ways and to what extent teachers provide scientific discovery and science practices for students and how QuarkNet contributes to the professionalism of participating teachers. Also, we describe success factors that enhance local center programs and describe important benefits of the program that flow to university faculty. Funded by the National Science Foundation and the US Department of Energy.

Benefits of an improved wheat crop information system

NASA Technical Reports Server (NTRS)

Kinne, I. L.

1976-01-01

The ECON work and the results of the independent reviews are summarized. Attempts are made to put this information into layman's terms and to present the benefits that can realistically be expected from a LANDSAT-type remote sensing system. Further the mechanisms by which these benefits can be expected to accrue are presented. The benefits are given including the nature of expected information improvements, how and why they can lead to benefits to society, and the estimated magnitude of the expected benefits. A brief description is presented of the ECON models, how they work, their results, and a summary of the pertinent aspects of each review. The ECON analyses show that substantial benefits will accrue from implementation of an improved wheat crop information system based on remote sensing.

Using Expected Value to Introduce the Laplace Transform

ERIC Educational Resources Information Center

Lutzer, Carl V.

2015-01-01

We propose an introduction to the Laplace transform in which Riemann sums are used to approximate the expected net change in a function, assuming that it quantifies a process that can terminate at random. We assume only a basic understanding of probability.

Setting Priorities in Behavioral Interventions: An Application to Reducing Phishing Risk.

PubMed

Canfield, Casey Inez; Fischhoff, Baruch

2018-04-01

Phishing risk is a growing area of concern for corporations, governments, and individuals. Given the evidence that users vary widely in their vulnerability to phishing attacks, we demonstrate an approach for assessing the benefits and costs of interventions that target the most vulnerable users. Our approach uses Monte Carlo simulation to (1) identify which users were most vulnerable, in signal detection theory terms; (2) assess the proportion of system-level risk attributable to the most vulnerable users; (3) estimate the monetary benefit and cost of behavioral interventions targeting different vulnerability levels; and (4) evaluate the sensitivity of these results to whether the attacks involve random or spear phishing. Using parameter estimates from previous research, we find that the most vulnerable users were less cautious and less able to distinguish between phishing and legitimate emails (positive response bias and low sensitivity, in signal detection theory terms). They also accounted for a large share of phishing risk for both random and spear phishing attacks. Under these conditions, our analysis estimates much greater net benefit for behavioral interventions that target these vulnerable users. Within the range of the model's assumptions, there was generally net benefit even for the least vulnerable users. However, the differences in the return on investment for interventions with users with different degrees of vulnerability indicate the importance of measuring that performance, and letting it guide interventions. This study suggests that interventions to reduce response bias, rather than to increase sensitivity, have greater net benefit. © 2017 Society for Risk Analysis.

Warmer temperatures reduce net carbon uptake, but do not affect water use, in a mature southern Appalachian forest

Treesearch

A. Christopher Oishi; Chelcy F. Miniat; Kimberly A. Novick; Steven T. Brantley; James M. Vose; John T. Walker

2018-01-01

Increasing air temperature is expected to extend growing season length in temperate, broadleaf forests, leading to potential increases in evapotranspiration and net carbon uptake. However, other key processes affecting water and carbon cycles are also highly temperature-dependent. Warmer temperatures may result in higher ecosystem carbon loss through...

Disruptive Effects of Net-Centricity on Command and Control

DTIC Science & Technology

2008-06-01

expectations too quickly are vulnerable to disruptive technologies . When the disruptive innovation gains market share, and old customers adopt new...it is important to remember that disruptive technologies are not merely those that have introduced steep performance improvements, but which, at the...technologies. Disruptive technologies are thereby distinguished from discontinuous sustaining innovations. Net-centric information environments are proving

Net-Shape HIP Powder Metallurgy Components for Rocket Engines

NASA Technical Reports Server (NTRS)

Bampton, Cliff; Goodin, Wes; VanDaam, Tom; Creeger, Gordon; James, Steve

2005-01-01

True net shape consolidation of powder metal (PM) by hot isostatic pressing (HIP) provides opportunities for many cost, performance and life benefits over conventional fabrication processes for large rocket engine structures. Various forms of selectively net-shape PM have been around for thirty years or so. However, it is only recently that major applications have been pursued for rocket engine hardware fabricated in the United States. The method employs sacrificial metallic tooling (HIP capsule and shaped inserts), which is removed from the part after HIP consolidation of the powder, by selective acid dissolution. Full exploitation of net-shape PM requires innovative approaches in both component design and materials and processing details. The benefits include: uniform and homogeneous microstructure with no porosity, irrespective of component shape and size; elimination of welds and the associated quality and life limitations; removal of traditional producibility constraints on design freedom, such as forgeability and machinability, and scale-up to very large, monolithic parts, limited only by the size of existing HIP furnaces. Net-shape PM HIP also enables fabrication of complex configurations providing additional, unique functionalities. The progress made in these areas will be described. Then critical aspects of the technology that still require significant further development and maturation will be discussed from the perspective of an engine systems builder and end-user of the technology.

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

Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs providesmore » a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.« less

Fiscal consequences of changes in morbidity and mortality attributed to rotavirus immunisation.

PubMed

Kotsopoulos, Nikolaos; Connolly, Mark P; Postma, Maarten J; Hutubessy, Raymond C W

2013-11-04

Changes in population health status are known to influence government fiscal transfers both in terms of lost tax revenue and increased expenditure for health and social services. To estimate the fiscal impact of changes in morbidity and mortality attributed to rotavirus immunisation, we developed a government perspective model to estimate discounted net tax revenue for Ghana and Vietnam. The model derived the impact of rotavirus morbidity and mortality on lifetime productive capacity and related tax transfers, and demand for government transfers in relation to education and healthcare in immunised and non-immunised cohorts. The discounted age-specific net tax revenue was derived by deducting transfers from gross taxes and discounting for time preference. In Ghana, taking into account immunisation costs, tax and transfers, the estimated net discounted tax for the immunised cohort was estimated to generate $2.6 billion in net taxes up to age 65. In Vietnam, the net revenue attributed to the immunised cohort reached $55.17 billion suggesting an incremental benefit of approximately $29 million. We posit that the government perspective fiscal framework described here is a valid approach for estimating how governments benefit from investments in immunisation that can be considered supplementary to conventional cost-effectiveness approaches for defining value. Copyright © 2013 Elsevier Ltd. All rights reserved.

Expectations of Benefit in Early-Phase Clinical Trials: Implications for Assessing the Adequacy of Informed Consent

PubMed Central

Weinfurt, Kevin P.; Seils, Damon M.; Tzeng, Janice P.; Compton, Kate L.; Sulmasy, Daniel P.; Astrow, Alan B.; Solarino, Nicholas A.; Schulman, Kevin A.; Meropol, Neal J.

2009-01-01

Background Participants in early-phase clinical trials have reported high expectations of benefit from their participation. There is concern that participants misunderstand the trials to which they have consented. Such concern is based on assumptions about what patients mean when they respond to questions about likelihood of benefit. Methods Participants were 27 women and 18 men in early-phase oncology trials at 2 academic medical centers in the United States. To determine whether expectations of benefit differ depending on how patients are queried, we randomly assigned participants to 1 of 3 interviews corresponding to 3 questions about likelihood of benefit: frequency-type, belief-type, and vague. In semistructured interviews, we queried participants about how they understood and answered the question. Participants then answered and discussed one of the other questions. Results Expectations of benefit in response to the belief-type question were significantly greater than expectations in response to the frequency-type and vague questions (P = .02). The most common justifications involved positive attitude (n = 27 [60%]) and references to physical health (n = 23 [51%]). References to positive attitude were most common among participants with higher (> 70%) expectations (n = 11 [85%]) and least common among those with lower (< 50%) expectations (n = 3 [27%]). Conclusions The wording of questions about likelihood of benefit shapes the expectations that patients express. Also, patients who express high expectations may not do so to communicate understanding, but rather to register optimism. Ongoing research will clarify the meaning of high expectations and examine methods for assessing understanding in this context. PMID:18378940

Spurious symptom reduction in fault monitoring

NASA Technical Reports Server (NTRS)

Shontz, William D.; Records, Roger M.; Choi, Jai J.

1993-01-01

Previous work accomplished on NASA's Faultfinder concept suggested that the concept was jeopardized by spurious symptoms generated in the monitoring phase. The purpose of the present research was to investigate methods of reducing the generation of spurious symptoms during in-flight engine monitoring. Two approaches for reducing spurious symptoms were investigated. A knowledge base of rules was constructed to filter known spurious symptoms and a neural net was developed to improve the expectation values used in the monitoring process. Both approaches were effective in reducing spurious symptoms individually. However, the best results were obtained using a hybrid system combining the neural net capability to improve expectation values with the rule-based logic filter.

Liver Cirrhosis in Patients With Atrial Fibrillation: Would Oral Anticoagulation Have a Net Clinical Benefit for Stroke Prevention?

PubMed

Kuo, Ling; Chao, Tze-Fan; Liu, Chia-Jen; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Liao, Jo-Nan; Chung, Fa-Po; Chen, Tzeng-Ji; Lip, Gregory Y H; Chen, Shih-Ann

2017-06-23

Patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. We hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation. This study used the National Health Insurance Research Database in Taiwan. Among 289 559 atrial fibrillation patients aged ≥20 years, there were 10 336 with liver cirrhosis, and 9056 of them having a CHA 2 DS 2 -VASc score ≥2 were divided into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin. Patients with liver cirrhosis had a higher risk of ischemic stroke (hazard ratio=1.10, P =0.046) and intracranial hemorrhage (hazard ratio=1.20, P =0.043) compared with those without. Among patients with liver cirrhosis, patients taking antiplatelet therapy had a similar risk of ischemic stroke (hazard ratio=1.02, 95%CI=0.88-1.18) compared to those without antithrombotic therapies, but the risk was significantly lowered among warfarin users (hazard ratio=0.76, 95%CI=0.58-0.99). For intracranial hemorrhage, there were no significant differences between those untreated and those taking antiplatelet therapy or warfarin. The use of warfarin was associated with a positive net clinical benefit compared with being untreated or receiving only antiplatelet therapy. For atrial fibrillation patients with liver cirrhosis in the current analysis of an observational study, warfarin use was associated with a lower risk of ischemic stroke and a positive net clinical benefit compared with nontreatment, and thus, thromboprophylaxis should be considered for such patients. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

The microeconomics of residential photovoltaics: Tariffs, network operation and maintenance, and ancillary services in distribution-level electricity markets

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

Boero, Riccardo; Backhaus, Scott N.; Edwards, Brian K.

Here, we develop a microeconomic model of a distribution-level electricity market that takes explicit account of residential photovoltaics (PV) adoption. The model allows us to study the consequences of most tariffs on PV adoption and the consequences of increased residential PV adoption under the assumption of economic sustainability for electric utilities. We also validated the model using U.S. data and extend it to consider different pricing schemes for operation and maintenance costs of the distribution network and for ancillary services. Results show that net metering promotes more environmental benefits and social welfare than other tariffs. But, if costs to operatemore » the distribution network increase, net metering will amplify the unequal distribution of surplus among households. In conclusion, maintaining the economic sustainability of electric utilities under net metering may become extremely difficult unless the uneven distribution of surplus is legitimated by environmental benefits.« less

The microeconomics of residential photovoltaics: Tariffs, network operation and maintenance, and ancillary services in distribution-level electricity markets

DOE PAGES

Boero, Riccardo; Backhaus, Scott N.; Edwards, Brian K.

2016-11-12

Here, we develop a microeconomic model of a distribution-level electricity market that takes explicit account of residential photovoltaics (PV) adoption. The model allows us to study the consequences of most tariffs on PV adoption and the consequences of increased residential PV adoption under the assumption of economic sustainability for electric utilities. We also validated the model using U.S. data and extend it to consider different pricing schemes for operation and maintenance costs of the distribution network and for ancillary services. Results show that net metering promotes more environmental benefits and social welfare than other tariffs. But, if costs to operatemore » the distribution network increase, net metering will amplify the unequal distribution of surplus among households. In conclusion, maintaining the economic sustainability of electric utilities under net metering may become extremely difficult unless the uneven distribution of surplus is legitimated by environmental benefits.« less

20 CFR 404.810 - How to obtain a statement of earnings and a benefit estimate statement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... records at the time of the request. If you have a social security number and have wages or net earnings... prescribed form, giving us your name, social security number, date of birth, and sex. You, your authorized... benefit estimate statement. 404.810 Section 404.810 Employees' Benefits SOCIAL SECURITY ADMINISTRATION...

A benefit-cost analysis of ten tree species in Modesto, California, U.S.A

Treesearch

E.G. McPherson

2003-01-01

Tree work records for ten species were analyzed to estimate average annual management costs by dbh class for six activity areas. Average annual benefits were calculated by dbh class for each species with computer modeling. Average annual net benefits per tree were greatest for London plane (Platanus acerifolia) ($178.57), hackberry (...

Presenting evidence and summary measures to best inform societal decisions when comparing multiple strategies.

PubMed

Eckermann, Simon; Willan, Andrew R

2011-07-01

Multiple strategy comparisons in health technology assessment (HTA) are becoming increasingly important, with multiple alternative therapeutic actions, combinations of therapies and diagnostic and genetic testing alternatives. Comparison under uncertainty of incremental cost, effects and cost effectiveness across more than two strategies is conceptually and practically very different from that for two strategies, where all evidence can be summarized in a single bivariate distribution on the incremental cost-effectiveness plane. Alternative methods for comparing multiple strategies in HTA have been developed in (i) presenting cost and effects on the cost-disutility plane and (ii) summarizing evidence with multiple strategy cost-effectiveness acceptability (CEA) and expected net loss (ENL) curves and frontiers. However, critical questions remain for the analyst and decision maker of how these techniques can be best employed across multiple strategies to (i) inform clinical and cost inference in presenting evidence, and (ii) summarize evidence of cost effectiveness to inform societal reimbursement decisions where preferences may be risk neutral or somewhat risk averse under the Arrow-Lind theorem. We critically consider how evidence across multiple strategies can be best presented and summarized to inform inference and societal reimbursement decisions, given currently available methods. In the process, we make a number of important original findings. First, in presenting evidence for multiple strategies, the joint distribution of costs and effects on the cost-disutility plane with associated flexible comparators varying across replicates for cost and effect axes ensure full cost and effect inference. Such inference is usually confounded on the cost-effectiveness plane with comparison relative to a fixed origin and axes. Second, in summarizing evidence for risk-neutral societal decision making, ENL curves and frontiers are shown to have advantages over the CEA frontier in directly presenting differences in expected net benefit (ENB). The CEA frontier, while identifying strategies that maximize ENB, only presents their probability of maximizing net benefit (NB) and, hence, fails to explain why strategies maximize ENB at any given threshold value. Third, in summarizing evidence for somewhat risk-averse societal decision making, trade-offs between the strategy maximizing ENB and other potentially optimal strategies with higher probability of maximizing NB should be presented over discrete threshold values where they arise. However, the probabilities informing these trade-offs and associated discrete threshold value regions should be derived from bilateral CEA curves to prevent confounding by other strategies inherent in multiple strategy CEA curves. Based on these findings, a series of recommendations are made for best presenting and summarizing cost-effectiveness evidence for reimbursement decisions when comparing multiple strategies, which are contrasted with advice for comparing two strategies. Implications for joint research and reimbursement decisions are also discussed.

A Multination Study of Socioeconomic Inequality in Expectations for Progression to Higher Education: The Role of Between-School Tracking and Ability Stratification

ERIC Educational Resources Information Center

Parker, Philip D.; Jerrim, John; Schoon, Ingrid; Marsh, Herbert W.

2016-01-01

Persistent inequalities in educational expectations across societies are a growing concern. Recent research has explored the extent to which inequalities in education are due to primary effects (i.e., achievement differentials) versus secondary effects (i.e., choice behaviors net of achievement). We explore educational expectations in order to…

Anti-proliferative and anti-secretory effects of everolimus on human pancreatic neuroendocrine tumors primary cultures: is there any benefit from combination with somatostatin analogs?

PubMed

Mohamed, Amira; Romano, David; Saveanu, Alexandru; Roche, Catherine; Albertelli, Manuela; Barbieri, Federica; Brue, Thierry; Niccoli, Patricia; Delpero, Jean-Robert; Garcia, Stephane; Ferone, Diego; Florio, Tullio; Moutardier, Vincent; Poizat, Flora; Barlier, Anne; Gerard, Corinne

2017-06-20

Therapeutic management of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is challenging. The mammalian target of rapamycin (mTOR) inhibitor everolimus recently obtained approval from the Food and Drug Administration for the treatment of patients with advanced pancreatic neuroendocrine tumors (pNETs). Despite its promising antitumor efficacy observed in cell lines, clinical benefit for patients is unsatisfactory. The limited therapeutic potential of everolimus in cancer cells has been attributed to Akt activation due to feedback loops relief following mTOR inhibition. Combined inhibition of Akt might then improve everolimus antitumoral effect. In this regard, the somatostatin analog (SSA) octreotide has been shown to repress the PI3K/Akt pathway in some tumor cell lines. Moreover, SSAs are well tolerated and routinely used to reduce symptoms caused by peptide release in patients carrying functional GEP-NETs. We have recently established and characterized primary cultures of human pNETs and demonstrated the anti-proliferative effects of both octreotide and pasireotide. In this study, we aim at determining the antitumor efficacy of everolimus alone or in combination with the SSAs octreotide and pasireotide in primary cultures of pNETs. Everolimus reduced both Chromogranin A secretion and cell viability and upregulated Akt activity in single treatment. Its anti-proliferative and anti-secretory efficacy was not improved combined with the SSAs. Both SSAs did not overcome everolimus-induced Akt upregulation. Furthermore, caspase-dependent apoptosis induced by SSAs was lost in combined treatments. These molecular events provide the first evidence supporting the lack of marked benefit in patients co-treated with everolimus and SSA.

Anti-proliferative and anti-secretory effects of everolimus on human pancreatic neuroendocrine tumors primary cultures: is there any benefit from combination with somatostatin analogs?

PubMed Central

Mohamed, Amira; Romano, David; Saveanu, Alexandru; Roche, Catherine; Albertelli, Manuela; Barbieri, Federica; Brue, Thierry; Niccoli, Patricia; Delpero, Jean-Robert; Garcia, Stephane; Ferone, Diego; Florio, Tullio; Moutardier, Vincent; Gerard, Corinne

2017-01-01

Therapeutic management of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is challenging. The mammalian target of rapamycin (mTOR) inhibitor everolimus recently obtained approval from the Food and Drug Administration for the treatment of patients with advanced pancreatic neuroendocrine tumors (pNETs). Despite its promising antitumor efficacy observed in cell lines, clinical benefit for patients is unsatisfactory. The limited therapeutic potential of everolimus in cancer cells has been attributed to Akt activation due to feedback loops relief following mTOR inhibition. Combined inhibition of Akt might then improve everolimus antitumoral effect. In this regard, the somatostatin analog (SSA) octreotide has been shown to repress the PI3K/Akt pathway in some tumor cell lines. Moreover, SSAs are well tolerated and routinely used to reduce symptoms caused by peptide release in patients carrying functional GEP-NETs. We have recently established and characterized primary cultures of human pNETs and demonstrated the anti-proliferative effects of both octreotide and pasireotide. In this study, we aim at determining the antitumor efficacy of everolimus alone or in combination with the SSAs octreotide and pasireotide in primary cultures of pNETs. Everolimus reduced both Chromogranin A secretion and cell viability and upregulated Akt activity in single treatment. Its anti-proliferative and anti-secretory efficacy was not improved combined with the SSAs. Both SSAs did not overcome everolimus-induced Akt upregulation. Furthermore, caspase-dependent apoptosis induced by SSAs was lost in combined treatments. These molecular events provide the first evidence supporting the lack of marked benefit in patients co-treated with everolimus and SSA. PMID:28454119

Role of Cost on Failure to Access Prescribed Pharmaceuticals: The Case of Statins.

PubMed

McRae, Ian; van Gool, Kees; Hall, Jane; Yen, Laurann

2017-10-01

In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme defines patient co-payment levels per script depending on whether patients are "concessional" (holding prescribed pension or other government concession cards) or "general", and whether they have reached a safety net defined by total out-of-pocket costs for Pharmaceutical Benefits Scheme-approved medicines. The purpose of this study was to explore the impact of costs on adherence to statins in this relatively low-cost environment. Using data from a large-scale survey of older Australians in the state of New South Wales linked to administrative data from the national medical and pharmaceutical insurance schemes, we explore the relationships between adherence to medication regimes for statins and out-of-pocket costs of prescribed pharmaceuticals, income, other health costs, and a wide set of demographic and socio-economic control variables using both descriptive analysis and logistic regressions. Within the general non-safety net group, which has the highest co-payment, those with lowest income have the lowest adherence, suggesting that the general safety threshold may be set at a level that forms a major barrier to statin adherence. This is reinforced by over 75% of those who were not adherent before reaching the safety net threshold becoming adherent after reaching the safety net with its lower co-payments. The main financial determinant of adherence is the concessional/general and safety net category of the patient, which means the main determinant is the level of co-payment.

Cost-benefit study of school nursing services.

PubMed

Wang, Li Yan; Vernon-Smiley, Mary; Gapinski, Mary Ann; Desisto, Marie; Maughan, Erin; Sheetz, Anne

2014-07-01

In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services. To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year. School health services provided by full-time registered nurses. Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars. During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit. The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

Development of a New Zealand SedNet model for assessment of catchment-wide soil-conservation works

NASA Astrophysics Data System (ADS)

Dymond, John R.; Herzig, Alexander; Basher, Les; Betts, Harley D.; Marden, Mike; Phillips, Chris J.; Ausseil, Anne-Gaelle E.; Palmer, David J.; Clark, Maree; Roygard, Jon

2016-03-01

Much hill country in New Zealand has been converted from indigenous forest to pastoral agriculture, resulting in increased soil erosion. Following a severe storm that hit the Manawatu-Wanaganui region in 2004 and caused 62,000 landslides, the Horizons Regional Council have implemented the Sustainable Land Use Initiative (SLUI), a programme of widespread soil conservation. We have developed a New Zealand version (SedNetNZ) of the Australian SedNet model to evaluate the impact of the SLUI programme in the 5850 km2 Manawatu catchment. SedNetNZ spatially distributes budgets of fine sediment in the landscape. It incorporates landslide, gully, earthflow erosion, surficial erosion, bank erosion, and flood-plain deposition, the important forms of soil erosion in New Zealand. Modelled suspended sediment loads compared well with measured suspended sediment loads with an R2 value of 0.85 after log transformation. A sensitivity analysis gave the uncertainty of estimated suspended sediment loads to be approximately plus or minus 50% (at the 95% confidence level). It is expected that by 2040, suspended sediment loads in targeted water management zones will decrease by about 40%. The expected decrease for the whole catchment is 34%. The expected reduction is due to maturity of tree planting on land at risk to soil erosion. The 34% reduction represents an annual rate of return of 20% on 20 million NZ of investment on soil conservation works through avoided damage to property and infrastructure and avoided clean-up costs.

12 CFR 34.3 - General rule.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., for example, the borrower's current and expected income, current and expected cash flows, net worth, other relevant financial resources, current financial obligations, employment status, credit history, or... thereunder in connection with loans made under this part. [68 FR 70131, Dec. 17, 2003, as amended at 69 FR...

12 CFR 34.3 - General rule.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., for example, the borrower's current and expected income, current and expected cash flows, net worth, other relevant financial resources, current financial obligations, employment status, credit history, or... thereunder in connection with loans made under this part. [68 FR 70131, Dec. 17, 2003, as amended at 69 FR...

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention

PubMed Central

Boyd, Matt; Baker, Michael G.; Mansoor, Osman D.; Kvizhinadze, Giorgi; Wilson, Nick

2017-01-01

Background Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. Objective To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. Methods An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). Results For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, “Scenario A”), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of “Scenario A”, or 2.75% of the country’s population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for “Scenario A” times three for 26 weeks of border closure–but not for only 12 weeks of closure when it would still be beneficial). Conclusions This “proof-of-concept” work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective. PMID:28622344

The paradox of disease prevention: celebrated in principle, resisted in practice.

PubMed

Fineberg, Harvey V

2013-07-03

Prevention of disease is often difficult to put into practice. Among the obstacles: the success of prevention is invisible, lacks drama, often requires persistent behavior change, and may be long delayed; statistical lives have little emotional effect, and benefits often do not accrue to the payer; avoidable harm is accepted as normal, preventive advice may be inconsistent, and bias against errors of commission may deter action; prevention is expected to produce a net financial return, whereas treatment is expected only to be worth its cost; and commercial interests as well as personal, religious, or cultural beliefs may conflict with disease prevention. Six strategies can help overcome these obstacles: (1) Pay for preventive services. (2) Make prevention financially rewarding for individuals and families. (3) Involve employers to promote health in the workplace and provide incentives to employees to maintain healthy practices. (4) Reengineer products and systems to make prevention simpler, lower in cost, and less dependent on individual action. (5) Use policy to reinforce choices that favor prevention. (6) Use multiple media channels to educate, elicit health-promoting behavior, and strengthen healthy habits. Prevention of disease will succeed over time insofar as it can be embedded in a culture of health.

77 FR 5243 - Proposed Priority, Requirements, Definitions, and Selection Criteria-Arts in Education National...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... professional development, partnerships, educational programming, and supporting systemic school reform. Child... alternative regulatory approaches, select those approaches that maximize net benefits (including potential... benefits justify their costs. In choosing among alternative regulatory approaches, we selected those...

Incremental cost effectiveness evaluation in clinical research.

PubMed

Krummenauer, Frank; Landwehr, I

2005-01-28

The health economic evaluation of therapeutic and diagnostic strategies is of increasing importance in clinical research. Therefore also clinical trialists have to involve health economic aspects more frequently. However, whereas they are quite familiar with classical effect measures in clinical trials, the corresponding parameters in health economic evaluation of therapeutic and diagnostic procedures are still not this common. The concepts of incremental cost effectiveness ratios (ICERs) and incremental net health benefit (INHB) will be illustrated and contrasted along the cost effectiveness evaluation of cataract surgery with monofocal and multifocal intraocular lenses. ICERs relate the costs of a treatment to its clinical benefit in terms of a ratio expression (indexed as Euro per clinical benefit unit). Therefore ICERs can be directly compared to a pre-specified willingness to pay (WTP) benchmark, which represents the maximum costs, health insurers would invest to achieve one clinical benefit unit. INHBs estimate a treatment's net clinical benefit after accounting for its cost increase versus an established therapeutic standard. Resource allocation rules can be formulated by means of both effect measures. Both the ICER and the INHB approach enable the definition of directional resource allocation rules. The allocation decisions arising from these rules are identical, as long as the willingness to pay benchmark is fixed in advance. Therefore both strategies crucially call for a priori determination of both the underlying clinical benefit endpoint (such as gain in vision lines after cataract surgery or gain in quality-adjusted life years) and the corresponding willingness to pay benchmark. The use of incremental cost effectiveness and net health benefit estimates provides a rationale for health economic allocation discussions and founding decisions. It implies the same requirements on trial protocols as yet established for clinical trials, that is the a priori definition of primary hypotheses (formulated as an allocation rule involving a pre-specified willingness to pay benchmark) and the primary clinical benefit endpoint (as a rationale for effectiveness evaluation).

Which Benefits Are Mentioned Most Often in Drug Development Publications?

PubMed

Strüver, Vanessa

2017-01-01

The aim was to identify theoretically expected as well as actually reported benefits from drug development and the importance of individual patient benefits compared to the collective benefits to society in general. Ethical guidelines require that clinical research involving humans offer the potential for benefit. A number of characteristics can be applied to define research benefit. Often benefit is categorized as being either direct or indirect. Indirect benefits can involve collective benefits for society rather than any benefits to the trial patient or subject. The purpose of this review was to examine which potential individual and societal benefits were mentioned as being expected in publications from government experts and which were mentioned in publications describing completed drug development trial results. Literature on research benefit was first identified by searching the PubMed database using several combinations of the key words benefit and clinical research . The search was limited to articles published in English. A Google search with the same combinations of key words but without any language limitation was then performed. Additionally, the reference lists of promising articles were screened for further thematically related articles. Finally, a narrative review was performed of relevant English- and German-language articles published between 1996 and 2016 to identify which of several potential benefits were either theoretically expected or which were mentioned in publications on clinical drug development trial results. The principal benefits from drug development discussed included 2 main types of benefit, namely individual benefits for the patients and collective benefits for society. Twenty-one of an overall total of 26 articles discussing theoretically expected benefits focused on individual patient benefits, whereas 17 out of 26 articles mentioned collective benefits to society. In these publications, the most commonly mentioned theoretically expected individual patient benefit was the chance to receive up-to-date care (38.1%). A general increase in knowledge about health care, treatments, or drugs (70.6%) was the most commonly mentioned theoretically expected benefit for society. In contrast, all 13 publications reporting actual benefits of clinical drug development trials focused on personal benefits and only 1 of these publications also mentioned a societal benefit. The most commonly mentioned individual benefit was an increased quality of life (53.9%), whereas the only mentioned collective benefit to society was a general gain of knowledge (100.0%). Both theoretically expected and actually reported benefits in the majority of the included publications emphasized the importance of individual patient benefits from drug development rather than the collective benefits to society in general. The authors of these publications emphasized the right of each individual patient or subject to look for and expect some personal benefit from participating in a clinical trial rather than considering societal benefit as a top priority. From an ethical point of view, the benefits each individual patient receives from his or her participation in a clinical trial might also be seen as a societal benefit, especially when the drug or device tested, if approved for marketing, would eventually be made available for other similar patients from the country in which the clinical trial was conducted.

20 CFR 404.1089 - Figuring net earnings for residents and nonresidents of Puerto Rico.

Code of Federal Regulations, 2014 CFR

2014-04-01

... nonresidents of Puerto Rico. 404.1089 Section 404.1089 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Puerto Rico. (a) Residents. If you are a resident of Puerto Rico, whether or not you are an alien, a citizen of the United States, or a citizen of Puerto Rico, you must figure your net earnings from self...

20 CFR 404.1089 - Figuring net earnings for residents and nonresidents of Puerto Rico.

Code of Federal Regulations, 2011 CFR

2011-04-01

... nonresidents of Puerto Rico. 404.1089 Section 404.1089 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Puerto Rico. (a) Residents. If you are a resident of Puerto Rico, whether or not you are an alien, a citizen of the United States, or a citizen of Puerto Rico, you must figure your net earnings from self...

20 CFR 404.1089 - Figuring net earnings for residents and nonresidents of Puerto Rico.

Code of Federal Regulations, 2012 CFR

2012-04-01

... nonresidents of Puerto Rico. 404.1089 Section 404.1089 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Puerto Rico. (a) Residents. If you are a resident of Puerto Rico, whether or not you are an alien, a citizen of the United States, or a citizen of Puerto Rico, you must figure your net earnings from self...

20 CFR 404.1089 - Figuring net earnings for residents and nonresidents of Puerto Rico.

Code of Federal Regulations, 2010 CFR

2010-04-01

... nonresidents of Puerto Rico. 404.1089 Section 404.1089 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Puerto Rico. (a) Residents. If you are a resident of Puerto Rico, whether or not you are an alien, a citizen of the United States, or a citizen of Puerto Rico, you must figure your net earnings from self...

20 CFR 404.1089 - Figuring net earnings for residents and nonresidents of Puerto Rico.

Code of Federal Regulations, 2013 CFR

2013-04-01

... nonresidents of Puerto Rico. 404.1089 Section 404.1089 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Puerto Rico. (a) Residents. If you are a resident of Puerto Rico, whether or not you are an alien, a citizen of the United States, or a citizen of Puerto Rico, you must figure your net earnings from self...

Quantifying the net economic benefits of mechanical wildfire hazard treatments on timberlands of the western United States

Treesearch

Jeffrey P. Prestemon; Karen L. Abt; James R. Barbour

2012-01-01

Mechanical treatment of vegetation is done on public and private lands for many possible reasons, including enhancing wildlife habitat, increasing timber growth of residual stands, and improving resistance to damaging pests. Few studies, however, have focused on the circumstances under which mechanical wildfire hazard reduction treatments can yield positive net...

Longevity and efficacy of bifenthrin treatment on desert-pattern U.S. military camouflage netting against mosquitoes in a hot-arid environment

USDA-ARS?s Scientific Manuscript database

Personnel deployed in support of US military operations will benefit from additions to the current Department of Defense pest management system. A recent study showed that residual insecticide treatment of woodland pattern US military camouflage netting was long lasting and effective at reducing mos...

Comparative cost-benefit analysis of tele-homecare for community-dwelling elderly in Japan: Non-Government versus Government Supported Funding Models.

PubMed

Akiyama, Miki; Abraham, Chon

2017-08-01

Tele-homecare is gaining prominence as a viable care alternative, as evidenced by the increase in financial support from international governments to fund initiatives in their respective countries. The primary reason for the funding is to support efforts to reduce lags and increase capacity in access to care as well as to promote preventive measures that can avert costly emergent issues from arising. These efforts are especially important to super-aged and aging societies such as in Japan, many European countries, and the United States (US). However, to date and to our knowledge, a direct comparison of non-government vs. government-supported funding models for tele-homecare is particularly lacking in Japan. The aim of this study is to compare these operational models (i.e., non-government vs. government-supported funding) from a cost-benefit perspective. This simulation study applies to a Japanese hypothetical cohort with implications for other super-aged and aging societies abroad. We performed a cost-benefit analysis (CBA) on two operational models for enabling tele-homecare for elderly community-dwelling cohorts based on a decision tree model, which we created with parameters from published literature. The two models examined are (a) Model 1-non-government-supported funding that includes monthly fixed charges paid by users for a portion of the operating costs, and (b) Model 2-government-supported funding that includes startup and installation costs only (i.e., no operating costs) and no monthly user charges. We performed base case cost-benefit analysis and probabilistic cost-benefit analysis with a Monte Carlo simulation. We calculated net benefit and benefit-to-cost ratios (BCRs) from the societal perspective with a five-year time horizon applying a 3% discount rate for both cost and benefit values. The cost of tele-homecare included (a) the startup system expense, averaged over a five-year depreciation period, and (b) operation expenses (i.e., labor and non-labor) per user per year. The benefit of tele-homecare was measured by annual willingness to pay (WTP) for tele-homecare by a user and medical expenditures avoided. Both costs and benefits were inflated using the relevant Japanese consumer price index (CPI) and converted into 2015 US dollars with purchasing power parity (PPP) adjusted. Base case net benefits of Model 1 and Model 2 were $417.00 and $97.30, respectively. Base case BCR of Model 1 tele-homecare was 1.63, while Model 2 was 1.03. The probabilistic analysis estimated mean (95%CI) for BCRs of Model 1 and Model 2 was 1.84 (1.89, 1.88) and 1.46 (1.43, 1.49), respectively. Sensitivity analysis showed robustness of Model 1 in 7 parameters but Model 2 was sensitive in all key parameters such as initial system cost, device cost, number of users, and medical expenditure saved. Break-even analysis showed that the system cost of Model 2 had to be under $187,500. Our results for each model collectively showed that tele-homecare in Japan is cost-saving to some extent. However, the government-funded model (i.e., Model 2), which typically requires use of all startup funding to be spent within the first year on system costs, was inferior to the monthly fee model (i.e., Model 1) that did not use the government funding for installation or continued operations, but rather incorporated a monthly fee from users to support the receipt of services via tele-homecare. While the benefits of Model 1 outweighed the benefits of Model 2, the government-subsidized method employed in Model 2 could be more beneficial in general if some explicit prequalifying estimated metrics are instituted prior to funding. Thus, governments need to require applicants requesting funding to note, at a minimum, (a) estimated costs, (b) the expected number of tele-homecare users, and expected benefits such as (c) WTP by the user, or (d) medical expenditure saved by tele-homecare as a means of financing some of the operational costs. Copyright © 2017 Elsevier B.V. All rights reserved.

[Ethical aspects of the fluoridation of water, salt, and milk].

PubMed

Rippe, K P

2009-05-01

The article discusses two ethical aspects of the fluoridation of water, salt, and milk. First, it considers whether fluoridation contradicts the right of self-determination. Second, it discusses the chances and risks of fluoridation. The answer to the first question depends on whether people can choose other options. Freedom of choice is not simply the right to choose between different options. It is a right which defends the moral integrity of persons. Nobody should be coerced to eat or drink something which he or she rejects morally. In the political sphere, personal rights of persons can be restricted if and only if it is necessary, if there is a public interest, and if the restriction of the right is reasonable. Regarding fluoridation, even in the best risk-chance scenario, some persons have to expect a net harm. Therefore, the reasoning in favor of fluoridation has to have a specific purpose. The proclaimed reasoning is that fluoridation will benefit the worst off and is therefore a demand of justice. But this argument fails as there are other options to benefit the worst off. Even in the best risk-chance scenario, only one option is morally permissible: the fluoridation of salt, which respects the freedom of choice.

Conjunctive use of groundwater and surface water for irrigated agriculture: Risk aversion

USGS Publications Warehouse

Bredehoeft, John D.; Young, Richard A.

1983-01-01

In examining the South Platte system in Colorado where surface water and groundwater are used conjunctively for irrigation, we find the actual installed well capacity is approximately sufficient to irrigate the entire area. This would appear to be an overinvestment in well capacity. In this paper we examine to what extent groundwater is being developed as insurance against periods of low streamflow. Using a simulation model which couples the hydrology of a conjunctive stream aquifer system to a behavioral-economic model which incorporates farmer behavior in such a system, we have investigated the economics of an area patterned after a reach of the South Platte Valley in Colorado. The results suggest that under current economic conditions the most reasonable groundwater pumping capacity is a total capacity capable of irrigating the available acreage with groundwater. Installing sufficient well capacity to irrigate all available acreage has two benefits: (1) this capacity maximizes the expected net benefits and (2) this capacity also minimizes the variation in annual income: it reduces the variance to essentially zero. As pumping capacity is installed in a conjunctive use system, the value of flow forecasts is diminished. Poor forecasts are compensated for by pumping groundwater.

Proposed 'grant-and-access' program with price caps could stimulate development of drugs for very rare diseases.

PubMed

Valverde, Ana M; Reed, Shelby D; Schulman, Kevin A

2012-11-01

The 1983 Orphan Drug Act created incentives for the development of orphan drugs. Despite its successes, including a substantial increase in new drugs, approved orphan drugs still treat fewer than 5 percent of registered rare diseases. In addition, concerns have arisen about the high prices of many of these therapies, which can cost hundreds of thousands of dollars per patient each year. In this article, we propose a new "grant-and-access pathway," in which drug developers could opt to compete for federal grants to subsidize the costs of clinical testing. In return for the grant funding, companies would no longer claim orphan drug tax credits and would agree to price caps for marketed products based on the duration and costs associated with drug development, expected market size, and target rate of return. We identify scenarios in which such a policy could provide a net benefit to society.

NASA Electric Aircraft Test Bed (NEAT) Development Plan - Design, Fabrication, Installation

NASA Technical Reports Server (NTRS)

Dyson, Rodger W.

2016-01-01

As large airline companies compete to reduce emissions, fuel, noise, and maintenance costs, it is expected that more of their aircraft systems will shift from using turbofan propulsion, pneumatic bleed power, and hydraulic actuation, to instead using electrical motor propulsion, generator power, and electrical actuation. This requires new flight-weight and flight-efficient powertrain components, fault tolerant power management, and electromagnetic interference mitigation technologies. Moreover, initial studies indicate some combination of ambient and cryogenic thermal management and relatively high bus voltages when compared to state of practice will be required to achieve a net system benefit. Developing all these powertrain technologies within a realistic aircraft architectural geometry and under realistic operational conditions requires a unique electric aircraft testbed. This report will summarize existing testbed capabilities located in the U.S. and details the development of a unique complementary testbed that industry and government can utilize to further mature electric aircraft technologies.

Placebo effect in clinical trial design for irritable bowel syndrome.

PubMed

Shah, Eric; Pimentel, Mark

2014-04-30

Ongoing efforts to improve clinical trial design in irritable bowel syndrome have been hindered by high placebo response rates and ineffective outcome measures. We assessed established strategies to minimize placebo effect as well as the various ap-proaches to placebo effect which can affect trial design. These include genetic markers such as catechol-O-methyltransferase, opioidergic and dopaminergic neurobiologic theory, pre-cebo effect centered on expectancy theory, and side effect unblinding grounded on conditioning theory. We reviewed endpoints used in the study of IBS over the past decade including adequate relief and subjective global relief, emphasizing their weaknesses in fully evaluating the IBS condition, specifically their motility effects based on functional net value and relative benefit-harm based on dropouts due to adverse events. The focus of this review is to highlight ongoing efforts to improve clinical trial design which can lead to better outcomes in a real-world setting.

A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland.

PubMed

Fawsitt, Christopher G; Bourke, Jane; Murphy, Aileen; McElroy, Brendan; Lutomski, Jennifer E; Murphy, Rosemary; Greene, Richard A

2017-12-01

The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective. To avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66-1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51-921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73-2027.51) and €1018.47 (95% CI 916.61-1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35-1991.93), compared with €123.23 (95% CI -376.58 to 621.42) for consultant-led care. While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.

Models for Trypanosoma evansi (surra), its control and economic impact on small-hold livestock owners in the Philippines.

PubMed

Dobson, R J; Dargantes, A P; Mercado, R T; Reid, S A

2009-08-01

Simple demographic and infectious disease models of buffaloes and other domestic hosts for animal trypanosomosis (surra) caused by Trypanosoma evansi were developed. The animal models contained deterministic and stochastic elements and were linked to simulate the benefit of control regimes for surra in village domestic animal populations in Mindanao, Philippines. The impact of the disease on host fertility and mortality were key factors in determining the economic losses and net-benefit from the control regimes. If using a high (99%) efficacy drug in surra-moderate to high risk areas, then treating all animals twice each year yielded low prevalence in 2 years; targeted treatment of clinically sick animals, constantly monitored (monthly), required 75% fewer treatments but took longer to reach a low prevalence than treating all animals twice each year. At high drug efficacy both of these treatment strategies increased the benefit over untreated animals by 81%. If drug efficacy declined then the benefit obtained from twice yearly treatment of all animals declined rapidly compared with regular monitoring and targeting treatment to clinically sick animals. The current control regimen applied in the Philippines of annual sero-testing for surra and only treating sero-positive animals provided the lowest net-benefit of all the control options simulated and would not be regarded as effective control. The total net-benefit from effective surra control for a typical village in a moderate/high risk area was 7.9 million pesos per annum (US $158,000). The value added to buffaloes, cattle, horses, goats/sheep and pigs as a result of this control was US $88, $84, $151, $7, $114 per animal/year, respectively.

Who wins and who loses? Public transfer accounts for US generations born 1850 to 2090

PubMed Central

Bommier, Antoine; Miller, Tim; Zuber, Stéphane

2010-01-01

Public transfer programs in industrial nations are thought to benefit the elderly through pension and health care programs at the expense of the young and future generations. However, this intergenerational picture changes if public education is also considered as a transfer program. We calculate the net present value (NPV) of benefits received minus taxes paid for US generations born 1850 to 2090. Surprisingly, all generations 1950 to 2050 are net gainers, while many current elderly are losers. Windfall gains from starting Social Security and Medicare partially offset windfall losses from starting public education, roughly consistent with the Becker-Murphy theory. PMID:20300431

Comparison of three versions of Partin tables to predict final pathologic stage in a Chinese cohort: a decision curve analysis.

PubMed

Xiao, Wen-Jun; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Dai, Bo

2013-01-01

To compare Partin tables (PTs) 1997, 2001, and 2007 for their clinical applicability in a Chinese cohort based upon a decision curve analysis (DCA). Clinical and pathologic data of 264 consecutive Chinese patients with clinically localized prostate cancer were used. These patients underwent open radical prostatectomy between 2005 and 2011. DCA quantified the net benefit of different PT versions relating to specific threshold probabilities of established capsular penetration (ECP), seminal vesicle involvement (SVI), and lymph node involvement (LNI). Overall, ECP, SVI, and LNI were recorded in 23.1, 10.2, and 6.1%, respectively. When the threshold probability was below the prevalence for LNI and ECP predictions, the DCA favored the 2007 version versus the 1997 version for SVI. DCA indicates that for low threshold probability, decision models are useful to discriminate the performance differences of three PT versions, although net benefit differences were not apparent. For high threshold probability, there may not be an important benefit from the use of PTs and the current analysis cannot translate into meaningful net gains differences. Copyright © 2013 S. Karger AG, Basel.

The net benefits of human-ignited wildfire forecasting: the case of Tribal land units in the United States

PubMed Central

Prestemon, Jeffrey P.; Butry, David T.; Thomas, Douglas S.

2017-01-01

Research shows that some categories of human-ignited wildfires might be forecastable, due to their temporal clustering, with the possibility that resources could be pre-deployed to help reduce the incidence of such wildfires. We estimated several kinds of incendiary and other human-ignited wildfire forecast models at the weekly time step for tribal land units in the United States, evaluating their forecast skill out of sample. Analyses show that an Autoregressive Conditional Poisson (ACP) model of both incendiary and non-incendiary human-ignited wildfires is more accurate out of sample compared to alternatives, and the simplest of the ACP models performed the best. Additionally, an ensemble of these and simpler, less analytically intensive approaches performed even better. Wildfire hotspot forecast models using all model types were evaluated in a simulation mode to assess the net benefits of forecasts in the context of law enforcement resource reallocations. Our analyses show that such hotspot tools could yield large positive net benefits for the tribes in terms of suppression expenditures averted for incendiary wildfires but that the hotspot tools were less likely to be beneficial for addressing outbreaks of non-incendiary human-ignited wildfires. PMID:28769549

The net benefits of human-ignited wildfire forecasting: the case of Tribal land units in the United States.

PubMed

Prestemon, Jeffrey P; Butry, David T; Thomas, Douglas S

2016-01-01

Research shows that some categories of human-ignited wildfires might be forecastable, due to their temporal clustering, with the possibility that resources could be pre-deployed to help reduce the incidence of such wildfires. We estimated several kinds of incendiary and other human-ignited wildfire forecast models at the weekly time step for tribal land units in the United States, evaluating their forecast skill out of sample. Analyses show that an Autoregressive Conditional Poisson (ACP) model of both incendiary and non-incendiary human-ignited wildfires is more accurate out of sample compared to alternatives, and the simplest of the ACP models performed the best. Additionally, an ensemble of these and simpler, less analytically intensive approaches performed even better. Wildfire hotspot forecast models using all model types were evaluated in a simulation mode to assess the net benefits of forecasts in the context of law enforcement resource reallocations. Our analyses show that such hotspot tools could yield large positive net benefits for the tribes in terms of suppression expenditures averted for incendiary wildfires but that the hotspot tools were less likely to be beneficial for addressing outbreaks of non-incendiary human-ignited wildfires.

A cost-benefit analysis of Wisconsin's screening, brief intervention, and referral to treatment program: adding the employer's perspective.

PubMed

Quanbeck, Andrew; Lang, Katharine; Enami, Kohei; Brown, Richard L

2010-02-01

A previous cost-benefit analysis found Screening, Brief Intervention, and Referral to Treatment (SBIRT) to be cost-beneficial from a societal perspective. This paper develops a cost-benefit model that includes the employer's perspective by considering the costs of absenteeism and impaired presenteeism due to problem drinking. We developed a Monte Carlo simulation model to estimate the costs and benefits of SBIRT implementation to an employer. We first presented the likely costs of problem drinking to a theoretical Wisconsin firm that does not currently provide SBIRT services. We then constructed a cost-benefit model in which the firm funds SBIRT for its employees. The net present value of SBIRT adoption was computed by comparing costs due to problem drinking both with and without the program. When absenteeism and impaired presenteeism costs were considered from the employer's perspective, the net present value of SBIRT adoption was $771 per employee. We concluded that implementing SBIRT is cost-beneficial from the employer's perspective and recommend that Wisconsin employers consider covering SBIRT services for their employees.

The Importance of Powertrain Downsizing in a Benefit-Cost Analysis of Vehicle Lightweighting

NASA Astrophysics Data System (ADS)

Ward, J.; Gohlke, D.; Nealer, R.

2017-04-01

Reducing vehicle weight is an important avenue to improve energy efficiency and decrease greenhouse gas emissions from our cars and trucks. Conventionally, models have estimated acceptable increased manufacturing cost as proportional to the lifetime fuel savings associated with reduced vehicle weight. Vehicle lightweighting also enables a decrease in powertrain size and significant reductions in powertrain cost. Accordingly, we propose and apply a method for calculating the maximum net benefits and breakeven cost of vehicle lightweighting that considers both efficiency and powertrain downsizing for a conventional internal combustion engine vehicle, a battery electric vehicle with a range of 300 miles (BEV300), and a fuel cell electric vehicle (FCEV). We find that excluding powertrain downsizing cost savings undervalues the potential total net benefits of vehicle lightweighting, especially for the BEV300 and FCEV.

Benefits of rebuilding global marine fisheries outweigh costs.

PubMed

Sumaila, Ussif Rashid; Cheung, William; Dyck, Andrew; Gueye, Kamal; Huang, Ling; Lam, Vicky; Pauly, Daniel; Srinivasan, Thara; Swartz, Wilf; Watson, Reginald; Zeller, Dirk

2012-01-01

Global marine fisheries are currently underperforming, largely due to overfishing. An analysis of global databases finds that resource rent net of subsidies from rebuilt world fisheries could increase from the current negative US$13 billion to positive US$54 billion per year, resulting in a net gain of US$600 to US$1,400 billion in present value over fifty years after rebuilding. To realize this gain, governments need to implement a rebuilding program at a cost of about US$203 (US$130-US$292) billion in present value. We estimate that it would take just 12 years after rebuilding begins for the benefits to surpass the cost. Even without accounting for the potential boost to recreational fisheries, and ignoring ancillary and non-market values that would likely increase, the potential benefits of rebuilding global fisheries far outweigh the costs.

Benefits of Rebuilding Global Marine Fisheries Outweigh Costs

PubMed Central

Sumaila, Ussif Rashid; Cheung, William; Dyck, Andrew; Gueye, Kamal; Huang, Ling; Lam, Vicky; Pauly, Daniel; Srinivasan, Thara; Swartz, Wilf; Watson, Reginald; Zeller, Dirk

2012-01-01

Global marine fisheries are currently underperforming, largely due to overfishing. An analysis of global databases finds that resource rent net of subsidies from rebuilt world fisheries could increase from the current negative US$13 billion to positive US$54 billion per year, resulting in a net gain of US$600 to US$1,400 billion in present value over fifty years after rebuilding. To realize this gain, governments need to implement a rebuilding program at a cost of about US$203 (US$130–US$292) billion in present value. We estimate that it would take just 12 years after rebuilding begins for the benefits to surpass the cost. Even without accounting for the potential boost to recreational fisheries, and ignoring ancillary and non-market values that would likely increase, the potential benefits of rebuilding global fisheries far outweigh the costs. PMID:22808187

A business case evaluation of workplace engineering noise control: a net-cost model.

PubMed

Lahiri, Supriya; Low, Colleen; Barry, Michael

2011-03-01

This article provides a convenient tool for companies to determine the costs and benefits of alternative interventions to prevent noise-induced hearing loss (NIHL). Contextualized for Singapore and in collaboration with Singapore's Ministry of Manpower, the Net-Cost model evaluates costs of intervention for equipment and labor, avoided costs of productivity losses and medical care, and productivity gains from the employer's economic perspective. To pilot this approach, four case studies are presented, with varying degrees of economic benefits to the employer, including one in which multifactor productivity is the main driver. Although compliance agencies may not require economic analysis of NIHL, given scarce resources in a market-driven economy, this tool enables stakeholders to understand and compare the costs and benefits of NIHL interventions comprehensively and helps in determining risk management strategies.

Cost-effectiveness of negative pressure wound therapy in patients with many comorbidities and severe wounds of various etiology.

PubMed

Driver, Vickie R; Eckert, Kristen A; Carter, Marissa J; French, Michael A

2016-11-01

This study analyzed a cross-section of patients with severe chronic wounds and multiple comorbidities at an outpatient wound clinic, with regard to the cost-effectiveness and cost-benefit of negative pressure wound therapy (intervention) vs. no negative pressure wound therapy (control) at 1 and 2 years. Medicare reimbursement charges for wound care were used to calculate costs. Amputation charges were assessed using diagnosis-related groups. Cost-benefit analysis was based on ulcer-free months and cost-effectiveness on quality-adjusted life-years. Undiscounted costs, benefits, quality-adjusted life-years, undiscounted and discounted incremental net health benefits, and incremental cost-effectiveness ratios were calculated for unmatched and matched cohorts. There were 150 subjects in the intervention group and 154 controls before matching and 103 subjects in each of the matched cohorts. Time to heal for the intervention cohort was significantly shorter compared to the controls (270 vs. 635 days, p = 1.0 × 10 -7 , matched cohorts). The intervention cohort had higher benefits and quality-adjusted life-year gains compared to the control cohort at years 1 and 2; by year 2, the gains were 68-73% higher. In the unmatched cohorts, the incremental net health benefit was $9,933 per ulcer-free month at year 2 for the intervention; the incremental cost-effectiveness ratio was -825,271 per quality-adjusted life-year gained (undiscounted costs and benefits). For the matched cohorts, the incremental net health benefits was only $1,371 per ulcer-free month for the intervention, but the incremental cost-effectiveness ratio was $366,683 per quality-adjusted life-year gained for year 2 (discounted costs and benefits). In a patient population with severe chronic wounds and serious comorbidities, negative pressure wound therapy resulted in faster healing wounds and was more cost-effective with greater cost-benefits than not using negative pressure wound therapy. Regarding overall cost-effectiveness, the intervention was still expensive, but that is the reality amidst limited treatment options for such serious cases of chronic wounds. © 2016 by the Wound Healing Society.

A National Study of the Net Benefits of State Pension Plans for Educators

ERIC Educational Resources Information Center

Toutkoushian, Robert K.; Bathon, Justin M.; McCarthy, Martha M.

2011-01-01

Although benefits can be a sizable part of an educator's total compensation, there has been little scholarly inquiry into the state pension plans for educators. Despite the fact that all defined benefit plans rely on the same basic formula for calculating annual pensions, they vary across states in the multiplier used, the method for calculating…

Benefits and Costs of Pulp and Paper Effluent Controls Under the Clean Water Act

NASA Astrophysics Data System (ADS)

Luken, Ralph A.; Johnson, F. Reed; Kibler, Virginia

1992-03-01

This study quantifies local improvements in environmental quality from controlling effluents in the pulp and paper industry. Although it is confined to a single industry, this study is the first effort to assess the actual net benefits of the Clean Water Act pollution control program. An assessment of water quality benefits requires linking regulatory policy, technical effects, and behavioral responses. Regulatory policies mandate specific controls that influence the quantity and nature of effluent discharges. We identify a subset of stream segments suitable for analysis, describe water quality simulations and control cost calculations under alternative regulatory scenarios, assign feasible water uses to each segment based on water quality, and determine probable upper bounds for the willingness of beneficiaries to pay. Because the act imposes uniform regulations that do not account for differences in compliance costs, existing stream quality, contributions of other effluent sources, and recreation potential, the relation between water quality benefits and costs varies widely across sites. This variation suggests that significant positive net benefits have probably been achieved in some cases, but we conclude that the costs of the Clean Water Act as a whole exceed likely benefits by a significant margin.

Economic benefit of chemical dependency treatment to employers.

PubMed

Jordan, Neil; Grissom, Grant; Alonzo, Gregory; Dietzen, Laura; Sangsland, Scott

2008-04-01

Using assessment data from the Substance Abuse Treatment Support System, we estimated the economic benefit of chemical dependency treatment to employers. A cohort of individuals (N = 498) treated at Kaiser Permanente's Addiction Medicine programs in Southern California completed assessments before and at least 30 days after treatment began. Compared to intake, subsequent assessments indicated substantial reduction in the number of patients who missed work, were late for work, were less productive than usual at work, and/or had conflict with coworkers or management. The net economic value of these improvements to their employers depended upon the utilization rate of the benefit and the salary level of the employees receiving treatment. For a utilization rate of 0.9% and a mean annual salary of US$45,000, the net benefit of treatment was US$1,538 for > or = 61 days of treatment. Based solely upon these employment-related measures, without factoring in the medical cost offset or indirect benefits of treatment that may help employees to maintain higher levels of productivity, employers break even on an investment of US$30 per member per year for a chemical dependency treatment benefit if the mean annual salary of the employees participating in treatment is US$36,565.

Work Disability Among Native-born and Foreign-born Americans: On Origins, Health, and Social Safety Nets.

PubMed

Engelman, Michal; Kestenbaum, Bert M; Zuelsdorff, Megan L; Mehta, Neil K; Lauderdale, Diane S

2017-12-01

Public debates about both immigration policy and social safety net programs are increasingly contentious. However, little research has explored differences in health within America's diverse population of foreign-born workers, and the effect of these workers on public benefit programs is not well understood. We investigate differences in work disability by nativity and origins and describe the mix of health problems associated with receiving Social Security Disability Insurance benefits. Our analysis draws on two large national data sources-the American Community Survey and comprehensive administrative records from the Social Security Administration-to determine the prevalence and incidence of work disability between 2001 and 2010. In sharp contrast to prior research, we find that foreign-born adults are substantially less likely than native-born Americans to report work disability, to be insured for work disability benefits, and to apply for those benefits. Overall and across origins, the foreign-born also have a lower incidence of disability benefit award. Persons from Africa, Northern Europe, Canada, and parts of Asia have the lowest work disability benefit prevalence rates among the foreign-born; persons from Southern Europe, Western Europe, the former Soviet Union, and the Caribbean have the highest rates.

Veterans Education Benefits | Nova Southeastern University

Science.gov Websites

SharkLink Student Portal Graduate & Professional Master's Over 60 degrees in fields like business and information sciences, and pharmacy. Professional Programs in high demand fields such as medicine Benefits Loans Payment Plans Net Price Calculator Graduate & Professional Scholarships Grants Student

The net benefit of public expenditures on avalanche defence structures in the municipality of Davos, Switzerland

NASA Astrophysics Data System (ADS)

Fuchs, S.; McAlpin, M. C.

2005-04-01

Avalanches pose a threat to settlements as well as industrial and recreational areas in the Alps. As a counter measure, technical mitigation measures have been implemented since the 19th century, resulting in a raise in value of formerly endangered areas. This increase in value can be considered as a benefit due to prevented damage. This paper compares the total costs and benefits of technical mitigation measures in the municipality of Davos, Switzerland as a basis for evaluating their net social benefit. The benefit of avalanche defence structures is determined using two different approaches. First, the replacement value of buildings protected by mitigation measures is quantified. Second, the number of protected persons is monetarily assessed by means of a human capital approach. The quantified benefit is compared with the present value of cumulative capital expenditures on avalanche mitigation measures. In addition, distributional effects of the public expenditures on technical mitigation measures are discussed based on the average future tax revenues within protected areas. Depending on whether benefits are calculated in terms of protected buildings or protected persons, the results show a large range of cost-benefit ratios. Critical issues of cost-benefit analyses in the context of alpine natural hazards are highlighted, including problems related to the human capital approach and the sensitivity of results to how benefits are calculated. The applicability of cost-benefit analyses for evaluating avalanche mitigation measures is discussed.

A cost-benefit analysis of preventative management for zebra and quagga mussels in the Colorado-Big Thompson System

USGS Publications Warehouse

Thomas, Catherine M.

2010-01-01

Zebra and quagga mussels are fresh water invaders that have the potential to cause severe ecological and economic damage. It is estimated that mussels cause $1 billion dollars per year in damages to water infrastructure and industries in the United States (Pimentel et al., 2004). Following their introduction to the Great Lakes in the late 1980s, mussels spread rapidly throughout the Mississippi River Basin and the Eastern U.S. The mussel invasion in the West is young. Mussels were first identified in Nevada in 2007, and have since been identified in California, Arizona, Colorado, Utah, and Texas. Western water systems are very different from those found in the East. The rapid spread of mussels through the eastern system was facilitated by connected and navigable waterways. Western water systems are less connected and are characterized by man-made reservoirs and canals. The main vector of spread for mussels in the West is overland on recreational boats (Bossenbroek et al., 2001). In response to the invasion, many western water managers have implemented preventative management programs to slow the overland spread of mussels on recreational boats. In Colorado, the Colorado Department of Wildlife (CDOW) has implemented a mandatory boat inspection program that requires all trailered boats to be inspected before launching in any Colorado water body. The objective of this study is to analyze the costs and benefits of the CDOW boat inspection program in Colorado, and to identify variables that affect the net benefits of preventative management. Predicting the potential economic benefits of slowing the spread of mussels requires integrating information about mussel dispersal potential with estimates of control costs (Keller et al., 2009). Uncertainty surrounding the probabilities of establishment, the timing of invasions, and the damage costs associated with an invasion make a simulation model an excellent tool for addressing "what if" scenarios and shedding light on the net benefits of preventative management strategies. This study builds a bioeconomic simulation model to predict and compare the expected economic costs of the CDOW boat inspection program ot the benefits of reduced expected control costs to water conveyance systems, hydropower generation stations, and minicipal water treatment facilities. The model is based on a case study water delivery and storage system, the Colorado-Big Thompson system. The Colorado-Big Thomspon system is an excellent example of water systems in the Rocky Mountain West. The system is nearly entirely man-made, with all of its reservoirs and delivery points connected via pipelines, tunnels, and canals. The structures and hydropower systems of the Colorado-Big Thompson system are common to other western storage and delivery systems, making the methods and insight developed from this case study transferal to other western systems. The model developed in this study contributes to the bioeconomic literature in several ways. Foremost, the model predicts the spread of dreissena mussels and associated damage costs for a connected water system in the Rocky Mountain West. Very few zebra mussel studies have focused on western water systems. Another distinguishing factor is the simultaneous consideration of spread from propagules introduced by boats and by flows. Most zebra mussel dispersal models consider boater movement patterns combined with limnological characteristics as predictors of spread. A separate set of studies have addressed mussel spread via downstream flows. To the author's knowledge, this is the first study that builds a zebra mussel spread model that specifically accounts for propagule pressure from boat introductions and from downstream flow introductions. By modeling an entire connected system, the study highlights how the spatial layout of a system, and the risk of invasion within a system affect the benefits of preventative management. This report is presented in five chapters. The first chapter provides background information including a history of the zebra mussel invasion in the U.S. and in the West, and details about the Colorado preventative management program and the Colorado-Big Thompson system. The chapter also includes a literature review of mussel dispersal models and economic studies that address control costs and preventative management for aquatic invasive species. Chapter 2 presents the methodological approach used to analyze the costs and benefits of preventative management in the Colorado-Big Thompson system and provides details of the bioeconomic simulation model used to predict invasion patterns and the net benefits of preventative management. Results of the analysis and sensitivity testing of model parameters are presented in Chapter 3. Chapter 4 provides a summary of the analysis and conclusions. A discussion of the limitations of the model and areas for future research is presented in Chapter 5.

Implementing Generalized Additive Models to Estimate the Expected Value of Sample Information in a Microsimulation Model: Results of Three Case Studies.

PubMed

Rabideau, Dustin J; Pei, Pamela P; Walensky, Rochelle P; Zheng, Amy; Parker, Robert A

2018-02-01

The expected value of sample information (EVSI) can help prioritize research but its application is hampered by computational infeasibility, especially for complex models. We investigated an approach by Strong and colleagues to estimate EVSI by applying generalized additive models (GAM) to results generated from a probabilistic sensitivity analysis (PSA). For 3 potential HIV prevention and treatment strategies, we estimated life expectancy and lifetime costs using the Cost-effectiveness of Preventing AIDS Complications (CEPAC) model, a complex patient-level microsimulation model of HIV progression. We fitted a GAM-a flexible regression model that estimates the functional form as part of the model fitting process-to the incremental net monetary benefits obtained from the CEPAC PSA. For each case study, we calculated the expected value of partial perfect information (EVPPI) using both the conventional nested Monte Carlo approach and the GAM approach. EVSI was calculated using the GAM approach. For all 3 case studies, the GAM approach consistently gave similar estimates of EVPPI compared with the conventional approach. The EVSI behaved as expected: it increased and converged to EVPPI for larger sample sizes. For each case study, generating the PSA results for the GAM approach required 3 to 4 days on a shared cluster, after which EVPPI and EVSI across a range of sample sizes were evaluated in minutes. The conventional approach required approximately 5 weeks for the EVPPI calculation alone. Estimating EVSI using the GAM approach with results from a PSA dramatically reduced the time required to conduct a computationally intense project, which would otherwise have been impractical. Using the GAM approach, we can efficiently provide policy makers with EVSI estimates, even for complex patient-level microsimulation models.

Projecting population change in the interior Columbia River Basin.

Treesearch

Stephen F. McCool; Richard W. Haynes

1996-01-01

Management of ecosystems requires projecting the human population for a biologically significant timeframe, because the impacts of potential alternative ecosystem management strategies will differ depending on the size, location, and expectations of the human population. Increases since 1990 in the net migration rates are changing the expectations for projections of...

Theranostics of Neuroendocrine Tumors.

PubMed

Lee, Sze Ting; Kulkarni, Harshad R; Singh, Aviral; Baum, Richard P

2017-10-01

Somatostatin receptor positron emission tomography/computed tomography using 68 Ga-labeled somatostatin analogs is the mainstay for the evaluation of receptor status in neuroendocrine tumors (NETs). This translates towards better therapy options, with increasing evidence of peptide receptor radionuclide therapy (PRRT) as the treatment of choice for advanced or progressive NETs. There are benefits in progression-free and overall survival as well as a significant improvement in clinical condition. In patients with progressive NETs, fractionated, personalized PRRT results in good therapeutic responses with no significant severe hematological and/or renal toxicity, thus improving quality of life.

Evaluation of the risk factors associated with rectal neuroendocrine tumors: a big data analytic study from a health screening center.

PubMed

Pyo, Jeung Hui; Hong, Sung Noh; Min, Byung-Hoon; Lee, Jun Haeng; Chang, Dong Kyung; Rhee, Poong-Lyul; Kim, Jae Jun; Choi, Sun Kyu; Jung, Sin-Ho; Son, Hee Jung; Kim, Young-Ho

2016-12-01

Rectal neuroendocrine tumor (NET) is the most common NET in Asia. The risk factors associated with rectal NETs are unclear because of the overall low incidence rate of these tumors and the associated difficulty in conducting large epidemiological studies on rare cases. The aim of this study was to exploit the benefits of big data analytics to assess the risk factors associated with rectal NET. A retrospective case-control study was conducted, including 102 patients with histologically confirmed rectal NETs and 52,583 healthy controls who underwent screening colonoscopy at the Center for Health Promotion of the Samsung Medical Center in Korea between January 2002 and December 2012. Information on different risk factors was collected and logistic regression analysis applied to identify predictive factors. Four factors were significantly associated with rectal NET: higher levels of cholesterol [odds ratio (OR) = 1.007, 95 % confidence interval (CI), 1.001-1.013, p = 0.016] and ferritin (OR = 1.502, 95 % CI, 1.167-1.935, p = 0.002), presence of metabolic syndrome (OR = 1.768, 95 % CI, 1.071-2.918, p = 0.026), and family history of cancer among first-degree relatives (OR = 1.664, 95 % CI, 1.019-2.718, p = 0.042). The findings of our study demonstrate the benefits of using big data analytics for research and clinical risk factor studies. Specifically, in this study, this analytical method was applied to identify higher levels of serum cholesterol and ferritin, metabolic syndrome, and family history of cancer as factors that may explain the increasing incidence and prevalence of rectal NET.

Projecting the impact of a nationwide school plain water access intervention on childhood obesity: a cost-benefit analysis.

PubMed

An, R; Xue, H; Wang, L; Wang, Y

2017-09-22

This study aimed to project the societal cost and benefit of an expansion of a water access intervention that promotes lunchtime plain water consumption by placing water dispensers in New York school cafeterias to all schools nationwide. A decision model was constructed to simulate two events under Markov chain processes - placing water dispensers at lunchtimes in school cafeterias nationwide vs. no action. The incremental cost pertained to water dispenser purchase and maintenance, whereas the incremental benefit was resulted from cases of childhood overweight/obesity prevented and corresponding lifetime direct (medical) and indirect costs saved. Based on the decision model, the estimated incremental cost of the school-based water access intervention is $18 per student, and the corresponding incremental benefit is $192, resulting in a net benefit of $174 per student. Subgroup analysis estimates the net benefit per student to be $199 and $149 among boys and girls, respectively. Nationwide adoption of the intervention would prevent 0.57 million cases of childhood overweight, resulting in a lifetime cost saving totalling $13.1 billion. The estimated total cost saved per dollar spent was $14.5. The New York school-based water access intervention, if adopted nationwide, may have a considerably favourable benefit-cost portfolio. © 2017 World Obesity Federation.

Dual conception of risk in the Iowa Gambling Task: effects of sleep deprivation and test-retest gap.

PubMed

Singh, Varsha

2013-01-01

Risk in the Iowa Gambling Task (IGT) is often understood in terms of intertemporal choices, i.e., preference for immediate outcomes in favor of delayed outcomes is considered risky decision making. According to behavioral economics, healthy decision makers are expected to refrain from choosing the short-sighted immediate gain because, over time (10 trials of the IGT), the immediate gains result in a long term loss (net loss). Instead decision makers are expected to maximize their gains by choosing options that, over time (10 trials), result in delayed or long term gains (net gain). However, task choices are sometimes made on the basis of the frequency of reward and punishment such that frequent rewards/infrequent punishments are favored over infrequent rewards/frequent punishments. The presence of these two attributes (intertemporality and frequency of reward) in IGT decision making may correspond to the emotion-cognition dichotomy and reflect a dual conception of risk. Decision making on the basis of the two attributes was tested under two conditions: delay in retest and sleep deprivation. An interaction between sleep deprivation and time delay was expected to attenuate the difference between the two attributes. Participants were 40 male university students. Analysis of the effects of IGT attribute type (intertemporal vs. frequency of reinforcement), sleep deprivation (sleep deprivation vs. no sleep deprivation), and test-retest gap (short vs. long delay) showed a significant within-subjects effect of IGT attribute type thus confirming the difference between the two attributes. Sleep deprivation had no effect on the attributes, but test-retest gap and the three-way interaction between attribute type, test-retest gap, and sleep deprivation were significantly different. Post-hoc tests revealed that sleep deprivation and short test-retest gap attenuated the difference between the two attributes. Furthermore, the results showed an expected trend of increase in intertemporal decision making at retest suggesting that intertemporal decision making benefited from repeated task exposure. The present findings add to understanding of the emotion-cognition dichotomy. Further, they show an important time-dependent effect of a universally experienced constraint (sleep deprivation) on decision making. It is concluded that risky decision making in the IGT is contingent on the attribute under consideration and is affected by factors such as time elapsed and constraint experienced before the retest.

Assessing the Benefits of Global Climate Stabilization Within an Integrated Modeling Framework

NASA Astrophysics Data System (ADS)

Beach, R. H.

2015-12-01

Increasing atmospheric carbon dioxide levels, higher temperatures, altered precipitation patterns, and other climate change impacts have already begun to affect US agriculture and forestry, with impacts expected to become more substantial in the future. There have been a number of studies of climate change impacts on agriculture or forestry. However, relatively few studies explore climate change impacts on both agriculture and forests simultaneously, including the interactions between alternative land uses and implications for market outcomes. Additionally, there is a lack of detailed analyses of the effects of stabilization scenarios relative to unabated emissions scenarios. Such analyses are important for developing estimates of the benefits of those stabilization scenarios, which can play a vital role in assessing tradeoffs associated with allocating resources across alternative mitigation and adaptation activities. We provide an analysis of the potential benefits of global climate change mitigation for US agriculture and forestry through 2100, accounting for landowner decisions regarding land use, crop mix, and management practices. The analytic approach involves a combination of climate models, a crop process model (EPIC), a dynamic vegetation model used for forests (MC1), and an economic model of the US forestry and agricultural sector (FASOM-GHG). We find substantial impacts on productivity, commodity markets, and consumer and producer welfare for the stabilization scenario relative to unabated climate change, though the magnitude and direction of impacts vary across regions and commodities. Although there is variability in welfare impacts across climate simulations, we find positive net benefits from stabilization in all cases, with cumulative impacts ranging from 32.7 billion to 54.5 billion over the period 2015-2100. Our estimates contribute to the literature on potential benefits of GHG mitigation and can help inform policy decisions weighing alternative mitigation and adaptation actions.

[The Probabilistic Efficiency Frontier: A Value Assessment of Treatment Options in Hepatitis C].

PubMed

Mühlbacher, Axel C; Sadler, Andrew

2017-06-19

Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV). This case study shows how methodological challenges could be overcome in order to use the efficiency frontier for economic analysis and health care decision-making. Method The operationalization of patient benefit was carried out on several patient-relevant endpoints. Preference data from a discrete choice experiment (DCE) study and clinical data based on clinical trials, which reflected the patient and the clinical perspective, respectively, were used for the aggregation of an overall benefit score. A probabilistic efficiency frontier was constructed in a Monte Carlo simulation with 10000 random draws. Patient-relevant endpoints were modeled with a beta distribution and preference data with a normal distribution. The assessment of overall benefit and costs provided information about the adequacy of the treatment prices. The parameter uncertainty was illustrated by the price-acceptability-curve and the net monetary benefit. Results Based on the clinical and preference data in Germany, the interferon-free treatment options proved to be efficient for the current price level. The interferon-free therapies of the latest generation achieved a positive net cost-benefit. Within the decision model, these therapies showed a maximum overall benefit. Due to their high additional benefit and approved prices, the therapies lie above of the extrapolated efficiency frontier, which suggests that these options have efficient reimbursement prices. Considering uncertainty, even a higher price would have resulted in a positive cost-benefit ratio. Conclusion IQWiG's efficiency frontier was used to assess the value of different treatment options in HCV. This study demonstrates that the probabilistic efficiency frontier, price-acceptability-curve and the net monetary benefit can contribute essential information to reimbursement decisions and price negotiations. © Georg Thieme Verlag KG Stuttgart · New York.

The Design of NetSecLab: A Small Competition-Based Network Security Lab

ERIC Educational Resources Information Center

Lee, C. P.; Uluagac, A. S.; Fairbanks, K. D.; Copeland, J. A.

2011-01-01

This paper describes a competition-style of exercise to teach system and network security and to reinforce themes taught in class. The exercise, called NetSecLab, is conducted on a closed network with student-formed teams, each with their own Linux system to defend and from which to launch attacks. Students are expected to learn how to: 1) install…

Assigning values to intermediate health states for cost-utility analysis: theory and practice.

PubMed

Cohen, B J

1996-01-01

Cost-utility analysis (CUA) was developed to guide the allocation of health care resources under a budget constraint. As the generally stated goal of CUA is to maximize aggregate health benefits, the philosophical underpinning of this method is classic utilitarianism. Utilitarianism has been criticized as a basis for social choice because of its emphasis on the net sum of benefits without regard to the distribution of benefits. For example, it has been argued that absolute priority should be given to the worst off when making social choices affecting basic needs. Application of classic utilitarianism requires use of strength-of-preference utilities, assessed under conditions of certainty, to assign quality-adjustment factors to intermediate health states. The two methods commonly used to measure strength-of-preference utility, categorical scaling and time tradeoff, produce rankings that systematically give priority to those who are better off. Alternatively, von Neumann-Morgenstern utilities, assessed under conditions of uncertainty, could be used to assign values to intermediate health states. The theoretical basis for this would be Harsanyi's proposal that social choice be made under the hypothetical assumption that one had an equal chance of being anyone in society. If this proposal is accepted, as well as the expected-utility axioms applied to both individual choice and social choice, the preferred societal arrangement is that with the highest expected von Neumann-Morgenstern utility. In the presence of risk aversion, this will give some priority to the worst-off relative to classic utilitarianism. Another approach is to raise the values obtained by time-tradeoff assessments to a power a between 0 and 1. This would explicitly give priority to the worst off, with the degree of priority increasing as a decreases. Results could be presented over a range of a. The results of CUA would then provide useful information to those holding a range of philosophical points of view.

Mount St. Helens, Washington Feasibility Report & Environmental Impact Statement. Volume 1: Main Report

DTIC Science & Technology

1984-12-01

Base Condition WITH-PROJECT CONDITION Single Retention Structure Identification of NED Plan Benefits - NED Plan SENSITIVITY OF NED PLAN TO...Downstream Actions COSTS OF THE PREFERRED PLAN BENEFITS OF THE PREFERRED PLAN Economic and Social Effects Prevention of Erosion Maintenance of...continued) TABLES Residual Damages Summary of Costs Preferred Alternative Sediment MOvement Net Average Annual NED Benefits Total Flood Damages Average

Return on Investment for the United States Navy’s Training with Industry Program

DTIC Science & Technology

2017-06-01

methodologies, an adaptable metric was developed for NAVSUP. The net benefit of the program divided by the program costs results in an ROI of 88... costs results in an ROI of 88%. Additional intangible benefits obtained include meeting capability gaps, meeting NAVSUP’s objectives, and increasing...Measure All Training Costs and Benefits .....................36 7. Step 7: Full Training Report

Retrospective Benefit-Cost Evaluation of DOE Investment in Photovoltaic Energy Systems

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

O'Connor, Alan C.; Loomis, Ross J.; Braun, Fern M.

2010-08-01

This study is a retrospective analysis of net benefits accruing from DOE's investment in photovoltaic (PV) technology development. The study employed a technology cluster approach. That is, benefits measured for a subset of technologies in a meaningful cluster, or portfolio, of technologies were compared to the total investment in the cluster to provide a lower bound measure of return for the entire cluster.

Why fly the extra mile? Using stress biomarkers to assess wintering habitat quality in migratory shorebirds.

PubMed

Aharon-Rotman, Yaara; Buchanan, Katherine L; Clark, Nicholas J; Klaassen, Marcel; Buttemer, William A

2016-10-01

Migratory birds make decisions about how far to travel based on cost-benefit trade-offs. However, in many cases the net effect of these trade-offs is unclear. We sought to address this question by measuring feather corticosterone (CORTf), leucocyte profile, avian malaria parasite prevalence and estimating fueling rates in three spatially segregated wintering populations of the migratory shorebird ruddy turnstone Arenaria interpres during their stay in the winter habitat. These birds fly from the high-Arctic breeding ground to Australia, but differ in that some decide to end their migration early (Broome, Western Australia), whereas others travel further to either South Australia or Tasmania. We hypothesized that the extra costs in birds migrating greater distances and overwintering in colder climates would be offset by benefits when reaching their destination. This would be evidenced by lower stress biomarkers in populations that travel further, owing to the expected benefits of greater resources and improved vitality. We show that avian malaria prevalence and physiological stress levels were lower in birds flying to South Australia and Tasmania than those overwintering in Broome. Furthermore, our modeling predicts that birds in the southernmost locations enjoy higher fueling rates. Our data are consistent with the interpretation that birds occupying more costly wintering locations in terms of higher migratory flight and thermoregulatory costs are compensated by better feeding conditions and lower blood parasite infections, which facilitates timely and speedy migration back to the breeding ground. These data contribute to our understanding of cost-benefit trade-offs in the decision making underlying migratory behaviour.

Simple Strategies

ERIC Educational Resources Information Center

Stevens, Tod

2008-01-01

A lot of misunderstandings exist regarding sustainable, or green, construction. It is important that educators understand the benefits so they can communicate them to stakeholders. According to the U.S. Green Building Council (USGBC), a $4 investment (per square foot) in building green nets a $58 benefit (per square foot) over 20 years. Savings…

77 FR 27547 - Federal Acquisition Regulation; Prohibition on Contracting With Inverted Domestic Corporations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-10

... concerns are unlikely to have been incorporated in the United States and then reincorporated in a tax haven... assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental...

42 CFR 403.253 - Calculation of benefits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the gross premiums are computed to provide coverage. (iv) Reserve for future contingent benefits means... the loss ratio calculation period. (iii) Net premium means the level portion of the gross premium used... period, to— (B) The total policy reserve at the last day of the loss ratio calculation period: and (ii...

Recharge Net Metering to Incentivize Sustainable Groundwater Management

NASA Astrophysics Data System (ADS)

Fisher, A. T.; Coburn, C.; Kiparsky, M.; Lockwood, B. S.; Bannister, M.; Camara, K.; Lozano, S.

2016-12-01

Stormwater runoff has often been viewed as a nuisance rather than a resource, but with passage of the Sustainable Groundwater Management Act (2014), many basins in California are taking a fresh look at options to enhance groundwater supplies with excess winter flows. In some basins, stormwater can be used for managed aquifer recharge (MAR), routing surface water to enhance groundwater resources. As with many public infrastructure programs, financing for stormwater-MAR projects can be a challenge, and there is a need for incentives that will engage stakeholders and offset operation and maintenance costs. The Pajaro Valley Water Management Agency (PVWMA), in central costal California, recently launched California's first Recharge Net Metering (ReNeM) program. MAR projects that are part of the ReNeM program are intended to generate ≥100 ac-ft/yr of infiltration benefit during a normal water year. A team of university and Resource Conservation District partners will collaborate to identify and assess potential project sites, screening for hydrologic conditions, expected runoff, ease and cost of project construction, and ability to measure benefits to water supply and quality. The team will also collect data and samples to measure the performance of each operating project. Groundwater wells within the PVWMA's service area are metered, and agency customers pay an augmentation fee for each unit of groundwater pumped. ReNeM projects will earn rebates of augmentation fees based on the amount of water infiltrated, with rebates calculated using a formula that accounts for uncertainties in the fate of infiltrated water, and inefficiencies in recovery. The pilot ReNeM program seeks to contribute 1000 ac-ft/yr of infiltration benefit by the end of the initial five-year operating period. ReNeM offers incentives that are distinct from those derived from traditional groundwater banking, and thus offers the potential for an innovative addition to the portfolio of options for sustaining and improving groundwater resources. Technical, economic, and institutional uncertainties remain, and ongoing research is addressing the potential for ReNeM in the Pajaro Valley and elsewhere.

Forging new, non-traditional partnerships among physicists, teachers and students

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

Bardeen, Marjorie; Adams, Mark; Wayne, Mitchell

The QuarkNet collaboration has forged new, nontraditional relationships among particle physicists, high school teachers and their students. QuarkNet provides professional development for teachers and creates opportunities for teachers and students to engage in particle physics data investigations and join research teams. Embedded in the U.S. particle research community, QuarkNet leverages the nature of particle physics research$-$the long duration of the experiments with extensive lead times, construction periods, and data collection and analysis periods. QuarkNet is patterned after the large collaborations with a central management infrastructure and a distributed workload across university- and lab-based research groups. As a result, we describemore » the important benefits of the QuarkNet outreach program that flow to university faculty and present successful strategies that others can adapt for use in their countries.« less

Forging new, non-traditional partnerships among physicists, teachers and students

DOE PAGES

Bardeen, Marjorie; Adams, Mark; Wayne, Mitchell; ...

2016-10-26

The QuarkNet collaboration has forged new, nontraditional relationships among particle physicists, high school teachers and their students. QuarkNet provides professional development for teachers and creates opportunities for teachers and students to engage in particle physics data investigations and join research teams. Embedded in the U.S. particle research community, QuarkNet leverages the nature of particle physics research$-$the long duration of the experiments with extensive lead times, construction periods, and data collection and analysis periods. QuarkNet is patterned after the large collaborations with a central management infrastructure and a distributed workload across university- and lab-based research groups. As a result, we describemore » the important benefits of the QuarkNet outreach program that flow to university faculty and present successful strategies that others can adapt for use in their countries.« less

Near-net-shape manufacturing: Spray-formed metal matrix composites and tooling

NASA Technical Reports Server (NTRS)

Mchugh, Kevin M.

1994-01-01

Spray forming is a materials processing technology in which a bulk liquid metal is converted to a spray of fine droplets and deposited onto a substrate or pattern to form a near-net-shape solid. The technology offers unique opportunities for simplifying materials processing without sacrificing, and oftentimes substantially improving, product quality. Spray forming can be performed with a wide range of metals and nonmetals, and offers property improvements resulting from rapid solidification (e.g. refined microstructures, extended solid solubilities and reduced segregation). Economic benefits result from process simplification and the elimination of unit operations. The Idaho National Engineering Laboratory is developing a unique spray-forming method, the Controlled Aspiration Process (CAP), to produce near-net-shape solids and coatings of metals, polymers, and composite materials. Results from two spray-accompanying technical and economic benefits. These programs involved spray forming aluminum strip reinforced with SiC particulate, and the production of tooling, such as injection molds and dies, using low-melting-point metals.

A coordination class analysis of college students' judgments about animated motion

NASA Astrophysics Data System (ADS)

Thaden-Koch, Thomas Christian

The coordination class construct was invented by di5essa and Sherin to clarify what it means to learn and use scientific concepts. A coordination class is defined to consist of readout strategies, which guide observation, and the causal net, which contains knowledge necessary for making inferences from observations. A coordination class, as originally specified, reliably extracts a certain class of information from a variety of situations. The coordination class construct is relatively new. To examine its utility, transcripts of interviews with college students were analyzed in terms of the coordination class construct. In the interviews, students judged the realism of several computer animations depicting balls rolling on a pair of tracks. When shown animations with only one ball, students made judgments consistent with focusing on the ball's speed changes. Adding a second ball to each animation strongly affected judgments made by students taking introductory physics courses, but had a smaller effect on judgments made by students taking a psychology course. Reasoning was described in this analysis as the coordination of readouts about animations with causal net elements related to realistic motion. Decision-making was characterized both for individual students and for groups by the causal net elements expressed, by the types of readouts reported, and by the coordination processes involved. The coordination class construct was found useful for describing the elements and processes of student decision-making, but little evidence was found to suggest that the students studied possessed reliable coordination classes. Students' causal nets were found to include several appropriate expectations about realistic motion. Several students reached judgments that appeared contrary to their expectations and reported mutually incompatible expectations. Descriptions of students' decision-making processes often included faulty readouts, or feedback loops in which causal net elements or readouts were adjusted. Comparisons of the interviewed groups' coordination were found to echo differences and similarities in animation judgments made by larger groups of students who were not interviewed.

75 FR 8788 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-25

... Payment of Taxes by a Corporation Expecting a New Operating Loss Carryback. Form: 1138. Description: Form... estimated taxes. Corporations may only file for an extension when they expect a net operating loss carryback... review and clearance under the Paperwork Reduction Act of 1995, Public Law 104-13 on or after the date of...

The economic value of an investment in physiotherapy education: a net present value analysis.

PubMed

Rivers, George; Foo, Jonathan; Ilic, Dragan; Nicklen, Peter; Reeves, Scott; Walsh, Kieran; Maloney, Stephen

2015-07-01

What is the economic value for an individual to invest in physiotherapy undergraduate education in Australia? How is this affected by increased education costs or decreased wages? A cost-benefit analysis using a net present value (NPV) approach was conducted and reported in Australian dollars. In relation to physiotherapy education, the NPV represents future earnings as a physiotherapist minus the direct and indirect costs in obtaining the degree. Sensitivity analyses were conducted to consider varying levels of experience, public versus private sector, and domestic versus international student fees. Comparable calculations were made for educational investments in medicine and nursing/midwifery. Assuming an expected discount rate of 9.675%, investment in education by domestic students with approximately 34 years of average work experience yields a NPV estimated at $784,000 for public sector physiotherapists and $815,000 for private sector therapists. In relation to international students, the NPV results for an investment and career as a physiotherapist is estimated at $705,000 in the public sector and $736,000 in the private sector. With an approximate payback period of 4 years, coupled with strong and positive NPV values, physiotherapy education in Australia is a financially attractive prospect and a viable value proposition for those considering a career in this field. Copyright © 2015 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

A robust impact assessment that informs actionable climate change adaptation: future sunburn browning risk in apple

NASA Astrophysics Data System (ADS)

Webb, Leanne; Darbyshire, Rebecca; Erwin, Tim; Goodwin, Ian

2017-05-01

Climate change impact assessments are predominantly undertaken for the purpose of informing future adaptation decisions. Often, the complexity of the methodology hinders the actionable outcomes. The approach used here illustrates the importance of considering uncertainty in future climate projections, at the same time providing robust and simple to interpret information for decision-makers. By quantifying current and future exposure of Royal Gala apple to damaging temperature extremes across ten important pome fruit-growing locations in Australia, differences in impact to ripening fruit are highlighted, with, by the end of the twenty-first century, some locations maintaining no sunburn browning risk, while others potentially experiencing the risk for the majority of the January ripening period. Installation of over-tree netting can reduce the impact of sunburn browning. The benefits from employing this management option varied across the ten study locations. The two approaches explored to assist decision-makers assess this information (a) using sunburn browning risk analogues and (b) through identifying hypothetical sunburn browning risk thresholds, resulted in varying recommendations for introducing over-tree netting. These recommendations were location and future time period dependent with some sites showing no benefit for sunburn protection from nets even by the end of the twenty-first century and others already deriving benefits from employing this adaptation option. Potential best and worst cases of sunburn browning risk and its potential reduction through introduction of over-tree nets were explored. The range of results presented highlights the importance of addressing uncertainty in climate projections that result from different global climate models and possible future emission pathways.

A robust impact assessment that informs actionable climate change adaptation: future sunburn browning risk in apple.

PubMed

Webb, Leanne; Darbyshire, Rebecca; Erwin, Tim; Goodwin, Ian

2017-05-01

Climate change impact assessments are predominantly undertaken for the purpose of informing future adaptation decisions. Often, the complexity of the methodology hinders the actionable outcomes. The approach used here illustrates the importance of considering uncertainty in future climate projections, at the same time providing robust and simple to interpret information for decision-makers. By quantifying current and future exposure of Royal Gala apple to damaging temperature extremes across ten important pome fruit-growing locations in Australia, differences in impact to ripening fruit are highlighted, with, by the end of the twenty-first century, some locations maintaining no sunburn browning risk, while others potentially experiencing the risk for the majority of the January ripening period. Installation of over-tree netting can reduce the impact of sunburn browning. The benefits from employing this management option varied across the ten study locations. The two approaches explored to assist decision-makers assess this information (a) using sunburn browning risk analogues and (b) through identifying hypothetical sunburn browning risk thresholds, resulted in varying recommendations for introducing over-tree netting. These recommendations were location and future time period dependent with some sites showing no benefit for sunburn protection from nets even by the end of the twenty-first century and others already deriving benefits from employing this adaptation option. Potential best and worst cases of sunburn browning risk and its potential reduction through introduction of over-tree nets were explored. The range of results presented highlights the importance of addressing uncertainty in climate projections that result from different global climate models and possible future emission pathways.

The Federal Budget: Current and Upcoming Issues

DTIC Science & Technology

2009-12-31

90 Milton Friedman , Capitalism and Freedom (Chicago: Univ. of Chicago Press, 1962), pp. 75-84. . The Federal Budget: Current...government made significant financial interventions aimed at alleviating economic recession. The final costs of federal responses to this turmoil will...benefits paid net of Social Security payroll taxes collected and the U.S. Postal Service’s net balance) the (on-budget) FY2008 federal deficit was

Impact of Replacing the Pooled Cohort Equation With Other Cardiovascular Disease Risk Scores on Atherosclerotic Cardiovascular Disease Risk Assessment (from the Multi-Ethnic Study of Atherosclerosis [MESA]).

PubMed

Qureshi, Waqas T; Michos, Erin D; Flueckiger, Peter; Blaha, Michael; Sandfort, Veit; Herrington, David M; Burke, Gregory; Yeboah, Joseph

2016-09-01

The increase in statin eligibility by the new cholesterol guidelines is mostly driven by the Pooled Cohort Equation (PCE) criterion (≥7.5% 10-year PCE). The impact of replacing the PCE with either the modified Framingham Risk Score (FRS) or the Systematic Coronary Risk Evaluation (SCORE) on assessment of atherosclerotic cardiovascular disease (ASCVD) risk assessment and statin eligibility remains unknown. We assessed the comparative benefits of using the PCE, FRS, and SCORE for ASCVD risk assessment in the Multi-Ethnic Study of Atherosclerosis. Of 6,815 participants, 654 (mean age 61.4 ± 10.3; 47.1% men; 37.1% whites; 27.2% blacks; 22.3% Hispanics; 12.0% Chinese-Americans) were included in analysis. Area under the curve (AUC) and decision curve analysis were used to compare the 3 risk scores. Decision curve analysis is the plot of net benefit versus probability thresholds; net benefit = true positive rate - (false positive rate × weighting factor). Weighting factor = Threshold probability/1 - threshold probability. After a median of 8.6 years, 342 (6.0%) ASCVD events (myocardial infarction, coronary heart disease death, fatal or nonfatal stroke) occurred. All 4 risk scores had acceptable discriminative ability for incident ASCVD events; (AUC [95% CI] PCE: 0.737 [0.713 to 0.762]; FRS: 0.717 [0.691 to 0.743], SCORE (high risk) 0.722 [0.696 to 0.747], and SCORE (low risk): 0.721 [0.696 to 0.746]. At the ASCVD risk threshold recommended for statin eligibility for primary prevention (≥7.5%), the PCE provides the best net benefit. Replacing the PCE with the SCORE (high), SCORE (low) and FRS results in a 2.9%, 8.9%, and 17.1% further increase in statin eligibility. The PCE has the best discrimination and net benefit for primary ASCVD risk assessment in a US-based multiethnic cohort compared with the SCORE or the FRS. Copyright © 2016 Elsevier Inc. All rights reserved.

Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis.

PubMed

Hoch, Jeffrey S; Briggs, Andrew H; Willan, Andrew R

2002-07-01

Economic evaluation is often seen as a branch of health economics divorced from mainstream econometric techniques. Instead, it is perceived as relying on statistical methods for clinical trials. Furthermore, the statistic of interest in cost-effectiveness analysis, the incremental cost-effectiveness ratio is not amenable to regression-based methods, hence the traditional reliance on comparing aggregate measures across the arms of a clinical trial. In this paper, we explore the potential for health economists undertaking cost-effectiveness analysis to exploit the plethora of established econometric techniques through the use of the net-benefit framework - a recently suggested reformulation of the cost-effectiveness problem that avoids the reliance on cost-effectiveness ratios and their associated statistical problems. This allows the formulation of the cost-effectiveness problem within a standard regression type framework. We provide an example with empirical data to illustrate how a regression type framework can enhance the net-benefit method. We go on to suggest that practical advantages of the net-benefit regression approach include being able to use established econometric techniques, adjust for imperfect randomisation, and identify important subgroups in order to estimate the marginal cost-effectiveness of an intervention. Copyright 2002 John Wiley & Sons, Ltd.

Decision curve analysis to compare 3 versions of Partin Tables to predict final pathologic stage.

PubMed

Augustin, Herbert; Sun, Maxine; Isbarn, Hendrik; Pummer, Karl; Karakiewicz, Pierre

2012-01-01

To perform a decision curve analysis (DCA) to compare the Partin Tables 1997, 2001, and 2007 for their clinical applicability. Clinical and pathologic data of 687 consecutive patients treated with open radical prostatectomy for clinically localized prostate cancer between 2003 and 2008 at a single institution were used. DCA quantified the net benefit relating to specific threshold probabilities of extraprostatic extension (EPE), seminal vesicle involvement (SVI), and lymph node involvement (LNI). Overall, EPE, SVI, and LNI were recorded in 17.8, 6.0, and 1.2%, respectively. For EPE predictions, the DCA favored the 2007 version vs. 1997 for SVI vs. none of the versions for LNI. DCA indicate that for very low prevalence conditions such as LNI (1.2%), decision models are not useful. For low prevalence rates such as SVI, the use of different versions of the Partin Tables does not translate into meaningful net gains differences. Finally, for intermediate prevalence conditions such as EPE (18%), despite apparent performance differences, the net benefit differences were also marginal. In consequence, the current analysis could not confirm an important benefit from the use of the Partin Tables and it could not identify a clearly better version of any of the 3 available iterations. Copyright © 2012 Elsevier Inc. All rights reserved.

Evaluation of Contrail Reduction Strategies Based on Environmental and Operational Costs

NASA Technical Reports Server (NTRS)

Chen, Neil Y.; Sridhar, Banavar; Ng, Hok K.; Li, Jinhua

2013-01-01

This paper evaluates a set of contrail reduction strategies based on environmental and operational costs. A linear climate model was first used to convert climate effects of carbon dioxide emissions and aircraft contrails to changes in Absolute Global Temperature Potential, a metric that measures the mean surface temperature change due to aircraft emissions and persistent contrail formations. The concept of social cost of carbon and the carbon auction price from recent California's cap-and-trade system were then used to relate the carbon dioxide emissions and contrail formations to an environmental cost index. The strategy for contrail reduction is based on minimizing contrail formations by altering the aircraft's cruising altitude. The strategy uses a user-defined factor to trade off between contrail reduction and additional fuel burn and carbon dioxide emissions. A higher value of tradeoff factor results in more contrail reduction but also more fuel burn and carbon emissions. The strategy is considered favorable when the net environmental cost benefit exceeds the operational cost. The results show how the net environmental benefit varies with different decision-making time-horizon and different carbon cost. The cost models provide a guidance to select the trade-off factor that will result in the most net environmental benefit.

Value of neonicotinoid seed treatments to US soybean farmers.

PubMed

Hurley, Terrance; Mitchell, Paul

2017-01-01

The benefits of neonicotinoid seed treatment to soybean farmers have received increased scrutiny. Rather than use data from small-plot experiments, this research uses survey data from 500 US farmers to estimate the benefit of neonicotinoid seed treatments to them. As seed treatment users, farmers are familiar with their benefits in the field and have economic incentives to only use them if they provide value. Of the surveyed farmers, 51% used insecticide seed treatments, averaging 87% of their soybean area. Farmers indicated that human and environmental safety is an important consideration affecting their pest management decisions and reported aphids as the most managed and important soybean pest. Asking farmers who used seed treatments to state how much value they provided gives an estimate of $US 28.04 ha -1 treated in 2013, net of seed treatment costs. Farmer-reported average yields provided an estimated average yield gain of 128.0 kg ha -1 treated in 2013, or about $US 42.20 ha -1 treated, net of seed treatment costs. These estimates using different data and methods are consistent and suggest the value of insecticide seed treatments to the US soybean farmers who used them in 2013 was around $US 28-42 ha -1 treated, net of seed treatment costs. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

System-wide and Superemitter Policy Options for the Abatement of Methane Emissions from the U.S. Natural Gas System

NASA Astrophysics Data System (ADS)

Mayfield, E. N.; Robinson, A. L.; Cohon, J. L.

2017-12-01

This work assesses trade-offs between system-wide and superemitter policy options for reducing methane emissions from compressor stations in the U.S. transmission and storage system. Leveraging recently collected national emissions and activity data sets, we developed a new process-based emissions model implemented in a Monte Carlo simulation framework to estimate emissions for each component and facility in the system. We find that approximately 83% of emissions, given the existing suite of technologies, have the potential to be abated, with only a few emission categories comprising a majority of emissions. We then formulate optimization models to determine optimal abatement strategies. Most emissions across the system (approximately 80%) are efficient to abate, resulting in net benefits ranging from 160M to 1.2B annually across the system. The private cost burden is minimal under standard and tax instruments, and if firms market the abated natural gas, private net benefits may be generated. Superemitter policies, namely, those that target the highest emitting facilities, may reduce the private cost burden and achieve high emission reductions, especially if emissions across facilities are highly skewed. However, detection across all facilities is necessary regardless of the policy option and there are nontrivial net benefits resulting from abatement of relatively low-emitting sources.

System-wide and Superemitter Policy Options for the Abatement of Methane Emissions from the U.S. Natural Gas System.

PubMed

Mayfield, Erin N; Robinson, Allen L; Cohon, Jared L

2017-05-02

This work assesses trade-offs between system-wide and superemitter policy options for reducing methane emissions from compressor stations in the U.S. transmission and storage system. Leveraging recently collected national emissions and activity data sets, we developed a new process-based emissions model implemented in a Monte Carlo simulation framework to estimate emissions for each component and facility in the system. We find that approximately 83% of emissions, given the existing suite of technologies, have the potential to be abated, with only a few emission categories comprising a majority of emissions. We then formulate optimization models to determine optimal abatement strategies. Most emissions across the system (approximately 80%) are efficient to abate, resulting in net benefits ranging from $160M to $1.2B annually across the system. The private cost burden is minimal under standard and tax instruments, and if firms market the abated natural gas, private net benefits may be generated. Superemitter policies, namely, those that target the highest emitting facilities, may reduce the private cost burden and achieve high emission reductions, especially if emissions across facilities are highly skewed. However, detection across all facilities is necessary regardless of the policy option and there are nontrivial net benefits resulting from abatement of relatively low-emitting sources.

Presentation of the results of a Bayesian automatic event detection and localization program to human analysts

NASA Astrophysics Data System (ADS)

Kushida, N.; Kebede, F.; Feitio, P.; Le Bras, R.

2016-12-01

The Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) has been developing and testing NET-VISA (Arora et al., 2013), a Bayesian automatic event detection and localization program, and evaluating its performance in a realistic operational mode. In our preliminary testing at the CTBTO, NET-VISA shows better performance than its currently operating automatic localization program. However, given CTBTO's role and its international context, a new technology should be introduced cautiously when it replaces a key piece of the automatic processing. We integrated the results of NET-VISA into the Analyst Review Station, extensively used by the analysts so that they can check the accuracy and robustness of the Bayesian approach. We expect the workload of the analysts to be reduced because of the better performance of NET-VISA in finding missed events and getting a more complete set of stations than the current system which has been operating for nearly twenty years. The results of a series of tests indicate that the expectations born from the automatic tests, which show an overall overlap improvement of 11%, meaning that the missed events rate is cut by 42%, hold for the integrated interactive module as well. New events are found by analysts, which qualify for the CTBTO Reviewed Event Bulletin, beyond the ones analyzed through the standard procedures. Arora, N., Russell, S., and Sudderth, E., NET-VISA: Network Processing Vertically Integrated Seismic Analysis, 2013, Bull. Seismol. Soc. Am., 103, 709-729.

VOEventNet: An Open Source of Transient Alerts for Astronomers.

NASA Astrophysics Data System (ADS)

Drake, Andrew J.; Williams, R.; Graham, M. J.; Mahabal, A.; Djorgovski, S. G.; White, R. R.; Vestrand, W. T.; Bloom, J.

2007-12-01

Event based astronomy is acquiring an increasingly important role in astronomy as large time-domain surveys such as Palomar Transient Factory (PTF), Pan-STARRs, SkyMapper and Allan Telescope Array (ATA) surveys come online. These surveys are expected to discover thousands of transients each year ranging from near earth asteroids to distant SNe. Although the primary instruments for of these surveys are in place, in order to fully utilize these event discovery streams, automated alerting and follow-up is a necessity. For the past two years the VOEventNet network has been globally distributing information about transient astronomical events using the VOEvent format, a Virtual Observatory standard. Events messages are openly distributed so that follow-up can utilize the most appropriate resources available in order to characterize the nature of the transients. Since its inception VOEventNet has broadcast more than 3500 SDSSSS Supernova candidates, 3300 GRB alert and follow-up notices from GCN, 700 OGLE microlensing event candidates, and 4300 newly discovered asteroid and optical transient candidates from the Palomar Quest survey. Additional transient event streams are expected this season including optical transients from the Catalina Sky Survey. VOEventNet astronomical transient events streams are available to all astronomers via traditional HTML tables, RSS news-feeds, real-time publication (via Jabber and TCP), and Google Sky mashups. VOEventNet currently carries out optical transient event follow-up with the Palomar 60 and 200in (Caltech), Faulkes Telescopes North and South (LCOGTN), RAPTOR (LANL), and PARITEL (UCB; CfA).

An Analysis of the Role of Social Safety Net Scholarships in Reducing School Drop-Out during the Indonesian Economic Crisis. Innocenti Working Papers.

ERIC Educational Resources Information Center

Cameron, Lisa A.

This paper uses regression and matching techniques to evaluate Indonesia's Social Safety Net Scholarships Programme. The scholarships program was developed to try to prevent large numbers of children from dropping out of school as a result of the Asian financial crisis. The expectation was that many families would find it difficult to keep their…

Benefits and costs of substance abuse treatment programs for state prison inmates: results from a lifetime simulation model.

PubMed

Zarkin, Gary A; Cowell, Alexander J; Hicks, Katherine A; Mills, Michael J; Belenko, Steven; Dunlap, Laura J; Houser, Kimberly A; Keyes, Vince

2012-06-01

Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society's drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals' lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners. Copyright © 2011 John Wiley & Sons, Ltd.

BENEFITS AND COSTS OF SUBSTANCE ABUSE TREATMENT PROGRAMS FOR STATE PRISON INMATES: RESULTS FROM A LIFETIME SIMULATION MODEL

PubMed Central

ZARKIN, GARY A.; COWELL, ALEXANDER J.; HICKS, KATHERINE A.; MILLS, MICHAEL J.; BELENKO, STEVEN; DUNLAP, LAURA J.; HOUSER, KIMBERLY A.; KEYES, VINCE

2011-01-01

SUMMARY Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society’s drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals’ lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners. PMID:21506193

Determining a sustainable and economically optimal wastewater treatment and discharge strategy.

PubMed

Hardisty, Paul E; Sivapalan, Mayuran; Humphries, Robert

2013-01-15

Options for treatment and discharge of wastewater in regional Western Australia (WA) are examined from the perspective of overall sustainability and social net benefit. Current practice in the state has typically involved a basic standard of treatment deemed to be protective of human health, followed by discharge to surface water bodies. Community and regulatory pressure to move to higher standards of treatment is based on the presumption that a higher standard of treatment is more protective of the environment and society, and thus is more sustainable. This analysis tests that hypothesis for Western Australian conditions. The merits of various wastewater treatment and discharge strategies are examined by quantifying financial costs (capital and operations), and by monetising the wider environmental and social costs and benefits of each option over an expanded planning horizon (30 years). Six technical treatment-disposal options were assessed at a test site, all of which met the fundamental criterion of protecting human health. From a financial perspective, the current business-as-usual option is preferred - it is the least cost solution. However, valuing externalities such as water, greenhouse gases, ecological impacts and community amenity, the status quo is revealed as sub-optimal. Advanced secondary treatment with stream disposal improves water quality and provides overall net benefit to society. All of the other options were net present value (NPV) negative. Sensitivity analysis shows that the favoured option outperforms all of the others under a wide range of financial and externality values and assumptions. Expanding the findings across the state reveals that moving from the identified socially optimal level of treatment to higher (tertiary) levels of treatment would result in a net loss to society equivalent to several hundred million dollars. In other words, everyone benefits from improving treatment to the optimum point. But society, the environment, and the Corporation are all worse off when treatment levels are pushed beyond what is economic and sustainable. Copyright © 2012 Elsevier Ltd. All rights reserved.

Decision-making deficits in patients with chronic schizophrenia: Iowa Gambling Task and Prospect Valence Learning model.

PubMed

Kim, Myung-Sun; Kang, Bit-Na; Lim, Jae Young

2016-01-01

Decision-making is the process of forming preferences for possible options, selecting and executing actions, and evaluating the outcome. This study used the Iowa Gambling Task (IGT) and the Prospect Valence Learning (PVL) model to investigate deficits in risk-reward related decision-making in patients with chronic schizophrenia, and to identify decision-making processes that contribute to poor IGT performance in these patients. Thirty-nine patients with schizophrenia and 31 healthy controls participated. Decision-making was measured by total net score, block net scores, and the total number of cards selected from each deck of the IGT. PVL parameters were estimated with the Markov chain Monte Carlo sampling scheme in OpenBugs and BRugs, its interface to R, and the estimated parameters were analyzed with the Mann-Whitney U-test. The schizophrenia group received significantly lower total net scores compared to the control group. In terms of block net scores, an interaction effect of group × block was observed. The block net scores of the schizophrenia group did not differ across the five blocks, whereas those of the control group increased as the blocks progressed. The schizophrenia group obtained significantly lower block net scores in the fourth and fifth blocks of the IGT and selected cards from deck D (advantageous) less frequently than the control group. Additionally, the schizophrenia group had significantly lower values on the utility-shape, loss-aversion, recency, and consistency parameters of the PVL model. These results indicate that patients with schizophrenia experience deficits in decision-making, possibly due to failure in learning the expected value of each deck, and incorporating outcome experiences of previous trials into expectancies about options in the present trial.

Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.

PubMed

Dobson, Allen; DaVanzo, Joan E; Haught, Randy; Phap-Hoa, Luu

2017-11-01

Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.

How do general practitioners use 'safety netting' in acutely ill children?

PubMed

Bertheloot, Karen; Deraeve, Pieterjan; Vermandere, Mieke; Aertgeerts, Bert; Lemiengre, Marieke; De Sutter, An; Buntinx, Frank; Verbakel, Jan Y

2016-01-01

'Safety netting' advice allows general practitioners (GPs) to cope with diagnostic uncertainty in primary care. It informs patients on 'red flag' features and when and how to seek further help. There is, however, insufficient evidence to support useful choices regarding 'safety netting' procedures. To explore how GPs apply 'safety netting' in acutely ill children in Flanders. We designed a qualitative study consisting of semi-structured interviews with 37 GPs across Flanders. Two researchers performed qualitative analysis based on grounded theory components. Although unfamiliar with the term, GPs perform 'safety netting' in every acutely ill child, guided by their intuition without the use of specific guidelines. They communicate 'red flag' features, expected time course of illness and how and when to re-consult and try to tailor their advice to the context, patient and specific illness. Overall, GPs perceive 'safety netting' as an important element of the consultation, acknowledging personal and parental limitations, such as parents' interpretation of their advice. GPs do not feel a need for any form of support in the near future. GPs apply 'safety netting' intuitively and tailor the content. Further research should focus on the impact of 'safety netting' on morbidity and how the advice is conveyed to parents.

Estimating the returns to United Kingdom publicly funded musculoskeletal disease research in terms of net value of improved health outcomes.

PubMed

Glover, Matthew; Montague, Erin; Pollitt, Alexandra; Guthrie, Susan; Hanney, Stephen; Buxton, Martin; Grant, Jonathan

2018-01-10

Building on an approach applied to cardiovascular and cancer research, we estimated the economic returns from United Kingdom public- and charitable-funded musculoskeletal disease (MSD) research that arise from the net value of the improved health outcomes in the United Kingdom. To calculate the economic returns from MSD-related research in the United Kingdom, we estimated (1) the public and charitable expenditure on MSD-related research in the United Kingdom between 1970 and 2013; (2) the net monetary benefit (NMB), derived from the health benefit in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of £25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1994 to 2013; (3) the proportion of NMB attributable to United Kingdom research; and (4) the elapsed time between research funding and health gain. The data collected from these four key elements were used to estimate the internal rate of return (IRR) from MSD-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using a one-way sensitivity analysis. Expressed in 2013 prices, total expenditure on MSD-related research from 1970 to 2013 was £3.5 billion, and for the period used to estimate the rate of return, 1978-1997, was £1.4 billion. Over the period 1994-2013 the key interventions analysed produced 871,000 QALYs with a NMB of £16 billion, allowing for the net NHS costs resulting from them and valuing a QALY at £25,000. The proportion of benefit attributable to United Kingdom research was 30% and the elapsed time between funding and impact of MSD treatments was 16 years. Our best estimate of the IRR from MSD-related research was 7%, which is similar to the 9% for CVD and 10% for cancer research. Our estimate of the IRR from the net health gain to public and charitable funding of MSD-related research in the United Kingdom is substantial, and justifies the research investments made between 1978 and 1997. We also demonstrated the applicability of the approach previously used in assessing the returns from cardiovascular and cancer research. Inevitably, with a study of this kind, there are a number of important assumptions and caveats that we highlight, and these can inform future research.

Time and expected value of sample information wait for no patient.

PubMed

Eckermann, Simon; Willan, Andrew R

2008-01-01

The expected value of sample information (EVSI) from prospective trials has previously been modeled as the product of EVSI per patient, and the number of patients across the relevant time horizon less those "used up" in trials. However, this implicitly assumes the eligible patient population to which information from a trial can be applied across a time horizon are independent of time for trial accrual, follow-up and analysis. This article demonstrates that in calculating the EVSI of a trial, the number of patients who benefit from trial information should be reduced by those treated outside as well as within the trial over the time until trial evidence is updated, including time for accrual, follow-up and analysis. Accounting for time is shown to reduce the eligible patient population: 1) independent of the size of trial in allowing for time of follow-up and analysis, and 2) dependent on the size of trial for time of accrual, where the patient accrual rate is less than incidence. Consequently, the EVSI and expected net gain (ENG) at any given trial size are shown to be lower when accounting for time, with lower ENG reinforced in the case of trials undertaken while delaying decisions by additional opportunity costs of time. Appropriately accounting for time reduces the EVSI of trial design and increase opportunity costs of trials undertaken with delay, leading to lower likelihood of trialing being optimal and smaller trial designs where optimal.

The option value of delay in health technology assessment.

PubMed

Eckermann, Simon; Willan, Andrew R

2008-01-01

Processes of health technology assessment (HTA) inform decisions under uncertainty about whether to invest in new technologies based on evidence of incremental effects, incremental cost, and incremental net benefit monetary (INMB). An option value to delaying such decisions to wait for further evidence is suggested in the usual case of interest, in which the prior distribution of INMB is positive but uncertain. of estimating the option value of delaying decisions to invest have previously been developed when investments are irreversible with an uncertain payoff over time and information is assumed fixed. However, in HTA decision uncertainty relates to information (evidence) on the distribution of INMB. This article demonstrates that the option value of delaying decisions to allow collection of further evidence can be estimated as the expected value of sample of information (EVSI). For irreversible decisions, delay and trial (DT) is demonstrated to be preferred to adopt and no trial (AN) when the EVSI exceeds expected costs of information, including expected opportunity costs of not treating patients with the new therapy. For reversible decisions, adopt and trial (AT) becomes a potentially optimal strategy, but costs of reversal are shown to reduce the EVSI of this strategy due to both a lower probability of reversal being optimal and lower payoffs when reversal is optimal. Hence, decision makers are generally shown to face joint research and reimbursement decisions (AN, DT and AT), with the optimal choice dependent on costs of reversal as well as opportunity costs of delay and the distribution of prior INMB.

Assessing the INDCs' land use, land use change, and forest emission projections.

PubMed

Forsell, Nicklas; Turkovska, Olga; Gusti, Mykola; Obersteiner, Michael; Elzen, Michel den; Havlik, Petr

2016-12-01

In preparation for the 2015 international climate negotiations in Paris, Parties submitted Intended Nationally Determined Contributions (INDCs) to the United Nations Framework Convention on Climate Change (UNFCCC) expressing each countries' respective post-2020 climate actions. In this paper we assess individual Parties' expected reduction of emissions/removals from land use, land use change, and forest (LULUCF) sector for reaching their INDC target, and the aggregate global effect on the INDCs on the future development of emission and removals from the LULUCF sector. This has been done through analysis Parties' official information concerning the role of LULUCF mitigation efforts for reaching INDC targets as presented in National Communications, Biennial Update Reports, and Additional file 1. On the aggregate global level, the Parties themselves perceive that net LULUCF emissions will increase over time. Overall, the net LULUCF emissions are estimated to increase by 0.6 Gt CO 2 e year -1 (range: 0.1-1.1) in 2020 and 1.3 Gt CO 2 e year -1 (range: 0.7-2.1) in 2030, both compared to 2010 levels. On the other hand, the full implementation of the INDCs is estimated to lead to a reduction of net LULUCF emissions in 2030 compared to 2010 levels. It is estimated that if all conditional and unconditional INDCs are implemented, net LULUCF emissions would decrease by 0.5 Gt CO 2 e year -1 (range: 0.2-0.8) by 2020 and 0.9 Gt CO 2 e year -1 (range: 0.5-1.3) by 2030, both compared to 2010 levels. The largest absolute reductions of net LULUCF emissions (compared to 2010 levels) are expected from Indonesia and Brazil, followed by China and Ethiopia. The results highlights that countries are expecting a significant contribution from the LULUCF sector to meet their INDC mitigation targets. At the global level, the LULUCF sector is expected to contribute to as much as 20% of the full mitigation potential of all the conditional and unconditional INDC targets. However, large uncertainties still surround how Parties estimate, project and account for emissions and removals from the LULUCF sector. While INDCs represent a new source of land-use information, further information and updates of the INDCs will be required to reduce uncertainty of the LULUCF projections.

Walking- and cycling track networks in Norwegian cities : cost-benefit analyses including health effects and external costs of road traffic : summary

DOT National Transportation Integrated Search

2002-04-01

Cost- benefit analyses of walking- and cycling track net-works in three Norwegian cities are presented in this study. A project group working with a National Cycling Strategy in Norway initialised the study. Motivation for starting the study is the P...

The net economic value of wilderness

Treesearch

J. Michael Bowker; J.E. Harvard; John C. Bergstrom; H. Ken Cordell; Donald B.K. English; John B. Loomis

2005-01-01

The purpose of this chapter is to inventory and assess what is currently known about the economic or "dollar" values accruing to Americans from the National Wilderness Preservation System. This chapter identifies the benefits of Wilderness and the economic value of these benefits through an extensive review of published conceptual and empirical literature. It...

29 CFR 4022.82 - Method of recoupment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... determine the fractional multiplier by dividing the amount of the net overpayment by the present value of... the present value of the benefit to which a participant or beneficiary is entitled under title IV of... by the present value of the benefit payable with respect to the participant under title IV of ERISA...

Curbside Recycling: Waste Resource or Waste of Resources?

ERIC Educational Resources Information Center

Aadland, David; Caplan, Arthur J.

2006-01-01

In this paper, we address the often contentious debate over state and local recycling policy by carefully estimating the social net benefit of curbside recycling. Benefits are estimated using household survey data from over 4,000 households across 40 western U.S. cities. We calibrate household willingness to pay for hypothetical bias using an…

Reallocation of water in the state of New Mexico based on cooperative game theory

NASA Astrophysics Data System (ADS)

Rouhi Rad, M.

2011-12-01

Water allocation models often aim to maximize net benefits in the river basin based on the water rights, thus there is no motivation to use water efficiently by the users with lower marginal value for water. Water markets not only could help increase the net benefits over the basin but also will encourage the stakeholders to save the water and use it in transfer markets and increase their income. This issue can be viewed as a game in which stakeholders can play non-cooperatively and try to increase their own benefits using the amount of water assigned to them or they could cooperate and make coalitions in order to increase the total benefits in the coalition and the whole basin. The aim of this study is to reallocate the water based on cooperation among different stakeholders, namely agricultural, municipal and industrial and environmental, in the Upper Rio Grande river basin in the state of New Mexico in order to increase efficiency, sustainability and equity of water distribution in the basin using different game theory schemes such as Nucleolus and the Shapley Value.

Software Tool Integrating Data Flow Diagrams and Petri Nets

NASA Technical Reports Server (NTRS)

Thronesbery, Carroll; Tavana, Madjid

2010-01-01

Data Flow Diagram - Petri Net (DFPN) is a software tool for analyzing other software to be developed. The full name of this program reflects its design, which combines the benefit of data-flow diagrams (which are typically favored by software analysts) with the power and precision of Petri-net models, without requiring specialized Petri-net training. (A Petri net is a particular type of directed graph, a description of which would exceed the scope of this article.) DFPN assists a software analyst in drawing and specifying a data-flow diagram, then translates the diagram into a Petri net, then enables graphical tracing of execution paths through the Petri net for verification, by the end user, of the properties of the software to be developed. In comparison with prior means of verifying the properties of software to be developed, DFPN makes verification by the end user more nearly certain, thereby making it easier to identify and correct misconceptions earlier in the development process, when correction is less expensive. After the verification by the end user, DFPN generates a printable system specification in the form of descriptions of processes and data.

Measuring the expectations of kidney donors: initial psychometric properties of the Living Donation Expectancies Questionnaire.

PubMed

Rodrigue, James R; Guenther, Robert; Kaplan, Bruce; Mandelbrot, Didier A; Pavlakis, Martha; Howard, Richard J

2008-05-15

We report on the initial development and validation of the Living Donation Expectancies Questionnaire (LDEQ), designed to measure the expectations of living kidney donor candidates. Potential living donors (n=443) at two transplant centers were administered the LDEQ and other questionnaires, and their medical records were reviewed. Factor analysis provides support for six LDEQ scales: Interpersonal Benefit, Personal Growth, Spiritual Growth, Quid Pro Quo, Health Consequences, and Miscellaneous Consequences. All but one scale showed good internal consistency. Expected benefits of donation were associated with higher optimism and lower mental health; expected consequences of donation were associated with lower optimism and lower physical and mental health. More potential donors with relative or absolute contraindications had high Interpersonal Benefit (P<0.0001), Personal Growth (P<0.01), Quid Pro Quo (P<0.0001), and Health Consequences (P<0.0001) expectations. The LDEQ has promise in evaluating donor candidates' expectations.

A Coupled Simulation Architecture for Agent-Based/Geohydrological Modelling

NASA Astrophysics Data System (ADS)

Jaxa-Rozen, M.

2016-12-01

The quantitative modelling of social-ecological systems can provide useful insights into the interplay between social and environmental processes, and their impact on emergent system dynamics. However, such models should acknowledge the complexity and uncertainty of both of the underlying subsystems. For instance, the agent-based models which are increasingly popular for groundwater management studies can be made more useful by directly accounting for the hydrological processes which drive environmental outcomes. Conversely, conventional environmental models can benefit from an agent-based depiction of the feedbacks and heuristics which influence the decisions of groundwater users. From this perspective, this work describes a Python-based software architecture which couples the popular NetLogo agent-based platform with the MODFLOW/SEAWAT geohydrological modelling environment. This approach enables users to implement agent-based models in NetLogo's user-friendly platform, while benefiting from the full capabilities of MODFLOW/SEAWAT packages or reusing existing geohydrological models. The software architecture is based on the pyNetLogo connector, which provides an interface between the NetLogo agent-based modelling software and the Python programming language. This functionality is then extended and combined with Python's object-oriented features, to design a simulation architecture which couples NetLogo with MODFLOW/SEAWAT through the FloPy library (Bakker et al., 2016). The Python programming language also provides access to a range of external packages which can be used for testing and analysing the coupled models, which is illustrated for an application of Aquifer Thermal Energy Storage (ATES).

Eight ways to go "e" without launching a Web service.

PubMed

Toth, C L; Goldstein, D

2000-01-01

With more than 100 million Americans on the Internet, the physician-patient relationship is evolving. The Net brings with it unlimited potential for communication and information dissemination, but these benefits do come with some side effects. No everything on the Net is reliable or credible, but many patients don't understand that. For this reason and others, physicians must involve themselves with online communication and e-commerce. There are many realistic and practical ways for physicians to do this, and not all of them involve building a Web site. Sending patients clinical information in a cost-effective manner, improving receivables management, and decreasing the volume of phone calls are just some of the many ways the Net can enhance your practice. Think of the Net as just another business tool--not a replacement for physician-patient relationships. Like the telephone before it, the Net affords improved communication, patient education, and relationship-building with patients.

Cost-benefit analysis in occupational health: a comparison of intervention scenarios for occupational asthma and rhinitis among bakery workers.

PubMed

Meijster, Tim; van Duuren-Stuurman, Birgit; Heederik, Dick; Houba, Remko; Koningsveld, Ernst; Warren, Nicholas; Tielemans, Erik

2011-10-01

Use of cost-benefit analysis in occupational health increases insight into the intervention strategy that maximises the cost-benefit ratio. This study presents a methodological framework identifying the most important elements of a cost-benefit analysis for occupational health settings. One of the main aims of the methodology is to evaluate cost-benefit ratios for different stakeholders (employers, employees and society). The developed methodology was applied to two intervention strategies focused on reducing respiratory diseases. A cost-benefit framework was developed and used to set up a calculation spreadsheet containing the inputs and algorithms required to calculate the costs and benefits for all cost elements. Inputs from a large variety of sources were used to calculate total costs, total benefits, net costs and the benefit-to-costs ratio for both intervention scenarios. Implementation of a covenant intervention program resulted in a net benefit of €16 848 546 over 20 years for a population of 10 000 workers. Implementation was cost-effective for all stakeholders. For a health surveillance scenario, total benefits resulting from a decreased disease burden were estimated to be €44 659 352. The costs of the interventions could not be calculated. This study provides important insights for developing effective intervention strategies in the field of occupational medicine. Use of a model based approach enables investigation of those parameters most likely to impact on the effectiveness and costs of interventions for work related diseases. Our case study highlights the importance of considering different perspectives (of employers, society and employees) in assessing and sharing the costs and benefits of interventions.

An improved null model for assessing the net effects of multiple stressors on communities.

PubMed

Thompson, Patrick L; MacLennan, Megan M; Vinebrooke, Rolf D

2018-01-01

Ecological stressors (i.e., environmental factors outside their normal range of variation) can mediate each other through their interactions, leading to unexpected combined effects on communities. Determining whether the net effect of stressors is ecologically surprising requires comparing their cumulative impact to a null model that represents the linear combination of their individual effects (i.e., an additive expectation). However, we show that standard additive and multiplicative null models that base their predictions on the effects of single stressors on community properties (e.g., species richness or biomass) do not provide this linear expectation, leading to incorrect interpretations of antagonistic and synergistic responses by communities. We present an alternative, the compositional null model, which instead bases its predictions on the effects of stressors on individual species, and then aggregates them to the community level. Simulations demonstrate the improved ability of the compositional null model to accurately provide a linear expectation of the net effect of stressors. We simulate the response of communities to paired stressors that affect species in a purely additive fashion and compare the relative abilities of the compositional null model and two standard community property null models (additive and multiplicative) to predict these linear changes in species richness and community biomass across different combinations (both positive, negative, or opposite) and intensities of stressors. The compositional model predicts the linear effects of multiple stressors under almost all scenarios, allowing for proper classification of net effects, whereas the standard null models do not. Our findings suggest that current estimates of the prevalence of ecological surprises on communities based on community property null models are unreliable, and should be improved by integrating the responses of individual species to the community level as does our compositional null model. © 2017 John Wiley & Sons Ltd.

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

PubMed

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

2006-08-15

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

[Economic impact of an automated dispensing system in an intensive care unit].

PubMed

Kheniene, F; Bedouch, P; Durand, M; Marie, F; Brudieu, E; Tourlonnias, M-M; Bongi, P; Allenet, B; Calop, J

2008-03-01

Automated dispensing systems (ADS) allow a reduction of medication errors and an improvement of drug distribution in clinical ward. The objective of this study was to evaluate the economic impact of ADS in an intensive care unit. A cost-benefit model was constructed based on the hospital perspective. The system was evaluated before-after implementation of an ADS in a 12-bed cardiovascular intensive care unit of a French teaching hospital: (a) by a measuring nurse and pharmacy technician working time required for various tasks; (b) by measuring the cost of drug storage and the cost of expired drug; (c) by measuring the nurses' acceptability. After ADS was installed, nursing personnel spent less time on medication-related activities (mean of 1.9 hour/day of nursing time). Pharmacy technicians spent more time on floor-stock activities (mean of 0.7 hour/day of technician time). Implementation reduced the cost of drug storage by 56% (14,742 euros) and cost of expired drug by 9,086 euros per year. Finally, cost-benefit analysis including potential savings in terms of working time showed a net benefit of 71,586 euros (14,317 euros/year). The ADS was given high marks by the nurses; 77% wanted to keep it on their unit. Implementation of ADS is expected to generate direct savings for the hospital and working time reallocation, for nurses to interact with patients and for pharmacy technicians to get involved on the ward.

Direct benefits and indirect costs of warm temperatures for high-elevation populations of a solitary bee.

PubMed

Forrest, Jessica R K; Chisholm, Sarah P M

2017-02-01

Warm temperatures are required for insect flight. Consequently, warming could benefit many high-latitude and high-altitude insects by increasing opportunities for foraging or oviposition. However, warming can also alter species interactions, including interactions with natural enemies, making the net effect of rising temperatures on population growth rate difficult to predict. We investigated the temperature-dependence of nesting activity and lifetime reproductive output over 3 yr in subalpine populations of a pollen-specialist bee, Osmia iridis. Rates of nest provisioning increased with ambient temperatures and with availability of floral resources, as expected. However, warmer conditions did not increase lifetime reproductive output. Lifetime offspring production was best explained by rates of brood parasitism (by the wasp Sapyga), which increased with temperature. Direct observations of bee and parasite activity suggest that although activity of both species is favored by warmer temperatures, bees can be active at lower ambient temperatures, while wasps are active only at higher temperatures. Thus, direct benefits to the bees of warmer temperatures were nullified by indirect costs associated with increased parasite activity. To date, most studies of climate-change effects on pollinators have focused on changing interactions between pollinators and their floral host-plants (i.e., bottom-up processes). Our results suggest that natural enemies (i.e., top-down forces) can play a key role in pollinator population regulation and should not be overlooked in forecasts of pollinator responses to climate change. © 2016 by the Ecological Society of America.

How Does Retiree Health Insurance Influence Public Sector Employee Saving?

PubMed Central

Clark, Robert L.

2017-01-01

Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: -Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers;-Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.-After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not. PMID:25479891

How does retiree health insurance influence public sector employee saving?

PubMed

Clark, Robert L; Mitchell, Olivia S

2014-12-01

Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not. Copyright © 2014 Elsevier B.V. All rights reserved.

Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care.

PubMed

Gc, Vijay Singh; Suhrcke, Marc; Hardeman, Wendy; Sutton, Stephen; Wilson, Edward C F

2018-01-01

Brief interventions (BIs) delivered in primary care have shown potential to increase physical activity levels and may be cost-effective, at least in the short-term, when compared with usual care. Nevertheless, there is limited evidence on their longer term costs and health benefits. To estimate the cost-effectiveness of BIs to promote physical activity in primary care and to guide future research priorities using value of information analysis. A decision model was used to compare the cost-effectiveness of three classes of BIs that have been used, or could be used, to promote physical activity in primary care: 1) pedometer interventions, 2) advice/counseling on physical activity, and (3) action planning interventions. Published risk equations and data from the available literature or routine data sources were used to inform model parameters. Uncertainty was investigated with probabilistic sensitivity analysis, and value of information analysis was conducted to estimate the value of undertaking further research. In the base-case, pedometer interventions yielded the highest expected net benefit at a willingness to pay of £20,000 per quality-adjusted life-year. There was, however, a great deal of decision uncertainty: the expected value of perfect information surrounding the decision problem for the National Health Service Health Check population was estimated at £1.85 billion. Our analysis suggests that the use of pedometer BIs is the most cost-effective strategy to promote physical activity in primary care, and that there is potential value in further research into the cost-effectiveness of brief (i.e., <30 minutes) and very brief (i.e., <5 minutes) pedometer interventions in this setting. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease.

PubMed

Rosenheck, Robert A; Leslie, Douglas L; Sindelar, Jody L; Miller, Edward A; Tariot, Peter N; Dagerman, Karen S; Davis, Sonia M; Lebowitz, Barry D; Rabins, Peter; Hsiao, John K; Lieberman, Jeffery A; Schneider, Lon S

2007-11-01

Second-generation antipsychotics (SGAs) are prescribed for psychosis, aggression, and agitation in Alzheimer disease (AD). To conduct a cost-benefit analysis of SGAs and placebo (taken to represent a "watchful waiting" treatment strategy) for psychosis and aggression in outpatients with AD. Randomized placebo-controlled trial of alternative SGA initiation strategies. Forty-two outpatient clinics. Outpatients with AD and psychosis, aggression, or agitation (N = 421). Intervention Participants were randomly assigned to treatment with olanzapine, quetiapine fumarate, risperidone, or placebo with the option of double-blind rerandomization to another antipsychotic or citalopram hydrobromide or open treatment over 9 months. Monthly interviews documented health service use and costs. The economic perspective addressed total health care and medication costs. Costs of study drugs were estimated from wholesale prices with adjustment for discounts and rebates. Quality-adjusted life-years (QALYs) were assessed with the Health Utilities Index Mark 3 and were supplemented with measures of functioning, activities of daily living, and quality of life. Primary analyses were conducted using all available data. Secondary analyses excluded observations after the first medication change (ie, phase 1 only). Cost-benefit analysis was conducted using the net health benefits approach in a sensitivity analysis in which QALYs were valued at $50,000 per year and $100,000 per year. Average total health costs, including medications, were significantly lower for placebo than for SGAs, by $50 to $100 per month. There were no differences between treatments in QALYs or other measures of function. Phase 1-only analyses were broadly similar. Net-benefit analysis showed greater net health benefits for placebo as compared with other treatments, with probabilities ranging from 50% to 90%. There were no differences in measures of effectiveness between initiation of active treatments or placebo (which represented watchful waiting) but the placebo group had significantly lower health care costs. clinicaltrials.gov Identifier: NCT00015548.

Bidding strategy for microgrid in day-ahead market based on hybrid stochastic/robust optimization

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

Liu, Guodong; Xu, Yan; Tomsovic, Kevin

In this paper, we propose an optimal bidding strategy in the day-ahead market of a microgrid consisting of intermittent distributed generation (DG), storage, dispatchable DG and price responsive loads. The microgrid coordinates the energy consumption or production of its components and trades electricity in both the day-ahead and real-time markets to minimize its operating cost as a single entity. The bidding problem is challenging due to a variety of uncertainties, including power output of intermittent DG, load variation, day-ahead and real-time market prices. A hybrid stochastic/robust optimization model is proposed to minimize the expected net cost, i.e., expected total costmore » of operation minus total benefit of demand. This formulation can be solved by mixed integer linear programming. The uncertain output of intermittent DG and day-ahead market price are modeled via scenarios based on forecast results, while a robust optimization is proposed to limit the unbalanced power in real-time market taking account of the uncertainty of real-time market price. Numerical simulations on a microgrid consisting of a wind turbine, a PV panel, a fuel cell, a micro-turbine, a diesel generator, a battery and a responsive load show the advantage of stochastic optimization in addition to robust optimization.« less

Bidding strategy for microgrid in day-ahead market based on hybrid stochastic/robust optimization

DOE PAGES

Liu, Guodong; Xu, Yan; Tomsovic, Kevin

2016-01-01

In this paper, we propose an optimal bidding strategy in the day-ahead market of a microgrid consisting of intermittent distributed generation (DG), storage, dispatchable DG and price responsive loads. The microgrid coordinates the energy consumption or production of its components and trades electricity in both the day-ahead and real-time markets to minimize its operating cost as a single entity. The bidding problem is challenging due to a variety of uncertainties, including power output of intermittent DG, load variation, day-ahead and real-time market prices. A hybrid stochastic/robust optimization model is proposed to minimize the expected net cost, i.e., expected total costmore » of operation minus total benefit of demand. This formulation can be solved by mixed integer linear programming. The uncertain output of intermittent DG and day-ahead market price are modeled via scenarios based on forecast results, while a robust optimization is proposed to limit the unbalanced power in real-time market taking account of the uncertainty of real-time market price. Numerical simulations on a microgrid consisting of a wind turbine, a PV panel, a fuel cell, a micro-turbine, a diesel generator, a battery and a responsive load show the advantage of stochastic optimization in addition to robust optimization.« less

Efficient Monte Carlo Estimation of the Expected Value of Sample Information Using Moment Matching.

PubMed

Heath, Anna; Manolopoulou, Ioanna; Baio, Gianluca

2018-02-01

The Expected Value of Sample Information (EVSI) is used to calculate the economic value of a new research strategy. Although this value would be important to both researchers and funders, there are very few practical applications of the EVSI. This is due to computational difficulties associated with calculating the EVSI in practical health economic models using nested simulations. We present an approximation method for the EVSI that is framed in a Bayesian setting and is based on estimating the distribution of the posterior mean of the incremental net benefit across all possible future samples, known as the distribution of the preposterior mean. Specifically, this distribution is estimated using moment matching coupled with simulations that are available for probabilistic sensitivity analysis, which is typically mandatory in health economic evaluations. This novel approximation method is applied to a health economic model that has previously been used to assess the performance of other EVSI estimators and accurately estimates the EVSI. The computational time for this method is competitive with other methods. We have developed a new calculation method for the EVSI which is computationally efficient and accurate. This novel method relies on some additional simulation so can be expensive in models with a large computational cost.

KM3NeT - ORCA: measuring the neutrino mass ordering in the Mediterranean

NASA Astrophysics Data System (ADS)

Kouchner, Antoine

2016-05-01

ORCA (Oscillations Research with Cosmics in the Abyss) is the low-energy branch of KM3NeT, the underwater Cherenkov neutrino detector in the Mediterranean. Its primary goal is to resolve the long-standing unsolved question of the neutrino mass ordering by measuring matter oscillation effects in atmospheric neutrinos. To be deployed at the French KM3NeT site, ORCA’s multi-PMT optical modules will exploit the excellent optical properties of deep seawater to reconstruct cascade and track events with a few GeV of energy. This contribution reviews the methods and technology, and discusses the current expected performances.

A comparison of municipal forest benefits and costs in Modesto and Santa Monica, California, U.S.A

Treesearch

E.G. McPherson; J.R. Simpson

2002-01-01

This paper presents a comparison of the structure, function, and value of street and park tree populations in two California cities. Trees provided net annual benefits valued at $ 2.2 million in Modesto and $805, 732 in Santa Monica. Benefit-cost ratios were 1.85:1 and 1.52:1 in Modesto and Santa Monica, respectively. Residents received $1.85 and $1.52 in annual...

The Role of Jahoda's Latent and Financial Benefits for Work Involvement: A Longitudinal Study

ERIC Educational Resources Information Center

Stiglbauer, Barbara; Batinic, Bernad

2012-01-01

This study examined the role of the latent and financial benefits of work as defined by Marie Jahoda (1982) in explaining a person's work involvement. Drawing upon theoretical frameworks on work commitment and work motivation, the latent benefits were expected to have a positive, whereas the financial benefits were expected to have a negative…

Evaluation of animal control measures on pet demographics in Santa Clara County, California, 1993-2006.

PubMed

Kass, Philip H; Johnson, Karen L; Weng, Hsin-Yi

2013-01-01

The measurable benefits of animal control programs are unknown and the aim of this study was to determine the impact of these programs on pet population changes. A prospective cross-sectional study of 1000 households was implemented in 2005 to evaluate characteristics of the owned and unowned population of dogs and cats in Santa Clara County, California. The same population was previously studied 12 years earlier. During this time period, the county instituted in 1994 and then subsequently disestablished a municipal spay/neuter voucher program for cats. Dog intakes declined from 1992-2005, as they similarly did for an adjacent county (San Mateo). However, cat intakes declined significantly more in Santa Clara County than San Mateo, with an average annual decline of approximately 700 cats for the 12 year period. Time series analysis showed a greater than expected decline in the number of cats surrendered to shelters in Santa Clara County during the years the voucher program was in effect (1994-2005). The net savings to the county by reducing the number of cat shelter intakes was estimated at approximately $1.5 million. The measurable benefits of animal control programs are unknown and the aim of this study was to determine the impact of these programs on pet population changes.

Economic value of angling on the Colorado River at Lees Ferry: Using secondary data to estimate the influence of seasonality

USGS Publications Warehouse

Bair, Lucas S.; Rogowski, David L.; Neher, Christopher

2016-01-01

Glen Canyon Dam (GCD) on the Colorado River in northern Arizona provides water storage, flood control, and power system benefits to approximately 40 million people who rely on water and energy resources in the Colorado River basin. Downstream resources (e.g., angling, whitewater floating) in Glen Canyon National Recreation Area (GCNRA) and Grand Canyon National Park are impacted by the operation of GCD. The GCD Adaptive Management Program was established in 1997 to monitor and research the effects of dam operations on the downstream environment. We utilized secondary survey data and an individual observation travel cost model to estimate the net economic benefit of angling in GCNRA for each season and each type of angler. As expected, the demand for angling decreased with increasing travel cost; the annual value of angling at Lees Ferry totaled US$2.7 million at 2014 visitation levels. Demand for angling was also affected by season, with per-trip values of $210 in the summer, $237 in the spring, $261 in the fall, and $399 in the winter. This information provides insight into the ways in which anglers are potentially impacted by seasonal GCD operations and adaptive management experiments aimed at improving downstream resource conditions.

A "Cap" on Medicaid: How Block Grants, Per Capita Caps, and Capped Allotments Might Fundamentally Change the Safety Net.

PubMed

Mager-Mardeusz, Haleigh; Lenz, Cosima; Kominski, Gerald F

2017-04-01

Changing the Medicaid program is a top priority for the Republican party. Common themes from GOP proposals include converting Medicaid from a jointly financed entitlement benefit to a form of capped federal financing. While proponents of this reform argue that it would provide greater flexibility and a more predictable budget for state governments, serious consequences would likely result for Medicaid enrollees and state governments. Under all three scenarios promoted by Republicans--block grants, capped allotments, and per capita caps—most states would face increased costs. For all three scenarios, the capped nature of the funding guarantees that the real value of funds would decrease in future years relative to what would be expected from growth under the current program. Although the federal government would undoubtedly realize savings from all three scenarios, the impact might lead states to reduce benefits and services, create waiting lists, impose cost-sharing on a traditionally low-income enrollee population, or impose other obstacles to coverage. Nationally, as many as 20.5 million Americans stand to lose coverage under the proposed Medicaid changes. In California, up to 6 million people could lose coverage if changes to the Medicaid program were coupled with the repeal of coverage for the expansion population.

Shifts in Medicaid and Uninsured Payer Mix at Safety-Net and Non-Safety-Net Hospitals During the Great Recession.

PubMed

Fingar, Kathryn R; Coffey, Rosanna M; Mulcahy, Andrew W; Andrews, Roxanne M; Stocks, Carol

2018-01-01

There has been ongoing concern regarding the viability of safety-net hospitals (SNHs), which care for vulnerable populations. The authors examined payer mix at SNHs and non-SNHs during a period covering the Great Recession using data from the 2006 to 2012 Healthcare Cost and Utilization Project State Inpatient Databases from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs. Non-SNHs increasingly served Medicaid-enrolled and uninsured patients; in SNHs, the number of Medicaid stays decreased and uninsured stays remained stable. These study findings suggest that SNHs were losing Medicaid-enrolled patients relative to non-SNHs before the Medicaid expansion under the Affordable Care Act (ACA). Postexpansion, Medicaid stays will likely increase for both SNHs and non-SNHs, but the increase at SNHs may not be as large as expected if competition increases. Because hospital stays with private insurance and Medicaid help SNHs offset uncompensated care, a lower-than-expected increase could affect SNHs' ability to care for the remaining uninsured population. Continued monitoring is needed once post-ACA data become available.

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

Melaina, Marc; Warner, Ethan; Sun, Yongling

The Alternative and Renewable Fuel and Vehicle Technologies Program (ARFVTP) supports a wide range of alternative, low-carbon fuel and vehicle projects in California. This report focuses on two types of ARFVTP benefits. Expected benefits reflect successful deployment of vehicles and fuels supported through program projects. Market transformation benefits represent benefits resulting from project influences on future market conditions to accelerated technology adoption rates. Data collected directly from ARFVTP projects funded from 2009 to first quarter 2014 are used as inputs to the benefits analysis, where possible. Expected benefit estimation methods rely primarily upon project-level data and result in year single-pointmore » estimates within the 2011 to 2025 analysis period. Results suggest that the 178 projects evaluated for expected benefits, representing an investment of $351.3 million in ARFVTP funds, could result in a reduction in petroleum fuel use by 236 million gallons per year and greenhouse gases (GHGs) by 1.7 million metric tonnes carbon dioxide equivalent (MMTCO2e) per year by 2025. Market transformation benefits are described as accruing in addition to expected benefits. They are inherently more uncertain and theoretical than expected benefits, and are therefore reported as high and low ranges, with results suggesting reductions of 1.1 MMTCO2e to 2.5 MMTCO2e per year in GHG reductions and 102 million to 330 million gallons per year in petroleum fuel reductions by 2025. Taking both benefit types into account, results suggest that ARFVTP projects have the potential to make substantial progress toward meeting California's long-term GHG and petroleum fuel use reduction goals. As additional project data become available and market success with alternative and renewable fuels and vehicles grows, the analytic framework relied upon to develop these estimates will become more rigorous and will have a greater capacity to inform future ARFVTP activities.« less

High-school seniors' college enrollment goals: Costs and benefits of ambitious expectations.

PubMed

Villarreal, Brandilynn J; Heckhausen, Jutta; Lessard, Jared; Greenberger, Ellen; Chen, Chuansheng

2015-12-01

High school students with high long-term educational expectations attain higher levels of education than those with lower expectations. Less studied is the role of students' short-term college enrollment expectations for the year after high school graduation. The purpose of the current study was to examine the costs and benefits of ambitious short-term expectations and the impact of falling short of these expectations on mental health, motivation, and educational outcomes. Over 1000 youth with expectations to attend college were surveyed during their senior year of high school, one year later, and four years later. Participants who did not achieve their short-term expectations had lower educational attainment four years later but were not less satisfied with their educational progress. The negative consequences of falling short of one's expectations were restricted to individuals with less ambitious short-term expectations. Thus, the benefits of ambitious short-term expectations for youth may outweigh the costs. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Internet-enabled solutions for health care business problems.

PubMed

Kennedy, R; Geisler, M

1997-01-01

Many health care delivery organizations have built, installed, or made use of Nets. As single entities merge with others, and independent institutions become part of much larger delivery networks, the need for collaboration is critical. With the formation of such partnerships, existing platforms will become increasingly available from which it will be possible to build disparate technologies that must somehow be part of a single working "system." Nets can enable this leveraging, allowing access from multiple technological platforms. The collaboration, distribution, application integration, and messaging possibilities with the Nets are unprecedented. We believe that meeting a health care delivery organization's needs without these benefits will soon be unthinkable. While Nets are not the answer to the challenges facing health care delivery today, they certainly are a large contributor to the solution.

Retrospective cost-effectiveness analyses for polio vaccination in the United States.

PubMed

Thompson, Kimberly M; Tebbens, Radboud J Duintjer

2006-12-01

The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of population and other dynamics, and shows the importance of dynamic modeling.

Economics of Malaria Prevention in US Travelers to West Africa

PubMed Central

Adachi, Kenji; Coleman, Margaret S.; Khan, Nomana; Jentes, Emily S.; Arguin, Paul; Rao, Sowmya R.; LaRocque, Regina C.; Sotir, Mark J.; Brunette, Gary; Ryan, Edward T.; Meltzer, Martin I.

2014-01-01

Background. Pretravel health consultations help international travelers manage travel-related illness risks through education, vaccination, and medication. This study evaluated costs and benefits of that portion of the health consultation associated with malaria prevention provided to US travelers bound for West Africa. Methods. The estimated change in disease risk and associated costs and benefits resulting from traveler adherence to malaria chemoprophylaxis were calculated from 2 perspectives: the healthcare payer's and the traveler's. We used data from the Global TravEpiNet network of US travel clinics that collect de-identified pretravel data for international travelers. Disease risk and chemoprophylaxis effectiveness were estimated from published medical reports. Direct medical costs were obtained from the Nationwide Inpatient Sample and published literature. Results. We analyzed 1029 records from January 2009 to January 2011. Assuming full adherence to chemoprophylaxis regimens, consultations saved healthcare payers a per-traveler average of $14 (9-day trip) to $372 (30-day trip). For travelers, consultations resulted in a range of net cost of $20 (9-day trip) to a net savings of $32 (30-day trip). Differences were mostly driven by risk of malaria in the destination country. Conclusions. Our model suggests that healthcare payers save money for short- and longer-term trips, and that travelers save money for longer trips when travelers adhere to malaria recommendations and prophylactic regimens in West Africa. This is a potential incentive to healthcare payers to offer consistent pretravel preventive care to travelers. This financial benefit complements the medical benefit of reducing the risk of malaria. PMID:24014735

Cost-benefit analysis of prophylactic granulocyte colony-stimulating factor during CHOP antineoplastic therapy for non-Hodgkin's lymphoma.

PubMed

Dranitsaris, G; Altmayer, C; Quirt, I

1997-06-01

Several randomised comparative trials have shown that granulocyte colony-stimulating factor (G-CSF) reduces the duration of neutropenia, hospitalisation and intravenous antibacterial use in patients with cancer who are receiving high-dosage antineoplastic therapy. However, one area that has received less attention is the role of G-CSF in standard-dosage antineoplastic regimens. One such treatment that is considered to have a low potential for inducing fever and neutropenia is the CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) for non-Hodgkin's lymphoma. We conducted a cost-benefit analysis from a societal perspective in order to estimate the net cost or benefit of prophylactic G-CSF in this patient population. This included direct costs for hospitalisation with antibacterial support, as well as indirect societal costs, such as time off work and antineoplastic therapy delays secondary to neutropenia. The findings were then tested by a comprehensive sensitivity analysis. The administration of G-CSF at a dosage of 5 micrograms/kg/day for 11 doses following CHOP resulted in an overall net cost of $Can1257. In the sensitivity analysis, lowering the G-CSF dosage to 2 micrograms/kg/day generated a net benefit of $Can6564, indicating a situation that was cost saving to society. The results of the current study suggest that the use of G-CSF in patients receiving CHOP antineoplastic therapy produces a situation that is close to achieving cost neutrality. However, low-dosage (2 micrograms/kg/day) G-CSF is an economically attractive treatment strategy because it may result in overall savings to society.

SYSTEMS APPROACH TO RECOVERY AND REUSE OF ORGANIC MATERIAL FLOWS IN SANTA BARBARA COUNTY TO EXTRACT MAXIMUM VALUE AND ELIMINATE WASTE

EPA Science Inventory

The goal of the project is to calculate the net social, environmental, and economic benefits of a systems approach to organic waste and resource management in Santa Barbara County. To calculate these benefits, a comparative method was chosen of the proposed desi...

Statistical Match of the VA 1979-1980 Recipient File against the 1979-1980 Basic Grant Recipient File. Revised.

ERIC Educational Resources Information Center

Applied Management Sciences, Inc., Silver Spring, MD.

The amount of misreporting of Veterans Administration (VA) benefits was assessed, along with the impact of misreporting on the Basic Educational Opportunity Grant (BEOG) program. Accurate financial information is need to determine appropriate awards. The analysis revealed: over 97% of VA beneficiaries misreported benefits; the total net loss to…

The High/Scope Perry Preschool Program: Cost-Benefit Analysis Using Data from the Age-40 Followup

ERIC Educational Resources Information Center

Belfield, Clive R.; Nores, Milagros; Barnett, Steve; Schweinhart, Lawrence

2006-01-01

This paper presents an updated cost-benefit analysis of the High/Scope Perry preschool Program, using data on individuals aged 40. Children were randomly assigned to a treatment or control group. Program costs are compared against treatment impacts on educational resources, earnings, criminal activity, and welfare receipt. Net present values are…

Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.

PubMed

Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V

2010-01-01

Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for ceiling values

Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units

PubMed Central

Bernatchez, Stéphanie F.; Ruckly, Stéphane; Timsit, Jean-François

2015-01-01

Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. Intervention Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings. Results The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. Conclusions According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing. Trial Registration This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682). PMID:26086783

Reconciling uncertain costs and benefits in bayes nets for invasive species management

USGS Publications Warehouse

Burgman, M.A.; Wintle, B.A.; Thompson, C.A.; Moilanen, A.; Runge, M.C.; Ben-Haim, Y.

2010-01-01

Bayes nets are used increasingly to characterize environmental systems and formalize probabilistic reasoning to support decision making. These networks treat probabilities as exact quantities. Sensitivity analysis can be used to evaluate the importance of assumptions and parameter estimates. Here, we outline an application of info-gap theory to Bayes nets that evaluates the sensitivity of decisions to possibly large errors in the underlying probability estimates and utilities. We apply it to an example of management and eradication of Red Imported Fire Ants in Southern Queensland, Australia and show how changes in management decisions can be justified when uncertainty is considered. ?? 2009 Society for Risk Analysis.

The National Map: Benefits at what cost?

USGS Publications Warehouse

Halsing, D.L.; Theissen, K.M.; Bernknopf, R.L.

2004-01-01

The U.S. Geological Survey has conducted a cost-benefit analysis of The National Map, and determined that, during its 30-year projected lifespan, the project will likely bring a net present value of benefits to society of $2.05 billion. Such a survey enhances the United States' ability to access, integrate, and apply geospatial data at global, national, and local scales. This paper gives an overview on the underlying economic model for evaluating program benefits and presents the primary findings as well as a sensitivity analysis assessing the robustness of the results.

Calculation of Oyster Benefits with a Bioenergetics Model of the Virginia Oyster

DTIC Science & Technology

2014-11-01

White, M., Powell. E., and Ray, S. (1988). “Effects of parasitism by the pyramidellid gastropod Boonea impressa on the net productivity of oysters...Effects of parasitism by the pyramidellid gastropod Boonea impressa on the net productivity of oysters (Crassostrea viginica),” Estuarine Coastal...Wisconsin Fish Model (Hanson et al. 1997) and was adapted for a model of Atlantic menhaden in Chesapeake Bay (Dalyander and Cerco 2010). Subsequent

Program Benefits Guidance: Analysis of Benefits Associated with Projects and Technologies Supported by the Alternative and Renewable Fuel and Vehicle Technology Program

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

Melaina, Marc; Warner, Ethan; Sun, Yongling

The Alternative and Renewable Fuel and Vehicle Technologies Program (ARFVTP) supports a wide range of alternative, low-carbon fuel and vehicle projects in California. This report focuses on two types of ARFVTP benefits. Expected benefits reflect successful deployment of vehicles and fuels supported through program projects. Market transformation benefits represent benefits resulting from project influences on future market conditions to accelerated technology adoption rates. Data collected directly from ARFVTP projects funded from 2009 to first quarter 2014 are used as inputs to the benefits analysis, where possible. Expected benefit estimation methods rely primarily upon project-level data and result in year single-pointmore » estimates within the 2011 to 2025 analysis period. Results suggest that the 178 projects evaluated for expected benefits, representing an investment of $351.3 million in ARFVTP funds, could result in a reduction in petroleum fuel use by 236 million gallons per year and greenhouse gases (GHGs) by 1.7 million metric tonnes carbon dioxide equivalent (MMTCO2e) per year by 2025. Market transformation benefits are described as accruing in addition to expected benefits. They are inherently more uncertain and theoretical than expected benefits, and are therefore reported as high and low ranges, with results suggesting reductions of 1.1 MMTCO2e to 2.5 MMTCO2e per year in GHG reductions and 102 million to 330 million gallons per year in petroleum fuel reductions by 2025. Taking both benefit types into account, results suggest that ARFVTP projects have the potential to make substantial progress toward meeting California's long-term GHG and petroleum fuel use reduction goals. As additional project data become available and market success with alternative and renewable fuels and vehicles grows, the analytic framework relied upon to develop these estimates will become more rigorous and will have a greater capacity to inform future ARFVTP activities.« less

Model for economic evaluation of high energy gas fracturing

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

Engi, D.

1984-05-01

The HEGF/NPV model has been developed and adapted for interactive microcomputer calculations of the economic consequences of reservoir stimulation by high energy gas fracturing (HEGF) in naturally fractured formations. This model makes use of three individual models: a model of the stimulated reservoir, a model of the gas flow in this reservoir, and a model of the discounted expected net cash flow (net present value, or NPV) associated with the enhanced gas production. Nominal values of the input parameters, based on observed data and reasonable estimates, are used to calculate the initial expected increase in the average daily rate ofmore » production resulting from the Meigs County HEGF stimulation experiment. Agreement with the observed initial increase in rate is good. On the basis of this calculation, production from the Meigs County Well is not expected to be profitable, but the HEGF/NPV model probably provides conservative results. Furthermore, analyses of the sensitivity of the expected NPV to variations in the values of certain reservoir parameters suggest that the use of HEGF stimulation in somewhat more favorable formations is potentially profitable. 6 references, 4 figures, 3 tables.« less

Health effects of adopting low greenhouse gas emission diets in the UK

PubMed Central

Milner, James; Green, Rosemary; Dangour, Alan D; Haines, Andy; Chalabi, Zaid; Spadaro, Joseph; Markandya, Anil; Wilkinson, Paul

2015-01-01

Objective Dietary changes which improve health are also likely to be beneficial for the environment by reducing emissions of greenhouse gases (GHG). However, previous analyses have not accounted for the potential acceptability of low GHG diets to the general public. This study attempted to quantify the health effects associated with adopting low GHG emission diets in the UK. Design Epidemiological modelling study. Setting UK. Participants UK population. Intervention Adoption of diets optimised to achieve the WHO nutritional recommendations and reduce GHG emissions while remaining as close as possible to existing dietary patterns. Main outcome Changes in years of life lost due to coronary heart disease, stroke, several cancers and type II diabetes, quantified using life tables. Results If the average UK dietary intake were optimised to comply with the WHO recommendations, we estimate an incidental reduction of 17% in GHG emissions. Such a dietary pattern would be broadly similar to the current UK average. Our model suggests that it would save almost 7 million years of life lost prematurely in the UK over the next 30 years and increase average life expectancy by over 8 months. Diets that result in additional GHG emission reductions could achieve further net health benefits. For emission reductions greater than 40%, improvements in some health outcomes may decrease and acceptability will diminish. Conclusions There are large potential benefits to health from adopting diets with lower associated GHG emissions in the UK. Most of these benefits can be achieved without drastic changes to existing dietary patterns. However, to reduce emissions by more than 40%, major dietary changes that limit both acceptability and the benefits to health are required. PMID:25929258

Value of Seasonal Fuzzy-based Inflow Prediction in the Jucar River Basin

NASA Astrophysics Data System (ADS)

Pulido-Velazquez, M.; Macian-Sorribes, H.

2016-12-01

The development and application of climate services in Integrated Water Resources Management (IWRM) is said to add important benefits in terms of water use efficiency due to an increase ability to foresee future water availability. A method to evaluate the economic impact of these services is presented, based on the use of hydroeconomic modelling techniques (hydroeconomic simulation) to compare the net benefits from water use in the system with and without the inflow forecasting. The Jucar River Basin (Spain) has been used as case study. Operating rules currently applied in the basin were assessed using fuzzy rule-based (FRB) systems via a co-development process involving the system operators. These operating rules use as input variable the hydrological inflows in several sub-basins, which need to be foreseen by the system operators. The inflow forecasting mechanism to preview water availability in the irrigation season (May-September) relied on fuzzy regression in which future inflows were foreseen based on past inflows and rainfall in the basin. This approach was compared with the current use of the two past year inflows for projecting the future inflow. For each irrigation season, the previewed inflows were determined using both methods and their impact on the system operation assessed through a hydroeconomic DSS. Results show that the implementation of the fuzzy inflow forecasting system offers higher economic returns. Another advantage of the fuzzy approach regards to the uncertainty treatment using fuzzy numbers, which allow us to estimate the uncertainty range of the expected benefits. Consequently, we can use the fuzzy approach to estimate the uncertainty associated with both the prediction and the associated benefits.

Health effects of adopting low greenhouse gas emission diets in the UK.

PubMed

Milner, James; Green, Rosemary; Dangour, Alan D; Haines, Andy; Chalabi, Zaid; Spadaro, Joseph; Markandya, Anil; Wilkinson, Paul

2015-04-30

Dietary changes which improve health are also likely to be beneficial for the environment by reducing emissions of greenhouse gases (GHG). However, previous analyses have not accounted for the potential acceptability of low GHG diets to the general public. This study attempted to quantify the health effects associated with adopting low GHG emission diets in the UK. Epidemiological modelling study. UK. UK population. Adoption of diets optimised to achieve the WHO nutritional recommendations and reduce GHG emissions while remaining as close as possible to existing dietary patterns. Changes in years of life lost due to coronary heart disease, stroke, several cancers and type II diabetes, quantified using life tables. If the average UK dietary intake were optimised to comply with the WHO recommendations, we estimate an incidental reduction of 17% in GHG emissions. Such a dietary pattern would be broadly similar to the current UK average. Our model suggests that it would save almost 7 million years of life lost prematurely in the UK over the next 30 years and increase average life expectancy by over 8 months. Diets that result in additional GHG emission reductions could achieve further net health benefits. For emission reductions greater than 40%, improvements in some health outcomes may decrease and acceptability will diminish. There are large potential benefits to health from adopting diets with lower associated GHG emissions in the UK. Most of these benefits can be achieved without drastic changes to existing dietary patterns. However, to reduce emissions by more than 40%, major dietary changes that limit both acceptability and the benefits to health are required. 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.

Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation).

PubMed

Patti, Giuseppe; Lucerna, Markus; Pecen, Ladislav; Siller-Matula, Jolanta M; Cavallari, Ilaria; Kirchhof, Paulus; De Caterina, Raffaele

2017-07-23

Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1-year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. We accessed individual patients' data from the prospective PREFER in AF (PREvention oF thromboembolic events-European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged ≥85 years, were analyzed. In patients aged <85 years, the incidence of thromboembolic events was 2.8%/year without OAC versus 2.3%/year with OAC (0.5% absolute reduction); in patients aged ≥85 years, it was 6.3%/year versus 4.3%/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on OAC and in those on antiplatelet therapy or without antithrombotic treatment (4.0%/year versus 4.2%/year; P =0.77). OAC was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (-2.19%; CI, -4.23%, -0.15%; P =0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit. Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of OAC is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients. © 2017 The Authors and Daiichi Sankyo Europe GmbH. Published on behalf of the American Heart Association, Inc., by Wiley.

Air quality and exercise-related health benefits from reduced car travel in the midwestern United States.

PubMed

Grabow, Maggie L; Spak, Scott N; Holloway, Tracey; Stone, Brian; Mednick, Adam C; Patz, Jonathan A

2012-01-01

Automobile exhaust contains precursors to ozone and fine particulate matter (PM ≤ 2.5 µm in aerodynamic diameter; PM2.5), posing health risks. Dependency on car commuting also reduces physical fitness opportunities. In this study we sought to quantify benefits from reducing automobile usage for short urban and suburban trips. We simulated census-tract level changes in hourly pollutant concentrations from the elimination of automobile round trips ≤ 8 km in 11 metropolitan areas in the upper midwestern United States using the Community Multiscale Air Quality (CMAQ) model. Next, we estimated annual changes in health outcomes and monetary costs expected from pollution changes using the U.S. Environmental Protection Agency Benefits Mapping Analysis Program (BenMAP). In addition, we used the World Health Organization Health Economic Assessment Tool (HEAT) to calculate benefits of increased physical activity if 50% of short trips were made by bicycle. We estimate that, by eliminating these short automobile trips, annual average urban PM2.5 would decline by 0.1 µg/m3 and that summer ozone (O3) would increase slightly in cities but decline regionally, resulting in net health benefits of $4.94 billion/year [95% confidence interval (CI): $0.2 billion, $13.5 billion), with 25% of PM2.5 and most O3 benefits to populations outside metropolitan areas. Across the study region of approximately 31.3 million people and 37,000 total square miles, mortality would decline by approximately 1,295 deaths/year (95% CI: 912, 1,636) because of improved air quality and increased exercise. Making 50% of short trips by bicycle would yield savings of approximately $3.8 billion/year from avoided mortality and reduced health care costs (95% CI: $2.7 billion, $5.0 billion]. We estimate that the combined benefits of improved air quality and physical fitness would exceed $8 billion/year. Our findings suggest that significant health and economic benefits are possible if bicycling replaces short car trips. Less dependence on automobiles in urban areas would also improve health in downwind rural settings.

Air Quality and Exercise-Related Health Benefits from Reduced Car Travel in the Midwestern United States

PubMed Central

Spak, Scott N.; Holloway, Tracey; Stone, Brian; Mednick, Adam C.; Patz, Jonathan A.

2011-01-01

Background: Automobile exhaust contains precursors to ozone and fine particulate matter (PM ≤ 2.5 µm in aerodynamic diameter; PM2.5), posing health risks. Dependency on car commuting also reduces physical fitness opportunities. Objective: In this study we sought to quantify benefits from reducing automobile usage for short urban and suburban trips. Methods: We simulated census-tract level changes in hourly pollutant concentrations from the elimination of automobile round trips ≤ 8 km in 11 metropolitan areas in the upper midwestern United States using the Community Multiscale Air Quality (CMAQ) model. Next, we estimated annual changes in health outcomes and monetary costs expected from pollution changes using the U.S. Environmental Protection Agency Benefits Mapping Analysis Program (BenMAP). In addition, we used the World Health Organization Health Economic Assessment Tool (HEAT) to calculate benefits of increased physical activity if 50% of short trips were made by bicycle. Results: We estimate that, by eliminating these short automobile trips, annual average urban PM2.5 would decline by 0.1 µg/m3 and that summer ozone (O3) would increase slightly in cities but decline regionally, resulting in net health bene-fits of $4.94 billion/year [95% confidence interval (CI): $0.2 billion, $13.5 billion), with 25% of PM2.5 and most O3 bene-fits to populations outside metropolitan areas. Across the study region of approximately 31.3 million people and 37,000 total square miles, mortality would decline by approximately 1,295 deaths/year (95% CI: 912, 1,636) because of improved air quality and increased exercise. Making 50% of short trips by bicycle would yield savings of approximately $3.8 billion/year from avoided mortality and reduced health care costs (95% CI: $2.7 billion, $5.0 billion]. We estimate that the combined benefits of improved air quality and physical fitness would exceed $8 billion/year. Conclusion: Our findings suggest that significant health and economic benefits are possible if bicycling replaces short car trips. Less dependence on automobiles in urban areas would also improve health in downwind rural settings. PMID:22049372

Comparison of liquid hot water and alkaline pretreatments of giant reed for improved enzymatic digestibility and biogas energy production.

PubMed

Jiang, Danping; Ge, Xumeng; Zhang, Quanguo; Li, Yebo

2016-09-01

Liquid hot water (LHW) and alkaline pretreatments of giant reed biomass were compared in terms of digestibility, methane production, and cost-benefit efficiency for electricity generation via anaerobic digestion with a combined heat and power system. Compared to LHW pretreatment, alkaline pretreatment retained more of the dry matter in giant reed biomass solids due to less severe conditions. Under their optimal conditions, LHW pretreatment (190°C, 15min) and alkaline pretreatment (20g/L of NaOH, 24h) improved glucose yield from giant reed by more than 2-fold, while only the alkaline pretreatment significantly (p<0.05) increased cumulative methane yield (by 63%) over that of untreated biomass (217L/kgVS). LHW pretreatment obtained negative net electrical energy production due to high energy input. Alkaline pretreatment achieved 27% higher net electrical energy production than that of non-pretreatment (3859kJ/kg initial total solids), but alkaline liquor reuse is needed for improved net benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

Successful Implantation of a Left Ventricular Assist Device After Treatment With the Paracor HeartNet.

PubMed

Schweiger, Martin; Stepanenko, Alexander; Potapov, Evgenji; Drews, Thorsten; Hetzer, Roland; Krabatsch, Thomas

2010-01-01

The Paracor HeartNet, a ventricular constraint device for the treatment of heart failure (HF), is implanted through a left lateral thoracotomy. It envelopes the heart like a mesh "bag." This method of application raises the question of whether adhesions with the pericardium allow the safe implantation of a left ventricular assist device (LVAD) if HF worsens. A male patient who had undergone implantation of the Paracor HeartNet 42 months earlier presented with advanced HF for cardiac transplantation. The patient's condition deteriorated, and because no suitable organ for transplantation was available, implantation of an LVAD became necessary. Surgery was performed via a median sternotomy without complications. No severe adhesions were found. This is the first report on "how to do" LVAD implantation after Paracor HeartNet implantation with images and information about cutting the constraint. Because the Paracor HeartNet is "wrapped" around the heart, concerns persist that severe adhesions with the pericardium might occur. In this case, LVAD implantation after therapy with the Paracor HeartNet was without complications, and the expected massive adhesions were absent.

Worth of Geophysical Data in Natural-Disaster-Insurance Rate Setting.

NASA Astrophysics Data System (ADS)

Attanasi, E. D.; Karlinger, M. R.

1982-04-01

Insurance firms that offer natural-disaster insurance base their rates on available information. The benefits from collecting additional data and incorporating this information to improve parameter estimates of probability distributions that are used to characterize natural-disaster events can be determined by computing changes in premiums as a function of additional data. Specifically, the worth of data can be measured by changes in consumer's surplus (the widely applied measure of benefits to consumers used in benefit-cost analysis) brought about when the premiums are adjusted. In this paper, a formal model of the process for setting insurance rates is hypothesized in which the insurance firm sets rates so as to trade off penalties of overestimation and underestimation of expected damages estimated from currently available hydrologic data. A Bayesian preposterior analysis is performed which permits the determination of the expected benefits of collecting additional geophysical data by examining the changes in expected premium rates as a function of the longer record before the data are actually collected. An estimate of the expected benefits associated with collecting more data for the representative consumer is computed using an assumed demand function for insurance. In addition, a sensitivity analysis of expected benefits to changes in insurance demand and firm rate-setting procedures is carried out. From these results, conclusions are drawn regarding aggregate benefits to all flood insurance purchasers.