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Sample records for external costs related

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

    PubMed

    van der Kamp, Jonathan; Bachmann, Till M

    2015-03-03

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

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

    PubMed

    Bachmann, Till M

    2015-08-18

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

  3. Thermodynamic cost of external control

    NASA Astrophysics Data System (ADS)

    Barato, Andre C.; Seifert, Udo

    2017-07-01

    Artificial molecular machines are often driven by the periodic variation of an external parameter. This external control exerts work on the system of which a part can be extracted as output if the system runs against an applied load. Usually, the thermodynamic cost of the process that generates the external control is ignored. Here, we derive a refined second law for such small machines that include this cost, which is, for example, generated by free energy consumption of a chemical reaction that modifies the energy landscape for such a machine. In the limit of irreversible control, this refined second law becomes the standard one. Beyond this ideal limiting case, our analysis shows that due to a new entropic term unexpected regimes can occur: the control work can be smaller than the extracted work and the work required to generate the control can be smaller than this control work. Our general inequalities are illustrated by a paradigmatic three-state system.

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

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

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

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

    PubMed Central

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

    2015-01-01

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

  6. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... costs. 231.205-70 Section 231.205-70 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 231.205-70 External restructuring costs. (a) Scope. This...

  7. External Communities of Practice and Relational Capital

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  8. External Communities of Practice and Relational Capital

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    SciTech Connect

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

    1993-01-01

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

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

    PubMed Central

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

    1989-01-01

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

  11. Incorporating Externalities and Uncertainty into Life-Cycle Cost Analysis

    DTIC Science & Technology

    2012-03-01

    that humanity has a right to a safe and healthy environment and that this right has been surrendered involuntarily due to a lack of oversight of the...also responsible for producing ground- level ozone, which has a number of human health effects, and destroying stratospheric ozone, which protects ...subject to copyright protection in the United States. AFIT/GEM/ENV/12-M02 INCORPORATING EXTERNALITIES AND UNCERTAINTY INTO LIFE-CYCLE COST

  12. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs.

    PubMed

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-07-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO2 and NOx. Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society. The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both the value of statistical life (VSL) and the amended human capital (AHC) approach were applied for external costs estimation, which could provide the upper and lower bound of the external costs due to PM2.5. To fully understand the uncertainty levels, the external cost distribution was determined via Monte Carlo simulation based on the uncertainty of the parameters such as PM2.5 concentration, exposure-response coefficients, and economic cost per case. The results showed that the external costs were equivalent to around 0.3% (AHC, China's guideline: C0 = 35 μg/m(3)) to 0.9% (VSL, WHO guideline: C0 = 10 μg/m(3)) of regional GDP depending on the valuation method and on the assumed baseline PM2.5 concentration (C0). Among all the health impacts, the economic loss due to premature deaths accounted for more than 80% of the overall external costs. The results of this study could help policymakers prioritizing the PM2.5 pollution control interventions and internalize the external costs through the application of economic policy instruments. Copyright © 2017 Elsevier Ltd

  13. Optimum alcohol taxation: balancing consumption and external costs.

    PubMed

    Richardson, J; Crowley, S

    1994-01-01

    This paper considers alternative approaches to the evaluation of the total cost of alcohol consumption in Australia. It calculates the impact of alternative tax rates on beer, wine and spirits separately and the 'consumption cost' of these taxes in terms of the distortion caused to consumption patterns. Two separate analyses are carried out. First optimal taxation is calculated which minimises the total loss from the 'consumption cost' of taxation plus the external cost of alcohol consumption. Secondly, the benefits of life are separated from other benefits and the impact of tax expressed in terms of the cost per life year gained. Conceptualised in this way, the results of this 'tax' program may be expressed in the same way as other health programs, namely as a net cost per life year gained. Alcohol taxation may then be compared with other life saving interventions. The chief conclusion reached is that in Australia there is a very compelling case for a new tax base and for a very significant increase in the rate of alcohol taxation.

  14. Cost-effectiveness of automated external defibrillators on airlines.

    PubMed

    Groeneveld, P W; Kwong, J L; Liu, Y; Rodriguez, A J; Jones, M P; Sanders, G D; Garber, A M

    2001-09-26

    Installation of automated external defibrillators (AEDs) on passenger aircraft has been shown to improve survival of cardiac arrest in that setting, but the cost-effectiveness of such measures has not been proven. To examine the costs and effectiveness of several different options for AED deployment in the US commercial air transportation system. Decision and cost-effectiveness analysis of a strategy of full deployment on all aircraft as well as several strategies of partial deployment only on larger aircraft, compared with a baseline strategy of no AEDs on aircraft (but training flight attendants in basic life support) for a hypothetical cohort of persons experiencing cardiac arrest aboard US commercial aircraft. Estimates for costs and outcomes were obtained from the medical literature, the Federal Aviation Administration, the Air Transport Association of America, a population-based cohort of Medicare patients, AED manufacturers, and the Bureau of Labor Statistics. Quality-adjusted survival after cardiac arrest; costs of AED deployment on aircraft and of medical care for cardiac arrest survivors. Adding AEDs on passenger aircraft with more than 200 passengers would cost $35 300 per quality-adjusted life-year (QALY) gained. Additional AEDs on aircraft with capacities between 100 and 200 persons would cost an additional $40 800 per added QALY compared with deployment on large-capacity aircraft only, and full deployment on all passenger aircraft would cost an additional $94 700 per QALY gained compared with limited deployment on aircraft with capacity greater than 100. Sensitivity analyses indicated that the quality of life, annual mortality rate, and the effectiveness of AEDs in improving survival were the most influential factors in the model. In 85% of Monte Carlo simulations, AED placement on large-capacity aircraft produced cost-effectiveness ratios of less than $50 000 per QALY. The cost-effectiveness of placing AEDs on commercial aircraft compares favorably

  15. Incorporating external evidence in trial-based cost-effectiveness analyses: the use of resampling methods

    PubMed Central

    2014-01-01

    Background Cost-effectiveness analyses (CEAs) that use patient-specific data from a randomized controlled trial (RCT) are popular, yet such CEAs are criticized because they neglect to incorporate evidence external to the trial. A popular method for quantifying uncertainty in a RCT-based CEA is the bootstrap. The objective of the present study was to further expand the bootstrap method of RCT-based CEA for the incorporation of external evidence. Methods We utilize the Bayesian interpretation of the bootstrap and derive the distribution for the cost and effectiveness outcomes after observing the current RCT data and the external evidence. We propose simple modifications of the bootstrap for sampling from such posterior distributions. Results In a proof-of-concept case study, we use data from a clinical trial and incorporate external evidence on the effect size of treatments to illustrate the method in action. Compared to the parametric models of evidence synthesis, the proposed approach requires fewer distributional assumptions, does not require explicit modeling of the relation between external evidence and outcomes of interest, and is generally easier to implement. A drawback of this approach is potential computational inefficiency compared to the parametric Bayesian methods. Conclusions The bootstrap method of RCT-based CEA can be extended to incorporate external evidence, while preserving its appealing features such as no requirement for parametric modeling of cost and effectiveness outcomes. PMID:24888356

  16. Damage control orthopaedics: Variability of construct design for external fixation of the lower extremity and implications on cost.

    PubMed

    Logan, Catherine; Hess, Arthur; Kwon, John Y

    2015-08-01

    To evaluate relative cost of external fixator constructs applied for damage control purposes in a cohort of advanced orthopaedic trainees and orthopaedic staff traumatologists. We also sought to evaluate physicians' understanding of component cost. Participants were asked to apply an external fixator for three separate fracture patterns in damage control fashion. A total of 19 physicians (nine PGY-4 residents, five PGY-5 residents, two orthopaedic trauma fellows and three orthopaedic staff traumatologists) participated. Total construct cost was calculated. Participants provided an estimate of the cost of each component in a fill-in format survey. Main outcome measures included cost of external fixator construct applied and the estimated cost of external fixator components. Average whole sale cost of an external fixator construct was $5252 (±$1798). Of the three fracture types examined, the tibial plafond fracture external fixator construct on average cost the most, followed by the tibial plateau fracture and the femur fracture construct. The large ex-fix combination clamp was the major contributor to cost for each construct. The combination clamp may be substituted for a multi-pin clamp, resulting in significant cost savings. The self-drilling Schanz pin and the large ex-fix combination clamp were most highly underestimated (25% and 22% of their actual cost, respectively). Innumerous construct designs exist and even small changes can significantly impact cost. Knowledge of component cost is low among staff and trainees. Education of component cost is vital to allow adequate consideration of construct design prior to fixator application. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Analysis of usage and associated cost of external fixators at an urban level 1 trauma centre.

    PubMed

    Chaus, George W; Dukes, Chase; Hak, David J; Mauffrey, Cyril; Mark Hammerberg, E

    2014-10-01

    To determine the usage, indication, duration, and cost associated with external fixation usage. Additionally, to show the significant cost associated with external fixator use and reinvigorate discussions on external fixator reuse. A retrospective review of a prospectively gathered trauma database was undertaken to identify all patients treated with external fixation frames for pelvic and lower extremity injuries between September 2007 and July 2010. We noted the indications for frame use, and we determined the average duration of external fixation for each indication. The cost of each frame was calculated from implant records. 341 lower extremity and pelvic fractures were treated with external fixation frames during the study period. Of these, 92% were used as temporary external fixation. The average duration of temporary external fixation was 10.5 days. The cost of external fixation frame components was $670,805 per year. The average cost per external fixation frame was $5900. The majority of external fixators are intended as temporary frames, in place for a limited period of time prior to definitive fixation of skeletal injuries. As such, most frames are not intended to withstand physiologic loads, nor are they expected provide a precise maintenance of reduction. Given the considerable expense associated with external fixation frame components, the practice of purchasing external fixation frame components as disposable "single-use" items appears to be somewhat wasteful. Level II. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    SciTech Connect

    Koomey, J.

    1990-07-01

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

  19. 48 CFR 231.205-70 - External restructuring costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... present value basis, for DoD resulting from the restructuring will exceed either— (A) The costs allowed by... will exceed the costs allowed by a factor of at least two to one on a present value basis. (ii) The... to DoD, and the audited projected savings for DoD will exceed the costs allowed on a present...

  20. Relations between Internalizing and Externalizing Problems in Early Childhood

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  1. Relations between Internalizing and Externalizing Problems in Early Childhood

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  2. External costs of atmospheric Pb emissions: valuation of neurotoxic impacts due to inhalation

    PubMed Central

    2010-01-01

    Background The Impact Pathway Approach (IPA) is an innovative methodology to establish links between emissions, related impacts and monetary estimates. Only few attempts have so far been presented regarding emissions of metals; in this study the external costs of airborne lead (Pb) emissions are assessed using the IPA. Exposure to Pb is known to provoke impacts especially on children's cognition. As cognitive abilities (measured as IQ, intelligence quotient) are known to have implications for lifetime income, a pathway can be established leading from figures for Pb emissions to the implied loss in earnings, and on this basis damage costs per unit of Pb emission can be assessed. Methods Different types of models are here linked. It is relatively straightforward to establish the relationship between Pb emissions and consequent increase in air-Pb concentration, by means of a Gaussian plume dispersion model (OML). The exposed population can then be modelled by linking the OML-output to population data nested in geo-referenced grid cells. Less straightforward is to establish the relationship between exposure to air-Pb concentrations and the resulting blood-Pb concentration. Here an Age-Dependent Biokinetic Model (ADBM) for Pb is applied. On basis of previous research which established links between increases in blood-Pb concentrations during childhood and resulting IQ-loss we arrive at our results. Results External costs of Pb airborne emissions, even at low doses, in our site are in the range of 41-83 €/kg emitted Pb, depending on the considered meteorological year. This estimate applies only to the initial effects of air-Pb, as our study does not address the effects due to the Pb environmental-accumulation and to the subsequent Pb re-exposure. These are likely to be between one and two orders of magnitude higher. Conclusions Biokinetic modelling is a novel tool not previously included when applying the IPA to explore impacts of Pb emissions and related external

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

    PubMed Central

    Yasutaka, Tetsuo; Naito, Wataru; Nakanishi, Junko

    2013-01-01

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

  4. Evaluation of Externality Costs in Life-Cycle Optimization of Municipal Solid Waste Management Systems.

    PubMed

    Martinez-Sanchez, Veronica; Levis, James W; Damgaard, Anders; DeCarolis, Joseph F; Barlaz, Morton A; Astrup, Thomas F

    2017-03-21

    The development of sustainable solid waste management (SWM) systems requires consideration of both economic and environmental impacts. Societal life-cycle costing (S-LCC) provides a quantitative framework to estimate both economic and environmental impacts, by including "budget costs" and "externality costs". Budget costs include market goods and services (economic impact), whereas externality costs include effects outside the economic system (e.g., environmental impact). This study demonstrates the applicability of S-LCC to SWM life-cycle optimization through a case study based on an average suburban U.S. county of 500 000 people generating 320 000 Mg of waste annually. Estimated externality costs are based on emissions of CO2, CH4, N2O, PM2.5, PM10, NOx, SO2, VOC, CO, NH3, Hg, Pb, Cd, Cr (VI), Ni, As, and dioxins. The results indicate that incorporating S-LCC into optimized SWM strategy development encourages the use of a mixed waste material recovery facility with residues going to incineration, and separated organics to anaerobic digestion. Results are sensitive to waste composition, energy mix and recycling rates. Most of the externality costs stem from SO2, NOx, PM2.5, CH4, fossil CO2, and NH3 emissions. S-LCC proved to be a valuable tool for policy analysis, but additional data on key externality costs such as organic compounds emissions to water would improve future analyses.

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

    SciTech Connect

    Nahman, Anton

    2011-09-15

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

  6. Pricing landfill externalities: emissions and disamenity costs in Cape Town, South Africa.

    PubMed

    Nahman, Anton

    2011-01-01

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

  7. Pesticide Environmental Accounting: a method for assessing the external costs of individual pesticide applications.

    PubMed

    Leach, A W; Mumford, J D

    2008-01-01

    The Pesticide Environmental Accounting (PEA) tool provides a monetary estimate of environmental and health impacts per hectare-application for any pesticide. The model combines the Environmental Impact Quotient method and a methodology for absolute estimates of external pesticide costs in UK, USA and Germany. For many countries resources are not available for intensive assessments of external pesticide costs. The model converts external costs of a pesticide in the UK, USA and Germany to Mediterranean countries. Economic and policy applications include estimating impacts of pesticide reduction policies or benefits from technologies replacing pesticides, such as sterile insect technique. The system integrates disparate data and approaches into a single logical method. The assumptions in the system provide transparency and consistency but at the cost of some specificity and precision, a reasonable trade-off for a method that provides both comparative estimates of pesticide impacts and area-based assessments of absolute impacts.

  8. Low-cost alternative external rotation shoulder brace and review of treatment in acute shoulder dislocations.

    PubMed

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

    2015-01-01

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

  9. Study on highway transportation greenhouse effect external cost estimation in China

    NASA Astrophysics Data System (ADS)

    Chu, Chunchao; Pan, Fengming

    2017-03-01

    This paper focuses on estimating highway transportation greenhouse gas emission volume and greenhouse gas external cost in China. At first, composition and characteristics of greenhouse gases were analysed about highway transportation emissions. Secondly, an improved model of emission volume was presented on basis of highway transportation energy consumption, which may be calculated by virtue of main affecting factors such as the annual average operation miles of each type of the motor vehicles and the unit consumption level. the model of emission volume was constructed which considered not only the availability of energy consumption statistics of highway transportation but also the greenhouse gas emission factors of various fuel types issued by IPCC. Finally, the external cost estimation model was established about highway transportation greenhouse gas emission which combined emission volume with the unit external cost of CO2 emissions. An example was executed to confirm presented model which ranged from 2011 to 2015 Year in China. The calculated result shows that the highway transportation total emission volume and greenhouse gas external cost are growing up, but the unit turnover external cost is steadily declining. On the whole overall, the situation is still grim about highway transportation greenhouse gas emission, and the green transportation strategy should be put into effect as soon as possible.

  10. The relative cost of biomass energy transport.

    PubMed

    Searcy, Erin; Flynn, Peter; Ghafoori, Emad; Kumar, Amit

    2007-04-01

    Logistics cost, the cost of moving feedstock or products, is a key component of the overall cost of recovering energy from biomass. In this study, we calculate for small- and large-project sizes, the relative cost of transportation by truck, rail, ship, and pipeline for three biomass feedstocks, by truck and pipeline for ethanol, and by transmission line for electrical power. Distance fixed costs (loading and unloading) and distance variable costs (transport, including power losses during transmission), are calculated for each biomass type and mode of transportation. Costs are normalized to a common basis of a giga Joules of biomass. The relative cost of moving products vs feedstock is an approximate measure of the incentive for location of biomass processing at the source of biomass, rather than at the point of ultimate consumption of produced energy. In general, the cost of transporting biomass is more than the cost of transporting its energy products. The gap in cost for transporting biomass vs power is significantly higher than the incremental cost of building and operating a power plant remote from a transmission grid. The cost of power transmission and ethanol transport by pipeline is highly dependent on scale of project. Transport of ethanol by truck has a lower cost than by pipeline up to capacities of 1800 t/d. The high cost of transshipment to a ship precludes shipping from being an economical mode of transport for distances less than 800 km (woodchips) and 1500 km (baled agricultural residues).

  11. On the Development of Schools' External Public Relations in China.

    ERIC Educational Resources Information Center

    Tianping, Yang

    2003-01-01

    Public relations is a basic function of a modern school's management, while external public relationship is a basic principle and component of it. To develop a school's public relationship, efforts should focus on its key publics, strengthening its coordination and communication with governments, education departments, and local communities.…

  12. On the Development of Schools' External Public Relations in China.

    ERIC Educational Resources Information Center

    Tianping, Yang

    2003-01-01

    Public relations is a basic function of a modern school's management, while external public relationship is a basic principle and component of it. To develop a school's public relationship, efforts should focus on its key publics, strengthening its coordination and communication with governments, education departments, and local communities.…

  13. Assessment of health-cost externalities of air pollution at the national level using the EVA model system

    NASA Astrophysics Data System (ADS)

    Brandt, J.; Frohn, L. M.; Christensen, J. H.; Andersen, M. S.; Hertel, O.; Geels, C.; Buus Hansen, A.; Hansen, K. M.; Hedegaard, G. B.; Skjøth, C. A.

    2009-04-01

    An integrated model system EVA (Economic Valuation of Air pollution) has been developed to assess external costs related to air pollution from individual sources as specific power plants or different emission sectors, as e.g. power production, road traffic, farming etc. The EVA system is based on the impact pathway chain and consists of a regional scale non-linear Eulerian atmospheric transport-chemistry model including detailed emissions inventories (the Danish Eulerian Hemispheric Model, DEHM), address-level or gridded population data, state-of-the-art exposure-response functions and monetary valuation of the impacts from air pollution. The first general assessment of health-cost externalities at the national level using the EVA system is presented here. Health-cost externalities from different emission sectors in Denmark e.g. power production, road traffic, as well as all sectors simultaneously have been calculated. Furthermore, the heath-cost externalities based on emissions from international ship traffic in the Baltic Sea as well as the North Sea have been estimated. Examples of delta functions, human exposure levels and the total costs of impacts from different chemical species are given. The work is partly carried out within the Centre for Energy, Environment and Health (www.CEEH.dk), which is a Danish strategic research centre funded by the Danish Council for Strategic Research. The mission of the centre is to develop a system to support planning of future energy systems in Denmark, where both direct and indirect costs related to environment, climate and health are considered.

  14. The impact of including passive benefits in cost-effectiveness analysis: the case of automated external defibrillators on commercial aircraft.

    PubMed

    Cram, Peter; Vijan, Sandeep; Wolbrink, Alex; Fendrick, A Mark

    2003-01-01

    Traditional cost-utility analysis assumes that all benefits from health-related interventions are captured by the quality-adjusted life-years (QALYs) gained by the few individuals whose outcome is improved by the intervention. However, it is possible that many individuals who do not directly benefit from an intervention receive utility, and therefore QALYs, because of the passive benefit (aka sense of security) provided by the existence of the intervention. The objective of this study was to evaluate the impact that varying quantities of passive benefit have on the cost-effectiveness of airline defibrillator programs. A decision analytic model with Markov processes was constructed to evaluate the cost-effectiveness of defibrillator deployment on domestic commercial passenger aircraft over 1 year. Airline passengers were assigned small incremental utility gains (.001-.01) during an estimated 3-hour flight to evaluate the impact of passive benefit on overall cost-effectiveness. In the base case analysis with no allowance for passive benefit, the cost-effectiveness of airline automated external defibrillator deployment was US dollars 34000 per QALY gained. If 1% of all passengers received utility gain of.01, the cost-effectiveness declined to US dollars 30000. Cost-effectiveness was enhanced when the quantity of passive benefit was raised or the percentage of individuals receiving passive benefit increased. Automated external defibrillator deployment on passenger aircraft is likely to be cost-effective. If a small percentage of airline passengers receive incremental utility gains from passive benefit of automated external defibrillator availability, the impact on overall cost-effectiveness may be substantial. Further research should attempt to clarify the magnitude and percentage of patients who receive passive benefit.

  15. Damage costs produced by electric power plants: an externality valuation in the Mexico City Metropolitan Area.

    PubMed

    Macías, P; Islas, J

    2010-09-15

    This paper presents an estimate of the externalities produced in the Mexico City Metropolitan Area (MCMA) through the impacts on health caused by secondary pollutants attributed to seven electric power plants located outside this area. An original method was developed to make possible a simplified application of the impact pathway approach to estimate the damage costs in the specified area. Our estimate shows that the annual costs attributed to secondary pollutants total 71 million USD (min/max 20/258 million USD). Finally, this paper discusses basic ideas on the implications for energy policy arising from this exercise in externality valuation.

  16. Assessment of Health-Cost Externalities of Air Pollution at the National Level using the EVA Model System

    NASA Astrophysics Data System (ADS)

    Brandt, Jørgen; Silver, Jeremy David; Heile Christensen, Jesper; Skou Andersen, Mikael; Geels, Camilla; Gross, Allan; Buus Hansen, Ayoe; Mantzius Hansen, Kaj; Brandt Hedegaard, Gitte; Ambelas Skjøth, Carsten

    2010-05-01

    Air pollution has significant negative impacts on human health and well-being, which entail substantial economic consequences. We have developed an integrated model system, EVA (External Valuation of Air pollution), to assess health-related economic externalities of air pollution resulting from specific emission sources/sectors. The EVA system was initially developed to assess externalities from power production, but in this study it is extended to evaluate costs at the national level. The EVA system integrates a regional-scale atmospheric chemistry transport model (DEHM), address-level population data, exposure-response functions and monetary values applicable for Danish/European conditions. Traditionally, systems that assess economic costs of health impacts from air pollution assume linear approximations in the source-receptor relationships. However, atmospheric chemistry is non-linear and therefore the uncertainty involved in the linear assumption can be large. The EVA system has been developed to take into account the non-linear processes by using a comprehensive, state-of-the-art chemical transport model when calculating how specific changes to emissions affect air pollution levels and the subsequent impacts on human health and cost. Furthermore, we present a new "tagging" method, developed to examine how specific emission sources influence air pollution levels without assuming linearity of the non-linear behaviour of atmospheric chemistry. This method is more precise than the traditional approach based on taking the difference between two concentration fields. Using the EVA system, we have estimated the total external costs from the main emission sectors in Denmark, representing the ten major SNAP codes. Finally, we assess the impacts and external costs of emissions from international ship traffic around Denmark, since there is a high volume of ship traffic in the region.

  17. Energy cost of balance control during walking decreases with external stabilizer stiffness independent of walking speed.

    PubMed

    Ijmker, Trienke; Houdijk, Han; Lamoth, Claudine J C; Beek, Peter J; van der Woude, Lucas H V

    2013-09-03

    Human walking requires active neuromuscular control to ensure stability in the lateral direction, which inflicts a certain metabolic load. The magnitude of this metabolic load has previously been investigated by means of passive external lateral stabilization via spring-like cords. In the present study, we applied this method to test two hypotheses: (1) the effect of external stabilization on energy cost depends on the stiffness of the stabilizing springs, and (2) the energy cost for balance control, and consequently the effect of external stabilization on energy cost, depends on walking speed. Fourteen healthy young adults walked on a motor driven treadmill without stabilization and with stabilization with four different spring stiffnesses (between 760 and 1820 Nm(-1)) at three walking speeds (70%, 100%, and 130% of preferred speed). Energy cost was calculated from breath-by-breath oxygen consumption. Gait parameters (mean and variability of step width and stride length, and variability of trunk accelerations) were calculated from kinematic data. On average external stabilization led to a decrease in energy cost of 6% (p<0.005) as well as a decrease in step width (24%; p<0.001), step width variability (41%; p<0.001) and variability of medio-lateral trunk acceleration (12.5%; p<0.005). Increasing stabilizer stiffness increased the effects on both energy cost and medio-lateral gait parameters up to a stiffness of 1260 Nm(-1). Contrary to expectations, the effect of stabilization was independent of walking speed (p=0.111). These results show that active lateral stabilization during walking involves an energetic cost, which is independent of walking speed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Commercial Aircraft Maintenance Experience Relating to Engine External Hardware

    NASA Technical Reports Server (NTRS)

    Soditus, Sharon M.

    2006-01-01

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

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

    PubMed

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

    2013-08-01

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

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

    SciTech Connect

    Petruccelli, Umberto

    2015-09-15

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

  1. The assessment of health impacts and external costs of natural gas-fired power plant of Qom.

    PubMed

    Fouladi Fard, Reza; Naddafi, Kazem; Yunesian, Masud; Nabizadeh Nodehi, Ramin; Dehghani, Mohammad Hadi; Hassanvand, Mohammad Sadegh

    2016-10-01

    The external health damage costs of the combined cycle natural gas-fired power plant of Qom were investigated via the simplified impact pathway approach. Emitted particulate matter (PM10) and gaseous pollutants (NO x , CO, and SO2) from the power plant stack were measured The health effects and related costs were estimated by QUERI model from AirPacts according to the emissions, source and stack parameters, pollutant depletion velocities, exposure-response functions, local and regional population density, and detailed meteorological data. The results showed that the main health effect was assigned to the nitrate as restricted activity days (RAD) with 25,240 days/year. For all pollutants, the maximum health damage costs were related to the long-term mortality (49 %), restricted activity days (27 %), and chronic bronchitis (21 %). The annual health damage costs were approximately 4.76 million US$, with the cost being 0.096 US per kWh of generating electricity. Although the health damage costs of gas-fired power plant were lower than those of other heavy fuels, it seems essential to consider the health and environmental damages and focus on the emission control strategies, particularly in site selection for the new power plants and expanding the current ones.

  2. Bar diameter is an important component of knee-spanning external fixator stiffness and cost.

    PubMed

    Kim, Hyunchul; Russell, Joseph P; Hsieh, Adam H; O'Toole, Robert V

    2014-07-01

    The authors' objective was to determine the effects of bar diameter on the stiffness and cost of a knee-spanning external fixator. The authors studied 2 versions of an external fixator with a difference in bar diameter (small bars, 8-mm diameter; large bars, 11-mm diameter). Fixators were tested using frame dimensions and a synthetic fracture model appropriate for a tibial plateau fracture. Five configurations of each fixator were tested: standard, cross-link, oblique pin, double stack, and super construct. The construct stiffness of each configuration (n=60) was measured in anterior-posterior bending, medial-lateral bending, axial torsion, and axial compression. Cost analysis allowed for calculation of the stiffness per unit cost. In the large bar group, an increase in construct stiffness was noted for all constructs and testing modes. Magnitude of stiffness increase ranged from 24% to 224% (P<.05 in all cases), depending on the configuration and loading mode. Increase in stiffness was so large that double-stack small bars performed similarly to standard construct large bars. Considering that the frame components have similar costs, the double-stack small bar fixator results in a 66% increase in cost for the same stiffness provided by the standard large bar. Bar diameter seems to have a large effect on knee-spanning external fixators. The authors observed an increase in stiffness of up to 191% under anterior-posterior bending despite an increase in bar size of only 37.5%. This finding might allow clinicians to use less expensive frames constructed of larger bars without sacrificing construct stiffness. Copyright 2014, SLACK Incorporated.

  3. Improved breast cancer biomarker detection through a simple, high frequency, low cost external proficiency testing program.

    PubMed

    Hung, Tawny; Wolber, Robert; Garratt, John; Kalloger, Steven; Gilks, C Blake

    2010-12-01

    We describe a simple, low cost, high frequency immunohistochemistry external proficiency testing program, and show how its use can lead to improved breast cancer biomarker detection. Over a 30 month period in British Columbia, Canada, we used tissue microarray slides to follow the performance of twelve clinical laboratories in nine separate external proficiency testing runs. Sensitivity for detection of oestrogen receptor (ER), progesterone receptor (PR), and HER2 were calculated for each laboratory, biomarker, and run. Mean sensitivities for detection of ER, PR, and HER2 were 97.1%, 84.8%, and 90.7%, respectively. HER2 sensitivity improved over time, from 87.0% to 92.9% (p=0.04), with a trend towards improvement seen for PR (81.9-88.1%, p=0.13). ER sensitivities were high throughout the test period. Improvements occurred without mandating any specific laboratory changes. This simple, low cost, high frequency external proficiency testing program is highly sustainable and can be implemented in any multi-institutional group or region.

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

    PubMed

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

    2014-03-01

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

  5. Tuberculosis Costs in Spain and Related Factors.

    PubMed

    Gullón, José Antonio; García-García, José María; Villanueva, Manuel Ángel; Álvarez-Navascues, Fernando; Rodrigo, Teresa; Casals, Martí; Anibarro, Luis; García-Clemente, Marta María; Jiménez, María Ángeles; Bustamante, Ana; Penas, Antón; Caminero, José Antonio; Caylà, Joan

    2016-12-01

    To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    SciTech Connect

    Budny, R.; Winfree, R.

    1999-09-27

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

  7. Cost-effectiveness of Automated External Defibrillator Deployment in Selected Public Locations

    PubMed Central

    Cram, Peter; Vijan, Sandeep; Fendrick, A Mark

    2003-01-01

    OBJECTIVE The American Heart Association (AHA) recommends an automated external defibrillator (AED) be considered for a specific location if there is at least a 20% annual probability the device will be used. We sought to evaluate the cost-effectiveness of the AHA recommendation and of AED deployment in selected public locations with known cardiac arrest rates. DESIGN Markov Decision Model employing a societal perspective. SETTING Selected public locations in the United States. PATIENTS A simulated cohort of the American public. INTERVENTION Strategy 1: individuals experiencing cardiac arrest were treated by emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals were treated with AEDs deployed as part of a public access defibrillation program. Strategies differed only in the initial availability of an AED and its impact on cardiac arrest survival. RESULTS Under the base-case assumption that a deployed AED will be used on 1 cardiac arrest every 5 years (20% annual probability of AED use), the cost per quality-adjusted life year (QALY) gained is $30,000 for AED deployment compared with EMS-D care. AED deployment costs less than $50,000 per QALY gained provided that the annual probability of AED use is 12% or greater. Monte Carlo simulation conducted while holding the annual probability of AED use at 20% demonstrated that 87% of the trials had a cost-effectiveness ratio of less than $50,000 per QALY. CONCLUSIONS AED deployment is likely to be cost-effective across a range of public locations. The current AHA guidelines are overly restrictive. Limited expansion of these programs can be justified on clinical and economic grounds. PMID:12950484

  8. Expressing air pollution-induced health-related externalities in physical terms with the help of DALYs.

    PubMed

    Bachmann, Till M; van der Kamp, Jonathan

    2017-06-01

    The unintended impacts of industrial activity on human health and the environment have regularly been assessed and monetised (referred to as "external costs"). External costs are, however, a rather abstract aggregate so that decision makers cannot easily relate them to tangible impacts. At the same time, physical health impact indicators have different units that cannot readily be compared and communicated in a joint way. To support better informed decisions at policy or company level, we propose and demonstrate a way to facilitate communication on non-monetized, that is, physical health indicators quantified in studies. The concept Disability-Adjusted Life Year (DALY) is chosen as metric due to its widespread use. We establish a comprehensive and consistent set of six health endpoints caused by particles and ozone, and derive related up-to-date DALYs. Further we apply the DALY values to a French smart grid demonstration project. Owing to its size, the gains in terms of reduced DALYs are however small. In contrast to external cost assessments, in the frame of which morbidity endpoints usually contribute to around 10-15%, they are found to be insubstantial in the overall DALY score (i.e. below 1%). This is because DALYs only consider time losses weighted by severity while external costs also factor in further welfare effects, i.e. combining resource, disutility and opportunity costs of illness. As a result, methodological limitations, mainly existing for the morbidity-related DALY values, appear to be less of concern. Overall, using the DALYs with and without morbidity impacts is justifiable. Either choice in the communication of health-related physical externalities induces the need to explain the limitations in terms of the treatment of morbidity endpoints (notably their definition and the disability weights used) or their complete disregard. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Online and Offline Printing...Relative Costs.

    ERIC Educational Resources Information Center

    Williams, Brian

    1987-01-01

    Two tables compare projected costs of online versus offline retrieval of citations from 50 databases using BRS and DIALOG. Data include database; databank; cost of access per hour; cost of 15-minute search with no retrieval; and cost of 15-minute search plus cost of 10 and 30 online or offline citations. (CLB)

  10. The Cost Implications in Ontario, Alberta, and British Columbia of Early Versus Delayed External Cephalic Version in the Early External Cephalic Version 2 (EECV2) Trial.

    PubMed

    Ahmed, Rashid J; Gafni, Amiram; Hutton, Eileen K

    2016-03-01

    According to the Early External Cephalic Version (EECV2) Trial, planning external cephalic version (ECV) early in pregnancy results in fewer breech presentations at delivery compared with delayed external cephalic version. A Cochrane review conducted after the EECV2 Trial identified an increase in preterm birth associated with early ECV. We examined whether a policy of routine early ECV (i.e., before 37 weeks' gestation) is more or less costly than a policy of delayed ECV. We undertook this analysis from the perspective of a third-party payer (Ministry of Health). We applied data, using resources reported in the EECV2 Trial, to the Canadian context using 10 hospital unit costs and 17 physician service/procedure unit costs. The data were derived from the provincial health insurance plan schedule of medical benefits in three Canadian provinces (Ontario, Alberta, and British Columbia). The difference in mean total costs between study groups was tested for each province separately. We found that planning early ECV results in higher costs than planning delayed ECV. The mean costs of all physician services/procedures and hospital units for planned ECV compared with delayed ECV were $7997.32 versus $7263.04 in Ontario (P < 0.001), $8162.82 versus $7410.55 in Alberta (P < 0.001), and $8178.92 versus $7417.04 in British Columbia (P < 0.001), respectively. From the perspective of overall cost, our analyses do not support a policy of routinely planning ECV before 37 weeks' gestation. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  11. Stressful life experiences and peer externalizing behaviors mediate the relation between reduced family support and externalizing symptoms in low-income urban youth.

    PubMed

    Davis, Trina M; Wagstaff, Amanda E; Grant, Kathryn E; Taylor, Jeremy A; Carleton, Russell A; Masini, Olivia

    2014-01-01

    Family support, urban stressors, and peer behavior were examined in relation to externalizing symptoms in 605 predominantly low-income urban sixth through eighth grade adolescents. Mother and father support were each associated with lower levels of externalizing symptoms in both males and females. For males, father absence was associated with increased peer externalizing behavior and heightened rates of youth externalizing symptoms. Stress (in the form of major life events, daily hassles, and exposure to violence) and peer externalizing behavior were examined as mediators of the relation between parent support and youth externalizing symptoms. Increased stress exposure mediated the relation between weak mother and father support and youth externalizing symptoms. Additionally, for females, peer externalizing behavior mediated the relation between weak mother support and youth externalizing symptoms.

  12. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... Rules § 413.9 Cost related to patient care. (a) Principle. All payments to providers of services must be... principles relating to specific items of revenue and cost. However, for cost reporting periods beginning...

  13. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... Rules § 413.9 Cost related to patient care. (a) Principle. All payments to providers of services must be... principles relating to specific items of revenue and cost. However, for cost reporting periods beginning...

  14. Cost-effectiveness of In-home Automated External Defibrillators for Individuals at Increased Risk of Sudden Cardiac Death

    PubMed Central

    Cram, Peter; Vijan, Sandeep; Katz, David; Fendrick, A Mark

    2005-01-01

    BACKGROUND/OBJECTIVE In-home automated external defibrillators (AEDs) are increasingly recommended as a means for improving survival of cardiac arrests that occur at home. The current study was conducted to explore the relationship between individuals' risk of cardiac arrest and cost-effectiveness of in-home AED deployment. DESIGN Markov decision model employing a societal perspective. PATIENTS Four hypothetical cohorts of American adults 60 years of age at progressively greater risk for sudden cardiac death (SCD): 1) all adults (annual probability of SCD 0.4%); 2) adults with multiple SCD risk factors (probability 2%); 3) adults with previous myocardial infarction (probability 4%); and 4) adults with ischemic cardiomyopathy unable to receive an implantable defibrillator (probability 6%). INTERVENTION Strategy 1: individuals suffering an in-home cardiac arrest were treated with emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals suffering an in-home cardiac arrest received initial treatment with an in-home AED, followed by EMS. RESULTS Assuming cardiac arrest survival rates of 15% with EMS-D and 30% with AEDs, the cost per quality-adjusted life-year gained (QALY) of providing in-home AEDs to all adults 60 years of age is $216,000. Costs of providing in-home AEDs to adults with multiple risk factors (2% probability of SCD), previous myocardial infarction (4% probability), and ischemic cardiomyopathy (6% probability) are $132,000, $104,000, and $88,000, respectively. CONCLUSIONS The cost-effectiveness of in-home AEDs is intimately linked to individuals' risk of SCD. However, providing in-home AEDs to all adults over age 60 appears relatively expensive. PMID:15836529

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

    PubMed

    Berlin, Mark F; Smith, Tommy H

    2004-01-01

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

  16. Assessment of past, present and future health-cost externalities of air pollution in Europe and the contribution from international ship traffic using the EVA model system

    NASA Astrophysics Data System (ADS)

    Brandt, J.; Silver, J. D.; Christensen, J. H.; Andersen, M. S.; Bønløkke, J. H.; Sigsgaard, T.; Geels, C.; Gross, A.; Hansen, A. B.; Hansen, K. M.; Hedegaard, G. B.; Kaas, E.; Frohn, L. M.

    2013-08-01

    An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North seas, since special regulatory actions on sulfur emissions, called SECA (sulfur emission control area), have been introduced in these areas. We conclude that, despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem for human health. Hence the related external costs are considerable. The total health-related external costs for the whole of Europe are estimated at 803 bn euros yr-1 for the year 2000, decreasing to 537 bn euros yr-1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr-1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulfur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern

  17. 77 FR 36534 - Third External Review Draft Integrated Science Assessment for Ozone and Related Photochemical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... AGENCY Third External Review Draft Integrated Science Assessment for Ozone and Related Photochemical... External Review Draft Integrated Science Assessment for Ozone and Related Photochemical Oxidants'' (EPA/600... Standards (NAAQS) for ozone. EPA is releasing this draft document to seek review by the Clean Air...

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    SciTech Connect

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

    1993-03-01

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

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

    SciTech Connect

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

    1990-10-01

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

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

    PubMed

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

    2016-01-01

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

  3. Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions.

    PubMed

    Reyes, Maria M; Munigala, Satish; Church, Emily L; Kulik, Tobias B; Keyrouz, Salah G; Zipfel, Gregory J; Warren, David K

    2017-05-01

    OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded. METHODS We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions. RESULTS We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio's definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements. CONCLUSIONS The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates. Infect Control Hosp Epidemiol 2017;38:574-579.

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

    PubMed

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Skalická, Vera; Stenseng, Frode; Wichstrøm, Lars

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Skalická, Vera; Stenseng, Frode; Wichstrøm, Lars

    2015-01-01

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

  10. Cost Curves and How They Relate.

    ERIC Educational Resources Information Center

    Mixon, J. Wilson; Tohemy, Soumaya M.

    2002-01-01

    Describes a Web site that contains Microsoft Excel workbooks that draft consistent short-run and long-run cost curves and the text describing them. Details a common error in representing the curves. Reports that the Web site also presents revenues and profits for a price taker and a price maker. (JEH)

  11. Changes in energy cost and total external work of muscles in elite race walkers walking at different speeds.

    PubMed

    Chwała, Wiesław; Klimek, Andrzej; Mirek, Wacław

    2014-12-09

    The aim of the study was to assess energy cost and total external work (total energy) depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers. The study involved 12 competitive race walkers aged 24.9 4.10 years with 6 to 20 years of experience, who achieved a national or international sports level. Their aerobic endurance was determined by means of a direct method involving an incremental exercise test on the treadmill. The participants performed three tests walking each time with one of the three speeds according to the same protocol: an 8-minute walk with at steady speed was followed by a recovery phase until the oxygen debt was repaid. To measure exercise energy cost, an indirect method based on the volume of oxygen uptake was employed. The gait of the participants was recorded using the 3D Vicon opto-electronic motion capture system. Values of changes in potential energy and total kinetic energy in a gate cycle were determined based on vertical displacements of the centre of mass. Changes in mechanical energy amounted to the value of total external work of muscles needed to accelerate and lift the centre of mass during a normalised gait cycle. The values of average energy cost and of total external work standardised to body mass and distance covered calculated for technical speed, threshold and racing speeds turned out to be statistically significant (p 0.001). The total energy cost ranged from 51.2 kJ.m-1 during walking at technical speed to 78.3 kJ.m-1 during walking at a racing speed. Regardless of the type of speed, the total external work of muscles accounted for around 25% of total energy cost in race walking. Total external work mainly increased because of changes in the resultant kinetic energy of the centre of mass movement.

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

    PubMed Central

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

    2013-01-01

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

  13. Managing External Relations: The Lifeblood of Mission Success

    NASA Technical Reports Server (NTRS)

    Dumbacher, Daniel L.

    2007-01-01

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

  14. A Cost/Performance Analysis of Hybrid Inertial/Externally Referenced Positioning/Orientation Systems

    DTIC Science & Technology

    1985-09-01

    externally referenced aids such as the Global Positioning System (GPS) or the U.S. Army’s Position Location Reporting System (PLRS) will result in ...externally referenced aids such as the Global Positioning System (GPS) or the U.S. Army’s Position Location Reporting System (PLRS) will result in ...destruction of the transmitting device. They are also subject to terrain mask•ing and, in the case where they broadcast as well as receive information

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

    PubMed

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

    2010-08-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2015-11-01

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

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

    PubMed

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

    2016-09-01

    In air traffic control (ATC), forgetting to perform deferred actions-prospective memory (PM) errors-can have severe consequences. PM demands can also interfere with ongoing tasks (costs). We examined the extent to which PM errors and costs were reduced in simulated ATC by providing extended practice, or by providing external aids combined with extended practice, or by providing external aids combined with instructions that removed perceived memory requirements. Participants accepted/handed-off aircraft and detected conflicts. For the PM task, participants were required to substitute alternative actions for routine actions when accepting aircraft. In Experiment 1, when no aids were provided, PM errors and costs were not reduced by practice. When aids were provided, costs observed early in practice were eliminated with practice, but residual PM errors remained. Experiment 2 provided more limited practice with aids, but instructions that did not frame the PM task as a "memory" task led to high PM accuracy without costs. Attention-allocation policies that participants set based on expected PM demands were modified as individuals were increasingly exposed to reliable aids, or were given instructions that removed perceived memory requirements. These findings have implications for the design of aids for individuals who monitor multi-item dynamic displays. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

    SciTech Connect

    1996-05-01

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

  20. Alcohol-related genes show an enrichment of associations with a persistent externalizing factor.

    PubMed

    Ashenhurst, James R; Harden, K Paige; Corbin, William R; Fromme, Kim

    2016-10-01

    Research using twins has found that much of the variability in externalizing phenotypes-including alcohol and drug use, impulsive personality traits, risky sex, and property crime-is explained by genetic factors. Nevertheless, identification of specific genes and variants associated with these traits has proven to be difficult, likely because individual differences in externalizing are explained by many genes of small individual effect. Moreover, twin research indicates that heritable variance in externalizing behaviors is mostly shared across the externalizing spectrum rather than specific to any behavior. We use a longitudinal, "deep phenotyping" approach to model a general externalizing factor reflecting persistent engagement in a variety of socially problematic behaviors measured at 11 assessment occasions spanning early adulthood (ages 18 to 28). In an ancestrally homogenous sample of non-Hispanic Whites (N = 337), we then tested for enrichment of associations between the persistent externalizing factor and a set of 3,281 polymorphisms within 104 genes that were previously identified as associated with alcohol-use behaviors. Next, we tested for enrichment among domain-specific factors (e.g., property crime) composed of residual variance not accounted for by the common factor. Significance was determined relative to bootstrapped empirical thresholds derived from permutations of phenotypic data. Results indicated significant enrichment of genetic associations for persistent externalizing, but not for domain-specific factors. Consistent with twin research findings, these results suggest that genetic variants are broadly associated with externalizing behaviors rather than unique to specific behaviors. (PsycINFO Database Record

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

    PubMed Central

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

    2016-01-01

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

  2. RELATIONS BETWEEN PSYCHOPATHY FACETS AND EXTERNALIZING IN A CRIMINAL OFFENDER SAMPLE

    PubMed Central

    Patrick, Christopher J.; Hicks, Brian M.; Krueger, Robert F.; Lang, Alan R.

    2008-01-01

    The construct of psychopathy is viewed as comprising distinctive but correlated affective-interpersonal and social deviance facets. Here, we examined these facets of Hare's Psychopathy Checklist-Revised (PCL-R) in terms of their associations with the externalizing dimension of adult psychopathology, defined as the common factor underlying symptoms of conduct disorder, adult antisocial behavior, alcohol use/abuse, and drug abuse, along with disinhibitory personality traits. Correlational analyses revealed a strong relationship between this externalizing dimension and the social deviance facet of psychopathy (r = .84), and a lesser relationship with the emotional-interpersonal component (r = .44). Structural models controlling for the moderate overlap between the PCL-R factors revealed that externalizing was substantially related to the unique variance in the social deviance features of psychopathy, but unrelated to the unique variance of the emotional and interpersonal features whether modeled together or as separate factors. These results indicate that the social deviance factor of the PCL-R reflects the externalizing dimension of psychopathology, whereas the emotional-interpersonal component taps something distinct aside from externalizing. In addition, based on our finding of an association between PCL-R social deviance and externalizing, we were able to predict new relations between this facet of psychopathy and criterion variables, including nicotine use and gambling, that have previously been linked to externalizing. Implications for future research on the causes and correlates of psychopathy are discussed. PMID:16178678

  3. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... indirectly, significantly to influence or direct the actions or policies of an organization or institution... 42 Public Health 2 2010-10-01 2010-10-01 false Cost to related organizations. 413.17 Section 413... Rules § 413.17 Cost to related organizations. (a) Principle. Except as provided in paragraph (d) of this...

  4. Older people's perceptions of prescription medicine costs and related costs: a pilot study in New Zealand.

    PubMed

    Tordoff, June; Bagge, Michael; Ali, Farina; Ahmed, Samira; Choong, Jie Ning; Fu, Rowena; Joe, Annie; Nishtala, Prasad

    2014-12-01

    Older people tend to take more medicines and prescription medicine costs may influence medicine adherence. The aim of this pilot study was to identify older people's perceptions of prescription medicine costs and related costs in four major cities across New Zealand. A questionnaire was administered to people aged 65 years and older visiting pharmacies in Auckland, Wellington, Christchurch, and Dunedin to identify their perceptions of costs relating to prescription medicines and related pharmacy and general practice services. Data were compared between cities and examined for associations between participants' views on costs and age, sex, income, ethnicity, number of medicines, and monthly cost. Participants (N=107) received a median of five prescription medicines (range 1-15), at a median cost of NZ$8.00 (range 0-55.30). Median part-charges for medicines only partly funded by the government were NZ$6.25 (range 0.60-100.00), and GP consultations ranged from NZ$0-60.00. Of the participants, 89 (83.2%) thought medicine costs and 63 (58.9%) thought GP consultation costs were reasonable. Participants with median monthly medicine costs of NZ$8.33-87.00 more commonly perceived medicines as expensive or very expensive (p=0.001, Fisher's exact test). Older people in this study mostly viewed their prescription medicines and related costs as reasonable; however, 17% and 41%, respectively, found medicines costs and GP consultation costs expensive. Larger, in-depth studies across New Zealand are needed to determine the sections of the population that find these costs expensive, and to explore how this might affect medicine adherence.

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

    NASA Technical Reports Server (NTRS)

    Bowes, M. A.

    1978-01-01

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

  6. Reciprocal Relations Between Harsh Discipline and Children's Externalizing Behavior in China: A 5-Year Longitudinal Study.

    PubMed

    Wang, Meifang; Liu, Li

    2017-02-01

    This research examined the overtime reciprocal relations between maternal and paternal harsh discipline and children's externalizing behavior. Seven hundred two father-mother dyads of children (6-9 years of age at baseline) completed measures of parental harsh discipline and children's externalizing behavior at five time points, 1 year apart. Autoregressive latent trajectory models revealed that maternal and paternal corporal punishment predicted subsequent children's externalizing behavior (parent-driven effects), whereas children's externalizing behavior predicted subsequent maternal and paternal psychological aggression (child-driven effects). The parent-driven effects became stronger, whereas the child-driven effects were equally strong across time. Furthermore, the parent-driven effects for corporal punishment were found for both boys and girls, whereas the child-driven effects for psychological aggression were found only for boys.

  7. Elbow joint stability in relation to forced external rotation: An experimental study of the osseous constraint.

    PubMed

    Deutch, Søren R; Jensen, Steen L; Olsen, Bo S; Sneppen, Otto

    2003-01-01

    The objective of this study was to evaluate the osseous constraint related to forced forearm external rotation as the initial stage in a posterior elbow dislocation. Six joint specimens without soft tissues were examined in a joint analysis system developed for simulation of dislocation. The osseous stability, expressed as the maximal torque needed for pathologic external forearm rotation, increased from varus to valgus stress (P =.0001) and from 10 degrees to 90 degrees of elbow flexion (P =.012) and also tended to increase from forearm supination to pronation. The work of pathologic external forearm rotation until the point of maximal torque decreased from a maximum in full extension to a minimum at 30 degrees of elbow flexion (P =.03). The elbow in a slightly flexed position, varus stress, and forearm external rotation trauma might be the important biomechanical factors in the posterior elbow dislocation, and they might serve as guidelines during clinical investigation for posterolateral instability.

  8. Coparenting Behavior Moderates Longitudinal Relations between Effortful Control and Preschool Children’s Externalizing Behavior

    PubMed Central

    Schoppe-Sullivan, Sarah J.; Weldon, Arielle H.; Cook, J. Claire; Davis, Evan F.; Buckley, Catherine K.

    2010-01-01

    Background Temperamental effortful control involves the voluntary control of attention and behavior. Deficits in effortful control put children at risk for developing externalizing behavior problems. Coparenting behavior, or the extent to which parents support or undermine each other’s parenting efforts, has also been identified as an important correlate of children’s socioemotional adjustment. The present study tested whether coparenting behavior moderated longitudinal relations between preschool children’s effortful control and their externalizing behavior. Methods Ninety-two families (mother, father, 4-year-old child) participated. Parents’ coparenting behavior was observed during family interaction, and children’s effortful control was rated by parents. At that time and one year later, mothers and teachers reported on children’s externalizing behavior. Results Supportive coparenting behavior moderated longitudinal relations between children’s effortful control and mothers’ and teachers’ reports of their externalizing behavior, even when taking into account initial levels of externalizing behavior. Conclusions Effective coparenting served as a buffer for children, such that when parents displayed high levels of supportive coparenting behavior, the link between low effortful control and increases in externalizing behavior was not observed. PMID:19207627

  9. Tightly Linked Systems: Reciprocal Relations Between Maternal Depressive Symptoms And Maternal Reports of Adolescent Externalizing Behavior

    PubMed Central

    Allen, Joseph P.; Manning, Nell; Meyer, Jess

    2010-01-01

    The frequently observed link between maternal depressive symptoms and heightened maternal reporting of adolescent externalizing behavior was examined from an integrative, systems perspective using a community sample of 180 adolescents, their mothers, fathers, and close peers, assessed twice over a three-year period. Consistent with this perspective, the maternal depression-adolescent externalizing link was found to reflect not simply maternal reporting biases, but heightened maternal sensitivity to independently observable teen misbehavior as well as long-term, predictive links between maternal symptoms and teen behavior. Maternal depressive symptoms predicted relative increases over time in teen externalizing behavior. Child effects were also found, however, in which teen externalizing behavior predicted future relative increases in maternal depressive symptoms. Findings are interpreted as revealing a tightly-linked behavioral-affective system in families with mothers experiencing depressive symptoms and teens engaged in externalizing behavior, and further suggest that research on depressive symptoms in women with adolescent offspring should now consider offspring externalizing behaviors as a significant risk factor. PMID:21090880

  10. The hospital costs of treating work-related sawmill injuries in British Columbia.

    PubMed

    Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

    2007-05-01

    This study estimates the hospital costs of treating work-related injury among a cohort of sawmill workers in British Columbia. Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5,876 actively employed sawmill workers. Injury cases were identified as work-related from these records using ICD-9 external cause of injury codes that indicate place of occurrence and the responsibility of payment schedule that identifies workers' compensation as being responsible for payment. The hospitals in British Columbia have a standard ward rate chart prepared annually by the provincial Ministry of Health to bill and collect payment from agency like workers' compensation agency. Costs were calculated from the hospital perspective using this billing chart. All costs were expressed in 1995 Canadian dollars. The workers' compensation claim records for this study population were extracted and matched with the hospitalised work-related injury records. Costs were also calculated for work-related hospitalisations that the hospital did not appear to be reimbursed for by the workers' compensation system. There were 173 injuries requiring hospitalisation during the 10-year followup period. The median stay in hospitals was 3 days and the median hospital costs were $847. The most costly cause of injury categories were fire, flame, natural and environmental and struck against with median costs of $10,575 and $1,206, respectively, while the least costly category was cutting and piercing with median costs of $296. The most costly nature of injury categories were burns and fracture of lower limb with median costs of $10,575 and $1,800, respectively, while the least costly category was dislocation, sprains and strains with median costs of $437. The total hospital costs for all the work-related injuries were $434,990. Out of a total hospital cost of $434,990 for the 173 work-related injuries, the provincial compensation agency apparently did not compensate $50,663 (12

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

    ERIC Educational Resources Information Center

    McGrath, Phyllis S.

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

  12. Standards-Based External Exams and Students' Science-Related Career Expectations: An International Perspective

    ERIC Educational Resources Information Center

    Han, Seong Won

    2016-01-01

    Students' science-related career expectations are important for predicting their future science, technology, engineering, and mathematics (STEM)-related educational and occupational attainments. This study examines the degree to which standards-based external examinations are associated with a student's propensity for pursuing science-related…

  13. Standards-Based External Exams and Students' Science-Related Career Expectations: An International Perspective

    ERIC Educational Resources Information Center

    Han, Seong Won

    2016-01-01

    Students' science-related career expectations are important for predicting their future science, technology, engineering, and mathematics (STEM)-related educational and occupational attainments. This study examines the degree to which standards-based external examinations are associated with a student's propensity for pursuing science-related…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  17. Income-related cost sharing in health insurance.

    PubMed

    Rice, T; Thorpe, K E

    1993-01-01

    The vast majority of health plans in the United States require patients to meet cost-sharing requirements that are unrelated to income. Because this is highly inequitable, the authors propose a new system in which cost sharing is explicitly linked to income levels. This proposal differs from earlier proposals to relate cost sharing to income, which relied on the federal income tax system. In this plan, employers and insurers (both public and private) would collect the information necessary to relate cost sharing amounts to income. The proposal could be applied to nearly any health system reform proposal currently under discussion. The authors examine the experience of a number of U.S. firms that have already incorporated income-related cost sharing, as possible models to apply to health insurance nationwide.

  18. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Cost to related organizations. 413.17 Section 413.17 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  19. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Cost to related organizations. 413.17 Section 413.17 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  20. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Cost to related organizations. 413.17 Section 413.17 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  1. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Cost related to patient care. 413.9 Section 413.9 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  2. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Cost related to patient care. 413.9 Section 413.9 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  3. 42 CFR 413.17 - Cost to related organizations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Cost to related organizations. 413.17 Section 413.17 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Cost related to patient care. 413.9 Section 413.9 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  5. Is the societal approach wide enough to include relatives? Incorporating relatives' costs and effects in a cost-effectiveness analysis.

    PubMed

    Davidson, Thomas; Levin, Lars-Ake

    2010-01-01

    It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives' costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives' costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives' effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives' QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient's QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives' costs and effects. Because cost-effectiveness analyses are used for

  6. Cost control through community relations: A competitive advantage

    SciTech Connect

    Germann, R.; Simmonds, C.

    1994-12-31

    The price tag for the average Superfund cleanup has surpassed $30 million. While focusing on remediation technologies and containment techniques to control costs, many organizations have neglected the real cost driver -- public opinion. This paper examines Superfund Community Relations from the perspective of an organization trying to control costs during a Superfund project. It details the strong correlation between the cost of a site cleanup and the level of public dissatisfaction and provides an organization with specific strategies on how to use proven communications techniques to lower costs. Examination of several case studies is provided including a study involving a Superfund site in which community representatives actively worked to reduce project costs. It is indisputable that any Superfund cleanup must be protective of public health and the environment. But it is becoming increasingly apparent that wise allocation of available resources has a profound effect on the program`s ability to ensure public and environmental safety.

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

    PubMed Central

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

    2008-01-01

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

  8. Suture Button Fixation Versus Syndesmotic Screws in Supination-External Rotation Type 4 Injuries: A Cost-Effectiveness Analysis.

    PubMed

    Neary, Kaitlin C; Mormino, Matthew A; Wang, Hongmei

    2017-01-01

    In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question. This study aimed to examine the cost-effectiveness of the suture button and determine whether suture button fixation is more cost-effective than two 3.5-mm syndesmotic screws not removed on a routine postoperative basis. Economic and decision analysis; Level of evidence, 2. Studies with the highest evidence levels in the available literature were used to estimate the hardware removal and failure rates for syndesmotic screws and suture button fixation. Costs were determined by examining the average costs for patients who underwent surgery for unstable SER IV ankle fractures at a single level-1 trauma institution. A decision analysis model that allowed comparison of the 2 fixation methods was developed. Using a 20% screw hardware removal rate and a 4% suture button hardware removal rate, the total cost for 2 syndesmotic screws was US$20,836 and the total effectiveness was 5.846. This yielded a total cost of $3564 per quality-adjusted life-year (QALY) over an 8-year time period. The total cost for suture button fixation was $19,354 and the total effectiveness was 5.904, resulting in a total cost of $3294 per QALY over the same time period. A sensitivity analysis was then conducted to assess suture button fixation costs as well as screw and suture button hardware removal rates. Other possible treatment scenarios were also examined, including 1 screw and 2 suture buttons for operative fixation of the syndesmosis. To become more cost-effective, the screw hardware removal rate would have to be reduced to less than 10

  9. The Impact of External Environment on Service-Related Decisions of Juvenile Courts.

    ERIC Educational Resources Information Center

    Breda, Carolyn S.

    This report describes outcomes of a survey that investigated the external environment of juvenile courts and whether this environment relates to the treatment of young offenders or custody decisions. In 1997, a statewide survey was administered to all courts with juvenile jurisdiction in a Mid-Southern state. This research was based on 71 courts…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

  15. Integrated Science Assessment (ISA) of Ozone and Related Photochemical Oxidants (Second External Review Draft, Sep 2011)

    EPA Science Inventory

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

  16. Integrated Science Assessment (ISA) of Ozone and Related Photochemical Oxidants (First External Review Draft, Feb 2011)

    EPA Science Inventory

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

  17. Integrated Science Assessment (ISA) of Ozone and Related Photochemical Oxidants (Third External Review Draft, Jun 2012)

    EPA Science Inventory

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

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

    ERIC Educational Resources Information Center

    Ronnlund, Michael; Karlsson, Erika

    2006-01-01

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

  19. The Relations among Maternal Depression, Maternal Criticism, and Adolescents' Externalizing and Internalizing Symptoms.

    ERIC Educational Resources Information Center

    Frye, Alice A.; Garber, Judy

    2005-01-01

    This study examined the relations between maternal criticism and externalizing and internalizing symptoms in adolescents who varied in their risk for psychopathology. Both maternal-effects and child-effects models were examined. The sample consisted of 194 adolescents (mean age = 11.8 years) and their mothers: 146 mothers had a history of…

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

    EPA Science Inventory

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

  1. Integrated Science Assessment (ISA) of Ozone and Related Photochemical Oxidants (Third External Review Draft, Jun 2012)

    EPA Science Inventory

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

  2. Integrated Science Assessment (ISA) of Ozone and Related Photochemical Oxidants (Second External Review Draft, Sep 2011)

    EPA Science Inventory

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

  3. Integrated Science Assessment (ISA) of Ozone and Related Photochemical Oxidants (First External Review Draft, Feb 2011)

    EPA Science Inventory

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

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

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

    PubMed

    Ramachandran, S; Srivastava, Rohit

    2013-05-01

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

  8. Cost of Crashes Related to Road Conditions, United States, 2006

    PubMed Central

    Zaloshnja, Eduard; Miller, Ted R.

    2009-01-01

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

  9. Reciprocal relations between parents' physical discipline and children's externalizing behavior during middle childhood and adolescence.

    PubMed

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

    2011-02-01

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

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

    PubMed

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

    2016-01-01

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

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

    SciTech Connect

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

    1995-07-01

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

  12. Local muscle oxygen consumption related to external and joint specific power.

    PubMed

    Skovereng, Knut; Ettema, Gertjan; van Beekvelt, Mireille

    2016-02-01

    The purpose of the present study was to examine the effects of external work rate on joint specific power and the relationship between knee extension power and vastus lateralis muscle oxygen consumption (mVO2). We measured kinematics and pedal forces and used inverse dynamics to calculate joint power for the hip, knee and ankle joints during an incremental cycling protocol performed by 21 recreational cyclists. Vastus lateralis mVO2 was estimated using near-infrared spectroscopy with an arterial occlusion. The main finding was a non-linear relationship between vastus lateralis mVO2 and external work rate that was characterised by an increase followed by a tendency for a levelling off (R(2)=0.99 and 0.94 for the quadratic and linear models respectively, p<0.05). When comparing 100W and 225W, there was a ∼43W increase in knee extension but still a ∼9% decrease in relative contribution of knee extension to external work rate resulting from a ∼47W increase in hip extension. When vastus lateralis mVO2 was related to knee extension power, the relationship was still non-linear (R(2)=0.99 and 0.97 for the quadratic and linear models respectively, p<0.05). These results demonstrate a non-linear response in mVO2 relative to a change in external work rate. Relating vastus lateralis mVO2 to knee extension power showed a better fit to a linear equation compared to external work rate, but it is not a straight line.

  13. Estimating the mission-related costs of teaching hospitals.

    PubMed

    Koenig, Lane; Dobson, Allen; Ho, Silver; Siegel, Jonathan M; Blumenthal, David; Weissman, Joel S

    2003-01-01

    Academic health centers and other teaching hospitals face higher patient care costs than nonteaching community hospitals face, because of their missions of graduate medical education (GME), biomedical research, and the maintenance of standby capacity for medically complex patients. We estimate that total mission-related costs were dollar 27 billion in 2002 for all teaching hospitals, with GME (including indirect and direct GME) and standby capacity accounting for roughly 60 and 35 percent of these costs, respectively. To assure their continued ability to perform important social missions in a competitive environment, it may be necessary to reassess the way in which these activities are financed.

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

    PubMed Central

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

    2014-01-01

    The move of vertebrates to a terrestrial lifestyle required major adaptations in their locomotory apparatus and reproductive organs. While the fin-to-limb transition has received considerable attention1,2, little is known about the developmental and evolutionary origins of external genitalia. Similarities in gene expression have been interpreted as a potential evolutionary link between the two anatomical structures3-6, yet without providing any underlying developmental mechanism. Here, we have reexamined this question using micro-Computed Tomography (μCT), lineage tracing in three amniote clades and RNA-Seq transcriptional profiling. We show that the developmental origin of external genitalia has shifted through evolution, and in some taxa limbs and genitals share a common primordium. In squamates, the genitalia develop directly from the budding hindlimbs, or the remnants thereof, whereas in mice the genital tubercle originates from the ventral and tail bud mesenchyme. The recruitment of different cell populations for genital outgrowth follows a change in the relative position of the cloaca, the genitalia organizing center. Ectopic grafting of the cloaca demonstrates the conserved ability of different mesenchymal cells to respond to these genitalia-inducing signals. Our results support a limb-like developmental origin of external genitalia as the ancestral condition. Moreover, it suggests that a change in the relative position of the cloacal signaling center during evolution has led to an altered developmental route of external genitalia in mammals, while preserving parts of the ancestral limb molecular circuitry due to a common evolutionary origin. PMID:25383527

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

    PubMed

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

    2014-01-01

    Although behavioral difficulties are well documented in reading disabilities, little is known about the relationship between math ability and internalizing and externalizing behaviors. Here, we use standardized measures to investigate the relation among early math ability, math anxiety, and internalizing and externalizing behaviors in a group of 366 second and third graders. Math achievement was significantly correlated with attentional difficulties and social problems but not with internalizing symptoms. The relation between math achievement and externalizing behavioral problems was stronger in girls than in boys. Math achievement was not correlated with trait anxiety but was negatively correlated with math anxiety. Critically, math anxiety differed significantly between children classified as math learning disabled (MLD), low achieving (LA), and typically developing (TD), with math anxiety significantly higher in the MLD and LA groups compared to the TD group. Our findings suggest that, even in nonclinical samples, math difficulties at the earliest stages of formal math learning are associated with attentional difficulties and domain-specific anxiety. These findings underscore the need for further examination of the shared cognitive, neural, and genetic influences underlying problem solving and nonverbal learning difficulties and accompanying internalizing and externalizing behaviors. © Hammill Institute on Disabilities 2013.

  16. Are externalizing and internalizing difficulties of young children with spelling impairment related to their ADHD symptoms?

    PubMed

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

    2012-08-01

    Children with literacy difficulties often suffer from a variety of co-occurring externalizing and internalizing difficulties, as well as comorbid ADHD. Therefore, these externalizing and internalizing problems might be more related to comorbid ADHD, rather than being a correlate of literacy difficulties per se. In the present study, we investigated the occurrence of externalizing and internalizing difficulties in elementary school children (third grade) with and without spelling impairment. Taking the high rate of comorbidity between literacy difficulties and ADHD into account, we investigated whether co-occurring difficulties are associated with spelling impairment per se or with comorbid ADHD symptoms. Results indicated that these young children with spelling impairment showed more co-occurring difficulties compared with children without spelling impairment. Hierarchical regression analysis indicated that occurrence of externalizing symptoms is more strongly related to comorbid ADHD symptoms than to spelling impairment per se. The pattern of results concerning internalizing problems was not as distinct but showed a similar trend. Preferably, carers and educators should be aware of co-occurring socio-emotional and behavioural problems in children with spelling impairment. Particularly children with spelling impairment and comorbid ADHD symptoms seem to have an increased risk of encountering further co-occurring difficulties.

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    PubMed

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

    2011-03-01

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

  1. Relation between severity of Alzheimer's disease and costs of caring

    PubMed Central

    Hux, M J; O'Brien, B J; Iskedjian, M; Goeree, R; Gagnon, M; Gauthier, S

    1998-01-01

    BACKGROUND: Data from the Canadian Study of Health and Aging (CSHA) were used to examine the relation between severity of Alzheimer's disease, as measured by the Mini-Mental State Examination (MMSE), and costs of caring. METHODS: The CSHA was a community-based survey of the prevalence of dementia, including subtypes such as Alzheimer's disease, among elderly Canadians. Survey subjects with a diagnosis of possible or probable Alzheimer's disease were grouped into disease severity levels of mild (MMSE score 21-26), mild to moderate (MMSE score 15-20), moderate (MMSE score 10-14) and severe (MMSE score below 10). Components of care available from the CSHA were use of nursing home care, use of medications, use of community support services by caregivers and unpaid caregiver time. Costs were calculated from a societal perspective and are expressed in 1996 Canadian dollars. RESULTS: The annual societal cost of care per patient increased significantly with severity of Alzheimer's disease. The cost per patient was estimated to be $9451 for mild disease, $16,054 for mild to moderate disease, $25,724 for moderate disease and $36,794 for severe disease. Institutionalization was the largest component of cost, accounting for as much as 84% of the cost for people with severe disease. For subjects living in the community, unpaid caregiver time and use of community services were the greatest components of cost and increased with disease severity. INTERPRETATION: The societal cost of care of Alzheimer's disease increases drastically with increasing disease severity. Institutionalization is responsible for the largest cost component. PMID:9757169

  2. Relation between severity of Alzheimer's disease and costs of caring.

    PubMed

    Hux, M J; O'Brien, B J; Iskedjian, M; Goeree, R; Gagnon, M; Gauthier, S

    1998-09-08

    Data from the Canadian Study of Health and Aging (CSHA) were used to examine the relation between severity of Alzheimer's disease, as measured by the Mini-Mental State Examination (MMSE), and costs of caring. The CSHA was a community-based survey of the prevalence of dementia, including subtypes such as Alzheimer's disease, among elderly Canadians. Survey subjects with a diagnosis of possible or probable Alzheimer's disease were grouped into disease severity levels of mild (MMSE score 21-26), mild to moderate (MMSE score 15-20), moderate (MMSE score 10-14) and severe (MMSE score below 10). Components of care available from the CSHA were use of nursing home care, use of medications, use of community support services by caregivers and unpaid caregiver time. Costs were calculated from a societal perspective and are expressed in 1996 Canadian dollars. The annual societal cost of care per patient increased significantly with severity of Alzheimer's disease. The cost per patient was estimated to be $9451 for mild disease, $16,054 for mild to moderate disease, $25,724 for moderate disease and $36,794 for severe disease. Institutionalization was the largest component of cost, accounting for as much as 84% of the cost for people with severe disease. For subjects living in the community, unpaid caregiver time and use of community services were the greatest components of cost and increased with disease severity. The societal cost of care of Alzheimer's disease increases drastically with increasing disease severity. Institutionalization is responsible for the largest cost component.

  3. The Longitudinal Relation Between Academic/Cognitive Skills and Externalizing Behavior Problems in Preschool Children

    PubMed Central

    Metcalfe, Lindsay A.; Harvey, Elizabeth A.; Laws, Holly B.

    2013-01-01

    Objective Existing research suggests that there is a relation between academic/cognitive deficits and externalizing behavior in young children, but the direction of this relation is unclear. The present study tested competing models of the relation between academic/cognitive functioning and behavior problems during early childhood Method Participants were 221 children (120 boys, 101 girls) who participated in a longitudinal study from age 3 to 6 Results A reciprocal relation (Model 3) was observed only between inattention and academic achievement; this relation remained controlling for SES and family stress. The relation between inattention and cognitive ability was consistent with Model 1 (cognitive skills predicting later inattention) with controls. For hyperactivity and aggression, there was some support for Model 2 (early behavior predicting later academic/cognitive ability), but this model was no longer supported when controlling for family functioning. Conclusion These results suggest that the relation between academic achievement/cognitive ability and externalizing problems may be driven primarily by inattention. These results also suggest that this relation is evident early in development, highlighting the need for early assessment and intervention. PMID:24039280

  4. The male bulbospongiosus muscle and its relation to the external anal sphincter.

    PubMed

    Peikert, Kevin; Platzek, Ivan; Bessède, Thomas; May, Christian Albrecht

    2015-04-01

    The bulbospongiosus muscle is part of the superficial muscular layer of the perineum and pelvic floor. Its morphology remains controversial in the literature. Therefore, we reinvestigated the fascial arrangement and fiber courses of the bulbospongiosus muscle and its topographical relation to the external anal sphincter. The perineum was dissected in 9 male cadavers (mean ± SD age 78.3 ± 10.7 years). Select samples were obtained for histology and immunohistochemistry. In 43 patients (mean age 60.7 ± 12 years) the topographical relation between the bulbospongiosus muscle and the external anal sphincter was determined by magnetic resonance imaging. The perineum contains several fascial layers consisting of elastic and collagen fibers as well as bundles of smooth muscle cells. The bulbospongiosus muscle was subdivided into a ventral and dorsal portion, which developed in 4 variants. The ventral insertion formed a morphological unity with the ischiocavernous muscle while the dorsal origin had a variable relation to the external anal sphincter (5 variants). A muscle-like or connective tissue-like connection was frequently present between the muscles. However, in some cases the muscles were completely separated. We suggest a concept of variations of bulbospongiosus muscle morphology that unifies the conflicting literature. Its ventral fiber group and the ischiocavernosus muscle form a functional and morphological unity. While the bulbospongiosus muscle and the external anal sphincter remain independent muscles, their frequent connection might have clinical implications for perineal surgery and anogenital disorders. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2009-01-01

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

  6. Energy density, energy costs and income - how are they related?

    PubMed

    Waterlander, Wilma E; de Haas, Wendy E; van Amstel, Inge; Schuit, Albertine J; Twisk, Jos W R; Visser, Marjolein; Seidell, Jacob C; Steenhuis, Ingrid H M

    2010-10-01

    To examine the association between energy density and energy costs in single food items and composed diets, and to explore differences in energy density and energy cost between income levels. A cross-sectional study using data from two Dutch cohort studies and recent national food prices. Food prices were retrieved from two market leader supermarkets. Data on dietary intake were measured using a computerized face-to-face interview (cohort 1) and 24 h recalls (cohort 2). The Netherlands. A sample of 373 young adults from the Amsterdam Growth and Health Longitudinal Study (AGHLS, measured in 2000) and a sample of 200 community-dwelling elderly from the Longitudinal Ageing Study Amsterdam (LASA, measured in 2007). We found significant inverse associations between energy density and energy costs in single food items (r = -0.436, P < 0.01) and composed diets (AGHLS men r = -0.505, women r = -0.413, P < 0.001; LASA men r = -0.559, women r = -0.562, P < 0.001). Furthermore, we found that people stratified into higher energy density quartiles consumed significantly more energy per day, less fruits and vegetables, and had significantly lower diet costs. Explorative analyses on income did not reveal significant differences regarding energy density, costs, or fruit and vegetable intake. In the Netherlands also, energy density was inversely related with energy costs, implying that healthier diets cost more. However, we could not find differences in energy density or costs between income levels. Future research, using precise food expenditures, is of main importance in studying the economics of obesity and in the aim of making the healthier choice easier.

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

    NASA Astrophysics Data System (ADS)

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

    2011-01-01

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

  8. Pricing Medicare's diagnosis-related groups: Charges versus estimated costs

    PubMed Central

    Price, Kurt F.

    1989-01-01

    Hospital payments under Medicare's prospective payment system (PPS) are based on prices established for 474 diagnosis-related groups (DRG's). Previous analyses using 1981 data demonstrated that DRG prices based on charges alone were not that different from prices calculated from estimated costs. Data for 1986 were used in this study to show that the differences between the two sets of DRG prices are much larger than previously reported. If DRG prices were once again based on estimated costs instead of the current charge-based prices, payments would be significantly redistributed. PMID:10313356

  9. [Cost of an intraperitoneal chemohyperthermia (IPCH) related to cytoreductive surgery].

    PubMed

    Bonastre, J; Jan, P; de Pouvourville, G; Pocard, M; Estphan, G; Elias, D

    2005-10-01

    A complete cytoreductive surgery followed with an intraperitoneal chemohyperthermia (IPCH) is a new treatment allowing curing some patients with a peritoneal carcinomatosis. The cost of this treatment, evaluated in different countries, is high. In France, we do not have any cost evaluation of this therapy, and this state slows its diffusion in our country. The aim of this study is to evaluate the real cost of maximal cytoreductive surgery with IPCH, and to compare it with the financial support given by the Ministery of Health. The real cost of this therapy was established on the standard analytic accountancy of our Institute. The analysis of the financial support received was done after the classification of the patients in the current official diagnosis-related groups, and according to the current rates of reimbursing of these acts. Seventy-three patients were treated with IPCH in our Institute during 2002 and 2003. The real mean cost for our hospital was 39,358 euros per patient, with a mean hospital staying of 27.7 days. In counterpart, our hospital received a mean financial support of 20,485 euros, resulting in a deficit of 18,873 euros per patient (and close to 1.4 million of euros for the two years). Our current classification of diagnosis-related groups does not allow to describe the real importance of this therapy which combines a maximal cytoreductive surgery with IPCH. In our system of reimbursing, the hospital which offers this type of new therapy to its patients receives only half of the real rate. Two correctives measures are suitable: to describe this combining treatment in the official list of medical acts, and to determine its specific cost for reimbursing.

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

    PubMed

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

    2016-09-01

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

  11. Developmental cascades of peer relations and symptoms of externalizing and internalizing problems from kindergarten to fourth-grade elementary school.

    PubMed

    van Lier, Pol A C; Koot, Hans M

    2010-08-01

    A developmental cascade model linking symptoms of externalizing and internalizing psychopathology through three indices of peer relational difficulty (peer rejection, peer victimization, friendedness) was tested in a general population sample of 653 children followed annually from kindergarten to fourth grade. Rejection and victimization linked kindergarten externalizing problems with fourth-grade internalizing problems. Transactional links between rejection and victimization were found. In addition, peer rejection added to the development of externalizing problems. Friendedness did not add to the development of externalizing or internalizing problems. Cascade paths were similar for boys and girls. Over the period of kindergarten to fourth grade, psychopathology and peer relations become entangled, and the dynamic interplay between multiple manifestations of poor peer relations ultimately adds to the development of both externalizing and internalizing problems and their cross-time relation. Implications for research and prevention are discussed.

  12. External causes of pediatric injury-related emergency department visits in the United States.

    PubMed

    Simon, Tamara D; Bublitz, Caroline; Hambidge, Simon J

    2004-10-01

    To characterize the types and external causes of pediatric injury-related visits (IRVs) to emergency departments (EDs), in particular, sports-related injuries. To compare the characteristics of children with IRVs with those with non-IRVs, specifically, differences in IRV rates by race and ethnicity and by health insurance. This was a stratified random-sample survey of EDs in the National Hospital Ambulatory Medical Care Survey (NHAMCS), including all IRVs for patients less than 19 years of age in 1998 (n = 2,656). National estimates of pediatric IRVs were obtained using the assigned patient visit weights in the NHAMCS databases and SUDAAN analyses. Measures of association between predictor variables (patient and health insurance characteristics) and whether a child had an IRV were calculated using multivariate logistic regression analyses to determine adjusted odds ratios with 95% confidence intervals. Pediatric IRVs accounted for more than 11 million ED visits annually. The most common diagnoses for IRVs were open wounds, contusions, sprains and strains, and fractures and dislocations. The leading external causes of IRVs were sports-related injuries, accidental falls, being struck by objects, and motor vehicle collisions. Children with IRVs differed from those who presented for non-IRVs in many characteristics: they were more likely to be male, to be older, to be of white race, and to have private insurance, and less likely to be of Asian or Hispanic ethnicity. Sports and recreation are the leading external causes of pediatric IRVs to EDs in the United States. There are different patterns of IRVs according to gender, age, race, ethnicity, and insurance. Identification of specific patterns of injury is necessary for the design of effective prevention strategies.

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

    NASA Astrophysics Data System (ADS)

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

    2014-02-01

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

  14. The Differential Relations Between Empathy and Internalizing and Externalizing Symptoms in Inpatient Adolescents.

    PubMed

    Gambin, Malgorzata; Sharp, Carla

    2016-12-01

    Impaired empathy is associated with a variety of psychiatric conditions; however, little is known about the differential relations between certain forms of psychopathology and cognitive and affective empathy in adolescent girls and boys. The aim of this study was to examine the relations between externalizing and internalizing disorders and cognitive and affective empathy, respectively, while controlling for covariance among different forms of psychopathology, separately in girls and boys. A total of 507 inpatient adolescents (319 girls and 188 boys) in the age range of 12-17 years completed the Basic Empathy Scale that measures affective and cognitive empathy. The Youth Self-Report Form and Child Behavior Checklist were used to assess the severity of psychopathological symptoms. Results demonstrated that affective and cognitive empathy were negatively associated with conduct problems only in girls, but not in boys. Affective empathy was positively related to internalizing problems observed by parents and youths and self-reported ADHD symptoms in girls and boys. The clinical implications of these differential relationships for externalizing versus internalizing symptoms and empathy are discussed.

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

    PubMed

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

    2016-01-01

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

  16. Assessment of Past, Present and Future Health-Cost Ex-ternalities of Air Pollution in Europe and the contribution from International Ship Traffic using the EVA Model System

    NASA Astrophysics Data System (ADS)

    Brandt, Jørgen; Silver, Jeremy D.; Christensen, Jesper H.; Andersen, Mikael S.; Bønløkke, Jakob H.; Sigsgaard, Torben; Geels, Camilla; Gross, Allan; Hansen, Ayoe B.; Hansen, Kaj M.; Hedegaard, Gitte B.; Kaas, Eigil; Frohn, Lise M.

    2013-04-01

    An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North Seas, since special regulatory actions on sulphur emissions, called SECA (sulphur emission control area), have been intro-duced in these areas,. We conclude that despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem to human health, hence the related external costs are considerable. The total health-related external costs for the whole of Europe is estimated at 803 bn Euro/year for the year 2000, decreasing to 537 bn Euro/year in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680,000/year, decreasing to approximately 450,000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulphur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern

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

    PubMed

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

    2017-05-01

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

  18. Using Dominance Analysis to Decompose Narcissism and Its Relation to Aggression and Externalizing Outcomes.

    PubMed

    Vize, Colin E; Collison, Katherine L; Crowe, Michael L; Campbell, W Keith; Miller, Joshua D; Lynam, Donald R

    2017-01-01

    Research on narcissism has shown it to be multidimensional construct. As such, the relations the larger construct bear with certain outcomes may mask heterogeneity apparent at the more basic trait level. This article used the Five Factor Narcissism Inventory, a Five-Factor Model-based measure of narcissism that allows for multiple levels of analysis, to examine the relative importance of narcissistic traits in relation to aggression, externalizing behavior, and self-esteem outcomes in two independent samples. The relative importance of the narcissism factors was determined through the use of dominance analysis-a relatively underused method for determining relative importance among a set of related predictors. The results showed that antagonism, compared with agentic extraversion and neuroticism, was the dominant predictor across all forms of aggressive behavior. Additional analyses showed that subscales within the broader factor of antagonism also showed differential importance relative to one another for certain aggression outcomes. The results are discussed in the context of the relation between narcissism and aggression and highlight the utility of using extensions of regression-based analyses to explore the heterogeneity within personality constructs.

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

    PubMed Central

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

    1988-01-01

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

  20. Methamphetamine-related emergency department utilization and cost.

    PubMed

    Hendrickson, Robert G; Cloutier, Robert; McConnell, K John

    2008-01-01

    To quantify the frequency, cost, and characteristics associated with emergency department (ED) visits that are related to methamphetamine use. This was a prospective observational study. The authors performed a training program for ED clinicians on the acute and chronic effects of methamphetamine and the signs of methamphetamine abuse. A standardized two question survey was administered to clinicians concerning the relationship between the ED visit and the patient's methamphetamine use. The survey was embedded in the patient tracking system and was required for all ED patients before disposition. Survey results were merged with administrative data on demographics, diagnosis, disposition, and charges. Univariate analyses were used to determine patient characteristics associated with methamphetamine-related ED visits. The authors examined 15,038 ED visits over a 20-week period from February 2006 to June 2006. There were a total of 353 methamphetamine-related visits, for an average of 17.65 visits per week (2.4% of all visits). Hospital charges for methamphetamine-related ED visits averaged $133,181 per week, for an estimated total of $6.9 M in annual charges. Methamphetamine-related ED patients were more likely to be male (odds ratio [OR] 1.6, 95% confidence interval [CI] = 1.30 to 2.01), white (OR 1.8, 95% CI = 1.38 to 2.29), and uninsured (OR 3.2, 95% CI = 2.21 to 4.69). The top four medical conditions associated with methamphetamine-related visits were mental health (18.7%), trauma (18.4%), skin infections (11.1%), and dental diagnoses (9.6%). Methamphetamine abuse accounts for a modest but substantial proportion of ED utilization and hospital cost. Methamphetamine-related ED visits are most commonly related to mental illness, trauma, skin, and dental-related problems.

  1. The cost of work-related physical assaults in Minnesota.

    PubMed Central

    McGovern, P; Kochevar, L; Lohman, W; Zaidman, B; Gerberich, S G; Nyman, J; Findorff-Dennis, M

    2000-01-01

    OBJECTIVE: To describe the long-term productivity costs of occupational assaults. DATA SOURCES/STUDY SETTING: All incidents of physical assaults that resulted in indemnity payments, identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees, and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringe benefits and household production losses were imputed. STUDY DESIGN: The human capital approach was used to describe the long-term costs of occupational assaults. Economic software was used to apply a modified version of Rice, MacKenzie, and Associates' (1989) model for estimating the present value of past losses from 1992 through 1995 for all cases, and the future losses for cases open in 1996. PRINCIPAL FINDINGS: The total costs for 344 nonfatal work-related assaults were estimated at $5,885,448 (1996 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $19,251 per case; $38 per employee), social service (incidence: 127/100,000; $24,210 per case; $31 per employee), and health care (incidence: 76/100,000; $13,197 per case; $10 per employee). CONCLUSIONS: Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates can serve as the basis for business calculations on the potential value of risk management interventions. PMID:10966089

  2. The development of personality extremity from childhood to adolescence: relations to internalizing and externalizing problems.

    PubMed

    Van den Akker, Alithe L; Prinzie, Peter; Deković, Maja; De Haan, Amaranta D; Asscher, Jessica J; Widiger, Thomas

    2013-12-01

    This study investigated the development of personality extremity (deviation of an average midpoint of all 5 personality dimensions together) across childhood and adolescence, as well as relations between personality extremity and adjustment problems. For 598 children (mean age at Time 1 = 7.5 years), mothers and fathers reported the Big Five personality dimensions 4 times across 8 years. Children's vector length in a 5-dimensional configuration of the Big Five dimensions represented personality extremity. Mothers, fathers, and teachers reported children's internalizing and externalizing problems at the 1st and final measurement. In a cohort-sequential design, we modeled personality extremity in children and adolescents from ages 6 to 17 years. Growth mixture modeling revealed a similar solution for both mother and father reports: a large group with relatively short vectors that were stable over time (mother reports: 80.3%; father reports: 84.7%) and 2 smaller groups with relatively long vectors (i.e., extreme personality configuration). One group started out relatively extreme and decreased over time (mother reports: 13.2%; father reports: 10.4%), whereas the other group started out only slightly higher than the short vector group but increased across time (mother reports: 6.5%; father reports: 4.9%). Children who belonged to the increasingly extreme class experienced more internalizing and externalizing problems in late adolescence, controlling for previous levels of adjustment problems and the Big Five personality dimensions. Personality extremity may be important to consider when identifying children at risk for adjustment problems. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  3. Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer.

    PubMed

    McGuffin, M; Merino, T; Keller, B; Pignol, J-P

    2017-03-01

    Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  4. Balancing yield, kinetics and cost for three external carbon sources used for suspended growth post-denitrification.

    PubMed

    Mokhayeri, Y; Riffat, R; Murthy, S; Bailey, W; Takacs, I; Bott, C

    2009-01-01

    Facilities across North America are designing plants to meet stringent limit of technology (LOT) treatment for nitrogen removal. In the Mid-Atlantic region of the United States, this is in response to the Chesapeake Bay Agreement, which limit effluent total nitrogen discharges from wastewater treatment plants to between 3-5 mg/L. Since denitrification is crucial for the removal of nitrogen, maximizing this process step will result in a decrease in nutrient load to the receiving waters. Of particular interest is the use of an alternate external carbon source to replace the most commonly used carbon, methanol. Three external carbon sources were evaluated in this study including: methanol, ethanol and acetate at 13 degrees C. The aim of this study was to evaluate the relative benefits and constraints for using these three carbon types. Laboratory scale Sequencing Batch Reactors (SBRs) were set up to grow and acclimate carbon free biomass to the specified substrate while in-situ Specific Denitrification Rates (SDNRs) were conducted concurrently. The results suggest that the SDNRs for acetate (31.0 + or - 4.6 mgNO(3)-N/gVSS/hr) and ethanol (29.6 + or - 5.6 mgNO(3)-N/gVSS/hr) are higher than that for methanol (10.1 + or - 2.5 mgNO(3)-N/gVSS/hr). The yield coefficients in g COD/g COD were observed to follow a similar trend with values of 0.45 + or - 0.05 for methanol, 0.53 + or - 0.06 for ethanol and 0.66 + or - 0.06 for acetate.

  5. Mechanisms in the relation between GABRA2 and adolescent externalizing problems.

    PubMed

    Wang, Frances L; Chassin, Laurie; Geiser, Christian; Lemery-Chalfant, Kathryn

    2016-01-01

    Conduct problems, alcohol problems and hyperactive-inattentive symptoms co-occur at a high rate and are heritable in adolescence. The γ-aminobutyric acid A receptor, α2 gene (GABRA2) is associated with a broad spectrum of externalizing problems and disinhibitory-related traits. The current study tested whether two important forms of disinhibition in adolescence, impulsivity and sensation seeking, mediated the effects of GABRA2 on hyperactive-inattentive symptoms, conduct problems, and alcohol problems. Participants were assessed at two waves (11-17 and 12-18 years old; N = 292). Analyses used the GABRA2 SNP, rs279858, which tags the two complementary (yin-yang) GABRA2 haplotypes. Multiple informants reported on adolescents' impulsivity and sensation seeking and adolescents self-reported their hyperactive-inattentive symptoms, conduct problems and lifetime alcohol problems. Impulsivity mediated the effect of GABRA2 on alcohol problems, hyperactive-inattentive symptoms, and conduct problems, whereas sensation seeking mediated the effect of GABRA2 on alcohol problems (AA/AG genotypes conferred risk). GABRA2 directly predicted adolescent alcohol problems, but the GG genotype conferred risk. Results suggest that there may be multiple pathways of risk from GABRA2 to adolescent externalizing problems, and suggest important avenues for future research.

  6. Mechanisms in the relation between GABRA2 and adolescent externalizing problems

    PubMed Central

    Wang, Frances L.; Chassin, Laurie; Geiser, Christian; Lemery-Chalfant, Kathryn

    2015-01-01

    Conduct problems, alcohol problems and hyperactive–inattentive symptoms co-occur at a high rate and are heritable in adolescence. The γ-aminobutyric acid A receptor, α2 gene (GABRA2) is associated with a broad spectrum of externalizing problems and disinhibitory-related traits. The current study tested whether two important forms of disinhibition in adolescence, impulsivity and sensation seeking, mediated the effects of GABRA2 on hyperactive–inattentive symptoms, conduct problems, and alcohol problems. Participants were assessed at two waves (11–17 and 12–18 years old; N = 292). Analyses used the GABRA2 SNP, rs279858, which tags the two complementary (yin–yang) GABRA2 haplotypes. Multiple informants reported on adolescents’ impulsivity and sensation seeking and adolescents self-reported their hyperactive–inattentive symptoms, conduct problems and lifetime alcohol problems. Impulsivity mediated the effect of GABRA2 on alcohol problems, hyperactive–inattentive symptoms, and conduct problems, whereas sensation seeking mediated the effect of GABRA2 on alcohol problems (AA/AG geno-types conferred risk). GABRA2 directly predicted adolescent alcohol problems, but the GG genotype conferred risk. Results suggest that there may be multiple pathways of risk from GABRA2 to adolescent externalizing problems, and suggest important avenues for future research. PMID:25804982

  7. Iliofemoral Venous Thrombosis Mainly Related to Iliofemoral Venous Obstruction by External Tumor Compression in Cancer Patients

    PubMed Central

    Liao, Tzu-Yao; Hsu, Hui-Ching; Wen, Min-Sheng; Juan, Yu-Hsiang; Hung, Yu-Hsin; Liaw, Chuang-Chi

    2016-01-01

    Background To study iliofemoral venous thrombosis related to iliofemoral venous obstruction in cancer patients. Methods In this case series study, 829 cancer patients were surveyed for iliofemoral obstruction/thrombosis within 10 years. The criteria for inclusion were: (1) presence of unilateral lower-extremity swelling; (2) computed tomography (CT) scans showing a tumor with external compression of the iliac or femoral vein, and (3) duplex ultrasound scans showing venous thrombosis or venous flow insufficiency over a femoral vein or saphenous vein. Results Sixty-three patients (8%) developed an iliofemoral venous obstruction. The presence of iliofemoral venous thrombosis was detected in 21 of these patients (33%). The rate of iliofemoral venous thrombosis was significantly higher in patients with an invasion of the inguinal region, D-dimer levels >3,000 ng/ml, gastrointestinal cancer, or invasion of the inguinal lymph nodes. However, none of our patients with iliofemoral venous thrombosis had a detection of iliofemoral venous obstruction. Improved lower-extremity swelling was reported in 84% of the patients following combination therapy involving low-molecular-weight heparin (LMWH) and systemic therapy. Conclusion Patients with an iliofemoral venous thrombosis mainly had iliofemoral venous obstruction by external tumor compression. Combination therapy with LMWH and systemic therapy were mandatory for these patients. PMID:27990113

  8. Relation optimization of the starting and main stages of rockets with short-running engine on the external oxidizer

    NASA Astrophysics Data System (ADS)

    Ustinov, L. A.; Zelenkov, P. V.; Kovalev, I. V.

    2016-11-01

    The paper considers an optimal choice of the mass relation of the starting and main stages of the rocket with a short-running engine on the external oxidizer from the point of view of achieving the maximum firing range.

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

    PubMed

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

    2015-04-01

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

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

    PubMed

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

    2016-01-01

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

  11. High-finesse cavity external optical feedback DFB laser with hertz relative linewidth.

    PubMed

    Zhao, Yang; Wang, Qiang; Meng, Fei; Lin, Yige; Wang, Shaokai; Li, Ye; Lin, Baike; Cao, Shiying; Cao, Jianping; Fang, Zhanjun; Li, Tianchu; Zang, Erjun

    2012-11-15

    We report hertz level relative linewidth distributed feedback diode lasers with external optical feedback from a high finesse F-P cavity, and demonstrate the efficient phase noise suppression and laser linewidth reduction of the optical feedback technique. The laser phase noise is dramatically suppressed throughout the measurement frequency range. Especially at the Fourier frequency of 17 kHz, approximately the linewidth of the F-P reference cavity, the laser phase noise is significantly suppressed by more than 92 dB. Above this Fourier frequency, the noise maintains a white phase noise plateau as low as -124.4 dBc/Hz. The laser's FWHM linewidth is reduced from 7 MHz to 4.4 Hz, and its instantaneous linewidth is 220 mHz in the Lorentzian fitting.

  12. Negative emotional reactivity moderates the relations between family cohesion and internalizing and externalizing symptoms in adolescence.

    PubMed

    Rabinowitz, Jill A; Osigwe, Ijeoma; Drabick, Deborah A G; Reynolds, Maureen D

    2016-12-01

    Lower family cohesion is associated with adolescent internalizing and externalizing problems. However, there are likely individual differences in youth's responses to family processes. For example, adolescents higher in negative emotional reactivity, who often exhibit elevated physiological responsivity to context, may be differentially affected by family cohesion. We explored whether youth's negative emotional reactivity moderated the relation between family cohesion and youth's symptoms and tested whether findings were consistent with the diathesis-stress model or differential susceptibility hypothesis. Participants were 651 adolescents (M = 12.99 ± .95 years old; 72% male) assessed at two time points (Time 1, ages 12-14; Time 2, age 16) in Pittsburgh, PA. At Time 1, mothers reported on family cohesion and youth reported on their negative emotional reactivity. At Time 2, youth reported on their symptoms. Among youth higher in negative emotional reactivity, lower family cohesion predicted higher symptoms than higher family cohesion, consistent with the diathesis-stress model.

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

    PubMed

    Punnett, L

    1999-01-01

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

  14. Interrelation between external oscillatory muscle coupling amplitude and in vivo intramedullary pressure related bone adaptation.

    PubMed

    Hu, Minyi; Cheng, Jiqi; Bethel, Neville; Serra-Hsu, Frederick; Ferreri, Suzanne; Lin, Liangjun; Qin, Yi-Xian

    2014-09-01

    Interstitial bone fluid flow (IBFF) is suggested as a communication medium that bridges external physical signals and internal cellular activities in the bone, which thus regulates bone remodeling. Intramedullary pressure (ImP) is one main regulatory factor of IBFF and bone adaptation related mechanotransduction. Our group has recently observed that dynamic hydraulic stimulation (DHS), as an external oscillatory muscle coupling, was able to induce local ImP with minimal bone strain as well as to mitigate disuse bone loss. The current study aimed to evaluate the dose dependent relationship between DHS's amplitude, i.e., 15 and 30mmHg, and in vivo ImP induction, as well as this correlation on bone's phenotypic change. Simultaneous measurements of ImP and DHS cuff pressures were obtained from rats under DHS with various magnitudes and a constant frequency of 2Hz. ImP inductions and cuff pressures upon DHS loading showed a positively proportional response over the amplitude sweep. The relationship between ImP and DHS cuff pressure was evaluated and shown to be proportional, in which ImP was raised with increases of DHS cuff pressure amplitudes (R(2)=0.98). A 4-week in vivo experiment using a rat hindlimb suspension model demonstrated that the mitigation effect of DHS on disuse trabecular bone was highly dose dependent and related to DHS's amplitude, where a higher ImP led to a higher bone volume. This study suggested that sufficient physiological DHS is needed to generate ImP. Oscillatory DHS, potentially induces local fluid flow, has shown dose dependence in attenuation of disuse osteopenia.

  15. Event-related oscillations to affective stimuli: heritability, linkage and relationship to externalizing disorders.

    PubMed

    Criado, Jose R; Gizer, Ian R; Slutske, Wendy S; Phillips, Evie; Ehlers, Cindy L

    2012-02-01

    Event-related oscillations (EROs) are heritable electrophysiological measures associated with cognitive activity and have been shown to be particularly informative for the genetic analysis of substance dependence and other psychiatric disorders. In the present study associations between the cortical event-related oscillations (EROs) elicited by affective stimuli, and the diagnosis of ASPD or CD (ASPD/CD) were investigated, and heritability and linkage analyses conducted in 662 individuals residing in an American Indian community. Results from this study found that participants with ASPD/CD showed increased alpha ERO energy in centro-parietal leads in the 0-250 ms time window in response to all three emotional expressions (sad, neutral and happy faces). Participants with ASPD/CD also showed increased alpha ERO energy in centro-parietal leads in the 400-700 ms time window in response to happy and neutral faces. Variance components analysis suggested a significant familial component to each of the described ERO phenotypes. Although a follow-up genome-wide linkage analysis failed to detect significant evidence of genetic linkage for any of these phenotypes, centro-parietal alpha energy in response to happy faces showed suggestive evidence of linkage to chromosome 1p36.31 (LOD = 2.40), in an area found in previous studies to be associated with externalizing phenotypes. Findings from this study suggest greater activation of neural circuits required to perform a facial recognition task in participants with ASPD/CD. The observed increase in alpha ERO energy may represent a heritable endophenotype associated with select externalizing disorders in this population. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2016-01-01

    The impact of agricultural management on global biodiversity highlights the need for farm-scale monitoring programmes capable of determining the performance of agriculture practices. Yet the identification of appropriate indicators is a challenging process and one that involves considering a number of different aspects and requirements. Besides the attention given to scientific effectiveness, relevant but less studied issues related to biodiversity measurements include the economic feasibility of monitoring programmes and the relevance of indicators for different end-users. In this paper, we combine an analytic assessment of costs and a stakeholder-based evaluation of the usefulness of a set of biodiversity-related parameters (habitat mapping, vegetation, bees, earthworms, spiders, and a farmer questionnaire) tested for scientific consistency in 12 European case studies and on more than 14,000 ha of farmland. The results point to the possibility of meeting the expectations of different end-users (administrators, farmers and consumers) with a common indicator set. Combining costs and usefulness also suggests the possibility of designing more efficient monitoring approaches involving private agencies and networks of volunteers and farmers for the field data collection at different stages of a monitoring programme. Although complex, such an approach would make it possible to enhance the effectiveness of available funds for farmland biodiversity monitoring. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Association between component costs, study methodologies, and foodborne illness-related factors with the cost of nontyphoidal Salmonella illness.

    PubMed

    McLinden, Taylor; Sargeant, Jan M; Thomas, M Kate; Papadopoulos, Andrew; Fazil, Aamir

    2014-09-01

    Nontyphoidal Salmonella spp. are one of the most common causes of bacterial foodborne illness. Variability in cost inventories and study methodologies limits the possibility of meaningfully interpreting and comparing cost-of-illness (COI) estimates, reducing their usefulness. However, little is known about the relative effect these factors have on a cost-of-illness estimate. This is important for comparing existing estimates and when designing new cost-of-illness studies. Cost-of-illness estimates, identified through a scoping review, were used to investigate the association between descriptive, component cost, methodological, and foodborne illness-related factors such as chronic sequelae and under-reporting with the cost of nontyphoidal Salmonella spp. illness. The standardized cost of nontyphoidal Salmonella spp. illness from 30 estimates reported in 29 studies ranged from $0.01568 to $41.22 United States dollars (USD)/person/year (2012). The mean cost of nontyphoidal Salmonella spp. illness was $10.37 USD/person/year (2012). The following factors were found to be significant in multiple linear regression (p≤0.05): the number of direct component cost categories included in an estimate (0-4, particularly long-term care costs) and chronic sequelae costs (inclusion/exclusion), which had positive associations with the cost of nontyphoidal Salmonella spp. illness. Factors related to study methodology were not significant. Our findings indicated that study methodology may not be as influential as other factors, such as the number of direct component cost categories included in an estimate and costs incurred due to chronic sequelae. Therefore, these may be the most important factors to consider when designing, interpreting, and comparing cost of foodborne illness studies.

  18. [Infectious complications related to external ventricular shunt. Incidence and risk factors].

    PubMed

    López-Amor, L; Viña, L; Martín, L; Calleja, C; Rodríguez-García, R; Astola, I; Forcelledo, L; Álvarez-García, L; Díaz-Gómez, C; Fernández-Domínguez, J; Vázquez, F; Escudero, D

    2017-07-25

    Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved. Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded. 87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p<0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p<0.01). No difference in mortality was found. One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.

  19. Validity of the Externalizing Spectrum Inventory in a criminal offender sample: relations with disinhibitory psychopathology, personality, and psychopathic features.

    PubMed

    Venables, Noah C; Patrick, Christopher J

    2012-03-01

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

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

    PubMed Central

    Venables, Noah C.; Patrick, Christopher J.

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Eilam, Billie; Poyas, Yael

    2010-11-01

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

  2. Protective factors promoting resilience in the relation between child sexual victimization and internalizing and externalizing symptoms.

    PubMed

    Pérez-González, Alba; Guilera, Georgina; Pereda, Noemí; Jarne, Adolfo

    2017-09-13

    Sexual victimization has been one of the most frequently studied forms of child victimization. Its effects are common and diverse; however, not all children and youth exposed to sexual victimization eventually develop adjustment problems. A total of 1105 children and youth (590 male and 515 female) aged between 12 and 17 from northeastern Spain were assessed regarding their experiences of sexual victimization, symptoms of psychopathology, and protective factors. The results showed that all forms of sexual victimization were associated with higher levels of emotional and behavioral problems. However, the presence of a low Negative Cognition, high Social Skills and high Confidence seem to act buffering internalizing problems. Additionally, a significant interaction between Sexual Victimization and low Negative Cognition was observed (p<0.5), so that, low Negative Cognition was related to a lower risk of being in the clinical range for internalizing problems. Likewise, high scores on Empathy/Tolerance, Connectedness to School, Connectedness to Family and low Negative Cognition acted as promotive factors in relation to externalizing symptoms, in this case without any interaction effect. The strong relationship found with emotional and behavioral problems highlights the importance of continuing the research on the protective factors underlying resilience in the relationship between sexual victimization and psychopathological symptoms. The findings also support the multi-dimensional and specific nature of resilience and identify some of the protective factors that should be regarded as key intervention targets in adolescents with a history of sexual victimization. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. [Unified National Health System costs in São José dos Campos, São Paulo State, Brazil, for hospital admissions due to external causes].

    PubMed

    Melione, Luís Paulo Rodrigues; Mello-Jorge, Maria Helena Prado de

    2008-08-01

    The objective of this study was to identify direct expenditures for hospitalizations due to external causes in the Unified National Health System (SUS) in the city of São José dos Campos, São Paulo State, Brazil. Admissions to the Dr. José de Carvalho Florence Municipal Hospital resulting from external causes or injuries - ICD-10, chapters XIX and XX respectively - were analyzed for the first semester of 2003. 976 patient admission forms were analyzed, after data evaluation. Admissions with the highest total cost were those resulting from motor vehicle accidents and falls. The highest mean cost for hospitalization for injury was due to motor vehicle accidents (BRL 614.63), followed by assault (BRL 594.90). The highest mean cost for hospitalization due to injury was for cervical fractures (BRL 1,191.42) and head injuries (BRL 1,000.44). Hospitalizations with the highest daily cost were skull and facial fractures (BRL 166.72) and abdominal trauma (BRL 148.26). The study confirmed that motor vehicle accidents, falls, and assault are an important source of costs due to hospitalization for injuries.

  4. Testing a Series of Causal Propositions Relating Time in Child Care to Children's Externalizing Behavior

    ERIC Educational Resources Information Center

    McCartney, Kathleen; Burchinal, Margaret; Clarke-Stewart, Aliso; Bub, Kristen L.; Owen, Margaret T.; Belsky, Jay

    2010-01-01

    Prior research has documented associations between hours in child care and children's externalizing behavior. A series of longitudinal analyses were conducted to address 5 propositions, each testing the hypothesis that child care hours causes externalizing behavior. Data from the National Institute of Child Health and Human Development Early Child…

  5. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP... advertising costs. 1631.205-70 Section 1631.205-70 Federal Acquisition Regulations System OFFICE OF PERSONNEL... cost of the message. (b) Costs of media messages not provided for in paragraph (a) of this section...

  6. Major Trends and Portents Related to Information Costs.

    ERIC Educational Resources Information Center

    Wilson, John H., Jr.

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

  7. Instructional Support Costs Related to Faculty Salary Costs. Report No. 79-02.

    ERIC Educational Resources Information Center

    Hample, Stephen R.

    Nonfaculty salary (instructional support) costs for Montana State University (MSU) are examined with specific reference to the adequacy of the 25 percent nonfaculty salary allowance for other costs. Two concepts are examined: nonfaculty salary expenses within the instruction program (direct instructional support costs) and both direct support…

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

    PubMed Central

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

    1994-01-01

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

  9. 48 CFR 970.3102-05-47 - Costs related to legal and other proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  10. The role of reverberation-related binaural cues in the externalization of speech.

    PubMed

    Catic, Jasmina; Santurette, Sébastien; Dau, Torsten

    2015-08-01

    The perception of externalization of speech sounds was investigated with respect to the monaural and binaural cues available at the listeners' ears in a reverberant environment. Individualized binaural room impulse responses (BRIRs) were used to simulate externalized sound sources via headphones. The measured BRIRs were subsequently modified such that the proportion of the response containing binaural vs monaural information was varied. Normal-hearing listeners were presented with speech sounds convolved with such modified BRIRs. Monaural reverberation cues were found to be sufficient for the externalization of a lateral sound source. In contrast, for a frontal source, an increased amount of binaural cues from reflections was required in order to obtain well externalized sound images. It was demonstrated that the interaction between the interaural cues of the direct sound and the reverberation strongly affects the perception of externalization. An analysis of the short-term binaural cues showed that the amount of fluctuations of the binaural cues corresponded well to the externalization ratings obtained in the listening tests. The results further suggested that the precedence effect is involved in the auditory processing of the dynamic binaural cues that are utilized for externalization perception.

  11. Employment and residential characteristics in relation to automated external defibrillator locations

    PubMed Central

    Griffis, Heather M.; Band, Roger A; Ruther, Matthew; Harhay, Michael; Asch, David A.; Hershey, John C.; Hill, Shawndra; Nadkarni, Lindsay; Kilaru, Austin; Branas, Charles C.; Shofer, Frances; Nichol, Graham; Becker, Lance B.; Merchant, Raina M.

    2015-01-01

    Background Survival from out-of-hospital cardiac arrest (OHCA) is generally poor and varies by geography. Variability in automated external defibrillator (AED) locations may be a contributing factor. To inform optimal placement of AEDs, we investigated AED access in a major US city relative to demographic and employment characteristics. Methods and Results This was a retrospective analysis of a Philadelphia AED registry (2,559 total AEDs). The 2010 US Census and the Local Employment Dynamics (LED) database by ZIP code was used. AED access was calculated as the weighted areal percentage of each ZIP code covered by a 400 meter radius around each AED. Of 47 ZIP codes, only 9%(4) were high AED service areas. In 26%(12) of ZIP codes, less than 35% of the area was covered by AED service areas. Higher AED access ZIP codes were more likely to have a moderately populated residential area (p=0.032), higher median household income (p=0.006), and higher paying jobs (p=008). Conclusions The locations of AEDs vary across specific ZIP codes; select residential and employment characteristics explain some variation. Further work on evaluating OHCA locations, AED use and availability, and OHCA outcomes could inform AED placement policies. Optimizing the placement of AEDs through this work may help to increase survival. PMID:26856232

  12. Motor neuron targeting of IGF-1 attenuates age-related external Ca2+-dependent skeletal muscle contraction in senescent mice.

    PubMed

    Payne, Anthony M; Messi, María Laura; Zheng, Zhenlin; Delbono, Osvaldo

    2007-04-01

    A population of fast muscle fibers from aging mice is dependent on external Ca(2+) to maintain tetanic force during repeated contractions. We hypothesized that age-related denervation in muscle fibers plays a role in initiating this contractile deficit, and that prevention of denervation by IGF-1 overexpression would prevent external Ca(2+)-dependent contraction in aging mice. IGF-1 overexpression in skeletal muscle prevents age-related denervation, and prevented external Ca(2+)-dependent contraction in this work. To determine if the effects of IGF-1 overexpression are on muscle or nerve, aging mice were injected with a tetanus toxin fragment-C (TTC) fusion protein that targets IGF-1 to spinal cord motor neurons. This treatment prevented external Ca(2+)-dependent contraction. We also show evidence that injections of the IGF-1-TTC fusion protein prevent age-related alterations to the nerve terminals at the neuromuscular junctions. We conclude that the slow age-related denervation of fast muscle fibers underlies dependence on external Ca(2+) to maintain tetanic force in a population of muscle fibers from senescent mice.

  13. The External Nose: The Nasal Arteries and Their Course in Relation to the Nasolabial Fold and Groove.

    PubMed

    Pilsl, Ulrike; Anderhuber, Friedrich

    2016-11-01

    The blood supply to the external nose is poorly described. The aim of this study was to identify the different types of blood supply to the external nose and the course of the arteries in relation to the nasolabial fold and groove and to the facial muscles. With 96 facial halves of 48 adult specimens, the arteries of the outer nose were dissected, and three-dimensional computed tomographic reconstructions and horizontal sections were made. Three main types of blood supply to the external nose were identified, associated with the different types of facial arteries. Moreover, a deep course of the nasal arteries in relation to the nasolabial fold and a very superficial course in relation to the nasolabial groove were found. Knowledge regarding the nasal arteries is clinically relevant for filler injection for aesthetic improvements of the nose and nasolabial fold and for planning local flaps in facial reconstructions and also for rhinoplasty.

  14. Parental corporal punishment in relation to children's executive function and externalizing behavior problems in China.

    PubMed

    Xing, Xiaopei; Wang, Meifang; Wang, Zhengyan

    2016-11-21

    The current study examined the relationship among paternal and maternal corporal punishment (CP), children's executive function (EF), and children's externalizing behavior problems. In total, 328 Chinese preschool-aged children and their parents and teachers participated. Paternal and maternal CP was assessed by father-reports and by mother-reports, respectively. Children's EF was assessed by the Executive Function Touch program. Children's externalizing behavior problems were assessed by mother-reports and by teacher-reports. The results of structural equation modeling generally supported working memory as a mediator linking paternal CP and children's externalizing behaviors and inhibitory control as a mediator linking maternal CP and children's externalizing behaviors. No differences by children's gender were found. The current findings highlight the importance of EF in behavioral outcomes of children who experience parental CP.

  15. Different patterns of boys' externalizing behavior and their relation to risk factors: a longitudinal study of preschool children.

    PubMed

    Stemmler, M; Lösel, F

    2010-01-01

    Childrens' externalizing behaviors such as aggression, delinquency and impulsivity are serious problems in many societies. In previous person-oriented analyses we found two types of externalizing problems in boys. One pattern contained externalizing problems only, whereas the other type showed both externalizing and internalizing problems (anxiety, depression etc.). The present study addressed these two groups in a prospective longitudinal design. It was investigated whether the previous descriptive findings remained stable over time and, in particular, whether the two types differed in important risk factors for antisocial behavior. The sample consisted of 198 boys from the Erlangen-Nuremberg Development and Prevention Study. The first assessment took place in kindergarten and the second 3.4 years later in elementary school. The behavior problems were assessed by ratings of kindergarten teachers and elementary school teachers using the Social Behavior Questionnaire (SBQ). The risk factors were low socio-economic status of the family, birth complications, physical punishment in parenting behavior, difficult temperament, low intelligence, and aggression-prone social information processing of the child. Approximately 15% of the boys revealed externalizing behavior problems. A variable-oriented analysis showed significant stability over time. In a person-oriented Configural Frequency Analysis the 'externalizing only' and the 'combined externalizing and internalizing' pattern could be replicated. For five of the six risk factors we found significant differences between the boys with behavior problems and a non-deviant group. However, the two different patterns of externalizing problems differed only in intelligence (lower for the group with combined problems). The results confirm models of cumulative biological, psychological and social risks for antisocial behavior over time. Furthermore, specified analyses of the two types and their relation to proactive and reactive

  16. External costs of atmospheric lead emissions from a waste-to-energy plant: a follow-up assessment of indirect exposure via topsoil ingestion.

    PubMed

    Pizzol, Massimo; Møller, Flemming; Thomsen, Marianne

    2013-05-30

    In this study the Impact Pathway Approach (IPA) was used to calculate the external costs associated with indirect exposure, via topsoil ingestion, to atmospheric emissions of lead (Pb) from a waste-to-energy plant in Denmark. Three metal-specific models were combined to quantify the atmospheric dispersion of lead, its deposition and accumulation in topsoil, and the increase in blood lead concentration for children resulting from lead intake via topsoil ingestion. The neurotoxic impact of lead on children was estimated using a lead-specific concentration-response function that measures impaired cognitive development in terms of IQ points lost per each incremental μg/dl of lead in blood. Since IQ loss during childhood can be associated with a percent decrease in expected lifetime earnings, the monetary value of such an impact can be quantified and the external costs per kg of lead emitted from the plant were then calculated. The costs of indirect exposure calculated over a time horizon of 100 years, for the sub-population of children of 0-3 years, and discounted at 3%, were in the range of 15-30 €/kg. Despite the continued accumulation of lead in topsoil resulting in increasing future indirect exposure, the results indicate that costs associated with this exposure pathway are of the same order of magnitude as costs associated with direct exposure via inhalation, calculated at 45-91 €/kg. Moreover, when the monetary value of future impacts is discounted to the present, the differences between the two exposure pathways are diminished. Finally, setting a short time horizon reduces the uncertainties but excludes part of the costs of indirect exposure from the assessment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Relations between parenting and externalizing and internalizing problem behaviour in early adolescence: child behaviour as moderator and predictor.

    PubMed

    Reitz, E; Deković, M; Meijer, A M

    2006-06-01

    In this longitudinal study we investigated relations between parenting and externalizing and internalizing problem behaviour during early adolescence. First, we examined parenting effects on problem behaviour, including child behaviour as a moderator. Second, we examined child behaviour as predictor of parenting, also including moderator effects. A total of 650 13- to 14-year-olds filled out the Youth Self-Report and questionnaires about parenting at two times within a one-year interval. Relations between parenting and problem behaviour appeared to be stronger for externalizing than for internalizing problem behaviour. Both parenting effects and child effects were found. Parenting significantly predicted an increase in externalizing problem behaviour one year later. Adolescent's previous level of problem behaviour predicted changes in parenting (involvement and decisional autonomy granting). In addition, parental and child characteristics interacted in predicting outcome.

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

    ERIC Educational Resources Information Center

    Lyons, John M.

    1978-01-01

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

  19. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... advertising costs. 1631.205-70 Section 1631.205-70 Federal Acquisition Regulations System OFFICE OF PERSONNEL... relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP... criteria are met: (1) The primary effect of the message is to disseminate information on health care cost...

  20. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... advertising costs. 1631.205-70 Section 1631.205-70 Federal Acquisition Regulations System OFFICE OF PERSONNEL... relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP... criteria are met: (1) The primary effect of the message is to disseminate information on health care cost...

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    The relations of parenting and temperament (effortful control and anger/frustration) to children's externalizing problems were examined in a 3.8-year longitudinal study of 425 native Chinese children (6-9 years) from Beijing. Children's experience of negative life events and coping efficacy were examined as mediators in the parenting- and…

  2. Does Parental Psychological Control Relate to Internalizing and Externalizing Problems in Early Childhood? An Examination Using the Berkeley Puppet Interview

    ERIC Educational Resources Information Center

    Stone, Lisanne L.; Otten, Roy; Janssens, Jan M. A. M.; Soenens, Bart; Kuntsche, Emmanuel; Engels, Rutger C. M. E.

    2013-01-01

    Parental psychological control has been linked to symptoms of psychopathology in adolescence, yet less is known about its correlates in childhood. The current study is among the first to address whether psychological control is related to internalizing and externalizing problems in early childhood. A community sample of 298 children aged 7.04…

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

    EPA Science Inventory

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

    ERIC Educational Resources Information Center

    Utendale, William T.; Hastings, Paul D.

    2011-01-01

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

  2. The relative importance of external and internal features of facial composites.

    PubMed

    Frowd, Charlie; Bruce, Vicki; McIntyre, Alex; Hancock, Peter

    2007-02-01

    Three experiments are reported that compare the quality of external with internal regions within a set of facial composites using two matching-type tasks. Composites are constructed with the aim of triggering recognition from people familiar with the targets, and past research suggests internal face features dominate representations of familiar faces in memory. However the experiments reported here show that the internal regions of composites are very poorly matched against the faces they purport to represent, while external feature regions alone were matched almost as well as complete composites. In Experiments 1 and 2 the composites used were constructed by participant-witnesses who were unfamiliar with the targets and therefore were predicted to demonstrate a bias towards the external parts of a face. In Experiment 3 we compared witnesses who were familiar or unfamiliar with the target items, but for both groups the external features were much better reproduced in the composites, suggesting it is the process of composite construction itself which is responsible for the poverty of the internal features. Practical implications of these results are discussed.

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

    PubMed Central

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

    2010-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

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

  5. 48 CFR 231.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  6. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. Cost of synthetic fuels in relation to oil prices - revisited

    SciTech Connect

    Daniels, E.J.

    1984-07-01

    The belief that oil prices drive the cost factors of synthetic fuels makes the economic analysis of these types of facilities certain and straightforward. The certainty, however, is neither logical nor mathematically correct. The expected costs of energy from synthetic fuels processes have undoubtably increased over time, but to infer that continued increases will make synthetic fuels always uncompetitive, regardless of the price of oil, is false. The task of estimating the economic feasibility of synthetic fuels processes or any technological process is difficult. Although the hypothesis may be appealing, there is no reason to believe that oil price increases cause increases in the expected cost of synthetic fuels. 11 references, 3 figures, 5 tables.

  8. How Is Sentence Processing Affected by External Semantic and Syntactic Information? Evidence from Event-Related Potentials

    PubMed Central

    Schacht, Annekathrin; Martín-Loeches, Manuel; Casado, Pilar; Abdel Rahman, Rasha; Sel, Alejandra; Sommer, Werner

    2010-01-01

    Background A crucial question for understanding sentence comprehension is the openness of syntactic and semantic processes for other sources of information. Using event-related potentials in a dual task paradigm, we had previously found that sentence processing takes into consideration task relevant sentence-external semantic but not syntactic information. In that study, internal and external information both varied within the same linguistic domain—either semantic or syntactic. Here we investigated whether across-domain sentence-external information would impact within-sentence processing. Methodology In one condition, adjectives within visually presented sentences of the structure [Det]-[Noun]-[Adjective]-[Verb] were semantically correct or incorrect. Simultaneously with the noun, auditory adjectives were presented that morphosyntactically matched or mismatched the visual adjectives with respect to gender. Findings As expected, semantic violations within the sentence elicited N400 and P600 components in the ERP. However, these components were not modulated by syntactic matching of the sentence-external auditory adjective. In a second condition, syntactic within-sentence correctness-variations were combined with semantic matching variations between the auditory and the visual adjective. Here, syntactic within-sentence violations elicited a LAN and a P600 that did not interact with semantic matching of the auditory adjective. However, semantic mismatching of the latter elicited a frontocentral positivity, presumably related to an increase in discourse level complexity. Conclusion The current findings underscore the open versus algorithmic nature of semantic and syntactic processing, respectively, during sentence comprehension. PMID:20305820

  9. The role, costs and value for money of external consultancies in the health sector: A study of New Zealand's District Health Boards.

    PubMed

    Penno, Erin; Gauld, Robin

    2017-04-01

    Public spending on external consultancies, particularly within the health sector, is highly controversial in many countries. Yet, despite the apparently large sums of money involved, there is little international analysis surrounding the scope of activities of consultants, meaning there is little understanding of how much is spent, for what purpose and with what result. This paper examines spending on external consultancies in each of New Zealand's 20 District Health Boards (DHB). Using evidence obtained from DHBs, it provides an insight into the cost and activities of consultants within the New Zealand health sector, the policies behind their engagement and the processes in place to ensure value for money. It finds that DHB spending on external consultants is substantial, at $NZ10-60 million annually. However, few DHBs had policies governing when consultants should be engaged and many were unable to easily identify the extent or purpose of consultancies within their organisation, making it difficult to derive an accurate picture of consultant activity throughout the DHB sector. Policies surrounding value for money were uncommon and, where present, were rarely applied. Given the large sums being spent by New Zealand's DHBs, and assuming expenditure is similar in other health systems, our findings point to the need for greater accountability for expenditure and better evidence of value for money of consultancies within publicly funded health systems.

  10. Relative Cost-Effectiveness of School Resources in Improving Achievement

    ERIC Educational Resources Information Center

    Ilon, Lynn; Normore, Anthony H.

    2006-01-01

    This study demonstrates a method for extending debates on the effectiveness of school inputs into the cost-effectiveness realm. This study uses the example of Florida's statewide initiative to reduce class sizes to determine which of many state inputs buys the most effect for the same expenditure. The method includes a three-stage process:…

  11. An Evaluation of the WSSC (Weapon System Support Cost) Cost Allocation Algorithms. VII. Quantitative and Data-Related Topics.

    DTIC Science & Technology

    1985-02-01

    implies that only one - 23 - p 5 .. . . " . - . , " i . , . . . . . allocation variable (the first selected) is required. On the other hand, if the...COST ALLOCATION AL..(U) DESMATICS INC STATE COLLEGE PA G J ZUNIC ET AL. FEB 85 TR-i± 5 -i F33608-80-C-0554 UNCLASSIFIED F/G W4i N Ehhmhommhhhhhum~hhh...CATEGORIES .. ............ 5 F. VOLUME VI -PERSONNEL RELATED CATEGORIES. .. ........ 6 III. THE IDENTIFICATION OF FIXED INSTALLATION SUPPORT COSTS

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

    PubMed

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

    2015-08-01

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

  13. Maximality of shoulder external rotation effort in patients presenting with work related injury: the clinical applicability of the DEC parameter.

    PubMed

    Chaler, Joaquim; Pujol, Eduard; Unyó, Carme; Quintana, Salvador; Müller, Bertram; Garreta, Roser; Javierre, Casimiro; Dvir, Zeevi

    2013-08-01

    The aim of the present study is to examine the applicability of the isokinetic DEC parameter for identifying submaximal effort in workers with potential weakness of the shoulder external rotators. A previous study indicated that the DEC was a powerful identifier of submaximal effort of shoulder external rotation in normal volunteers. Its applicability in shoulder injury patients is of specific interest. Thus, a retrospective study of 74 (33 female and 41 male) patients who claimed compensation for work-related shoulder injury was designed. 52 patients had their injured side DEC values within the normal range and were thus labeled as maximal performers. Ten patients had higher than cutoff DEC values, indicating submaximal effort whereas 12 patients had exceedingly low DEC values. Gender comparison showed a significantly different proportion of maximal performers. Strength deficits registered in patients demonstrating maximal performance correlated with the final outcome. The findings support the application of the DEC for determination of the extent of weakness of shoulder external rotators in male patients. In terms of shoulder external rotators status in male worker injury, the results support the application of isokinetic tests both in the clinical and medicolegal sense. However, the gender discrepancy warrants further research.

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

    PubMed Central

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

    2011-01-01

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

  15. Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and Realities.

    PubMed

    Rubin, Geoffrey D

    2017-02-01

    Costs direct decisions that influence the effectiveness of radiology in the care of patients on a daily basis. Yet many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported. In the United States, recent payment trends directing value-based payments for bundles of care advance the imperative for radiology providers to articulate their value. This begins with the development of an understanding of the providers' own costs, as well as the complex interrelationships and imaging-associated costs of other participants across the imaging value chain. Controlling the costs of imaging necessitates understanding them at a procedural level and quantifying the costs of delivering specific imaging services. Effective product-level costing is dependent on a bottom-up approach, which is supported through recent innovations in time-dependent activity-based costing. Once the costs are understood, they can be managed. Within the high fixed cost and high overhead cost environment of health care provider organizations, stakeholders must understand the implications of misaligned top-down cost management approaches that can both paradoxically shift effort from low-cost workers to much costlier professionals and allocate overhead costs counterproductively. Radiology's engagement across a broad spectrum of care provides an excellent opportunity for radiology providers to take a leading role within the health care organizations to enhance value and margin through principled and effective cost management. Following a discussion of the rationale for measuring costs, this review contextualizes costs from the perspectives of a variety of stakeholders (relativity), discusses core concepts in how costs are classified (rudiments), presents common and improved methods for measuring

  16. How much does mental health discrimination cost: valuing experienced discrimination in relation to healthcare care costs and community participation.

    PubMed

    Evans-Lacko, S; Clement, S; Corker, E; Brohan, E; Dockery, L; Farrelly, S; Hamilton, S; Pinfold, V; Rose, D; Henderson, C; Thornicroft, G; McCrone, P

    2015-10-01

    This study builds on existing research on the prevalence and consequences of mental illness discrimination by investigating and quantifying the relationships between experienced discrimination and costs of healthcare and leisure activities/social participation among secondary mental health service users in England. We use data from the Mental Illness-Related Investigations on Discrimination (MIRIAD) study (n = 202) and a subsample of the Viewpoint study (n = 190). We examine experiences of discrimination due to mental illness in the domains of personal relationships, community activities, and health care, and how such experienced discrimination relates to patterns of service use and engagement in leisure activities. Our findings show that the cost of health services used for individuals who reported previous experiences of discrimination in a healthcare setting was almost twice as high as for those who did not report any discrimination during the last 12 months (Relative Risk: 1.73; 95% Confidence Interval (CI): 1.39, 2.17) and this was maintained after controlling for symptoms and functioning. Experienced discrimination in healthcare (Relative Risk: 0.83; 95% CI: 0.81, 0.84) or in relationships (Relative Risk: 0.89; 95% CI: 0.87, 0.91), however, was associated with lower participation in, and hence lower costs of, leisure activities. Individuals who reported any discrimination in a healthcare setting had, on average, £434 higher costs associated with health service use while reported discrimination in the community was associated with increased leisure costs of £32. These findings make an important initial step towards understanding the magnitude of the costs of mental health-related discrimination.

  17. Cost-effectiveness of smoking cessation to prevent age-related macular degeneration

    PubMed Central

    Hurley, Susan F; Matthews, Jane P; Guymer, Robyn H

    2008-01-01

    Background Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk. Methods We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving 1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year. Results If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective. Conclusion Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone. PMID:18783631

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

    PubMed

    Giaccaria, Sergio; Frontuto, Vito

    2012-08-01

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

  19. Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

    PubMed

    Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

    2014-11-13

    The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

  20. Overseas Basing of U.S. Military Forces: An Assessment of Relative Costs and Strategic Benefits

    DTIC Science & Technology

    2013-01-01

    U.S. Military Forces: An Assessment of Relative Costs and Strategic Benefits 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...Pettyjohn, Jerry M. Sollinger, Stephen M. Worman Overseas Basing of U.S. Military Forces An Assessment of Relative Costs Prepared for the...Military Forces An Assessment of Relative Costs and Strategic Benefits Michael J. Lostumbo, Michael J. McNerney, Eric Peltz, Derek Eaton, David R

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  2. Measuring PM and related air pollutants using low-cost ...

    EPA Pesticide Factsheets

    Emerging air quality sensors may play a key role in better characterizing levels of air pollution in a variety of settings There are a wide range of low-cost (< $500 US) sensors on the market, but few have been characterized. If accurate, this new generation of inexpensive sensors can potentially allow larger fleets of monitors to be deployed to better study the spatial and temporal variability of pollutants. The small size and light weight of these sensors also allows for the possibility of wearable or drone applications. Sensor networks will very likely play a key role in future estimates of human health impacts of pollutants, in particular particulate matter (PM), and will allow for the better characterization of pollutant sources and source regions.We will present measurements from an assortment of sensors, costing $20-$700, that have been used to measure air pollution in the US, India, and China with a focus on estimating PM concentrations. Their performance has been evaluated in these very different settings with low concentrations seen in the US (up to approximately 20 ug m-3) and much higher concentrations measured in India and China (up to approximately 300 ug m-3). Based on these studies the optimal concentration ranges of these sensors have been determined. Used in conjunction with data from a carbon dioxide sensor, emissions factors were estimated in some of the locations. In addition temperature and humidity sensors can be used to calculate c

  3. The External Degree.

    ERIC Educational Resources Information Center

    Houle, Cyril O.

    This book examines the external degree in relation to the extremes of attitudes, myths, and data. Emphasis is placed on the emergence of the American external degree, foreign external-degree programs, the purpose of the external degree, the current scene, institutional issues, and problems of general policy. (MJM)

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

    ERIC Educational Resources Information Center

    Jeon, K. Seon; Kim, Hae-Young

    2007-01-01

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

  5. The health effects of cost-related treatment delays.

    PubMed

    Chen, Jie; Rizzo, John A; Rodriguez, Hector P

    2011-01-01

    The number of Americans who report delaying or forgoing necessary medical care because of cost concerns has increased markedly in recent years. Delaying or forgoing treatment may result in negative health effects, but empirical evidence is scarce. Using the merged data set of the Medical Expenditure Panel Survey and the National Health Interview Survey 2002-2006, the effect of delaying or forgoing medical care on ex post health status was estimated. Results indicate that people who delayed or forwent medical treatment were significantly less likely to report having excellent or very good ex post health status and had significantly lower quality-of-life scores compared with people who never delayed or forwent necessary medical care, controlling for socioeconomic and demographic factors, chronic medical conditions, and baseline health status. The Blinder-Oaxaca decomposition results suggest that expanding health insurance coverage can prevent 9% to 12% of the health decrements associated with delaying or forgoing medical treatment.

  6. PR for Pennies: Low-Cost Library Public Relations.

    ERIC Educational Resources Information Center

    Baeckler, Virginia Van Wynen

    This manual is designed to demystify a number of public relations techniques for those who wish to start producing their own materials with a minimum of time and money. Chapters focus on public relations; the library stereotype; words, ideas, and pictures; offset printing; creative print distribution; exhibits and posters; public speaking; and the…

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

    NASA Astrophysics Data System (ADS)

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

    2011-05-01

    The need to increase food production for a growing world population makes an assessment of global agricultural water productivities and virtual water flows important. Using the hydrology and agro-biosphere model LPJmL, we quantify at 0.5° resolution the amount of blue and green water (irrigation and precipitation water) needed to produce one unit of crop yield, for 11 of the world's major crop types. Based on these, we also quantify the agricultural water footprints (WFP) of all countries, for the period 1998-2002, distinguishing internal and external WFP (virtual water imported from other countries) and their blue and green components, respectively. Moreover, we calculate water savings and losses, and for the first time also land savings and losses, through international trade with these products. The consistent separation of blue and green water flows and footprints shows that green water globally dominates both the internal and external WFP (84 % of the global WFP and 94 % of the external WFP rely on green water). While no country ranks among the top ten with respect to all water footprints calculated here, Pakistan and Iran demonstrate high absolute and per capita blue WFP, and the US and India demonstrate high absolute green and blue WFPs. The external WFPs are relatively small (6 % of the total global blue WFP, 16 % of the total global green WFP). Nevertheless, current trade of the products considered here saves significant water volumes and land areas (~263 km3 and ~41 Mha, respectively, equivalent to 5 % of the sowing area of the considered crops and 3.5 % of the annual precipitation on this area). Relating the proportions of external to internal blue/green WFP to the per capita WFPs allows recognizing that only a few countries consume more water from abroad than from their own territory and have at the same time above-average WFPs. Thus, countries with high per capita water consumption affect mainly the water availability in their own country. Finally

  8. Launching Payloads Into Orbit at Relatively Low Cost

    NASA Technical Reports Server (NTRS)

    Wilcox, Brian

    2007-01-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Public relations and advertising costs. 2131.205-1 Section 2131.205-1 Federal Acquisition Regulations System OFFICE OF PERSONNEL... relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the...

  10. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Responding to inquiries on company policies and activities; (ii) Communicating with the public, press... advertising costs. 31.205-1 Section 31.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION... Organizations 31.205-1 Public relations and advertising costs. (a) Public relations means all functions...

  11. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... such as advertising, customer relations, etc. (b) Advertising means the use of media to promote the... what will appear, the media in which it will appear, and when it will appear. Advertising media include... relations and advertising costs include the costs of media time and space, purchased services performed...

  12. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. SOCIETAL COSTS ASSOCIATED WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN THE UNITED STATES.

    PubMed

    Brown, Melissa M; Brown, Gary C; Lieske, Heidi B; Tran, Irwin; Turpcu, Adam; Colman, Shoshana

    2016-02-01

    The purpose of this study was to use a cross-sectional prevalence-based health care economic survey to ascertain the annual, incremental, societal ophthalmic costs associated with neovascular age-related macular degeneration. Consecutive patients (n = 200) with neovascular age-related macular degeneration were studied. A Control Cohort included patients with good (20/20-20/25) vision, while Study Cohort vision levels included Subcohort 1: 20/30 to 20/50, Subcohort 2: 20/60 to 20/100, Subcohort 3: 20/200 to 20/400, and Subcohort 4: 20/800 to no light perception. An interviewer-administered, standardized, written survey assessed 1) direct ophthalmic medical, 2) direct nonophthalmic medical, 3) direct nonmedical, and 4) indirect medical costs accrued due solely to neovascular age-related macular degeneration. The mean annual societal cost for the Control Cohort was $6,116 and for the Study Cohort averaged $39,910 (P < 0.001). Study Subcohort 1 costs averaged $20,339, while Subcohort 4 costs averaged $82,984. Direct ophthalmic medical costs comprised 17.9% of Study Cohort societal ophthalmic costs, versus 74.1% of Control Cohort societal ophthalmic costs (P < 0.001) and 10.4% of 20/800 to no light perception subcohort costs. Direct nonmedical costs, primarily caregiver, comprised 67.1% of Study Cohort societal ophthalmic costs, versus 21.3% ($1,302/$6,116) of Control Cohort costs (P < 0.001) and 74.1% of 20/800 to no light perception subcohort costs. Total societal ophthalmic costs associated with neovascular age-related macular degeneration dramatically increase as vision in the better-seeing eye decreases.

  14. Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease.

    PubMed

    Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

    2010-11-01

    Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year. Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  17. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  18. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  19. HPV-related external genital lesions among men residing in Brazil.

    PubMed

    Silva, Roberto J C; Sudenga, Staci L; Sichero, Laura; Baggio, Maria Luiza; Galan, Lenice; Cintra, Ricardo; Torres, B Nelson; Stoler, Mark; Giuliano, Anna R; Villa, Luisa L

    2017-04-08

    The aims of this study were to determine the incidence of external genital lesions (EGLs), specifically histologically confirmed condyloma (genital warts) and Penile Intraepithelial Neoplasia (PeIN), and genital HPV infection progression to EGLs among healthy men aged 18-73 residing in Brazil. Subjects included 1118 men enrolled in the HPV Infection in Men (HIM) study between July 2005 and June 2009. At each visit, EGLs were biopsied and subjected to pathological evaluation. HPV status in genital swabs and biopsies was determined by Linear Array and INNO-LiPA, respectively. Age-specific EGLs incidence and the proportion and median time to EGL development were estimated. Kaplan-Meier cumulative incidence rates at 6, 12, and 24 months were determined. During follow-up, 73 men developed an incident EGL. Men could develop multiple EGLs and there were 36 men with condyloma, 27 men with lesions suggestive of condyloma, six men with PeIN, and 20 men with non-HPV lesions. HPV-positive men who developed EGLs were younger (p=0.002) than men that did not develop lesions. Among the 815 men with HPV infection, 4% progressed to EGL with the same HPV detected in the swab. During follow up, 15.7% of genital HPV-6 and HPV-11 infections progressed to condyloma (median progression time of nine months for HPV-6 versus 6.8 months for HPV-11). Approximately 1% of HPV-16 infections progressed to PeIN with a median progression time of 25 months. HPV types covered by the 4-valent HPV vaccine were detected in 82.3% and 83.3% of condyloma and PeIN, respectively. The high burden of HPV and high frequency of progression to disease underscores the need to offer HPV prophylactic vaccination to men to reduce the overall burden of infection and diseases caused by HPV.

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

    PubMed Central

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

    2016-01-01

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

  1. Quantitative ultrastructural evidence of alterations in prolactin secretion related to external salinity in a teleost fish (Poecilia latipinna).

    PubMed

    Batten, T F; Ball, J N

    1977-11-30

    Quantitative ultrastructural morphometric studies were made on the prolactin cells of Poecilia latipinna adapted to freshwater (FW), one-third seawater (1/3 SW) and full-strength seawater (SW), and at various times after transfers between 1/3 SW and FW. In fully-adapted fish the rates of prolactin (PRL) synthesis and PRL release are inversely related to environmental salinity. During adaptation to a new salinity the two rates are temporarily uncoordinated, with release increasing or decreasing more readily than synthesis. Synthesis appears to take 30 h or longer to come into balance with the increased release rate following transfer from 1/3 SW to FW, and 72 h or longer to adjust to the reduction in release rate that follows the reverse transfer. The excess PRL granules that accumulate in the latter situation appear to be removed by lysosomal digestion. As in other teleosts, in fish adapted to the external medium the size of the stored PRL granules is inversely related to external salinity, but this relationship breaks down during adaptation to a new salinity. The stellate cells which penetrate between the PRL cells are more prominent, more extensively ramified, and appear more metabolically active in FW-adapted fish than in the other groups. These cells seem to be closely related in function to the secretory activity of the PRL cells.

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

    PubMed

    Tscheulin, Dieter K; Drevs, Florian

    2010-04-01

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

  3. External mirroring of inner chaos: blogging as experienced by the relatives of people with cancer.

    PubMed

    Andersson, Maria; Gustafsson, Elisabeth; Hansson, Kristina; Karlsson, Margareta

    2013-01-01

    Relatives of a person suffering from cancer risk being affected both physically and psychologically. Blogging has become increasingly popular as a forum for communicating experiences, but few studies have focused on what blogging about a relative's cancer journey means to the author. To illuminate relatives' experiences of blogging when a family member is in the end-of-life phase of cancer. Telephone interviews were conducted with 12 people about their experiences of blogging during and after their family member's illness. The data was analysed using qualitative content analysis. Blogging facilitated everyday life, introduced the relatives to new friends with similar experiences, helped them in their grief process, and helped them to preserve memories. The negative aspects were being misunderstood and publicly criticised as well as the feeling of providing readers with 'reality show' entertainment. Blogging was seen as a complement to professional care that contributed to the prevention of ill health.

  4. Perceived parental control of food intake is related to external, restrained and emotional eating in 7-12-year-old boys and girls.

    PubMed

    van Strien, Tatjana; Bazelier, Francien G

    2007-11-01

    This study examined the prevalence of external, restrained and emotional eating and the relationship of these disturbed types of eating behaviours with perceived parental control of food intake (pressure to eat and restriction) in a group of 7- to 12-year-old boys and girls (n = 596). External eating turned out to be the most prevalent disturbed eating behaviour for boys and girls, followed by restrained eating and emotional eating. Sex differences were found in external and restrained eating. For the boys, perceived pressure to eat was positively related to emotional and external eating. For both sexes, perceived restriction to eat was negatively related to emotional and external eating and positively related to restrained eating. This led to the conclusion that perceived pressure to eat has a disruptive effect on a child's self-regulating mechanism of food intake, particularly so for boys, whereas perceived restriction can also have a positive effect.

  5. External and internal controls of lunar-related reproductive rhythms in fishes.

    PubMed

    Takemura, A; Rahman, M S; Park, Y J

    2010-01-01

    Reproductive activities of many fish species are, to some extent, entrained to cues from the moon. During the spawning season, synchronous spawning is repeated at intervals of c. 1 month (lunar spawning cycle) and 2 weeks (semi-lunar spawning cycle) or daily according to tidal changes (tidal spawning cycle). In species showing lunar-related spawning cycles, oocytes in the ovary develop towards and mature around a specific moon phase for lunar spawners, around spring tides for semi-lunar spawners and at daytime high tides for tidal spawners. The production of sex steroid hormones also changes in accordance with synchronous oocyte development. Since the production of the steroid hormones with lunar-related reproductive periodicity is regulated by gonadotropins, it is considered that the higher parts of the hypothalamus-pituitary-gonad axis play important roles in the perception and regulation of lunar-related periodicity. It is likely that fishes perceive cues from the moon by sensory organs; however, it is still unknown how lunar cues are transduced as an endogenous rhythm exerting lunar-related spawning rhythmicity. Recent research has revealed that melatonin fluctuated according to the brightness at night, magnetic fields and the tidal cycle. In addition, cyclic changes in hydrostatic pressure had an effect on monoamine contents in the brain. These factors may be indirectly related to the exertion of lunar-related periodicity. Molecular approaches have revealed that mRNA expressions of light-sensitive clock genes change with moonlight, suggesting that brightness at night plays a role in phase-shifting or resetting of biological clocks. Some species may have evolved biological clocks in relation to lunar cycles, although it is still not known how lunar periodicities are endogenously regulated in fishes. This review demonstrates that lunar-related periodicity is utilized and incorporated by ecological and physiological mechanisms governing the reproductive success

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

    SciTech Connect

    Baci, Syrja; Telhaj, Ervis; Malkaj, Partizan

    2016-03-25

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

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

    NASA Astrophysics Data System (ADS)

    Baci, Syrja; Telhaj, Ervis; Malkaj, Partizan

    2016-03-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Costs of childhood asthma due to traffic-related pollution in two California communities.

    PubMed

    Brandt, Sylvia J; Perez, Laura; Künzli, Nino; Lurmann, Fred; McConnell, Rob

    2012-08-01

    Recent research suggests the burden of childhood asthma that is attributable to air pollution has been underestimated in traditional risk assessments, and there are no estimates of these associated costs. We aimed to estimate the yearly childhood asthma-related costs attributable to air pollution for Riverside and Long Beach, CA, USA, including: 1) the indirect and direct costs of healthcare utilisation due to asthma exacerbations linked with traffic-related pollution (TRP); and 2) the costs of health care for asthma cases attributable to local TRP exposure. We calculated costs using estimates from peer-reviewed literature and the authors' analysis of surveys (Medical Expenditure Panel Survey, California Health Interview Survey, National Household Travel Survey, and Health Care Utilization Project). A lower-bound estimate of the asthma burden attributable to air pollution was US$18 million yearly. Asthma cases attributable to TRP exposure accounted for almost half of this cost. The cost of bronchitic episodes was a major proportion of both the annual cost of asthma cases attributable to TRP and of pollution-linked exacerbations. Traditional risk assessment methods underestimate both the burden of disease and cost of asthma associated with air pollution, and these costs are borne disproportionately by communities with higher than average TRP.

  10. COSTS OF CHILDHOOD ASTHMA DUE TO TRAFFIC-RELATED POLLUTION IN TWO CALIFORNIA COMMUNITIES

    PubMed Central

    Brandt, Sylvia J.; Perez, Laura; Künzli, Nino; Lurmann, Fred; McConnell, Rob

    2015-01-01

    Recent research suggests the burden of childhood asthma attributable to air pollution has been underestimated in traditional risk assessments, and there are no estimates of these associated costs. We estimated the yearly childhood asthma-related costs attributable to air pollution for Riverside and Long Beach, California, including: 1) the indirect and direct costs of health care utilization due to asthma exacerbations linked to traffic-related pollution (TRP); and 2) the costs of health care for asthma cases attributable to local TRP exposure. We estimated these costs using estimates from peer-reviewed literature and the authors' analysis of surveys (Medical Expenditure Panel Survey, California Health Interview Survey, National Household Travel Survey, and Health Care Utilization Project). A lower-bound estimate of the asthma burden attributable to air pollution was $18 million yearly. Asthma cases attributable to TRP exposure accounted for almost half of this cost. The cost of bronchitic episodes was a major proportion of both the annual cost of asthma cases attributable to TRP and of pollution-linked exacerbations. Traditional risk assessment methods underestimate both the burden of disease and cost of asthma associated with air pollution, and these costs are borne disproportionately by communities with higher than average TRP. PMID:22267764

  11. The evolution of Australian intensive care and its related costs: A narrative review.

    PubMed

    Thompson, Kelly; Taylor, Colman; Forde, Kevin; Hammond, Naomi

    2017-09-26

    To conduct a narrative review on the evolution of intensive care and the cost of intensive care services in Australia. A narrative review using a search of online medical databases and grey literature with keyword verification via Delphi-technique. Using Medical Subject Headings and keywords (intensive care, critical care, mechanical ventilation, renal replacement therapy, extracorporeal membrane oxygenation, monitoring, staffing, cost, cost analysis) we searched MEDLINE, PubMed, CINAHL, Embase, Google and Google Scholar. The search yielded 30 articles from which we provide a narrative synthesis on the evolving intensive care practice in relation to key service elements and therapies. For the review of costs, we found five relevant publications and noted significant variation in methods used to cost ICU. Notwithstanding the limitations of the methods used to cost all publications reported staffing as the primary cost driver, representing up to 71% of costs. Intensive care is a highly specialised medical field, which has developed rapidly and plays an increasingly important role in the provision of hospital care. Despite the increasing importance of the specialty and the known resource intensity there is a paucity of data on the cost of providing this service. In Australia, staffing costs consistently represent the majority of costs associated with operating an ICU. This finding should be interpreted cautiously given the variation of methods used to cost ICU services and the limited number of available studies. Developing standardised methods to consistently estimate ICU costs which can be incorporated in research into the cost-effectiveness of alternate practice is an important step to ensuring cost-effective care. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  14. Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland

    PubMed Central

    Sartorius, Benn; Dlamini, Xolisile; Östensson, Ellinor

    2017-01-01

    Background Human papillomavirus (HPV) has proven to be the cause of several severe clinical conditions on the cervix, vulva, vagina, anus, oropharynx and penis. Several studies have assessed the costs of cervical lesions, cervical cancer (CC), and genital warts. However, few have been done in Africa and none in Swaziland. Cost analysis is critical in providing useful information for economic evaluations to guide policymakers concerned with the allocation of resources in order to reduce the disease burden. Materials and methods A prevalence-based cost of illness (COI) methodology was used to investigate the economic burden of HPV-related diseases. We used a top-down approach for the cost associated with hospital care and a bottom-up approach to estimate the cost associated with outpatient and primary care. The current study was conducted from a provider perspective since the state bears the majority of the costs of screening and treatment in Swaziland. All identifiable direct medical costs were considered for cervical lesions, cervical cancer and genital warts, which were primary diagnoses during 2015. A mix of bottom up micro-costing ingredients approach and top-down approaches was used to collect data on costs. All costs were computed at the price level of 2015 and converted to dollars ($). Results The total annual estimated direct medical cost associated with screening, managing and treating cervical lesions, CC and genital warts in Swaziland was $16 million. The largest cost in the analysis was estimated for treatment of high-grade cervical lesions and cervical cancer representing 80% of the total cost ($12.6 million). Costs for screening only represented 5% of the total cost ($0.9 million). Treatment of genital warts represented 6% of the total cost ($1million). Conclusion According to the cost estimations in this study, the economic burden of HPV-related cervical diseases and genital warts represents a major public health issue in Swaziland. Prevention of HPV

  15. External Actors and National Preference Formation: European Energy Security Policy & Relations with Russia

    NASA Astrophysics Data System (ADS)

    Le Renard, Callie

    This dissertation examines how Russia has impacted the development of a common European energy security policy through case studies of six member states which represent a variety of perspectives on integration and relations with Russia. These case studies focus on how national preferences on energy security policy are formed and the role, if any, Russia has played. The cases, which include Germany, Poland, UK, Bulgaria, Lithuania and France, rely on open source data and interviews with member states' Permanent Representations and subject matter experts from a variety of institutions both in Brussels and in the member states. The cases were selected based on factors such as size, wealth, energy dependence, historic relations with Russia, and membership in the former Eastern Bloc.

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

    PubMed Central

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

    2009-01-01

    Family functioning and parenting were hypothesized to mediate the relation between remission of maternal depression and children's psychosocial adjustment. Participants were 114 mother-child dyads participating in the Sequenced Treatment Alternatives to Relieve Depression Child 3-month follow-up. All mothers had been diagnosed with major depressive disorder and were treated initially with citalopram; 33% of mothers experienced remission of depressive symptoms. Youth ranged in age from 7 to 17. Remission of maternal depression was associated with changes in children's reports of their mothers' warmth/acceptance, which in turn partially mediated the relation between maternal depression remission and youth internalizing symptoms, accounting for 22.9% of the variance. PMID:18991123

  17. [Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].

    PubMed

    Liang, Sen; Zhang, Shun-xiang; Ma, Qi-shan; Xiao, He-wei; Lü, Qiu-ying; Xie, Xu; Mei, Shu-jiang; Hu, Dong-sheng; Zhou, Bo-ping; Li, Bing; Chen, Jing-fang; Cui, Fu-qiang; Wang, Fu-zhen; Liang, Xiao-feng

    2010-12-01

    To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the

  18. Relation of the external mechanical stress to the properties of piezoelectric materials for energy harvesting

    NASA Astrophysics Data System (ADS)

    Jeong, Soon-Jong; Kim, Min-Soo; Lee, Dae-Su; Song, Jae-Sung; Cho, Kyung-Ho

    2013-12-01

    We investigated the piezoelectric properties and the generation of voltage and power under the mechanical compressive loads for three types of piezoelectric ceramics 0.2Pb(Mg1/3Nb2/3)O3-0.8Pb(Zr0.475Ti0.525)O3 (soft-PZT), 0.1Pb(Mg1/3Sb2/3)O3- 0.9Pb(Zr0.475Ti0.525)O3 (hard-PZT) and [0.675Pb(Mg1/3Nb2/3)O3-0.35PbTiO3]+5 wt% BaTiO3 (textured-PMNT). The piezoelectric d 33 coefficients of all specimens increased with increasing compressive load. The generated voltage and power showed a linear relation and square relation to the applied stress, respectively. These results were larger than those calculated using the simple piezoelectric equation due to the non-linear characteristics of the ceramics, so they were evaluated with a simple model based on a non-linear relation.

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

    PubMed Central

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

    2003-01-01

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

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

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

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

  1. 42 CFR 457.224 - FFP: Conditions relating to cost sharing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

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

  4. The effects of age, gender, and crash types on drivers' injury-related health care costs.

    PubMed

    Shen, Sijun; Neyens, David M

    2015-04-01

    There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.

  5. External loops of human premotor spinal oscillators identified by simultaneous measurements of interspike intervals and phase relations.

    PubMed

    Schalow, G; Zäch, G A

    1996-08-01

    Single nerve-fibre action potentials (APs) were recorded extracellularly from alpha and gamma-motoneurons and secondary muscle spindle afferents from a ventral S4 nerve root (some afferents are contained in lower sacral motor roots) in an individual with traumatic spinal cord lesion sub TH1. Simultaneous interspike intervals (IIs) of, and phases between, the APs of 5 nerve fibres were measured, and distributions were constructed. The II distributions were of a broad peak type. Phase distributions showed 1 to 3 peaks interpreted as phase relations between the firings of the nerve fibres. Under certain phase relations, the rhythmic firing of alpha and gamma-motoneurons is further interpreted as an interaction of oscillatory firing neuronal subnetworks driving alpha and gamma-motoneurons. Following repetitive touch and pin-prick stimulation in- and outside the anal reflex area, the II distributions of alpha and gamma-motoneurons and of secondary spindle afferents assimilated partly or fully, while preserving their phase relations. This coordinated firing is interpreted as the oscillatory firing of alpha neuronal networks building up an external loop to the periphery via the gamma-loop. Upon touch, pin-prick, and anal reflex stimulation, and anal and bladder catheter pulling, the values and the number of the phase relations changed. Mostly two phase relations per oscillation cycle were observed. Two phase relations probably represent the physiologic case for the somatic nervous system. Only one phase relation was found when full synchronization of all units occurred. Three phase relations were found when the parasympathetic nervous system division interacted with the somatic one. Based on data obtained from brain-dead individuals it is discussed that the increased synchronization and instability in the number and the values of phase relations suggested pathologic functioning of the caudal functionally disconnected spinal cord in patients with spinal cord lesions

  6. Cost per incident of alcohol-related crime in New South Wales.

    PubMed

    Byrnes, Joshua M; Doran, Christopher M; Shakeshaft, Anthony P

    2012-11-01

    The purpose of this paper is to provide a per incident of crime cost measure for New South Wales that is suitable for the use within cost-effectiveness studies of interventions aimed at reducing the burden of alcohol. This paper seeks to quantify the individual cost of an assault, property damage, sexual offence and disorderly conduct in New South Wales. Costs regarding the criminal act, police involvement, prosecution in criminal courts and incarceration are estimated and then using a four-stage probability analysis, the expected cost per incident is calculated. It is found that expected cost per incident for assault, sexual offence, property damage and disorderly conduct (in 2006 dollar values) is $3982, $5976, $1166 and $501 respectively. A large total cost figure is a powerful policy motivator; however, for the purpose of economic analysis it is often more useful to estimate the per incident cost. This research furthers the existing research on cost of crime estimates and facilitates future cost-effectiveness and other economic analysis of interventions that reduce alcohol-related crime. © 2012 Australasian Professional Society on Alcohol and other Drugs.

  7. Costs and health-related quality of life in Alpha-1-Antitrypsin Deficient COPD patients.

    PubMed

    Karl, Florian M; Holle, Rolf; Bals, Robert; Greulich, Timm; Jörres, Rudolf A; Karch, Annika; Koch, Armin; Karrasch, Stefan; Leidl, Reiner; Schulz, Holger; Vogelmeier, Claus; Wacker, Margarethe E

    2017-04-17

    Alpha-1-Antitrypsin Deficiency (AATD) is an economically unexplored genetic disease. Direct and indirect costs (based on self-reported information on healthcare utilization) and health-related quality of life (HRQL, as assessed by SGRQ, CAT, and EQ-5D-3 L) were compared between 131 AATD patients (106 with, 25 without augmentation therapy (AT)) and 2,049 COPD patients without AATD participating in the COSYCONET COPD cohort. The medication costs of AT were excluded from all analyses to reveal differences associated with morbidity profiles. The association of AATD (with/without AT) with costs or HRQL was examined using generalized linear regression modelling (GLM) adjusting for age, sex, GOLD grade, BMI, smoking status, education and comorbidities. Adjusted mean direct annual costs were €6,099 in AATD patients without AT, €7,117 in AATD patients with AT (excluding costs for AT), and €7,460 in COPD patients without AATD. AATD with AT was significantly associated with higher outpatient (+273%) but lower inpatient (-35%) and medication costs (-10%, disregarding AT) compared with COPD patients without AATD. There were no significant differences between groups regarding indirect costs and HRQL. Apart from AT costs, AATD patients tended to have lower, though not significant, overall costs and similar HRQL compared to COPD patients without AATD. AT was not associated with lower costs or higher HRQL. NCT01245933.

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

    PubMed Central

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

    2015-01-01

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

  9. Relating the Stored Magnetic Energy of a Parallel-Plate Inductor to the Work of External Forces

    NASA Astrophysics Data System (ADS)

    Gauthier, N.

    2007-11-01

    Idealized models are often used in introductory physics courses. For one, such models involve simple mathematics, which is a definite plus since complex mathematical manipulations quickly become an obstacle rather than a tool for a beginner. Idealized models facilitate a student's understanding and grasp of a given physical phenomenon, yet they convey the essential elements of a sometimes intricate and abstract physical concept. It is thus worthwhile to use available models, or to develop new ones, for use in the introductory classroom. Early discussions of electric energy storage within the framework of the infinite parallel-plate capacitor model are an excellent case in point. In this case one can show, through relatively simple mathematical manipulations, that the work done by an external agent in order to increase the separation between the plates is equal to the corresponding change in the electrical energy of the system. The purpose of this paper is to show that a similar model can also be used to discuss magnetic energy storage based on a calculation of the work done by the external forces that act on the system, a subject that is greatly neglected at the introductory level. We examine this system next.

  10. Resting-state EEG power predicts conflict-related brain activity in internally guided but not in externally guided decision-making.

    PubMed

    Nakao, Takashi; Bai, Yu; Nashiwa, Hitomi; Northoff, Georg

    2013-02-01

    Most experimental studies of decision-making have specifically examined situations in which a single correct answer exists (externally guided decision-making). Along with such externally guided decision-making, there are instances of decision-making in which no correct answer based on external circumstances is available for the subject (internally guided decision-making, e.g. preference judgment). We compared these two different types of decision-making in terms of conflict-monitoring and their relation with resting-state brain activity. Current electroencephalography (EEG) data demonstrated that conflict-related N2 amplitudes (i.e., difference between large-conflict and small-conflict conditions) in externally guided decision-making were modulated by the type of external stimulus (i.e., large-conflict stimulus pair or small-conflict stimulus pair) but were not found to be correlated with resting-state brain activity (i.e. resting-state EEG power). In contrast, conflict-related N2 amplitudes in internally guided decision-making were found to be correlated with resting-state brain activity, but were not found to be modulated by the type of stimulus itself: the degree to which the type of external stimulus modulates the conflict during stimulus encoding varies according to individual differences in intrinsic brain activity. Considering those results comprehensively, we demonstrate for the first time resting-state and stimulus-related differences between externally and internally guided decision-making.

  11. Externally controlled involuntary cognitions and their relations with other representations in consciousness.

    PubMed

    Cushing, Donish; Gazzaley, Adam; Morsella, Ezequiel

    2017-10-01

    Percepts and action-related urges often enter consciousness insuppressibly. The Reflexive Imagery Task (RIT) was developed to investigate how high-level cognitions (e.g., subvocalizations), too, can enter consciousness in this manner. Limitations of the paradigm include (a) that no data have confirmed subjects' introspections about the involuntary subvocalizations, and (b) that, in everyday life, adaptive responses to involuntary cognitions often depend on the nature of the other contents in consciousness. To address a and b, we developed an RIT in which subjects were presented with visual objects and instructed to not think of the object names. If a subvocalization did arise, however, subjects responded motorically only if the subvocalization rhymed with a word held in memory and if there was a visual "go" cue. Subjects successfully (on 0.83 of the trials) emitted this complex, "multi-determined" response, which provides evidence for the occurrence of the involuntary subvocalizations and illuminates the function of consciousness. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Relative Response Cost Determines the Sensitivity of Instrumental Reward Seeking to Dopamine Receptor Blockade

    PubMed Central

    Ostlund, Sean B; Kosheleff, Alisa R; Maidment, Nigel T

    2012-01-01

    Dopamine is a critical mediator of instrumental reward seeking behavior and appears to have a particularly important role in motivating actions that require considerable effort. As with rewards, response costs can be evaluated in both absolute and relative terms. The current study investigated whether the extent to which instrumental performance is dependent on dopamine transmission is influenced by relative or absolute response cost. Three groups of rats were rewarded for lever pressing on different fixed ratio (FR) schedules that required 1 (FR-1), 10 (FR-10), or 20 (FR-20) presses for each food reward. Rats were then injected systemically with flupentixol, a dopamine receptor antagonist, or vehicle before testing all groups on an intermediate-cost (FR-10) schedule, such that only the relative cost of responding differed across groups. Rats experiencing an upshift in cost (group FR-1/FR-10) showed greater response suppression following flupentixol administration than rats experiencing no shift in cost (group FR-10/FR-10), whereas flupentixol treatment had no effect on rats experiencing a downshift in cost (group FR-20/FR-10). A second round of flupentixol tests was conducted using the rats' maintenance schedules, such that only absolute response costs differed across groups. Here, the pattern was reversed among the groups, in line with previous reports. Specifically, flupentixol had a stronger suppressive effect in group FR-20/FR-20 than in group FR-10/FR-10, and had no detectable effect in group FR-1/FR-1. These findings suggest that response costs are evaluated in both absolute and relative terms and that dopamine has a role in overcoming both kinds of cost. PMID:22805602

  13. Activity-based cost analysis of opioid-related nausea and vomiting among inpatients.

    PubMed

    Eberhart, Leopold; Koch, Tilo; Kranke, Peter; Rüsch, Dirk; Torossian, Alexander; Nardi-Hiebl, Stefan

    2014-01-01

    Nausea and/or vomiting (N/V) are frequent side effects of opioid drugs. These are of major concerns to patients and caregivers and only few studies have focused on their economical costs. This is a prospective, nonproduct-related, activity-based evaluation of personnel and material costs of opioid-related N/V among inpatients. Data were obtained from surgical, general medicine, and palliative care wards at 16 German hospitals of different size, healthcare mandate, and ownership. According to predefined criteria, of 462 documented N/V events, 340 were diagnosed as opioid related. Elicited activities and pharmacological interventions for N/V episodes followed local standards. Both materials used and the time engaged to treat patients with N/V were documented on an "ad hoc" activity recording form. The total cost of an opioid-related N/V episode was calculated based on standard wages of the involved personnel and standard costs of the inherent materials used. Mean staff tenure time for handling an episode of N/V was 26.2 ± 19.8 minutes (nausea 16.9 ± 28.7 minutes; nausea + vomiting: 33.4 ± 26.8 minutes). In the German context, this corresponds to average personnel costs of €18.06 ± 13.64. Material cost contributes to another €13.49 ±13.38 of costs mainly depending on acquisition costs of antiemetic drugs. N/V showed to have impact on workload of nurses and (to lesser extent) physicians and economic burden of €31 ± 22 for each N/V episode. In view of these results, the potential costs of strategies to minimize the incidence of N/V (use of antiemetics and/or the use of new analgesics) should be outweighed against the incurred costs of N/V.

  14. Health care cost containment in Denmark and Norway: a question of relative professional status?

    PubMed

    Andersen, Lotte B

    2014-04-01

    The demand for publicly subsidized health care services is insatiable, but the costs can be contained in different ways: formal rules can limit access to and the number of subsidized services, demand and supply can be regulated through the price mechanism, the relevant profession can contain the costs through state-sanctioned self-regulation, and other professions can contain the costs (e.g. through referrals). The use of these cost containment measures varies between countries, depending on demand and supply factors, but the relative professional status of the health professions may help explain why different countries use cost containment measures differently for different services. This article compares cost containment measures in Denmark and Norway because these countries vary with regard to the professional status of the medical profession relative to other health care providers, while other relevant variables are approximately similar. The investigation is based on formal agreements and rules, historical documents, existing analyses and an analysis of 360 newspaper articles. It shows that high relative professional status seems to help professions to avoid user fees, steer clear of regulation from other professions and regulate the services produced by others. This implies that relative professional status should be taken into consideration in analyses of health care cost containment.

  15. Assessing relational schemas in parents of children with externalizing behavior disorders: reliability and validity of the Family Affective Attitude Rating Scale.

    PubMed

    Pasalich, Dave S; Dadds, Mark R; Hawes, David J; Brennan, John

    2011-02-28

    Direct observational assessment of parent-child interaction is important in clinical intervention with conduct-problem children, but is costly and resource-intensive. We examined the reliability and validity of a brief measure of parents' relational schemas (RSs) regarding their child. Children (aged 4 to 11years) and their families receiving treatment at a clinic for externalizing behavior problems (n=150) or mood/developmental disorders (n=28) were assessed using a multi-method, multi-informant procedure. RSs were coded from Five-Minute Speech Samples (FMSS) using the Family Affective Attitude Rating Scale (FAARS), and were compared with directly observed parent-child interaction and questionnaire measures of family and parental dysfunction and conduct problems. Mothers' and fathers' RS scales were internally consistent and could be reliably coded in under 10min. Less positive RSs and more negative RSs were associated with higher rates of child conduct problems, and were more characteristic of the speech samples of parents of children with externalizing disorders, compared with clinic control parents. RSs demonstrated some associations with parenting behavior and measures of family functioning and symptoms of parental psychopathology, and predicted conduct problems independently of observed parental criticism. The results demonstrate the reliability and validity of the FAARS assessment of parental RSs in clinic-referred families. This brief measure of parent-child dynamics appears well-suited to 'real-world' (i.e., community) clinical settings in which intensive methods of observation are often not feasible. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  16. 32 CFR 37.535 - How do I value cost sharing related to real property or equipment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false How do I value cost sharing related to real... Evaluation Cost Sharing § 37.535 How do I value cost sharing related to real property or equipment? You rarely should accept values for cost sharing contributions of real property or equipment that are...

  17. Age-related shapes of the cost of reproduction in vertebrates.

    PubMed

    Proaktor, G; Milner-Gulland, E J; Coulson, T

    2007-12-22

    The shape of the association between age and the cost of reproduction varies across species. However, it is unclear whether there are any general patterns in the way the cost of reproduction varies with life history, taxon or ecological function. Using a simple theoretical method, we identified three characteristic patterns to describe the age-related survival cost of reproduction. The most frequent pattern is an approximately exponential decay (ED) with increasing age. Two additional u-shaped patterns were identified, where the cost of reproduction was higher for young and old individuals compared with intermediate-aged individuals. The majority of these u-shaped curves suggested higher costs of reproduction at older ages (RQ), with the rest suggesting a higher cost at young ages (LQ). While predators were most likely to exhibit ED-shaped cost curves, herbivores were equally likely to exhibit ED and RQ curves; birds were likely to exhibit ED-shaped curves and mammals were split equally between ED and RQ curves. These findings suggest that there may be predictable differences in the age-related shape of the cost of reproduction between species, but further research is required to identify the mechanisms generating such differences.

  18. Relation between discharge regularity and responses to externally applied galvanic currents in vestibular nerve afferents of the squirrel monkey.

    PubMed

    Goldberg, J M; Smith, C E; Fernández, C

    1984-06-01

    Most vestibular nerve afferents can be classified as regularly or irregularly discharging. Two factors are theoretically identified as being potentially responsible for differences in discharge regularity. The first, ascribable to synaptic noise, is the variance (sigma v2) characterizing the transmembrane voltage fluctuations of the axon's spike trigger site, i.e., the place where impulses normally arise. The second factor is the slope (dmuv/dt) of the trigger site's postspike recovery function. Were (dmuv/dt) a major determinant of discharge regularity, the theory predicts that the more irregular the discharge of a unit, the greater should be its sensitivity to externally applied galvanic currents and the faster should be the postspike recovery of its electrical excitability. The predictions would not hold if differences in the discharge regularity between units largely reflected variations in sigma v. To test these predictions, the responses of vestibular nerve afferents to externally applied galvanic currents were studied in the barbiturate-anesthetized squirrel monkey. Current steps of 5-s duration and short (50 microsecond) shocks were delivered by way of the perilymphatic space of the vestibule. Results were similar regardless of which end organ an afferent innervated. The regularity of discharge of each unit was expressed by a normalized coefficient of variation (CV*). The galvanic sensitivity (beta p) of a unit, measured from its response to current steps, was linearly related to discharge regularity (CV*), there being approximately 20-fold variations in both variables across the afferent population. Various geometric factors--including fiber diameter, position of individual axons within the various nerve branches, and the configuration of unmyelinated processes within the sensory epithelium--are unlikely to have made a major contribution to the positive relation between beta P and CV*. The postspike recovery of electrical excitability was measured as

  19. The Cost of Work-Related Stress to Society: A Systematic Review.

    PubMed

    Hassard, Juliet; Teoh, Kevin R H; Visockaite, Gintare; Dewe, Philip; Cox, Tom

    2017-03-30

    A systematic review of the available evidence examining the cost of work-related stress (WRS) would yield important insights into the magnitude of this social phenomenon. The objective of this review was to collate, extract, and synthesize economic evaluations of the cost of WRS to society. A research protocol was developed. Included cost-of-illness (COI) studies estimated the cost of WRS at a societal level, and were published in English, French or German. Searches were carried out in ingentaconnect, EBSCO, JSTOR, Science Direct, Web of Knowledge, Google, and Google scholar. Included studies were assessed against 10 COI quality assessment criteria. Fifteen studies met the inclusion criteria and were reviewed. These originated from Australia, Canada, Denmark, France, Sweden, Switzerland, the United Kingdom, and the EU-15. The total estimated cost of WRS was observed to be considerable and ranged substantially from US$221.13 million to $187 billion. Productivity related losses were observed to proportionally contribute the majority of the total cost of WRS (between 70 to 90%), with health care and medical costs constituting the remaining 10 to 30%. The evidence reviewed here suggests a sizable financial burden imposed by WRS on society. The observed range of cost estimates was understood to be attributable to variations in definitions of WRS; the number and type of costs estimated; and, in how production loss was estimated. It is postulated that the cost estimates identified by this review are likely conservative because of narrow definitions of WRS and the exclusion of diverse range of cost components. (PsycINFO Database Record

  20. Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia.

    PubMed

    Cobiac, Linda; Vos, Theo; Doran, Christopher; Wallace, Angela

    2009-10-01

    To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector. © 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction.

  1. Using probability vs. nonprobability sampling to identify hard-to-access participants for health-related research: costs and contrasts.

    PubMed

    Feild, Lucy; Pruchno, Rachel A; Bewley, Jennifer; Lemay, Edward P; Levinsky, Norman G

    2006-08-01

    This article compares the recruitment costs and participant characteristics associated with the use of probability and nonprobability sampling strategies in a longitudinal study of older hemodialysis patients and their spouses. Contrasts were made of people who accrued to the study based on probability and nonprobability sampling strategies. Probability-based sampling was more time-efficient and cost-effective than nonprobability sampling. There were no significant differences between the respondents identified through probability and nonprobability sampling on age, gender, years married, education, work status, and professional job status. Respondents from the probability sample were more likely to be Protestant and less likely to be Catholic than those from the nonprobability sample. Respondents from the probability sample were more likely to be Black, whereas those from the nonprobability sample were more likely to be White. There are strengths and shortcomings associated with both nonprobability and probability sampling. Researchers need to consider representativeness and external validity issues when designing sampling and related recruitment plans for health-related research.

  2. One-year disease-related health care costs of incident vertebral fractures in osteoporotic patients.

    PubMed

    Lange, A; Zeidler, J; Braun, S

    2014-10-01

    The study aims to estimate the direct disease-related costs of osteoporotic vertebral compression fractures (OVCF) in patients with newly diagnosed fracture in the first year after index in Germany. Analyses reveal that OVCFs are associated with significant costs. In light of high and increasing incidence, the results emphasize importance of research in this field. OVCF are among the most common fractures related to osteoporosis. They have been shown to be associated with excess mortality and meaningful healthcare costs. Costs calculations have illustrated the significant financial burden to society and national social security systems. However, this information is not available for Germany. Therefore, aim of the study was to estimate the direct disease-related costs of OVCF in patients with newly diagnosed fracture in the first year after index in Germany. Data were obtained from a claims dataset of a large German health insurance fund. Subjects ≥ 60 years with a new vertebral fracture between 2006 and 2010 were studied retrospectively compared to a matched paired OVCF-free patient group. All-cause and fracture-specific medical costs were calculated in the 1-year baseline and follow-up period. Generalized linear model (GLM) was estimated for total follow-up healthcare cost. A total of 2,277 pairs of matched OVCF and OVCF-free patients were included in the analysis. Baseline costs were higher in the OVCF group. Mean unadjusted all-cause healthcare cost difference in the four quarters following the index date between OVCF and OVCF-free patients was 8,200 (p < 0.001). Of the difference, almost two third was attributable to inpatient services and one quarter to prescription drug costs. The GLM procedure revealed that OVCF-related costs in the first year after the index date add up to 6,490 (p < 0.001; CI 5,809 -6,731 ). Despite limitations of this study, our results are consistent with other research and demonstrate that OVCFs are

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

    PubMed

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

    2015-03-02

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

  4. [Cost-effectiveness of photodynamic therapy in age-related macular degeneration].

    PubMed

    Muslera, E; Natal, C

    2006-04-01

    The aim of this study was to estimate the public health service cost of visual acuity improvement or maintenance with photodynamic therapy in patients with age-related macular degeneration (ARMD). This illness is the most frequent cause of blindness in elderly patients in western countries. A cost-effectiveness analysis was carried out to compare photodynamic therapy versus no treatment. The analysis point of view was that of the health service. The improvement or maintenance of visual acuity and contrast sensitivity were considered efficacy results. Direct costs were estimated by means of cost accountancy. Quality adjusted costs per visual acuity life year gained (QACVAG) were calculated through utility values from other studies. The cost per year of maintenance of visual acuity in a two-year period was 36,530 euro for women and 34,804 euro for men. If this cost was estimated for life expectancy in Asturias, it would be reduced to 4,298 euro for women and 5,354 euro for men. If costs of the QACVAG, in a two-year period, were considered, photodynamic therapy would cost 66,931 euro for women and 70,249 euro for men. This cost-effectiveness analysis allows decisions to be made about public financing. Some research in our country suggests that public health financing should be provided for interventions whose cost-effectiveness is less than 30,000 euro of CVAQA. The treatment evaluated here far exceeds this value. It is recommended that the use of more restrictive patient selection, incorporating diagnostic criteria and patient autonomy indicators, could improve the results of this intervention.

  5. Allocation to Reproduction and Relative Reproductive Costs in Two Species of Dioecious Anacardiaceae with Contrasting Phenology

    PubMed Central

    Matsuyama, Shuhei; Sakimoto, Michinori

    2008-01-01

    Background and Aims The cost of reproduction in dioecious plants is often female-biased. However, several studies have reported no difference in costs of reproduction between the sexes. In this study, the relative reproductive allocation and costs at the shoot and whole-plant levels were examined in woody dioecious Rhus javanica and R. trichocarpa, in order to examine differences between types of phenophase (i.e. physiological stage of development). Methods Male and female Rhus javanica and R. trichocarpa were sampled and the reproductive and vegetative allocation of the shoot were estimated by harvesting reproductive current-year shoots during flowering and fruiting. Measurements were made of the number of reproductive and total current-year shoots per whole plant, and of the basal area increment (BAI). The numbers of reproductive and total current-year shoots per 1-year-old shoot were counted in order to examine the costs in the following year at the shoot level. Key Results A female-biased annual reproductive allocation was found; however, the ratio of reproductive current-year shoots per tree and the BAI did not differ between sexes in Rhus javanica and R. trichocarpa. The percentage of 1-year-old shoots with at least one reproductive current-year shoot was significantly male-biased in R. trichocarpa, but not in R. javanica, indicating that there was a relative cost at the shoot level only in R. trichocarpa. The female-biased leaf mass per shoot, an indicator of compensation for costs, was only found in R. javanica. Conclusions Relative reproductive costs at the shoot level were detected in Rhus trichocarpa, which has simultaneous leafing and flowering, but not in R. javanica, which has leafing followed by flowering. However, the costs for the whole-plant level were diminished in both species. The results suggest that the phenophase type may produce the different costs for R. javanica and R. trichocarpa through the development of a compensation mechanism. PMID

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

    PubMed

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

    2015-03-01

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

  7. Surgical workload and cost of postoperative adhesion-related intestinal obstruction: importance of previous surgery.

    PubMed

    Kössi, Jyrki A O; Salminen, Paulina T P; Laato, Matti K

    2004-07-01

    Postoperative intraabdominal adhesions cause morbidity of varying degree. Intestinal obstruction is the most severe complication of adhesions. This study examined the importance of previous surgery on clinical and economic workloads caused by intestinal obstruction due to postoperative intraabdominal adhesions. All emergency hospitalizations due to adhesion-related intestinal obstruction from January 1, 1999 to December 31, 1999 in a hospital district serving roughly 450,000 inhabitants was reviewed retrospectively. The patient population was divided into six groups according to the site of previous surgery, and the total as well as group-related surgical workload and direct costs of inpatient care were analyzed. There were 123 hospitalizations due to postoperative adhesion-related intestinal obstruction during the study period. A total of 101 patients had experienced 176 operations. The most prevalent operations were colorectal (with or without other operations), upper abdominal, and female reproductive system procedures. Colorectal surgery preceded 40% and 38% of inpatient episodes and inpatient days, respectively. Altogether, 40 operations were performed because of adhesion-related intestinal obstruction. No differences between groups were seen in terms of the mean operating or theater time. Total annual inpatient costs due to emergency hospitalizations for intestinal adhesion-related obstruction related to colorectal surgery in a hospital district serving roughly 450,000 inhabitants was 72,520.60 (U.S. dollars) which accounted for 35.3% of all annual costs caused by postoperative adhesion-related intestinal obstructions. There were no significant differences between groups regarding the total mean inpatient episode costs. Intestinal obstruction due to postoperative adhesions poses substantial costs for the society. Colorectal operations are the most important procedures preceding adhesion-related intestinal obstruction, accounting for 35.3% to 46.8% of the

  8. The relative costs of proton and X-ray radiation therapy.

    PubMed

    Goitein, M; Jermann, M

    2003-02-01

    To study the costs of intensity-modulated proton therapy and intensity-modulated X-ray therapy with the particular goal of understanding their relative differences. To analyse the ratio of the cost per fraction of proton therapy to the cost per fraction of X-ray therapy. We have used a computer spreadsheet tool in which a large number (typically 130) of input parameters characterizing a particular therapeutic modality can be stored. From these parameters a number of derived variables are computed, and from these derived variables the costs of sub-systems, the entire facility, running costs and cost per fraction and per treatment can be computed. The sensitivity of any given variable (e.g. cost/fraction) to any given parameter (e.g. set-up time) can be explored, together with an estimate of the associated confidence interval. The costs of facility construction and facility operation are considered separately. Key data for the input variables regarding the cost of the therapy equipment (a dominant cost for proton beam therapy) were provided by four commercial vendors. Other costs, such as costs for building construction and shielding or personnel costs, are much more standard and our estimates were primarily based on practical experience. We considered two scenarios: (1) both facilities operating under current conditions; and (2) future facilities where foreseeable improvements in efficiency and a 25% reduction in the cost of the proton equipment were assumed. The construction cost of a current two-gantry proton facility, complete with the equipment, was estimated at 62,500 kEE and of a two-linac X-ray facility at 16,800 kEE. In the case of proton therapy the cost of operation of the facility was found to be dominated, by the business cost (42%--primarily the cost of repaying the presumed loan for facility construction), personnel costs (28%) and the cost of servicing the equipment (21%). For X-ray therapy, the cost of operation was seen to be dominated by the

  9. Induction-related cost of patients with acute myeloid leukaemia in France.

    PubMed

    Nerich, Virginie; Lioure, Bruno; Rave, Maryline; Recher, Christian; Pigneux, Arnaud; Witz, Brigitte; Escoffre-Barbe, Martine; Moles, Marie-Pierre; Jourdan, Eric; Cahn, Jean Yves; Woronoff-Lemsi, Marie-Christine

    2011-04-01

    The economic profile of acute myeloid leukaemia (AML) is badly known. The few studies published on this disease are now relatively old and include small numbers of patients. The purpose of this retrospective study was to evaluate the induction-related cost of 500 patients included in the AML 2001 trial, and to determine the explanatory factors of cost. "Induction" patient's hospital stay from admission for "induction" to discharge after induction. The study was performed from the French Public Health insurance perspective, restrictive to hospital institution costs. The average management of a hospital stay for "induction" was evaluated according to the analytical accounting of Besançon University Teaching Hospital and the French public Diagnosis-Related Group database. Multiple linear regression was used to search for explanatory factors. Only direct medical costs were included: treatment and hospitalisation. Mean induction-related direct medical cost was estimated at €41,852 ± 6,037, with a mean length of hospital stay estimated at 36.2 ± 10.7 days. After adjustment for age, sex and performance status, only two explanatory factors were found: an additional induction course and salvage course increased induction-related cost by 38% (± 4) and 15% (± 1) respectively, in comparison to one induction. These explanatory factors were associated with a significant increase in the mean length of hospital stay: 45.8 ± 11.6 days for 2 inductions and 38.5 ± 15.5 if the patient had a salvage course, in comparison to 32.9 ± 7.7 for one induction (P < 10⁻⁴). This result is robust and was confirmed by sensitivity analysis. Consideration of economic constraints in health care is now a reality. Only the control of length of hospital stay may lead to a decrease in induction-related cost for patients with AML.

  10. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Introduction to capital-related costs. 413.130 Section 413.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Capital-Related...

  11. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Introduction to capital-related costs. 413.130 Section 413.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Capital-Related...

  12. 42 CFR 413.130 - Introduction to capital-related costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Introduction to capital-related costs. 413.130 Section 413.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Capital-Related...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Introduction to capital-related costs. 413.130 Section 413.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Capital-Related...

  14. City-scale analysis of water-related energy identifies more cost-effective solutions.

    PubMed

    Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

    2017-02-01

    Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This

  15. Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases.

    PubMed

    Popkin, B M; Kim, S; Rusev, E R; Du, S; Zizza, C

    2006-08-01

    Most studies that have focused on the costs of obesity have ignored the direct effects of obesity-related patterns of diet and physical activity. This study reviews the full effects of each component--poor dietary and physical activity patterns and obesity--on morbidity, mortality and productivity. The direct healthcare costs are based on a review of the effects of these factors on key diseases and the related medical care costs of each disease. The indirect costs on reduced disability, mortality and sickness during the period of active labour force participation prior to retirement are also examined. A case study is prepared for China to provide some guidance in the utilization of this review for economic analysis of obesity. The case study shows that the indirect costs are often far more important than the direct medical care costs. The Chinese case study found that the indirect effects of obesity and obesity-related dietary and physical activity patterns range between 3.58% and 8.73% of gross national product (GNP) in 2000 and 2025 respectively.

  16. DSM-IV personality disorders and associations with externalizing and internalizing disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

    PubMed

    Harford, Thomas C; Chen, Chiung M; Saha, Tulshi D; Smith, Sharon M; Ruan, W June; Grant, Bridget F

    2013-11-01

    Although associations between personality disorders and psychiatric disorders are well established in general population studies, their association with liability dimensions for externalizing and internalizing disorders has not been fully assessed. The purpose of this study is to examine associations between personality disorders (PDs) and lifetime externalizing and internalizing Axis I disorders. Data were obtained from the total sample of 34,653 respondents from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drawing on the literature, a 3-factor exploratory structural equation model was selected to simultaneously assess the measurement relations among DSM-IV Axis I substance use and mood and anxiety disorders and the structural relations between the latent internalizing-externalizing dimensions and DSM-IV PDs, adjusting for gender, age, race/ethnicity, and marital status. Antisocial, histrionic, and borderline PDs were strong predictors for the externalizing factor, while schizotypal, borderline, avoidant, and obsessive-compulsive PDs had significantly larger effects on the internalizing fear factor when compared to the internalizing misery factor. Paranoid, schizoid, narcissistic, and dependent PDs provided limited discrimination between and among the three factors. An overarching latent factor representing general personality dysfunction was significantly greater on the internalizing fear factor followed by the externalizing factor, and weakest for the internalizing misery factor. Personality disorders offer important opportunities for studies on the externalizing-internalizing spectrum of common psychiatric disorders. Future studies based on panic, anxiety, and depressive symptoms may elucidate PD associations with the internalizing spectrum of disorders. Published by Elsevier Ltd.

  17. Costs for integrating wind into the future ERCOT system with related costs for savings in CO2 emissions.

    PubMed

    Lu, Xi; McElroy, Michael B; Sluzas, Nora A

    2011-04-01

    Wind power can make an important contribution to the goal of reducing emissions of CO2. The major problem relates to the intrinsic variability of the source and the difficulty of reconciling the supply of electricity with demand particularly at high levels of wind penetration. This challenge is explored for the case of the ERCOT system in Texas. Demand for electricity in Texas is projected to increase by approximately 60% by 2030. Considering hourly load data reported for 2006, assuming that the pattern of demand in 2030 should be similar to 2006, and adopting as a business as usual (BAU) reference an assumption that the anticipated additional electricity should be supplied by a combination of coal and gas with prices, discounted to 2007 dollars of $2 and $6 per MMBTU respectively, we conclude that the bus-bar price for electricity would increase by about 1.1 ¢/kWh at a wind penetration level of 30%, by about 3.4 ¢/kWh at a penetration level of 80%. Corresponding costs for reductions in CO2 range from $20/ton to $60/ton. A number of possibilities are discussed that could contribute to a reduction in these costs including the impact of an expanded future fleet of electrically driven vehicles.

  18. Conservation goals and the relative importance of costs and benefits in reserve selection.

    PubMed

    Perhans, Karin; Kindstrand, Claes; Boman, Mattias; Djupström, Line Boberg; Gustafsson, Lena; Mattsson, Leif; Schroeder, Leif Martin; Weslien, Jan; Wikberg, Sofie

    2008-10-01

    Including both economic costs and biological benefits of sites in systematic reserve selection greatly increases cost-efficiency. Nevertheless, limited funding generally forces conservation planners to choose which data to focus the most resources on; therefore, the relative importance of different types of data must be carefully assessed. We investigated the relative importance of including information about costs and benefits for 3 different commonly used conservation goals: 2 in which biological benefits were measured per site (species number and conservation value scores) and 1 in which benefits were measured on the basis of site complementarity (total species number in the reserve network). For each goal, we used site-selection models with data on benefits only, costs only, and benefits and costs together, and we compared the efficiency of each model. Costs were more important to include than benefits for the goals in which benefits were measured per site. By contrast, for the complementarity-based goal, benefits were more important to include. To understand this pattern, we compared the variability in benefits and in costs for each goal. By comparing the best and the worst possible selection of sites with regard to costs alone and benefits alone for each conservation goal, we introduced a simple and consistent variability measure that is applicable to all kinds of reserve-selection situations. In our study, benefit variability depended strongly on how the conservation goal was formulated and was largest for the complementarity-based conservation goal. We argue that from a cost-efficiency point of view, most resources should be spent on collecting the most variable type of data for the conservation goal at hand.

  19. Relative cost comparison of embolic materials used for treatment of wide-necked intracranial aneurysms.

    PubMed

    Simon, Scott D; Reig, Adam S; James, Robert F; Reddy, Prasad; Mericle, Robert A

    2010-06-01

    Embolization of wide-necked intracranial aneurysms can be associated with excessive expense, especially for large/giant aneurysms. Depending on the material used, endovascular treatment may be cost prohibitive. The goal of this study was to evaluate the relative cost of various embolic agents. Utilizing software available at http://www.angiocalc.com, theoretical aneurysm volumes were calculated using aneurysm diameters ranging from 3 to 25 mm increasing in 1 mm increments. For each volume, the software calculated the length of coil needed to fill each size of aneurysm to a consistent, standardized and desirable packing density (25% coil:aneurysm volume). Each theoretical aneurysm was embolized by filling volume in a consistent, standardized, step-wise fashion. The cost of liquid embolics was calculated by adding the cost of 1.5 ml vials of Onyx HD 500 required to fill each volume. The embolic agents were then grouped into seven categories depending on the coil type and the cost of each aneurysm size was averaged. The average embolization with small outer diameter (0.010 inches) helical coils ranged between $714 for a 3 mm aneurysm to $113,009 for a 25 mm aneurysm, and between $2855 and $157,245 for small diameter spherical coils. Large outer diameter (>0.010 inches) helical coils cost between $2195 and $34,034 and large diameter spherical coils cost between $2195 and $86,957. Bioactive coils ranged between $1984 and $172,179, liquid embolic $5950 and $35,700, and hydrocoils $1295 and $32,873. Larger outer diameter helical coils, hydrocoils and liquid embolics provide a relative cost savings compared with standard, spherical or bioactive coils when aneurysm size, shape, packing density and embolic agent were controlled and standardized. This cost differential increases as the size of the aneurysm increases.

  20. Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research.

    PubMed

    van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

    2017-09-20

    The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2) developing a costing tool to support reviewers of grant proposals in assessing whether the proposed budget is realistic. For granted study proposals from the Netherlands Organization for Health Research and Development (ZonMw), type of study, potential cost drivers, proposed budget, and general characteristics were extracted. Regression analysis was conducted in an attempt to generate a 'predicted budget' for certain combinations of cost drivers, for implementation in the costing tool. Of 133 drug-related research grant proposals, 74 were included for complete data extraction. Because an association between cost drivers and budgets was not confirmed, we could not generate a predicted budget based on regression analysis, but only historic reference budgets given certain study characteristics. The costing tool was designed accordingly, i.e. with given selection criteria the tool returns the range of budgets in comparable studies. This range can be used in VOI analysis to estimate whether the expected net benefit of sampling will be positive to decide upon the net value of future research. The absence of association between study characteristics and budgets may indicate inconsistencies in the budgeting or granting process. Nonetheless, the tool generates useful information on historical budgets, and the option to formally relate VOI to budgets. To our knowledge, this is the first attempt at creating such a tool, which can be complemented with new studies being granted, enlarging the underlying database and keeping estimates up to date.

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

    PubMed

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

    2015-01-01

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

  2. The relation of potassium and sodium intakes to diet cost among US adults

    PubMed Central

    Drewnowski, Adam; Rehm, Colin D; Maillot, Matthieu; Monsivais, Pablo

    2014-01-01

    The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4,744 adults, the association between the energy-adjusted sodium and potassium intakes and the sodium-to-potassium ratio (Na:K), and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower sodium-potassium ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost among participants with highest and lowest potassium intakes was $1.49 (95% CI 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines. PMID:24871907

  3. Treatment costs related to bipolar disorder and comorbid conditions among Medicaid patients with bipolar disorder.

    PubMed

    Guo, Jeff J; Keck, Paul E; Li, Hong; Patel, Nick C

    2007-08-01

    This study assessed costs among patients with bipolar disorder for treatment related to bipolar disorder and to comorbid conditions. Risk factors associated with costs were also assessed. Data (January 1998 to December 2002) were from a seven-state Medicaid managed care claims database for 13,471 patients who had received a diagnosis of bipolar disorder, most of whom received medications. Each medical claims cost was adjusted by the medical component of the Consumer Price Index as the dollar value in 2002. In a Poisson regression analysis, treatment costs per enrollment month were regressed on patient's age, gender, medications, and clinical comorbidities. Bipolar disorder treatment accounted for 30% of costs and comorbid disorders for 70%. Key cost components were inpatient care (35%), outpatient care (16%), prescriptions (13%), and physician encounters (11%). Patients with bipolar disorder received a variety of medications: lithium, 13%; anticonvulsants, 35%; second-generation antipsychotics, 24%; first-generation antipsychotics, 22%; and antidepressants, 42%. Compared with the costs for patients receiving antidepressants alone or no medication, the high costs for bipolar disorder treatment and overall treatment were associated with use of second-generation antipsychotics (rate ratio [RR]=1.71, 95% confidence interval [CI]=1.58-1.86 and RR=1.26, CI=1.18-1.34, respectively) and use of anticonvulsants (RR=1.37, CI=1.26-1.48 and RR=1.06, CI=1.00-1.12). Higher costs were significantly associated with key comorbidities, such as drug abuse (RR=1.58, CI=1.47-1.70), cerebral-vascular disease (RR=1.72, CI=1.51-1.94), ischemic heart disease (RR=1.47, CI=1.30-1.66), and hypertension (RR=1.44, CI=1.33-1.56). Cost-containment efforts may need to manage or prevent key comorbidities among patients with bipolar disorder and to evaluate the association between antipsychotic use and treatment outcomes and hospital services.

  4. Computerized model of cost-utility analysis for treatment of age-related macular degeneration.

    PubMed

    Fletcher, E C; Lade, R J; Adewoyin, T; Chong, N V

    2008-12-01

    To present a computerized model assessing individualized cost utility for current treatments for neovascular age-related macular degeneration (AMD) to enhance discussion regarding treatment options. Case- and eye-specific cost-utility analysis using individual case scenarios. Visual acuity data from published randomized controlled trials are incorporated into this analysis. Computerized model (Microsoft Visual Basic 6.0 programming) to establish preference-based cost-utility analysis in association with individual cost of treatment and blindness for neovascular AMD for both the better and worst seeing eye, with extrapolation of results over a 5-year term. Cost per quality-adjusted life-year (QALY) and cost per QALY gained for comparison of treatments for specific visual acuities. All treatments show an increase in utility in comparison with best supportive care (BSC) if the better-seeing eye is treated. Ranibizumab, using the Phase IIIb, Multicenter, Randomized, Double-Masked, Sham Injection-Controlled Study of the Efficacy and Safety of Ranibizumab in Subjects with Subfoveal Choroidal Neovascularisation (CNV) with or without Classic CNV Secondary to AMD (PIER) regimen, is the most cost effective at $626 938 per QALY gained for treatment of the better seeing eye. To increase utility value when treating the worst seeing eye, the vision must improve to such a degree that it becomes the better seeing eye. This level of improvement is only possible if there is <9 letters difference between the 2 eyes and treated with ranibizumab. Over 5 years, increasing influence from the cost of blindness results in increasing costs for those treatments unable to stabilize vision. Within 5 years, the cost per QALY for the BSC is greater than all treatments except monthly ranibizumab injections. Assessment of cost of treatment incorporates both effectiveness of treatment, cost of treatment, and cost of blindness. Cost analysis enables incorporation of these aspects of treatment with

  5. Cost effectiveness of treatments for wet age-related macular degeneration.

    PubMed

    Mitchell, Paul; Annemans, Lieven; White, Richard; Gallagher, Meghan; Thomas, Simu

    2011-02-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged ≥50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination and Cochrane Library databases were searched for all wet AMD health technology assessments (HTAs). Overall, 44 publications were evaluated in full and included in this review. A broad range of cost-effectiveness analyses were identified for the most commonly used therapies for wet AMD (pegaptanib, ranibizumab and photodynamic therapy [PDT] with verteporfin). Three studies evaluated the cost effectiveness of bevacizumab in wet AMD. A small number of analyses of other treatments, such as laser photocoagulation and antioxidant vitamins, were also found. Ranibizumab was consistently shown to be cost effective for wet AMD in comparison with all the approved wet AMD therapies (four of the five studies identified showed ranibizumab was cost effective vs usual care, PDT or pegaptanib); however, there was considerable variation in the methodology for cost-effectiveness modelling between studies. Findings from the HTAs supported those from the PubMed and EMBASE searches; of the seven HTAs that included ranibizumab, six (including HTAs for Australia, Canada and the UK) concluded that ranibizumab was cost effective for the treatment of wet AMD; most compared ranibizumab with PDT and/or pegaptanib. By contrast, HTAs at best generally recommended pegaptanib or PDT for restricted use in subsets of patients with wet AMD. In the literature analyses, pegaptanib was found to be cost effective versus usual/best supportive care (including PDT) or no treatment in one of five studies; the other four

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

    PubMed

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

    2015-08-01

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

  7. [Cost relation between severity of Alzheimer's disease and cognitive and functional impairment].

    PubMed

    López-Pousa, Secundino; Garre-Olmo, Josep; Turon-Estrada, Antoni; Hernández, Francisco; Expósito, Inmaculada; Lozano-Gallego, Manoli; Hernández-Ferrándiz, Marta; Gelada-Batlle, Esther; Pericot-Nierga, Imma; Vilalta-Franch, Joan

    2004-05-29

    This study aims to identify the relationship between costs of medical and social attention in patients with dementia of Alzheimer disease (AD) type and clinical and sociodemographic data of patients and their caregivers. It was an analytic observational study in a cohort of patients diagnosed with Alzheimer's disease who received ambulatory attention. Information about the use of health-related resources was collected and costs were estimated from a societal perspective. Indirect costs were calculated using a replacement cost approach. Patients and caregivers were examined with the Mini-Mental State Examination (MMSE), the Rapid Disability Rating Scale (RDRS-2), the Neuropsychiatric Inventory (NPI), the Burden Interview (BI) and the Resource Utilization in Dementia (RUD). Patients were grouped taking into account the score obtained in the MMSE. A cohort of 417 patients, mean age (SD) 75.2 (6.6) years, 71% females, was studied. Disease severity levels were distributed as follows: MMSE, 26% for MMSE > 19, 66% for MMSE = 19-11, and 8% for MMSE < 11. 69% of caregivers were women, with a mean age of 57.1 (15.8) years. The cost per patient and per month was estimated to be 419.3 Euro for MMSE > 19, 641.9 Euro for MMSE = 19-11, and 1150.6 Euro for MMSE < 11. The societal cost of AD increases dramatically with increasing disease severity. Caregiver burden and sex as well as the marital status of patients are associated with the cost of the disease.

  8. [Costs of temporary disability in Spain related to diabetes mellitus and its complications].

    PubMed

    Vicente-Herrero, M Teófila; Terradillos García, M Jesús; Capdevila García, Luisa M; Ramírez Iñiguez de la Torre, M Victoria; López-González, Angel Arturo

    2013-10-01

    To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. In 2011, diabetes and its complications were related to 2.567 TD processes, which resulted in the loss of 154.214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297.095.3 €, with an estimated cost per patient and year of 141 €. These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  9. Variations in car crash-related hospitalization costs amongst young adults in New South Wales, Australia.

    PubMed

    Chen, H Y; Jan, S; Boufous, S; Martiniuk, A L C; Ivers, R; Senserrick, T; Norton, R; Muscatello, D

    2012-09-01

    This study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES). Data on patients aged 17-25 years, admitted to public hospitals due to a crash during July 2000-June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas). During 2000-2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17-25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p<0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant. Annually, young adults' crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based

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

    NASA Technical Reports Server (NTRS)

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

    1974-01-01

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

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

    PubMed

    Hu, T W; Slaysman, K S

    1984-01-01

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

  12. The learning of 90° continuous relative phase with and without Lissajous feedback: external and internally generated bimanual coordination.

    PubMed

    Kovacs, Attila J; Shea, Charles H

    2011-03-01

    Results from recent experiments (e.g., Kovacs, Buchanan, & Shea, 2009a-b, 2010a,b) suggest that when salient visual information is presented using Lissajous plots bimanual coordination patterns typically thought to be very difficult to perform without extensive practice can be performed with remarkably low relative phase error and variability with 5min or less of practice. However, when this feedback is removed, performance deteriorates. The purpose of the present experiment was to determine if reducing the frequency of feedback presentation will decrease the participant's reliance on the feedback and will facilitate the development of an internal representation capable of sustaining performance when the Lissajous feedback is withdrawn. The results demonstrated that reduced frequency Lissajous feedback results in very effective bimanual coordination performance on tests with Lissajous feedback available and when feedback is withdrawn. Taken together the present experiments add to the growing literature that supports the notion that salient perceptual information can override some aspects of the system's intrinsic dynamics typically linked to motor output control. Additionally, the present results suggest that the learning of both externally and internally driven bimanual coordination is facilitated by providing reduced frequency Lissajous feedback. Copyright © 2010 Elsevier B.V. All rights reserved.

  13. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA.

    PubMed

    Gililland, Jeremy M; Anderson, Lucas A; Sun, Grant; Erickson, Jill A; Peters, Christopher L

    2012-01-01

    The use of barbed suture for surgical closure has been associated with lower operative times, equivalent wound complication rate, and comparable cosmesis scores in the plastic surgery literature. Similar studies would help determine whether this technology is associated with low complication rates and reduced operating times for orthopaedic closures. We compared a running barbed suture with an interrupted standard suture technique for layered closure in primary TKA to determine if the barbed suture would be associated with (1) shorter estimated closure times; (2) lower cost; and (3) similar closure-related perioperative complication rates. We retrospectively compared two-layered closure techniques in primary TKA with either barbed or knotted sutures. The barbed group consisted of 104 primary TKAs closed with running barbed suture. The standard group consisted of 87 primary TKAs closed with interrupted suture. Cost analysis was based on cost of suture and operating room time. Clinical records were assessed for closure-related complications within the 6-week perioperative period. Average estimated closure time was 2.3 minutes shorter with the use of barbed suture. The total closure cost was similar between the groups. The closure-related perioperative complication rates were similar between the groups. Barbed suture is associated with a slightly shorter estimated closure time, although this small difference is of questionable clinical importance. With similar overall cost and no difference in perioperative complications in primary TKA, this closure methodology has led to more widespread use at our institution.

  14. Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries.

    PubMed

    Koh, Rongzhen; Pukallus, Margaret; Kularatna, Sanjeewa; Gordon, Louisa G; Barnett, Adrian G; Walsh, Laurence J; Seow, Wan Kim

    2015-12-01

    To evaluate the cost-effectiveness of a home-visit intervention conducted by oral health therapists relative to a telephone-based alternative and no intervention. A Markov model was built to combine data on dental caries incidence, dental treatments, quality of life and costs for a cohort of children from age 6 months to 6 years. The probabilities of developing caries and subsequent treatments were derived primarily from the key intervention study. The outcome measures were costs (US dollars), quality-adjusted life years (QALYs) and the number of carious teeth prevented. One-way and probabilistic sensitivity analyses were used to test the stability of the model. For every group of 100 children, the model predicted that having the home-visit intervention would save $167 032 and telephone contacts $144 709 over 5½ years relative to no intervention (usual care). The home visits and telephone intervention would prevent 113 and 100 carious teeth (per 100 children) relative to no intervention in a period of 5½ years. Sensitivity analysis showed that a lower rate of caries reduced the intervention's cost-effectiveness primarily through reducing general anaesthesia costs. The home visits and telephone interventions resulted in 7 and 6 QALYs, respectively, gained over the usual care group for the 100 children over 5½ years. Both interventions were 'dominant,' as they saved costs and produced health benefits over usual care. Both the home visits and telephone-based community interventions conducted by oral health therapists were highly cost-effective than no intervention in preventing early childhood caries. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study.

    PubMed

    Schnur, Julie B; Graff Zivin, Joshua; Mattson, David M K; Green, Sheryl; Jandorf, Lina H; Wernicke, A Gabriella; Montgomery, Guy H

    2012-12-01

    Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The secondary aims were to: (1) estimate nonmedical out-of-pocket costs, (2) examine the nature of the costs, (3) explore potential background predictors of costs, and (4) explore the relationship between patient-reported dermatologic quality of life and expenditures. A total of 50 patients (mean age = 54.88, Stage 0-III) undergoing external beam radiotherapy completed a demographics/medical history questionnaire as well as a seven-item Skin Toxicity Costs (STC) questionnaire and the Skindex-16 in week 5 of treatment. Mean skin toxicity costs were $131.64 (standard error [SE] = $23.68). Most frequently incurred expenditures were new undergarments and products to manage toxicity. Education was a significant unique predictor of spending, with more educated women spending more money. Greater functioning impairment was associated with greater costs. The STC proved to be a practical, brief measure which successfully indicated specific areas of patient expenditures and need. Results reveal the nonmedical, out-of-pocket costs associated with acute skin toxicity in the context of breast cancer radiotherapy. To our knowledge, this study is the first to quantify individual costs associated with this treatment side effect, as well as the first to present a scale specifically designed to assess such costs. In future research, the STC could be used as an outcome variable in skin toxicity prevention and control research, as a behavioral indicator of symptom burden, or as part of a needs assessment.

  16. Similarities and differences between mind-wandering and external distraction: a latent variable analysis of lapses of attention and their relation to cognitive abilities.

    PubMed

    Unsworth, Nash; McMillan, Brittany D

    2014-07-01

    The current study examined the extent to which task-unrelated thoughts represent both vulnerability to mind-wandering and susceptibility to external distraction from an individual difference perspective. Participants performed multiple measures of attention control, working memory capacity, and fluid intelligence. Task-unrelated thoughts were assessed using thought probes during the attention control tasks. Using latent variable techniques, the results suggested that mind-wandering and external distraction reflect distinct, yet correlated constructs, both of which are related to working memory capacity and fluid intelligence. Furthermore, the results suggest that the common variance shared by mind-wandering, external distraction, and attention control is what primarily accounts for their relation with working memory capacity and fluid intelligence. These results support the notion that lapses of attention are strongly related to cognitive abilities. Copyright © 2014 Elsevier B.V. All rights reserved.

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

    PubMed

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

    2013-05-01

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

  18. Army Pacific Pathways: Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance Value for Participating Units

    DTIC Science & Technology

    2016-11-01

    ARMY PACIFIC PATHWAYS Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance... PACIFIC PATHWAYS Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance Value for Participating Units What...GAO Found U.S. Army Pacific (USARPAC), the Army’s component command in the Asia- Pacific region, has identified Pacific Pathways costs and taken steps

  19. Dual task cost of walking is related to fall risk in persons with multiple sclerosis.

    PubMed

    Wajda, Douglas A; Motl, Robert W; Sosnoff, Jacob J

    2013-12-15

    Persons with multiple sclerosis (MS) commonly have walking and cognitive impairments. While walking with a simultaneous cognitive task, persons with MS experience a greater decline in walking performance than healthy controls. This change in performance is termed dual task cost or dual task interference and has been associated with fall risk in older adults. We examined whether dual task cost during walking was related to fall risk in persons with MS. Thirty-three ambulatory persons with MS performed walking tasks with and without a concurrent cognitive task (dual task condition) as well as underwent a fall risk assessment. Dual task cost was operationalized as the percent change in velocity from normal walking conditions to dual task walking conditions. Fall risk was quantified using the Physiological Profile Assessment. A Spearman correlation analysis revealed a significant positive correlation between dual task cost of walking velocity and fall risk as well as dual task cost of stride length and fall risk. Overall, the findings indicate that dual task cost is associated with fall risk and may be an important target for falls prevention strategies.

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

    ERIC Educational Resources Information Center

    Segal, Mark A.; Bird, Bruce M.

    2011-01-01

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

  1. 77 FR 17360 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-26

    ... OF MANAGEMENT AND BUDGET 2 CFR Chapters I and II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And Administrative Requirements (Including Single Audit Act) AGENCY: Executive Office of the President, Office of Management and Budget (OMB). ACTION: Advance notice of proposed...

  2. 78 FR 17300 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-21

    ...; ] OFFICE OF MANAGEMENT AND BUDGET 2 CFR Chapters I and II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and Administrative Requirements (Including Single Audit Act) AGENCY: Executive Office of the President, Office of Management and Budget (OMB). ACTION: Extension of comment...

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

    PubMed

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

    2015-04-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. Epidemiology of workplace-related fall from height and cost of trauma care in Qatar.

    PubMed

    Tuma, Mazin A; Acerra, John R; El-Menyar, Ayman; Al-Thani, Hassan; Al-Hassani, Ammar; Recicar, John F; Al Yazeedi, Wafaa; Maull, Kimball I

    2013-01-01

    This study was designed to identify the incidence, injury patterns, and actual medical costs of occupational-related falls in Qatar, in order to provide a reference for establishing fall prevention guidelines and recommendations. Retrospective database registry review in Level 1 Trauma Center at Tertiary Hospital in Qatar. During a 12-month period between November 1(st) 2007 and October 31(st) 2008, construction workers who fell from height were enrolled. A database was designed to characterize demographics, injury severity score (ISS), total hospital length of stay, resource utilization, and cost of care. Data were presented as proportions, mean ± standard deviation or median and range as appropriate. In addition, case fatality rate and cost analysis were obtained from the Biostatistics and finance departments of the same hospital. There were 315 fall-related injuries, of which 298 were workplace related. The majority (97%) were male immigrants with mean age of 33 ± 11 years. The most common injuries were to the spine, head, and chest. Mean ISS was 16.4 ± 10. There was total of 29 deaths (17 pre-hospital and 12 in-hospital deaths) for a case fatality rate of 8.6%. Mean cost of care (rounded figures) included pre-hospital services Emergency Medical Services (EMS), trauma resuscitation room, radiology and imaging, operating room, intensive care unit care, hospital ward care, rehabilitation services, and total cost (123, 82, 105, 130, 496, 3048,434, and 4418 thousand United States Dollars (USD), respectively). Mean cost of care per admitted patient was approximately 16,000 USD. Falling from height at a construction site is a common cause of trauma that poses a significant financial burden on the health care system. Injury prevention efforts are warranted along with strict regulation and enforcement of occupational laws.

  6. Epidemiology of workplace-related fall from height and cost of trauma care in Qatar

    PubMed Central

    Tuma, Mazin A.; Acerra, John R.; El-Menyar, Ayman; Al-Thani, Hassan; Al-Hassani, Ammar; Recicar, John F.; Al Yazeedi, Wafaa; Maull, Kimball I.

    2013-01-01

    Background: This study was designed to identify the incidence, injury patterns, and actual medical costs of occupational-related falls in Qatar, in order to provide a reference for establishing fall prevention guidelines and recommendations. Settings and Design: Retrospective database registry review in Level 1 Trauma Center at Tertiary Hospital in Qatar. Materials and Methods: During a 12-month period between November 1st 2007 and October 31st 2008, construction workers who fell from height were enrolled. A database was designed to characterize demographics, injury severity score (ISS), total hospital length of stay, resource utilization, and cost of care. Statistical Analysis: Data were presented as proportions, mean ± standard deviation or median and range as appropriate. In addition, case fatality rate and cost analysis were obtained from the Biostatistics and finance departments of the same hospital. Results: There were 315 fall-related injuries, of which 298 were workplace related. The majority (97%) were male immigrants with mean age of 33 ± 11 years. The most common injuries were to the spine, head, and chest. Mean ISS was 16.4 ± 10. There was total of 29 deaths (17 pre-hospital and 12 in-hospital deaths) for a case fatality rate of 8.6%. Mean cost of care (rounded figures) included pre-hospital services Emergency Medical Services (EMS), trauma resuscitation room, radiology and imaging, operating room, intensive care unit care, hospital ward care, rehabilitation services, and total cost (123, 82, 105, 130, 496, 3048,434, and 4418 thousand United States Dollars (USD), respectively). Mean cost of care per admitted patient was approximately 16,000 USD. Conclusions: Falling from height at a construction site is a common cause of trauma that poses a significant financial burden on the health care system. Injury prevention efforts are warranted along with strict regulation and enforcement of occupational laws. PMID:23724377

  7. Specific count model for investing the related factors of cost of GERD and functional dyspepsia

    PubMed Central

    Abadi, Alireza; Chaibakhsh, Samira; Safaee, Azadeh; Moghimi-Dehkordi, Bijan

    2013-01-01

    Aim The purpose of this study is to analyze the cost of GERD and functional dyspepsia for investing its related factors. Background Gastro-oesophageal reflux disease GERD and dyspepsia are the most common symptoms of gastrointestinal disorders. Recent studies showed high prevalence and variety of clinical presentation of these two symptoms imposed enormous economic burden to the society. Cost data that related to economics burden have specific characteristics. So this kind of data needs to specific models. Poisson regression (PR) and negative binomial regression (NB) are the models that were used for analyzing cost data in this paper. Patients and methods This study designed as a cross-sectional household survey from May 2006 to December 2007 on a random sample of individual in the Tehran province, Iran to find the prevalence of gastrointestinal symptoms and disorders and its related factors. The Cost in each item was counted. PR and NB were carried out to the data respectively. Likelihood ratio test was performed for comparison between models. Also Log likelihood, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare performance of the models. Results According to Likelihood ratio test and all three criterions that we used to compare performance of the models, NB was the best model for analyzing this cost data. Sex, age and insurance statues were being significant. Conclusion PR and NB models were carried out for this data and according the results improved fit of the NB model over PR, it clearly indicates that over-dispersion is involved due to unobserved heterogeneity and/or clustering. NB model in cost data more appropriate fit than PR. PMID:24834282

  8. Work-related stress in Australia: The effects of legislative interventions and the cost of treatment.

    PubMed

    Guthrie, Robert; Ciccarelli, Marina; Babic, Angela

    2010-01-01

    The Australian Institute of Health and Welfare data published in 2002 shows a continued rise in health care costs to the Australian community due to the growing number of people diagnosed with mental health disorders. Those mental health disorders may originate from a number of sources, including work and non-work-related factors. The so called work-related stress claims in all Australian jurisdictions are the most expensive form of workers compensation claim. In the most part this is due to the lengthy period of absence (duration) and complicated medical care which are characteristic of these claims. In Australia, in the last decade, attempts have been made to reduce the costs of compensable stress-related claims by imposing special legislative thresholds on such claims. This 'back end' approach to cost reduction has resulted in an array of legislative formula designed to exclude work-related stress claims. This article surveys the various legislative provisions dealing with work-related stress claims in Australia and provides an analysis of their effectiveness. A range of options are presented as alternatives to the exclusion of particular forms of work-related stress claims. The use of a corporate citizenship approach to the prevention and management of stress claims is also discussed as a proactive alternative to occupational safety and health legislative provisions and the workers compensation legislative exclusions.

  9. The Italian external quality assessment for RAS testing in colorectal carcinoma identifies methods-related inter-laboratory differences.

    PubMed

    Normanno, Nicola; Pinto, Carmine; Castiglione, Francesca; Fenizia, Francesca; Barberis, Massimo; Marchetti, Antonio; Fontanini, Gabriella; De Rosa, Gaetano; Taddei, Gian Luigi

    2015-09-03

    In 2014 the European Medicines Agency included exon 2, 3 and 4 KRAS and NRAS testing for the selection of metastatic colorectal cancer (mCRC) patients eligible for the therapy with anti-EGFR monoclonal antibodies. The Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology and Cytology (SIAPEC) organized an external quality assessment (EQA) scheme for CRC to evaluate inter-laboratory consistency and to ensure standardization of the results in the transition from KRAS to all-RAS testing. Ten formalin fixed paraffin embedded specimens including KRAS/NRAS (exons 2, 3, 4) and BRAF (codon 600) mutations were validated by three referral laboratories and sent to 88 participant centers. Molecular pathology sample reports were also requested to each laboratory. A board of assessors from AIOM and SIAPEC evaluated the results according to a predefined scoring system. The scheme was composed of two rounds. In the first round 36% of the 88 participants failed, with 23 centers having at least one false positive or false negative while 9 centers did not meet the deadline. The genotyping error rate was higher when Sanger sequencing was employed for testing as compared with pyrosequencing (3 vs 1.3%; p = 0.01; Pearson Chi Square test). In the second round, the laboratories improved their performance, with 23/32 laboratories passing the round. Overall, 79/88 participants passed the RAS EQA scheme. Standardized Human Genome Variation Society nomenclature was incorrectly used to describe the mutations identified and relevant variations were noticed in the genotype specification. The results of the Italian RAS EQA scheme indicate that the mutational analyses are performed with good quality in many Italian centers, although significant differences in the methods used were highlighted. The relatively high number of centers failing the first round underlines the fundamental role in continued education covered by EQA schemes.

  10. High cost factors for leukaemia and lymphoma patients: a new analysis of costs within these diagnosis related groups.

    PubMed

    Quantin, C; Entezam, F; Brunet-Lecomte, P; Lepage, E; Guy, H; Dusserre, L

    1999-01-01

    To determine high cost factors to help managers and clinicians to analyse the reasons of adverse costs and provide indications for financial negotiation. To locate high cost or long stay patients, the analysis was designed on the basis of a mixture of Weibull distributions. In this new model, the proportion of high cost patients was expressed according to the multinomial logistic regression, permitting the determination of high cost factors. The 1993 French reference database, constituted in the framework of the national study of DRG costs, conducted by the French Ministry of Health. The database of discharge abstracts recorded in 1993 in the Dijon public teaching hospital. The analyses were based on 1352 abstracts from the French reference database and 368 from the Dijon database concerning patients, aged 18 and over, suffering from leukaemia and lymphoma. High cost and long stay factors were the same: number of stays, death, transfer, acute leukaemia, neutropenia, septicaemia, high dose aplastic chemotherapy, central venous catheterisation, parenteral nutrition, protected or laminar airflow room, blood transfusion, and intravenous antibiotherapy. Taking into account high cost predictive factors, as shown in the case of leukaemia and lymphoma patients, would help to reduce the adverse effects of a prospective payment system.

  11. High cost factors for leukaemia and lymphoma patients: a new analysis of costs within these diagnosis related groups

    PubMed Central

    Quantin, C.; Entezam, F.; Brunet-Lecomte, P.; Lepage, E.; Guy, H.; Dusserre, L.

    1999-01-01

    STUDY OBJECTIVE: To determine high cost factors to help managers and clinicians to analyse the reasons of adverse costs and provide indications for financial negotiation. DESIGN: To locate high cost or long stay patients, the analysis was designed on the basis of a mixture of Weibull distributions. In this new model, the proportion of high cost patients was expressed according to the multinomial logistic regression, permitting the determination of high cost factors. SETTING: The 1993 French reference database, constituted in the framework of the national study of DRG costs, conducted by the French Ministry of Health. The database of discharge abstracts recorded in 1993 in the Dijon public teaching hospital. PARTICIPANTS: The analyses were based on 1352 abstracts from the French reference database and 368 from the Dijon database concerning patients, aged 18 and over, suffering from leukaemia and lymphoma. MAIN RESULTS: High cost and long stay factors were the same: number of stays, death, transfer, acute leukaemia, neutropenia, septicaemia, high dose aplastic chemotherapy, central venous catheterisation, parenteral nutrition, protected or laminar airflow room, blood transfusion, and intravenous antibiotherapy. CONCLUSIONS: Taking into account high cost predictive factors, as shown in the case of leukaemia and lymphoma patients, would help to reduce the adverse effects of a prospective payment system.   PMID:10326049

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

    USGS Publications Warehouse

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

    2014-01-01

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

  13. The health-related quality of life and cost implications of falls in elderly women.

    PubMed

    Iglesias, C P; Manca, A; Torgerson, D J

    2009-06-01

    Fractures and falls are serious cause of morbidity and cost to society. Our results suggest that the main burden to morbidity, measured as impact on health-related quality of life, is due to fear of falling rather than falls or their sequelae, such as fractures. Fractures and falls are serious cause of morbidity and cost to society. We investigated the impact on health-related quality of life (HRQoL) associated with falls, fractures and fear of falling and falls and fractures cost. Three datasets providing longitudinal data on fear of falling, HRQoL and a common set of baseline risk factors for fracture (smoking status, weight and age) were analysed. Multilevel random effects models were used to estimate the long-term impact on HRQoL associated with falls, fractures and fear of falling. Healthcare resource use primary data were collected to estimate falls and fractures cost. Older, low weight and smoking women reported lower HRQoL. The impact on HRQoL of a fracture was at least twice as large as that associated with falls. The largest negative effect on HRQoL was associated with self-reported fear of falling. The cost of falls was 1088 pounds. Similarly, the cost of falls leading to a fracture was 15,133 pounds, 2,753 pounds, 1,863 pounds, 1,331 pounds and 3,498 pounds for hip, wrist, arm, vertebral and other fractures, respectively. The main burden to morbidity is due to fear of falling. Interventions aimed at reducing fear of falling may produce larger gains in HRQoL.

  14. Comparative treatment-related adverse event cost burden in immune thrombocytopenic purpura.

    PubMed

    Donga, Prina Z; Bilir, Sara P; Little, Gregg; Babinchak, Tim; Munakata, Julie

    2017-09-08

    Real-world evidence on the safety profile and costs associated with immune thrombocytopenic purpura (ITP) treatment in adults is lacking. This study quantifies and compares adverse event (AE) crude rates and costs associated with ITP treatments as found in claims data. A retrospective claims-based analysis was conducted using IMS Pharmetrics Plus database. Included patients were ≥18 years old, with a diagnosis of ITP (2007-2012); an ITP-related claim for anti-D, intravenous immunoglobulin (IVIG), rituximab, romiplostim, or eltrombopag; and 1-year continuous enrollment (3-years for rituximab) during follow-up. AEs and event costs were identified during active treatment, defined from the first claim of each drug to a pre-defined treatment gap or end of study period. Descriptive statistics were reported with Wilcoxon rank-sum significance tests. A total of 2,518 patients were identified (mean age = 50.8 (±16.3 years); 55.8% male). Of all patients, 22.8% experienced any AE. Significantly fewer anti-D patients had any AE (13.8% vs IVIG: 21.1%, rituximab: 29.4%, romiplostim: 28.1%, eltrombopag: 22.4%). Nausea/vomiting and arthralgia/musculoskeletal pain were most common across treatments, and hemolytic events did not differ significantly across treatments. Most costly AEs were urinary tract infection, aseptic meningitis, and fever ($5000+/case); headache, nasal congestion, and hemolytic event were $4,000-5,000/case. Cost per AE did not differ by treatment. Although lower than trial-based AE rates, claims for ITP treatment-related AEs are common, with higher numbers for rituximab and lower numbers for anti-D. This disparity suggests a possible differential cost burden overall that future analysis should explore.

  15. Disease-related and all-cause health care costs of elderly patients with gout.

    PubMed

    Wu, Eric Q; Patel, Pankaj A; Yu, Andrew P; Mody, Reema R; Cahill, Kevin E; Tang, Jackson; Krishnan, Eswar

    2008-03-01

    Gout is a common cause of inflammatory arthritis in the United States, and its prevalence has increased in recent decades, especially among older adults. Older adults with gout are of particular interest because they tend to experience higher rates of tophi, an advanced stage of gout, than do younger patients. For older adults with gout to (1) assess health care utilization and costs from a third-party payer perspective; (2) evaluate health care costs related to tophi; and (3) explore the relationship between elevated serum uric acid (UA) level, an indicator of disease control, and health care utilization. Data were extracted from the Integrated Healthcare Information Services (IHCIS) claims database (1999-2005), which includes approximately 40 private health plans in the United States for approximately 13 million beneficiaries, about 4% of whom are aged 65 years or older. Patients were included in the study if they: (1) had 2 diagnoses of gout (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code of 274.xx) on separate medical claims or 1 gout diagnosis plus at least 1 gout-related pharmacy claim (i.e., allopurinol, probenecid, colchicines, or sulfinpyrazone); (2) were at least 65 years old at the first diagnosis date (study index date); and (3) had 1 year of continuous eligibility both before and after the study index date. A comparison sample of elderly members without gout was selected using a 1:1 match to gout patients based on age, gender, and geographic region. Individuals in the comparison group also had 1 year of continuous eligibility both before and after the study index date, defined as the same index date as the respective matched gout patient. Patients with possible tophi were identified from at least 1 medical claim with an ICD-9-CM code 274.8x (274.81=gouty tophi of the ear; 274.82 = gouty tophi of other sites except ear; 274.89 = gout with other specified manifestations) during the 12-month study period

  16. Relation between quality and production cost for pure biodiesel bases on the mixes of raw materials

    NASA Astrophysics Data System (ADS)

    Tsanaktsidis, C. G.; Spinthiropoulos, K. G.; Guliyev, Fariz; Dimitriou, D.; Euthaltsidou, K.; Tzilantonis, G. T.

    2016-08-01

    Nowadays biodiesel has become more attractive because it is made from renewable resources. The main ingredients of industrial biodiesel are rap oil, sun oil, fat acid, olive oil cooked. In this study we verify that, the proportion of these components sets the qualitative composition and energy efficiency of the final product. Essential we link the raw materials (rap oil, sun oil, fat acid, olive oil cooked) used in the manufacture of industrial biodiesel the proportion of mixes, with the variation of physicochemical properties of biodiesel produced. According to the quantitative analysis we notice that the physiochemical properties which alter the value for example humidity, acidity, while a large number of physicochemical properties do not change their value depending on the ratio of raw materials in each mixture. The analysis of these changes seems that the presence of fat acids is negative for the quality of the mixture. From the analysis of the cost of the final mixtures that lower cost is achieved in the mixture was 10 and the highest cost was in the mixture 3. Based on a study of the cost of the mixtures can determine a basic relation between the quality and the cost of the final product.

  17. Relation between postural sway magnitude and metabolic energy cost during upright standing on a compliant surface.

    PubMed

    Houdijk, Han; Brown, Starr E; van Dieën, Jaap H

    2015-09-15

    Postural control performance is often described in terms of postural sway magnitude, assuming that lower sway magnitude reflects better performance. However, people do not typically minimize sway magnitude when performing a postural control task. Possibly, other criteria are satisfied when people select the amount of sway they do. Minimal metabolic cost has been suggested as such a criterion. The aim of this study was to experimentally test the relation between sway magnitude and metabolic cost to establish whether metabolic cost could be a potential optimization criterion in postural control. Nineteen healthy subjects engaged in two experiments in which different magnitudes of sway were evoked during upright standing on a foam surface while metabolic energy expenditure, center of pressure (CoP) excursion, and muscle activation were recorded. In one experiment, sway was manipulated by visual feedback of CoP excursion. The other experiment involved verbal instructions of standing still, natural or relaxed. In both experiments, metabolic cost changed with sway magnitude in an asymmetric parabolic fashion, with a minimum around self-selected sway magnitudes and a larger increase at small compared with large sway magnitudes. This metabolic response was paralleled by a change in tonic and phasic EMG activity in the major leg muscles. It is concluded that these results are in line with the notion that metabolic cost can be an optimization criterion used to set postural control and as such could account for the magnitude of naturally occurring postural sway in healthy individuals, although the pathway remains to be elucidated.

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

    PubMed Central

    Clutton-Brock, Tim H.

    2016-01-01

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

  19. [Cost assessment for endoscopic procedures in the German diagnosis-related-group (DRG) system - 5 year cost data analysis of the German Society of Gastroenterology project].

    PubMed

    Rathmayer, Markus; Heinlein, Wolfgang; Reiß, Claudia; Albert, Jörg G; Akoglu, Bora; Braun, Martin; Brechmann, Thorsten; Gölder, Stefan K; Lankisch, Tim; Messmann, Helmut; Schneider, Arne; Wagner, Martin; Dollhopf, Markus; Gundling, Felix; Röhling, Michael; Haag, Cornelie; Dohle, Ines; Werner, Sven; Lammert, Frank; Fleßa, Steffen; Wilke, Michael H; Schepp, Wolfgang; Lerch, Markus M

    2017-09-08

    Background In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. Methods To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Results Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. Discussion For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses. © Georg Thieme Verlag KG Stuttgart · New York.

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

    SciTech Connect

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

    1985-01-01

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

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

    ERIC Educational Resources Information Center

    Bader, Stephanie H.; Barry, Tammy D.

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    USDA-ARS?s Scientific Manuscript database

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  9. The economic cost of firearm-related injuries in the United States from 2006 to 2010.

    PubMed

    Lee, Jarone; Quraishi, Sadeq A; Bhatnagar, Saurabha; Zafonte, Ross D; Masiakos, Peter T

    2014-05-01

    Estimates of the number of firearm-related injuries widely vary. Although focus has been primarily on deaths, the societal cost of caring for victims of these injuries is largely unknown. Our goal was to estimate the economic impact of nonfatal, firearm-related injuries in the United States based on recent, publically available data. We queried several national registries for hospital and emergency department (ED) discharges from 2006 to 2010 to estimate the annual incidence of firearm-related injuries. The cost of direct medical services and lost productivity from firearm-related injuries were extrapolated from recently published estimates. To identify potentially important trends, we compared the economic impact and payor mix for firearm-related injuries in 2006 with those in 2010. During the 5-year analytic period, we identified 385,769 (SE = 29,328) firearm-related ED visits resulting in 141,914 (SE = 14,243) hospital admissions, costing more than $88 billion (SE = $8.0 billion). Between 2006 and 2010, there was a decrease in the rate of hospital visits from 6.65 per 10,000 visits in 2006 to 5.76 per 10,000 visits in 2010 (P < .001). Similarly, the rate of hospital admissions and ED visits without admission decreased from 2.58 per 10,000 to 1.96 per 10,000 (P < .001) and 4.08 per 10,000 to 3.79 per 10,000 (P < .001). Regression of the economic costs from 2006 to 2010, adjusted for Consumer Price Index, showed no change (P = .15). There was a decrease in the proportion of Uninsured between 2006 and 2010 from 51.6% to 46.78% (P < .001). Firearm-related injuries are a major economic burden to not only the American health care system but also to American society. The incidence of these injuries has decreased slightly from 2006 to 2010, with no change in the economic burden. Research aimed at understanding the associated financial, social, health, and disability-related issues related to firearm injuries is necessary and would likely enhance our knowledge of the

  10. Together Achieving More: Primary Care Team Communication and Alcohol-Related Health Care Utilization and Costs

    PubMed Central

    Mundt, Marlon P.; Zakletskaia, Larissa I.; Shoham, David A.; Tuan, Wen-Jan; Carayon, Pascale

    2015-01-01

    Background Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Methods Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team’s primary care patient panel. Results Teams (n=31) whose RNs displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (RR=0.90; 95% CI: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1030 (95% CI: −$1819, −$241) lower alcohol-related patient health care costs per 1000 team patients in the past 12 months. Conversely, teams whose primary care practitioner had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR=1.12; 95: CI: 1.03, 1.23) and $1428 (95% CI: $378, $2478) higher alcohol-related healthcare costs per 1000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and co-morbidity diagnoses. Conclusions Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic

  11. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

    PubMed

    Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

    2015-10-01

    Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose

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

    PubMed

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

    2015-10-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-06-10

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

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-05-01

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

  18. Externalities of oil imports revisited

    SciTech Connect

    Lemon, R.

    1980-09-01

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

  19. Costs of treating patients with schizophrenia who have illness-related crisis events.

    PubMed

    Zhu, Baojin; Ascher-Svanum, Haya; Faries, Douglas E; Peng, Xiaomei; Salkever, David; Slade, Eric P

    2008-08-26

    Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413). Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37,329), persons with prior

  20. Costs of treating patients with schizophrenia who have illness-related crisis events

    PubMed Central

    Zhu, Baojin; Ascher-Svanum, Haya; Faries, Douglas E; Peng, Xiaomei; Salkever, David; Slade, Eric P

    2008-01-01

    Background Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Methods Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413). Results Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37

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

    ERIC Educational Resources Information Center

    Stacks, Ann M.

    2007-01-01

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

  2. Longitudinal Relations between Depressive Symptoms and Externalizing Behavior in Adolescence: Moderating Effects of Maltreatment Experience and Gender

    ERIC Educational Resources Information Center

    Brensilver, Matthew; Negriff, Sonya; Mennen, Ferol E.; Trickett, Penelope K.

    2011-01-01

    Among the explanations for the high rates of co-occurrence between depressive symptoms and externalizing behavior is the possibility of direct causal associations between the two symptom groups. However, the mechanisms by which co-occurrence arises may not be the same across etiologically significant variables. A gender-balanced sample of 303…

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  5. The Collegiate Ideal and the Tools of External Relations: The Uses of High-Profile Intercollegiate Athletics.

    ERIC Educational Resources Information Center

    Toma, J. Douglas

    1999-01-01

    High-profile athletic programs contribute to the collegiate ideal and are used by many institutions to provide connections to their internal and external constituencies. The magnitude of major athletic events contributes to and in some cases defines institutional image, even serving as a surrogate for the more intimate community-building…

  6. Mortality from solid cancers other than lung, liver, and bone in relation to external dose among plutonium and non-plutonium workers in the Mayak Worker Cohort.

    PubMed

    Sokolnikov, Mikhail; Preston, Dale; Stram, Daniel O

    2017-03-01

    Exposure to ionizing radiation has well-documented long-term effects on cancer rates and other health outcomes in humans. While in vitro experimental studies had demonstrated that the nature of some radiation effects depend on both total dose of the radiation and the dose rate (i.e., the pattern of dose distribution over time), the question of whether or not the carcinogenic effect of radiation exposure depends on the dose rate remains unanswered. Another issue of interest concerns whether or not concomitant exposure to external gamma rays and inhaled plutonium aerosols has any effect on the external exposure effects. The analyses of the present paper focus on the risk of solid cancers at sites other than lung, liver, and bone in Mayak workers. Recent findings are reviewed indicating that there is no evidence of plutonium dose response for these cancers in the Mayak worker cohort. Then the evidence for differences in the external dose effects among workers with and without the potential for exposure to alpha particles from inhaled plutonium is examined. It is found that there is no evidence that exposure to plutonium aerosols significantly affects the risk associated with external exposure. While the Mayak external dose risk estimate of an excess relative risk of 0.16 per Gy is somewhat lower than an appropriately normalized risk estimate from the Life Span Study of Japanese atomic bomb survivors, the uncertainties in these estimates preclude concluding that the external dose excess relative risks of this group of solid cancers differ in the two cohorts.

  7. Relation between physical time-energy cost of a quantum process and its information fidelity

    NASA Astrophysics Data System (ADS)

    Fung, Chi-Hang Fred; Chau, H. F.

    2014-08-01

    A quantum system can be described and characterized by at least two different concepts, namely, its physical and informational properties. Here, we explicitly connect these two concepts, by equating the time-energy cost which is the product of the largest energy of a Hamiltonian of quantum dynamics and the evolution time, and the entanglement fidelity which is the informational difference between an input state and the corresponding output state produced by a quantum channel characterized by the Hamiltonian. Specifically, the worst-case entanglement fidelity between the input and output states is exactly the cosine of the channel's time-energy cost (except when the fidelity is zero). The exactness of our relation makes a strong statement about the intimate connection between information and physics. Our exact result may also be regarded as a time-energy uncertainty relation for the fastest state that achieves a certain fidelity.

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

    PubMed

    Filin, Ido

    2015-01-07

    Variation in offspring size with female size and other aspects of the maternal phenotype is commonly observed and taxonomically widespread. However, life history theory predicts that optimal offspring size should not depend on maternal size or total reproductive effort. This incongruity persists despite various modifications to theory, that nonetheless, either are limited in their applicability or fail to alter the prediction of fixed offspring size. I demonstrate that the persistence of this theoretical outcome stems from an ideal assumption that reproductive effort relates only to direct material costs, and therefore, equal or proportional to clutch mass or the product of offspring size and number. A major innovation in my study is to explicitly distinguish between direct and overhead components of the costs of reproduction. When overhead energetic costs of reproduction are explicitly incorporated, I readily obtain variation in optimal offspring size with maternal phenotype. This consequence of overhead costs of reproduction has not been demonstrated before. I identify functional forms of such overhead costs that facilitate variation in optimal offspring size. In particular, costs that are more sensitive to offspring size than to offspring number are most effective in causing variation in offspring size. The novelty of the model lies in succeeding to resolve the above incongruity both within the framework of traditional models of optimal offspring size and within more dynamic description of the lifecycle (addressing simultaneously both offspring and maternal performance), including stochastic effects, difference between reserves and structural components of size, and distinction between starvation and extrinsic mortality. My predictions explain several patterns of variation in size and body composition of offspring, with respect to both environmental conditions and maternal phenotype. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Physics and Slavery: The Relative Cost of Calories for Slave Infants and Their Mothers,

    DTIC Science & Technology

    1979-11-01

    THE RELATIVE COST OF CALORIES FOR SLAVE INFANTS AND THEIR MOTHERSI In Time On The Cross Robert Fogel and Stanley Engerman use as the rate of slave...was supported by National Science Foundation Grants GS-3262 and GS-27262 to Harvard University. 2Robert William Fogel and Stanley L. Engerman, Time On...is an exemplary practice in this regard. Since the methods employed by Fogel and Engerman give more weight to children than to adults, their value

  10. Cost-related medication nonadherence among adolescent and young adult cancer survivors.

    PubMed

    Kaul, Sapna; Avila, Jaqueline C; Mehta, Hemalkumar B; Rodriguez, Ana M; Kuo, Yong-Fang; Kirchhoff, Anne C

    2017-07-15

    This study investigated cost-related medication nonadherence among survivors of adolescent and young adult cancer and a comparison group in the United States. A cross-sectional analysis of the 2013 to 2015 National Health Interview Survey was performed. N=953 patients who were diagnosed with cancer between the ages of 15 and 39 years were identified, and a comparison group was created using propensity scores. Cost-related medication nonadherence was determined by individuals' report of skipping medication, taking less medication, or delaying filling medication to save money in the previous year. Covariates included demographics, insurance status, financial factors (eg, out-of-pocket health care expenditures), and health-related factors (eg, comorbidity and mental distress). Chi-square tests were used to compare nonadherence between survivors and the comparison group. Logistic regressions identified covariates associated with nonadherence. Survivors were more likely to report nonadherence than the comparison group (23.8% vs 14.3%; P < .001). Survivors were also more likely to report that they could not afford medication, asked their physician for lower cost medication, and used alternative therapies in the previous year to save money. Uninsured survivors were more likely to report nonadherence than those privately insured (odds ratio [OR], 3.19; 95% confidence interval [CI], 1.67-6.09). Non-Hispanic black survivors, those who reported greater mental distress, and those with greater comorbidities reported nonadherence more often than their counterparts. Survivors reporting a usual source of care were at a lower risk of nonadherence than those without it (OR, 0.39; 95% CI, 0.18-0.82). Cost-related communication with survivors may be needed to increase medication adherence. Uninsured and sicker survivors should receive regular screening to improve adherence. Future work should evaluate adherence for specific drugs. Cancer 2017;123:2726-34. © 2017 American Cancer

  11. Understanding the full breadth of cancer-related patient costs in Ontario: a qualitative exploration.

    PubMed

    Longo, Christopher J; Fitch, Margaret; Grignon, Michel; McAndrew, Alison

    2016-11-01

    This research informs existing work by examining the full scope of out-of-pocket costs and lost income, patients' private insurance behaviors, and their overall management of finances during their cancer treatment. The intent was to gain a deeper understanding of patient circumstances and the related costs. Participant qualitative interviews were conducted in person during outpatient clinic visits or by telephone and were recorded between June 2011 and July 2012. Interviews were transcribed verbatim and subjected to a descriptive qualitative analysis. The research team collaborated early in the process (after three subjects were enrolled) to develop a preliminary coding framework. The coding framework was modified to incorporate additional emerging content until saturation of data was evident. Transcripts were coded using the qualitative software NVivo version 9.0. Fifteen patients agreed to participate in the study and 14 completed the interview (seven breast, three colorectal, two lung, and two prostate). Consistent with existing published work, participants expressed concerns regarding expenses related to medications, complementary/alternative medicines, devices, parking and travel. These concerns were exacerbated if patients did not have insurance or lost insurance coverage due to loss of work. Although many acknowledged in hindsight that additional insurance would have helped, they also recognized that at the time of their diagnoses, it was not a viable option. Previously unidentified categorical costs identified in this study included modifications to housing arrangements or renovations, special clothing, fitness costs and the impact of an altered diet. We confirmed the results of earlier Canadian quantitative work. Additionally, cost categories not previously explored were identified, which will facilitate the development of an improved and more comprehensive quantitative questionnaire for future research. Many patients indicated that supplemental health

  12. Environmental impacts and costs of energy.

    PubMed

    Rabl, Ari; Spadaro, Joseph V

    2006-09-01

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

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

    SciTech Connect

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

    2003-09-02

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

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

    PubMed

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

    2016-04-26

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

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

    PubMed Central

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

    2016-01-01

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

  16. Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study.

    PubMed

    Patel, Minal R; Resnicow, Kenneth; Lang, Ian; Kraus, Kathleen; Heisler, Michele

    2017-04-01

    Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting. We report a pre-post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool. Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% "learned a lot," 98% "topics relevant" 95% "applicable to their lives," 98% "liked the information"). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p < .05) and pharmacists (13% to 25.5%, p < .01), not skipping doses of medicines due to cost (11% to 4%, p < .03), and financial management (33.83 to 39.62, p < .007). There were no significant changes in perception of financial burden. A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.

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

    NASA Astrophysics Data System (ADS)

    Oschman, Scot

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

  18. TEN-YEAR FOLLOW-UP OF EYES TREATED WITH STEREOTACTIC FRACTIONATED EXTERNAL BEAM RADIATION FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

    PubMed Central

    TRIKHA, RUPAN; MORSE, LAWRENCE S.; ZAWADZKI, ROBERT J.; WERNER, JOHN S.; PARK, SUSANNA S.

    2012-01-01

    Purpose To determine the long-term effects of stereotactic fractionated external beam radiation on eyes treated for neovascular age-related macular degeneration. Methods A retrospective review of all eyes treated with stereotactic fractionated external beam radiation (20–40 Gy, 2-Gy fractions) between 1997 and 2000 was performed to identify eyes with ≥2-year follow-up for analysis. A subset was imaged prospectively using a high-resolution Fourier-domain optical coherence tomography. Results Among 94 eyes treated, 33 eyes (32 subjects) had ≥2-year follow-up information (mean follow-up, 6.2 years; range, 2–10 years). Final visual acuity ranged from 20/50 to no light perception. Final macular findings included central geographic atrophy (49%), disciform scar (30%), and active choroidal neovascular membrane (9%). Fourier-domain optical coherence tomography images of three eyes with geographic atrophy revealed photoreceptor layer loss within areas of geographic atrophy with intact retinal morphology in areas of radiation exposure outside geographic atrophy. Radiation retinopathy was suspected in 18% and confirmed by fluorescein angiography in 15%, ranging from mild to neovascular glaucoma/phthisis bulbi (2 eyes). Mean time from stereotactic fractionated external beam radiation to development of radiation retinopathy was 5.4 years (range, 1–10 years). Conclusion A moderate rate of delayed radiation retinopathy was noted in eyes with neovascular age-related macular degeneration treated with stereotactic fractionated external beam radiation. Geographic atrophy was a common finding. PMID:21499195

  19. Solar System constraints on renormalization group extended general relativity: The PPN and Laplace-Runge-Lenz analyses with the external potential effect

    NASA Astrophysics Data System (ADS)

    Rodrigues, Davi C.; Mauro, Sebastião; de Almeida, Álefe O. F.

    2016-10-01

    General relativity extensions based on renormalization group effects are motivated by a known physical principle and constitute a class of extended gravity theories that have some unexplored unique aspects. In this work we develop in detail the Newtonian and post-Newtonian limits of a realization called renormalization group extended general relativity (RGGR). Special attention is given to the external potential effect, which constitutes a type of screening mechanism typical of RGGR. In the Solar System, RGGR depends on a single dimensionless parameter ν¯⊙, and this parameter is such that for ν¯⊙=0 one fully recovers GR in the Solar System. Previously this parameter was constrained to be |ν¯ ⊙|≲10-21 , without considering the external potential effect. Here we show that under a certain approximation RGGR can be cast in a form compatible with the parametrized post-Newtonian (PPN) formalism, and we use both the PPN formalism and the Laplace-Runge-Lenz technique to put new bounds on ν¯⊙, either considering or not the external potential effect. With the external potential effect the new bound reads |ν¯ ⊙|≲10-16 . We discuss the possible consequences of this bound on the dark matter abundance in galaxies.

  20. Work-related tetraplegia: cause of injury and annual medical costs.

    PubMed

    Webster, B; Giunti, G; Young, A; Pransky, G; Nesathurai, S

    2004-04-01

    Descriptive study. To describe the demographics, cause of injury, and annual-paid medical costs for the 5 years following injury for cases of work-related tetraplegia. A single United States workers' compensation (WC) claims database. Tetraplegia cases with initial date of injury from 1 January 1989 to 31 December 1999 were selected by cross-referencing word search terms pertaining to body part injured and nature of injury. The main outcome measures were injury causes and annual-paid medical payments (adjusted to year 2000 medical consumer price index) of work-related tetraplegia by injury group for each year postinjury over a 5-year time period. A total of 62 claimants with work-related tetraplegia injured between 1 January 1989 and 31 December 1999. The vast majority of those identified were male claimants (92%) and more than a quarter worked in the construction industry (26%). Other highly represented industries included transportation and retail (15% each), manufacturing (13%), and agriculture and utility (11% each). The majority of injuries were the result of falls (36%) and vehicular accidents (34%). The mean Year 1 cost was US dollars 560524 for those with a high-level tetraplegia (C2-4 ASIA A-C), US dollars 431033 for a low-level injury (C5-8 ASIA A-C), and US dollars 178041 for those with an ASIA D tetraplegia injury. The mean cost of subsequent years (Years 2-5) was US dollars 130992 for a high-level, US dollars 129250 for a low-level, and Us dollars 34352 for an ASIA D tetraplegia injury. Mean costs for Year 1 postinjury in WC cases are similar to previously published estimates. Comparing the current results with those of previous spinal cord injury cost studies suggests that those with work-related tetraplegia may receive more injury-related paid medical benefits after the first year postinjury than cases who do not receive WC-supported benefits. Supported, in part, by a grant from the National Institute on Disability and Rehabilitation Research (NIDDR

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  3. Extending OPNET Modeler with External Pseudo Random Number Generators and Statistical Evaluation by the Limited Relative Error Algorithm

    NASA Astrophysics Data System (ADS)

    Becker, Markus; Weerawardane, Thushara Lanka; Li, Xi; Görg, Carmelita

    Pseudo Random Number Generators (PRNG) are the base for stochastic simulations. The usage of good generators is essential for valid simulation results. OPNET Modeler a well-known tool for simulation of communication networks provides a Pseudo Random Number Generator. The extension of OPNET Modeler with external generators and additional statistical evaluation methods that has been performed for this paper increases the flexibility and options in the simulation studies performed.

  4. Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs?

    PubMed

    Rydén, Petra J; Hagfors, Linda

    2011-09-01

    To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs. Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs. Sweden. A nationally representative sample of 2160 children aged 4, 8 or 11 years. Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively. Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.

  5. Statewide Implementation of Parenting with Love and Limits Among Youth with Co-Existing Internalizing and Externalizing Functional Impairments Reduces Return to Service Rates and Treatment Costs.

    PubMed

    Sterrett-Hong, Emma M; Karam, Eli; Kiaer, Lynn

    2017-01-24

    Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems.

  6. Cost-effectiveness analysis in relation to budgetary constraints and reallocative restrictions.

    PubMed

    Adang, Eddy; Voordijk, Leo; Jan van der Wilt, Gert; Ament, André

    2005-10-01

    decision makers with a short time horizon. The short-term savings amount to only 11% of the anticipated savings in the long run. Nevertheless, the combined treatment remains a cost-effective treatment. Analysing the budgetary constraints resulted in the finding that the substitution of the in-hospital treatment by the combined treatment has taken place without negative financial consequences for the hospital. Case 2: The ground bound mobile medical team--Economic arguments to implement the ground bound mobile medical team (MMT) are undecided. With respect to the budgetary constraints we find that the budget for the trauma centre is conditional upon the deployment of the ground bound MMT. Moreover, the cost of the ground bound MMT is a relatively small part of the budget for the trauma centre and therefore no hurdle to implement. On the basis of these findings we conclude that limitations in reallocating resources and adjusting budgets in health care may hamper the usefulness of economic evaluation for decision-making. Researching the extent of these limitations provides, together with the CEA, better information on which the decision whether a new technology should be implemented and what the expected welfare gains from such an implementation might be can be made. For this a set of checklists is developed.

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

    PubMed

    Piedrahita, Hugo

    2006-01-01

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

  8. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran.

    PubMed

    Gharekhani, Afshin; Kanani, Negin; Khalili, Hossein; Dashti-Khavidaki, Simin

    2014-09-01

    Medication errors are ongoing problems among hospitalized patients especially those with multiple co-morbidities and polypharmacy such as patients with renal diseases. This study evaluated the frequency, types and direct related cost of medication errors in nephrology ward and the role played by clinical pharmacists. During this study, clinical pharmacists detected, managed, and recorded the medication errors. Prescribing errors including inappropriate drug, dose, or treatment durations were gathered. To assess transcription errors, the equivalence of nursery charts and physician's orders were evaluated. Administration errors were assessed by observing drugs' preparation, storage, and administration by nurses. The changes in medications costs after implementing clinical pharmacists' interventions were compared with the calculated medications costs if the medication errors were continued up to patients' discharge time. More than 85% of patients experienced medication error. The rate of medication errors was 3.5 errors per patient and 0.18 errors per ordered medication. More than 95% of medication errors occurred at prescription nodes. Most common prescribing errors were omission (26.9%) or unauthorized drugs (18.3%) and low drug dosage or frequency (17.3%). Most of the medication errors happened on cardiovascular drugs (24%) followed by vitamins and electrolytes (22.1%) and antimicrobials (18.5%). The number of medication errors was correlated with the number of ordered medications and length of hospital stay. Clinical pharmacists' interventions decreased patients' direct medication costs by 4.3%. About 22% of medication errors led to patients' harm. In conclusion, clinical pharmacists' contributions in nephrology wards were of value to prevent medication errors and to reduce medications cost.

  9. Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring.

    PubMed

    George, Jason; Abdulla, Rami Khoury; Yeow, Raymond; Aggarwal, Anshul; Boura, Judith; Wegner, James; Franklin, Barry A

    2017-02-15

    Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p <0.001) than their counterparts who attained <5 METs. In patients whose body mass index was ≥30 kg/m(2), there were significant differences in health care costs depending on whether they achieved <5 or ≥5 METs estimated by ambulatory ECG monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved <5 METs. In conclusion, average and peak daily energy expenditures estimated from ambulatory ECG monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.

  10. Use of Six Sigma Worksheets for assessment of internal and external failure costs associated with candidate quality control rules for an ADVIA 120 hematology analyzer.

    PubMed

    Cian, Francesco; Villiers, Elisabeth; Archer, Joy; Pitorri, Francesca; Freeman, Kathleen

    2014-06-01

    Quality control (QC) validation is an essential tool in total quality management of a veterinary clinical pathology laboratory. Cost-analysis can be a valuable technique to help identify an appropriate QC procedure for the laboratory, although this has never been reported in veterinary medicine. The aim of this study was to determine the applicability of the Six Sigma Quality Cost Worksheets in the evaluation of possible candidate QC rules identified by QC validation. Three months of internal QC records were analyzed. EZ Rules 3 software was used to evaluate candidate QC procedures, and the costs associated with the application of different QC rules were calculated using the Six Sigma Quality Cost Worksheets. The costs associated with the current and the candidate QC rules were compared, and the amount of cost savings was calculated. There was a significant saving when the candidate 1-2.5s, n = 3 rule was applied instead of the currently utilized 1-2s, n = 3 rule. The savings were 75% per year (£ 8232.5) based on re-evaluating all of the patient samples in addition to the controls, and 72% per year (£ 822.4) based on re-analyzing only the control materials. The savings were also shown to change accordingly with the number of samples analyzed and with the number of daily QC procedures performed. These calculations demonstrated the importance of the selection of an appropriate QC procedure, and the usefulness of the Six Sigma Costs Worksheet in determining the most cost-effective rule(s) when several candidate rules are identified by QC validation. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  11. Temporal data mining for the assessment of the costs related to diabetes mellitus pharmacological treatment.

    PubMed

    Concaro, Stefano; Sacchi, Lucia; Cerra, Carlo; Stefanelli, Mario; Fratino, Pietro; Bellazzi, Riccardo

    2009-11-14

    Diabetes care and chronic disease management represent data-intensive contexts which allow Local Healthcare Agencies (ASL) to collect a huge amount of information. Time is often an essential component of such information, given the strong importance of the temporal evolution of the considered disease and of its treatment. In this paper we show the application of a temporal data mining technique to extract temporal association rules over an integrated repository including both administrative and clinical data related to a sample of diabetic patients. We will show how the method can be used to highlight cases and conditions which lead to the highest pharmaceutical costs. Considering the perspective of a Regional Healthcare Agency, this method could be properly exploited to assess the overall standards and quality of care, while lowering costs.

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

    SciTech Connect

    1998-10-01

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

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

    PubMed

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

    2011-01-01

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

  14. 25 CFR 39.160 - Does ISEF provide supplemental funding for extraordinary costs related to a school's geographic...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... costs related to a school's geographic isolation? Yes. Havasupai Elementary School, for as long as it... costs related to a school's geographic isolation? 39.160 Section 39.160 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School...

  15. 25 CFR 39.160 - Does ISEF provide supplemental funding for extraordinary costs related to a school's geographic...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... costs related to a school's geographic isolation? Yes. Havasupai Elementary School, for as long as it... costs related to a school's geographic isolation? 39.160 Section 39.160 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School...

  16. 25 CFR 39.160 - Does ISEF provide supplemental funding for extraordinary costs related to a school's geographic...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... costs related to a school's geographic isolation? Yes. Havasupai Elementary School, for as long as it... costs related to a school's geographic isolation? 39.160 Section 39.160 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School...

  17. 25 CFR 39.160 - Does ISEF provide supplemental funding for extraordinary costs related to a school's geographic...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... costs related to a school's geographic isolation? Yes. Havasupai Elementary School, for as long as it... costs related to a school's geographic isolation? 39.160 Section 39.160 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School...

  18. 25 CFR 39.160 - Does ISEF provide supplemental funding for extraordinary costs related to a school's geographic...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... costs related to a school's geographic isolation? Yes. Havasupai Elementary School, for as long as it... costs related to a school's geographic isolation? 39.160 Section 39.160 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Indian School...

  19. Clinical outcomes and incremental costs from a medication adherence pilot intervention targeting low-income patients with diabetes at risk of cost-related medication nonadherence.

    PubMed

    Ryan, John G; Fedders, Mark; Jennings, Terri; Vittoria, Isabel; Yanes, Melissa

    2014-12-01

    The extent to which reducing cost-related barriers affects diabetes outcomes and medication adherence among uninsured patients is not known. The purpose of these analyses was to understand the clinical impact and cost considerations of a prescription assistance program targeting low-income, minority patients with diabetes and at high risk for cost-related medication nonadherence. Patients received diabetes medications without copayments for 12 months. Change in diabetes control was calculated by using glycosylated hemoglobin (HbA1c) level at follow-up compared with baseline. Clinical data were collected from the electronic health record. Medication adherence for diabetes medications was estimated by using proportion of days covered (PDC). Incremental acquisition and per-patient costs, based on actual hospital medication costs, were calculated for different baseline HbA1c levels. Patients with baseline HbA1c levels ≥7%, ≥8%, and ≥9% experienced mean HbA1c reductions of 0.82% (P = 0.008), 1.02% (P = 0.010), and 1.47% (P = 0.010), respectively, during the 12-month period. The average PDC was 70.55%; 45.24% had a PDC ≥80%, indicating an adequate level of medication adherence. Medication adherence ≥80% was associated with ethnicity (P = 0.015), whereas mean PDC was associated with number of diabetes medication classes used (P = 0.031). Acquisition cost for 1242 prescriptions filled by 103 patients was $13,365.82, representing per-patient costs of $132.39; however, as baseline targets increased, acquisition costs decreased and per-patient costs increased from $10,682.59 and $169.56 to $6509.91 and $192.27, respectively. Clinically significant reductions in HbA1c levels were achieved for all patients, although greater reductions were achieved with modest per-patient cost increases when considering patients with uncontrolled diabetes. Incorporating a multifactorial intervention to address cost-related medication nonadherence with a behavior change component may

  20. The relative importance of factors that determine log-hauling costs

    Treesearch

    A. Jeff Martin; A. Jeff Martin

    1971-01-01

    Hauling costs are a major expense to lumbermen, but little is known about which factors affect hauling costs the most. A recent Forest Service study of hauling costs on 34 logging operations sheds light on whmich factors of cost are important and which might require less attention. These results should help lumbermen adopt a cost accounting procedure and help them with...

  1. A review of cost-effectiveness of varenicline and comparison of cost-effectiveness of treatments for major smoking-related morbidities.

    PubMed

    Zimovetz, Evelina A; Wilson, Koo; Samuel, Miny; Beard, Stephen M

    2011-04-01

    This review aims to examine economic evaluations of varenicline, to compare the reported cost-effectiveness of varenicline with that of treatments for major smoking-related diseases and to evaluate the findings for decision making. A literature search was performed to identify published articles in English indexed in MEDLINE and the Cochrane Library (Issue 1, 2009), which includes the Economic Evaluation Database. Additional sources also were searched to identify unpublished varenicline studies, including conference abstracts. The search for varenicline studies was limited from 2006 to October 2009; searches for all other types of studies were limited from 1990 to October 2009. The search yielded a total of 20 relevant economic evaluations of varenicline. In addition, 37 reviews of economic evaluations in chronic obstructive pulmonary disease, non-small cell lung cancer and cardiovascular disease, as well as studies evaluating the impact of economic rewarding were considered in this review. From these identified economic evaluations, the incremental cost-effectiveness ratios for varenicline ranged from dominance (more effective and cost saving) to €18,582 per quality-adjusted life-year (including indirect costs). These estimates appeared substantially lower when compared with incremental cost-effectiveness ratios reported for secondary prevention of smoking-related diseases, which in some cases were as high as €66,218 per quality-adjusted life-year. Varenicline appears to be cost-effective from the perspective of both health care payers and employers, because of reduced health care consumption and costs. The cost-effectiveness of varenicline also compares favourably to that of interventions recommended for the treatment and prevention of smoking-related diseases. © 2010 Blackwell Publishing Ltd.

  2. The internal/external issue what is an outer object? Another person as object and as separate other in object relations models.

    PubMed

    Zachrisson, Anders

    2013-01-01

    The question of what we mean by the term outer object has its roots in the epistemological foundation of psychoanalysis. From the very beginning, Freud's view was Kantian, and psychoanalysis has kept that stance, as it seems. The author reviews the internal/external issue in Freud's thinking and in the central object relations theories (Klein, Winnicott, and Bion). On this background he proposes a simple model to differentiate the concept of object along one central dimension: internal object, external object, and actual person. The main arguments are: (1) there is no direct, unmediated perception of the actual person--the experience of the other is always affected by the perceiver's subjectivity; (2) in intense transference reactions and projections, the perception of the person is dominated by the qualities of an inner object--and the other person "becomes" an external object for the perceiver; (3) when this distortion is less dominating, the other person to a higher degree remains a separate other--a person in his or her own right. Clinical material illustrates these phenomena, and a graphical picture of the model is presented. Finally with the model as background, the author comments on a selection of phenomena and concepts such as unobjectionable transference, "the third position," mourning and loneliness. The way that the internal colours and distorts the external is of course a central preoccupation of psychoanalysis generally. (Spillius et al., 2011, p. 326)

  3. An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy.

    PubMed

    Baines, Carol R; McGuiness, William; O'Rourke, Geraldine A

    2017-04-01

    To review literature associated with external beam radiotherapy and skin damage. A focus of the literature search is to highlight and discuss the myriad of skin assessment tools that are available to the clinician when assessing skin injury in patients receiving external beam radiation therapy. It is apparent that despite considerable work being progressed in the development of individualised skin assessment tools, uptake and use is poor. These tools are designed to assist the clinician in the evaluation of damaged skin and predict the radiation wound development pathway. An integrated review can be used to address a mature or new and emerging topic through a systematic methodology, which is either theoretical or empirical, gained from research, practice or policy initiatives (Whittemore & Knafl, Journal of Advanced Nursing, 52, 2005, 546). This review is particularly concerned with the employment of skin assessment tools by clinicians in patients with radiation damaged skin. Using the search terms synonyms for radiation, skin and epidermal damage, PubMed/MEDLINE, Medical Complete and Web of Science databases were searched. Consulting professional peers was employed as part of the inclusion and exclusion process. There is a high level of unpredictability about which patient will have an uncomplicated course of external beam radiotherapy. Variables may include, but are not limited to, an acute reaction, a delayed reaction resulting in actual skin damage or no visible skin disturbance. The skin assessment tools that are readily available are not regularly referenced in clinical practice when attempting to manage the many side effects of radiation therapy. Skin assessment tools require ongoing clinical validation, so they can be used to guide practitioners to undertake further assessment of skin integrity. The current body of knowledge suggests clinicians caring for patients receiving therapeutic radiotherapy should consider integrating a recognised patient assessment

  4. Gender differences in cost-related medication non-adherence among cancer survivors.

    PubMed

    Lee, Minjee; Khan, M Mahmud

    2016-04-01

    It has been reported that cancer survivors are delaying or avoiding necessary care due to costs. Medication non-adherence is one of the important aspects of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by gender and factors associated with CRN among cancer survivors. Using 2006-2013 National Health Interview Survey (NHIS), we examined self-reported CRN among cancer survivors by gender. Descriptive statistics and multiple logistic regression models were used to examine gender differences in CRN. In a nationally representative sample of 15,159 cancer survivors, 7.4% of male and 12.5% of female reported CRN. Overall, the prevalence of CRN was found to be the highest for uninsured group and the lowest for Medicare, but gender differences persist for all insurance types, including Medicare. After controlling for relevant covariates, female cancer survivors were 27% more likely (odds ratio (OR) = 1.27, confidence intervals (CI), 1.06-1.53) than male to report CRN. With higher number of comorbidities and activity limitations, CRN rates tend to increase for both male and female cancer survivors. Significant gender differences in CRN were found among cancer survivors after controlling for differences in sociodemographic, health status, and insurance coverage. Given the rapid increase in prescription drug costs, it is important to monitor closely the CRN in high-risk subgroups.

  5. Older adults and substance-related disorders: trends and associated costs.

    PubMed

    Rosen, Daniel; Heberlein, Emily; Engel, Rafael J

    2013-01-01

    Purpose. The aim of this study is to examine the changing service profile of older adults receiving substance abuse services over the past decade and the increased costs of treating this population. Design and Methods. Medicaid claims for mental health and substance abuse services data from a medium sized county in an eastern state were analyzed for individuals aged 50 years and older in calendar year 2000 or 2009. Univariate statistics are presented to describe the substance abuse and mental health services used by older adults in these two years. Results. The number of low-income older adults who accessed services for treatment and who had a substance-related diagnosis grew from 545 individuals in 2000 to 1,653 individuals in 2009. Costs for services utilized by older adults with a substance-related diagnosis rose by 358% from $2.1 million in 2000 to $9.5 million in 2009. Implications. The increase in the number of low-income older adults with a substance-related disorder and the concomitant rise in total spending for Medicaid reimbursed services indicate that local and state social service providers need to prepare for an older adult population who will need appropriate substance abuse prevention and treatment programs.

  6. Older Adults and Substance-Related Disorders: Trends and Associated Costs

    PubMed Central

    Heberlein, Emily; Engel, Rafael J.

    2013-01-01

    Purpose. The aim of this study is to examine the changing service profile of older adults receiving substance abuse services over the past decade and the increased costs of treating this population. Design and Methods. Medicaid claims for mental health and substance abuse services data from a medium sized county in an eastern state were analyzed for individuals aged 50 years and older in calendar year 2000 or 2009. Univariate statistics are presented to describe the substance abuse and mental health services used by older adults in these two years. Results. The number of low-income older adults who accessed services for treatment and who had a substance-related diagnosis grew from 545 individuals in 2000 to 1,653 individuals in 2009. Costs for services utilized by older adults with a substance-related diagnosis rose by 358% from $2.1 million in 2000 to $9.5 million in 2009. Implications. The increase in the number of low-income older adults with a substance-related disorder and the concomitant rise in total spending for Medicaid reimbursed services indicate that local and state social service providers need to prepare for an older adult population who will need appropriate substance abuse prevention and treatment programs. PMID:25938120

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

    PubMed Central

    Zeier, Joshua D.; Newman, Joseph P.

    2013-01-01

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

  8. The internal and external validity of sluggish cognitive tempo and its relation with DSM-IV ADHD

    PubMed Central

    Willcutt, Erik G.; Chhabildas, Nomita; Kinnear, Mikaela; DeFries, John C.; Olson, Richard K.; Leopold, Daniel R.; Keenan, Janice M.; Pennington, Bruce F.

    2013-01-01

    Studies of subtypes of DSM-IV attention-deficit/hyperactivity disorder (ADHD) have provided inconsistent support for the discriminant validity of the combined type (ADHD-C) and predominantly inattentive type (ADHD-I). A large sample of children and adolescents with ADHD (N = 410) and a comparison group without ADHD (N = 311) were used to test the internal and external validity of sluggish cognitive tempo (SCT), a dimension characterized by low energy and sleepy and sluggish behavior. SCT scores were then incorporated in analyses of ADHD subtypes to test whether the discriminant validity of ADHD-C and ADHD-Icould be improved by includingSCT symptoms as part of the criteria for ADHD-I. Factor analyses of parent and teacher ratings indicated that six SCT items loaded on a factor separate from symptoms of ADHD and other psychopathology, providing important support for the internal validity of SCT. The external validity of SCT was supported by significant associationsbetween SCT and measures of functional impairment and neuropsychological functioning when symptoms of ADHD and other psychopathology were controlled. However, contrary to initial predictions, high levels of SCT did not identify a subgroup of ADHD-I that was clearly distinct from ADHD-C. Instead, the current results suggest that DSM-IV inattention and SCT are separate but correlated symptom dimensions that are each independently associated with important aspects of functional impairment and neuropsychological functioning. PMID:24122408

  9. Feature-based attention and conflict monitoring in criminal offenders: interactive relations of psychopathy with anxiety and externalizing.

    PubMed

    Zeier, Joshua D; Newman, Joseph P

    2013-08-01

    As predicted by the response modulation model, psychopathic offenders are insensitive to potentially important inhibitory information when it is peripheral to their primary focus of attention. To date, the clearest tests of this hypothesis have manipulated spatial attention to cue the location of goal-relevant versus inhibitory information. However, the theory predicts a more general abnormality in selective attention. In the current study, male prisoners performed a conflict-monitoring task, which included a feature-based manipulation (i.e., color) that biased selective attention toward goal-relevant stimuli and away from inhibitory distracters on some trials but not others. Paralleling results for spatial cuing, feature-based cuing resulted in less distracter interference, particularly for participants with primary psychopathy (i.e., low anxiety). This study also investigated the moderating effect of externalizing on psychopathy. Participants high in psychopathy but low in externalizing performed similarly to primary psychopathic individuals. These results demonstrate that the abnormal selective attention associated with primary psychopathy is not limited to spatial attention but, instead, applies to diverse methods for establishing attentional focus. Furthermore, they demonstrate a novel method of investigating psychopathic subtypes using continuous analyses. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  10. 15 CFR 717.4 - Report of inspection-related costs.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  11. 15 CFR 717.4 - Report of inspection-related costs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  12. 15 CFR 717.4 - Report of inspection-related costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  14. 15 CFR 717.4 - Report of inspection-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  15. Metabolic costs of heat solicitation calls in relation to thermal need in embryos of American white pelicans.

    PubMed

    Abraham; Evans

    1999-04-01

    Chilled embryos of pelicans, Pelecanus erythrorhynchos, begin to vocally solicit parental heat at the pipped-egg stage. Honest signalling models predict that if vocal heat solicitation is a true reflection of need, then solicitation should be costly and costs should increase with the embryo's need for warmth. Using open-flow respirometry, we measured the metabolic costs associated with vocal heat solicitation by exposing embryos to either a decreasing or increasing series of body temperatures, ranging from 25 to 37.8 degrees C. We measured baseline costs (stable temperature, embryo silent) and costs associated with cold-induced calling at each temperature. At natural incubation temperature (37.8 degrees C), call rates and costs associated with calling were negligible, as was thermal need. Metabolic costs relative to baseline costs and costs per call increased with thermal need as body temperature declined. Absolute metabolic costs increased between 37.8 and 35 degrees C, then remained stable down to 25 degrees C. Call rates increased as embryos were chilled within the range of temperatures most frequently experienced in nature (35-37.8 degrees C), then decreased significantly for all lower temperatures, probably owing to reduced overall metabolic rate at lower temperatures (25-37.8 degrees C). The results generally support the honest signalling prediction that vocal heat solicitation is metabolically costly, and that costs increase with need. Copyright 1999 The Association for the Study of Animal Behaviour.

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

    PubMed Central

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

    2014-01-01

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

  17. Accommodation: The role of the external muscles of the eye: A consideration of refractive errors in relation to extraocular malfunction.

    PubMed

    Hargrave, B K

    2014-11-01

    Speculation as to optical malfunction has led to dissatisfaction with the theory that the lens is the sole agent in accommodation and to the suggestion that other parts of the eye are also conjointly involved. Around half-a-century ago, Robert Brooks Simpkins suggested that the mechanical features of the human eye were precisely such as to allow for a lengthening of the globe when the eye accommodated. Simpkins was not an optical man but his theory is both imaginative and comprehensive and deserves consideration. It is submitted here that accommodation is in fact a twofold process, and that although involving the lens, is achieved primarily by means of a give - and - take interplay between adducting and abducting external muscles, whereby an elongation of the eyeball is brought about by a stretching of the delicate elastic fibres immediately behind the cornea. The three muscles responsible for convergence (superior, internal and inferior recti) all pull from in front backwards, while of the three abductors (external rectus and the two obliques) the obliques pull from behind forwards, allowing for an easy elongation as the eye turns inwards and a return to its original length as the abducting muscles regain their former tension, returning the eye to distance vision. In refractive errors, the altered length of the eyeball disturbs the harmonious give - and - take relationship between adductors and abductors. Such stresses are likely to be perpetuated and the error exacerbated. Speculation is not directed towards a search for a possible cause of the muscular imbalance, since none is suspected. Muscles not used rapidly lose tone, as evidenced after removal of a limb from plaster. Early attention to the need for restorative exercise is essential and results usually impressive. If flexibility of the external muscles of the eyes is essential for continuing good sight, presbyopia can be avoided and with it the supposed necessity of glasses in middle life. Early attention

  18. Parkinson's disease: health-related quality of life, economic cost, and implications of early treatment.

    PubMed

    Chen, Jack J

    2010-03-01

    Parkinson's disease (PD) is the second most common neurodegenerative disorder, marked by progressive increases in movement-related disability, impaired balance, and nonmotor symptoms. Its prevalence in the United States is expected to double within the next 20 years as the percentage of the elderly in the population grows. Patients with PD have twice the direct medical costs of those without PD, the majority of which occur later in the disease as disability and therapy-related complications increase. Greater awareness of a prodromal/premotor stage of the disease, efforts toward early and accurate diagnosis, and the continuous refinement of treatment paradigms provide an opportunity for discussion on the use of potential disease-modifying agents to slow or halt the progression of motor and nonmotor disability. Such compounds could not only significantly improve patient and caregiver quality of life, but substantially reduce direct and indirect costs. To date, numerous compounds have been evaluated in clinical trials, including coenzyme Q10, creatine, levodopa, pramipexole, rasagiline, ropinirole, and selegiline. None has demonstrated irrefutable and enduring disease-modifying qualities, although the best available clinical evidence appears most promising for rasagiline.

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

    PubMed

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

    2012-07-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  2. Army Pacific Pathways: Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance Value for Participating Units

    DTIC Science & Technology

    2016-11-01

    ARMY PACIFIC PATHWAYS Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance...the costs of Pacific Pathways. The corrected section should read: “For fiscal year 2015, the three Pathway operations cost a total of $34.5 million...complexity for partners, such as by providing more equipment to exercises; supports the rebalance of forces to the Pacific with a persistent forward

  3. Measuring the societal burden of cancer: the cost of lost productivity due to premature cancer-related mortality in Europe.

    PubMed

    Hanly, Paul; Soerjomataram, Isabelle; Sharp, Linda

    2015-02-15

    Every cancer-related death in someone of working age represents an economic loss to society. To inform priorities for cancer control, we estimated costs of lost productivity due to premature cancer-related mortality across Europe, for all cancers and by site, gender, region and country. Cancer deaths in 2008 were obtained from GLOBOCAN for 30 European countries across four regions. Costs were valued using the human capital approach. Years of productive life lost (YPLL) were computed by multiplying deaths between 15 and 64 years by working-life expectancy, then by country-, age- and gender-specific annual wages, corrected for workforce participation and unemployment. Lost productivity costs due to premature cancer-related mortality in Europe in 2008 were €75 billion. Male costs (€49 billion) were almost twice female costs (€26 billion). The most costly sites were lung (€17 billion; 23% of total costs), breast (€7 billion; 9%) and colorectum (€6 billion; 8%). Stomach cancer (in Southern and Central-Eastern Europe) and pancreatic cancer (in Northern and Western Europe) were also among the most costly sites. The average lost productivity cost per cancer death was €219,241. Melanoma had the highest cost per death (€312,798), followed by Hodgkin disease (€306,628) and brain and CNS cancer (€288,850). Premature mortality costs were 0.58% of 2008 European gross domestic product, highest in Central-Eastern Europe (0.81%) and lowest in Northern Europe (0.51%). Premature cancer-related mortality costs in Europe are significant. These results provide a novel perspective on the societal cancer burden and may be used to inform priority setting for cancer control.

  4. Examining the economic costs related to lifestyle and pharmacological interventions in youth with Type 2 diabetes

    PubMed Central

    Songer, Thomas; Glazner, Judith; Coombs, Laura P; Cuttler, Leona; Daniel, Mary; Estrada, Silvia; Klingensmith, Georgeanna; Kriska, Andrea; Laffel, Lori; Zhang, Ping

    2009-01-01

    The best treatment option for children with Type 2 diabetes has not yet been established. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study is currently testing the efficacy of three therapies: metformin, metformin plus rosiglitazone and metformin plus an intensive lifestyle intervention. The relative cost–effectiveness of these therapies is also being examined. This review discusses the rationale for the design and methods applied in the economic analysis. The design of the economic analysis in the TODAY study was influenced by the existing literature and two primary study parameters: the nature of the interventions and the participants' age. The lifestyle intervention is an intensive behavioral intervention comprising diet and physical activity. Since economic factors influence both diet and physical activity, the analytical plan includes measurement of food and exercise-related purchases. Due to the young age of the participants, the impact of the intervention on adult caregivers is also included in the analysis. This analysis focuses on the time spent by the caregivers in both medical treatment and nutrition- and activity-related activities, and the value of this time relative to usual activities. Important methodological questions include how and when to collect information, not only on medical costs, but also on the impact of caregiver time, travel, food and equipment purchases. In the TODAY study, these latter resources are being measured by regularly administered surveys completed by the caregivers. The approach to the cost–effectiveness assessment undertaken by the TODAY study is one of the first in diabetes research to focus on youth and to include a societal perspective, regular and prospective assessment of clinician and caregiver time, and a comprehensive assessment of the costs associated with lifestyle behaviors. It can serve as a model for future studies of diabetes treatments. PMID:19774104

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

    SciTech Connect

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

    2015-03-01

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

  6. Costs Associated with Anesthesia-Related Adverse Events During Labor and Delivery in New York State, 2010.

    PubMed

    Hunt, Tristan D; Guglielminotti, Jean; Li, Guohua

    2016-06-01

    The safety of anesthetic care provided during childbirth has improved during the past 2 decades in the United States, with a marked decrease in the rate of anesthesia-related adverse events (ARAEs). To date, there is little research on the costs of ARAEs in obstetrics. This study aims to assess the excess cost and cost per admission associated with ARAEs during labor and delivery. Data came from the New York State Inpatient Database 2010. Discharge records indicating labor and delivery and ARAEs were identified with International Classification of Diseases, Ninth Revision, Clinical Modification codes. ARAEs were defined as minor if not associated with maternal death, cardiac arrest, or severe morbidity. Costs were calculated as the product of hospital charges and the group average all-payer inpatient charge-to-cost conversion ratio. Excess cost was calculated as the difference between the mean cost of discharges with and without ARAEs. The cost per admission was calculated as the product of the excess cost and ARAE incidence. Excess costs and cost per admission were also calculated for 2 pregnancy-related complications: postpartum hemorrhage and preeclampsia/eclampsia. There were 228,104 delivery-related discharges in the study; of these, 1053 recorded at least 1 ARAE (4.6 per 1000), with 1034 (98.2%) of the ARAEs being minor. The adjusted excess cost associated with ARAEs was $1189 (95% confidence interval [CI], 1033-1350) and the cost per admission $5.49 (95% CI, 4.77-6.23). The incidence of postpartum hemorrhage and preeclamspia/eclampsia was 25.1 and 43.8 per 1000, respectively. The adjusted excess cost was $679 (95% CI, 608-748) and $1328 (95% CI, 1272-1378), respectively; the cost per admission was $17.07 (95% CI, 15.27-18.81) and $58.16 (95% CI, 55.72-60.34), respectively. ARAEs during labor and delivery are associated with significant excess cost. However, the excess cost per admission for ARAEs is significantly less compared with the excess cost per

  7. Relative costs of prebasic and prealternate molts for male blue-winged teal

    USGS Publications Warehouse

    Hohman, W.L.; Manley, S.W.; Richard, D.

    1997-01-01

    We compared masses of definitive basic and alternate plumages of male Blue-winged Teal (Anas discors) to evaluate the hypothesis that nutritional investments in basic and alternate plumages are related to the duration that plumages are worn and to assess the relative costs of prebasic and prealternate molts. Because these plumages are worn by males for approximately equal durations, we predicted that masses of the basic and alternate body plumages would be similar. To assess nutritional stress (demands greater than available resources) associated with molt, we examined the relation between remigial length and structural size and compared predicted and observed plum-age masses of Blue-winged Teal and other ducks. If birds were nutritionally challenged during remigial molt, then we predicted remigial length would be influenced by nutrition rather than size, and remigial length and size would be unrelated. Alternate body plumage of male Blue-winged Teal weighed about 10% more than the basic body plumage; however, masses of both plumages were less than that predicted on the basis of lean body mass. We argue that deviations between observed and predicted plumage masses were related to factors other than nutrition. Further, remigial lengths were significantly, albeit weakly, related to structural size. We therefore concluded that, although the potential for molt-induced stress may be greatest in small-bodied waterfowl species, there was no clear evidence that molting male Blue-winged Teal were nutritionally stressed. ?? The Cooper Ornithological Society 1997.

  8. Costs and hospital procedures in an urology department of a tertiary hospital. Analysis of groups related by their diagnosis.

    PubMed

    Boronat, F; Barrachina, I; Budia, A; Vivas Consuelo, D; Criado, M C

    The health care system has management tools available in hospitals that facilitate the assessment of efficiency through the study of costs and management control in order to make a better use of the resources. The aim of the study was the calculation and analysis of the total cost of a urology department, including ambulatory, hospitalization and surgery activity and the drafting of an income statement where service costs are compared with income earned from the Government fees during 2014. From the information recorded by the Economic Information System of the Department of Health, ABC and top-down method of cost calculation was applied by process care activity. The cost results obtained were compared with the rates established for ambulatory and hospital production in the Tax Law of the Generalitat Valenciana. The production was structured into outpatient (external and technical consultations) and hospital stays and surgeries (inpatient). A total of 32,510 outpatient consultations, 7,527 techniques, 2,860 interventions and 4,855 hospital stays were made during 2014. The total cost was 7,579,327€; the cost for outpatient consultations was 1,748,145€, 1,229,836 Euros for technical consultations, 2,621,036€ for surgery procedures and 1,980,310€ for hospital admissions. Considered as income the current rates applied in 2014 (a total of 15,035,843€), the difference between income and expenditure was 7,456,516€. The economic balance was positive with savings over 50% and a mean adjusted hospitalization stay rate (IEMAC) rate of 0.67 (33% better than the standard). CMA had a favorable impact on cost control. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. 26 CFR 1.1059A-1 - Limitation on taxpayer's basis or inventory cost in property imported from related persons.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... 1202); imports on which no duty is imposed that are valued by customs for statistical purposes only... cost in property imported from related persons. 1.1059A-1 Section 1.1059A-1 Internal Revenue INTERNAL...) Special Rules § 1.1059A-1 Limitation on taxpayer's basis or inventory cost in property imported from...

  10. 26 CFR 1.1059A-1 - Limitation on taxpayer's basis or inventory cost in property imported from related persons.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... 1202); imports on which no duty is imposed that are valued by customs for statistical purposes only... cost in property imported from related persons. 1.1059A-1 Section 1.1059A-1 Internal Revenue INTERNAL...) Special Rules § 1.1059A-1 Limitation on taxpayer's basis or inventory cost in property imported from...

  11. Impact of measurement invariance on construct correlations, mean differences, and relations with external correlates: an illustrative example using Big Five and RIASEC measures.

    PubMed

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

    2011-12-01

    The impact of measurement invariance and the provision for partial invariance in confirmatory factor analytic models on factor intercorrelations, latent mean differences, and estimates of relations with external variables is investigated for measures of two sets of widely assessed constructs: Big Five personality and the six Holland interests (RIASEC). In comparing models that include provisions for partial invariance with models that do not, the results indicate quite small differences in parameter estimates involving the relations between factors, one relatively large standardized mean difference in factors between the subgroups compared and relatively small differences in the regression coefficients when the factors are used to predict external variables. The results provide support for the use of partially invariant models, but there does not seem to be a great deal of difference between structural coefficients when the measurement model does or does not include separate estimates of subgroup parameters that differ across subgroups. Future research should include simulations in which the impact of various factors related to invariance is estimated.

  12. Direct Diabetes-Related Costs in Young Patients with Early-Onset, Long-Lasting Type 1 Diabetes

    PubMed Central

    Straßburger, Klaus; Flechtner-Mors, Marion; Hungele, Andreas; Beyer, Peter; Placzek, Kerstin; Hermann, Ulrich; Schumacher, Andrea; Freff, Markus; Stahl-Pehe, Anna

    2013-01-01

    Objective To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. Research Design and Methods Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. Results Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. Conclusions Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group. PMID:23967077

  13. Relation of dyspnea severity on admission for acute heart failure with outcomes and costs.

    PubMed

    Mentz, Robert J; Mi, Xiaojuan; Sharma, Puza P; Qualls, Laura G; DeVore, Adam D; Johnson, Katherine Waltman; Fonarow, Gregg C; Curtis, Lesley H; Hernandez, Adrian F

    2015-01-01

    Hospitalization for heart failure (HF) is frequently related to dyspnea, yet associations among dyspnea severity, outcomes, and health care costs are unknown. The aim of this study was to describe the characteristics of patients hospitalized for acute HF by dyspnea severity and to examine associations among dyspnea severity, outcomes, and costs. Registry data for patients hospitalized for HF were linked with Medicare claims to evaluate dyspnea and outcomes in patients ≥65 years of age. We classified patients by patient-reported dyspnea severity at admission. Outcomes included length of stay, mortality 30 days after admission, days alive and out of the hospital, readmission, and Medicare payments 30 days after discharge. Of 48,616 patients with acute HF and dyspnea, 4,022 (8.3%) had dyspnea with moderate activity, 19,619 (40.3%) with minimal activity, and 24,975 (51.4%) at rest. Patients with dyspnea with minimal activity or at rest had greater co-morbidities, including renal insufficiency. Greater severity of baseline dyspnea was associated with mortality (moderate activity, 6.3%; minimal activity, 7.6%; at rest, 11.6%) and HF readmission (7.2%, 9.0%, and 9.4%). After multivariate adjustment, dyspnea at rest was associated with greater 30-day mortality and HF readmission, fewer days alive and out of the hospital, longer length of stay, and higher Medicare payments compared with dyspnea with moderate activity. In conclusion, dyspnea at rest on presentation was associated with greater mortality, readmission, length of stay, and health care costs in patients hospitalized with acute HF. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2013-01-01

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

  15. Health care utilization, costs, and the burden of disease related to eosinophilic esophagitis in the United States

    PubMed Central

    Jensen, Elizabeth T.; Kappelman, Michael D.; Martin, Christopher F.; Dellon, Evan S.

    2015-01-01

    Objectives Eosinophilic esophagitis (EoE) has rapidly become a major cause of upper GI morbidity, but health care costs related to EoE have not been described. This study aimed to estimate EoE-related health care costs and utilization in the United States. Methods We performed a study of health care utilization of EoE cases compared to age- and sex-matched controls using administrative claims data, representative of the commercially insured population in the U.S. Cases of EoE were identified using a previously validated definition. We assessed inpatient, outpatient, emergency department, outpatient prescription, and endoscopy-related costs for patients with EoE, and estimated total costs related to EoE extrapolated to the U.S. population. Results We identified 8,135 cases of EoE and 32,540 controls. The median total annual cost per EoE case was $3,304 compared to $1,001 for controls (p<0.001). For EoE, median costs included $2,508/year for outpatient visits, $157 for endoscopies, and $325 for pharmacy claims, compared to $699, $0, and $76 for controls (p<0.001 for all). The overall median costs associated with EoE were $2,302/year/patient. Total costs in the U.S. ranged from $503 million to $1.36 billion/year, depending on the prevalence estimate, with costs attributable to EoE ranging from $350-$947 million/year. Conclusions Patients with EoE have an estimated annual health care cost of as much as $1.4 billion in the U.S. This represents a remarkable burden of disease for an entity that was essentially unknown two decades ago. These cost data can be used by policy makers to guide resource allocation. PMID:25267327

  16. [Costs of appendicitis treatment by diagnosis-related groups in a third-level pediatric hospital].

    PubMed

    Tlacuilo-Parra, Alberto; Hernández-Hernández, Araceli; Venegas-Dávalos, Martha; Gutiérrez-Hermosillo, Violeta; Guevara-Gutiérrez, Elizabeth; Ambriz-González, Gabriela

    2014-01-01

    Diagnosis-related groups (DRGs) are widely used in Europe. They allow performing comparisons in hospitals and incurrent hospital payment systems, defining the payment categories. We undertook this study to classify children who underwent appendectomy according to DRGs. Cross-sectional study. Comorbidities, length of hospitalization, histopathologic classification, and DRG classifications were analyzed. We included 313 patients, 62% males, with an average age of 8 ± 3 years; 91% were referred by another hospital and 67% were treated at night. Average length of hospitalization was 4 ± 3 days. There were comorbidities in 8% and surgical complications in 11%. According to histopathology, appendicitis was edematous (11%), suppurative (36%), gangrenous (22%), perforated (29%), and abscessed (2%). At discharge, 97% of the patients were healthy. Total cost for DRG 343 was $10,470,173.00 (Mexican pesos), DRG 342 was $1,227,592.00 and DRG 340 was $511,521.00. The global amount was $12,209,286.00 (Mexican pesos). The unitary cost for treatment of appendectomy for DRG 343 was $37,935.00, for DRG 342 was $49,103.00 and for DRG 340 was $42,626.00 (Mexican pesos). Because 88% of the cases of appendicitis were uncomplicated, this amount of money could be spent to treat these patients in a second-level hospital, using reimbursement 343 without generating additional expenses.

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

    PubMed

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

    2007-08-01

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

  18. No costly prosociality among related long-tailed macaques (Macaca fascicularis).

    PubMed

    Sterck, Elisabeth H M; Olesen, Caroline U; Massen, Jorg J M

    2015-08-01

    Altruism, benefiting another at a cost to the donor, may be achieved through prosocial behavior. Studies of nonhuman animals typically investigate prosocial behavior with paradigms in which the donor can choose to give a recipient a food item, and the choice does not affect the donor's reward (which is either present or absent). In such tasks, long-tailed macaques (Macaca fascicularis) show prosocial behavior, especially toward kin. Here, we tested captive long-tailed macaques with related recipients in an alternative task, in which the donor had to give up a preferred reward to benefit the recipient; that is, they had to choose a lower valued reward for themselves to provide food to their kin. Overall, the macaques did not provide their kin with food. The task forced the donor to balance its prosocial behavior with its selfish choice for a higher value reward, a balance that turned out to favor selfish motives. Consequently, our study shows that a prosocial tendency is not sufficient to elicit costly prosocial behavior in long-tailed macaques. Subsequently, we feel that tasks in which the donor must choose a lower value reward to benefit another individual may allow the titration of the strength of prosocial behavior, and thus provides interesting possibilities for future comparative studies. (c) 2015 APA, all rights reserved).

  19. Transdiagnostic Factors and Pathways to Multifinality: The Error-Related Negativity Predicts Whether Preschool Irritability is Associated with Internalizing Versus Externalizing Symptoms at Age 9

    PubMed Central

    Kessel, Ellen M.; Meyer, Alexandria; Hajcak, Greg; Dougherty, Lea R.; Torpey-Newman, Dana C.; Carlson, Gabrielle A.; Klein, Daniel N.

    2017-01-01

    There is increasing interest among developmental psychopathologists in broad transdiagnostic factors that give rise to a wide array of clinical presentations (multifinality), but little is known about how these processes lead to particular psychopathological manifestations over the course of development. We examined whether individual differences in the error related negativity (ΔERN), a neural indicator of error monitoring, predicts whether early persistent irritability—a prototypical transdiagnostic construct— is associated with later internalizing versus externalizing outcomes. When children were 3 years old, mothers were interviewed about children’s persistent irritability and completed questionnaires about their children’s psychopathology. Three years later, EEG was recorded while children performed a go/no-go task to measure the ΔERN. When children were approximately 9 years old, mothers again completed questionnaires about their children’s psychopathology. Results indicated that among children who were persistently irritable at age 3, an enhanced or more negative ΔERN at age 6 predicted the development of internalizing symptoms at age 9, whereas a blunted or smaller ΔERN at age 6 predicted the development of externalizing symptoms. Our results suggest that variation in error monitoring predicts, and may even shape, the expression of persistent irritability and differentiates developmental trajectories from preschool persistent irritability to internalizing versus externalizing outcomes in middle-late childhood. PMID:27739383

  20. Decreasing catheter-related infection and hospital costs by continuous quality improvement.

    PubMed

    Civetta, J M; Hudson-Civetta, J; Ball, S

    1996-10-01

    a) To reduce the rate of catheter-related infection, using improved skin preparation and catheters impregnated with silver sulfadiazine and chlorhexidine; b) to decrease the number of unnecessary guidewire exchanges of existing catheters by substituting suspected catheter-related sepsis for fever alone as an indication to change an indwelling catheter; and c) to decrease the hospital costs associated with guidewire exchanges and new catheter insertions. Sequential, prospective, descriptive studies using a continuous quality management approach. A 20-bed trauma intensive care unit at a university teaching hospital. Patients (n = 147) admitted from July 1 to December 31, 1992 (phase 1); 34 patients admitted in June and September 1993 (phase 2); and 156 patients admitted between January 1 and June 30, 1994 (phase 3). Phase 1: Proportions of catheter-related infections and catheter-related bacteremia were compared with our prior reported results. Indications for guidewire exchange were analyzed, and the rate of catheter-related infection for each indication was derived. Phase 2: The rate of catheter-related infection was determined for a trial group of triple-lumen catheters impregnated with silver sulfadiazine and chlorhexidine. Phase 3: Four components were altered. Impregnated triple-lumen catheters were used instead of unprotected catheters. Chlorhexidine skin cleanser was substituted for povidone-iodine solution during initial aseptic preparation during catheter insertion and subsequent guidewire exchange. Suspected catheter-related sepsis was substituted for fever as an indication for guidewire exchange. The "safe" period (the time before considering changing a catheter because catheter-related sepsis was suspected) was extended from 2 to 4 days. The overall rate of catheter-related infection in phase 1 was 15% (15% for triple-lumen catheters and 16% for introducers). Catheters changed for site inflammation had a 46% rate of catheter-related infection

  1. Socioeconomic costs and health-related quality of life in juvenile idiopathic arthritis: a cost-of-illness study in the United Kingdom.

    PubMed

    Angelis, Aris; Kanavos, Panos; López-Bastida, Julio; Linertová, Renata; Serrano-Aguilar, Pedro

    2016-08-02

    Juvenile idiopathic arthritis (JIA) refers to a number of rare chronic inflammatory diseases. Although JIA imposes a significant societal burden, limited data are available on the cost of JIA. The study's objective is to quantify the socioeconomic burden of JIA patients in the United Kingdom (UK), along with their health-related quality of life (HRQoL). A bottom-up, cross-sectional, cost-of-illness analysis of 23 patients was carried out. To collect data on demographic characteristics, health resource utilization, informal care, productivity losses and HRQoL, questionnaires were administered to and completed by patients or their caregivers. The EuroQol five dimensions (EQ-5D) instrument was used to measure HRQoL. This study found that the average annual cost for a JIA patient was €31,546, with direct health care costs equalling €14,509 (46.0 % of total costs), direct non-health care costs amounting to €8,323 (26.4 %) and productivity losses being €8,715 (27.6 %). This was calculated using unit costs for 2012. The largest expenditures on average were accounted for by early retirement (27.0 %), followed by informal care (24.1 %), medications (21.1 %), outpatient and primary health care visits (13.2 %) and diagnostic tests (7.9 %). Important differences existed between JIA patients in need of caregiver assistance and those with no need (€39,469 vs. €25,452 respectively). Among adult JIA patients, mean EQ-5D index scores and visual analogue scale (VAS) scores were found to be 0.26 and 49.00 respectively; the same scores among caregivers were 0.66 and 67.14 respectively. JIA poses a significant cost burden on the UK society. Over half of the total average costs (54 %) are related to non-health care and productivity losses. HRQoL of JIA patients is considerably worse than the UK general population.

  2. Parametric head-related transfer function modeling and interpolation for cost-efficient binaural sound applications.

    PubMed

    Ramos, German; Cobos, Maximo

    2013-09-01

    Parametric methods for modeling the perceptually relevant features of head-related transfer functions (HRTFs) are very important for the development of low-cost immersive sound applications. This letter describes an efficient method based on a low-order infinite impulse response filter implemented by a chain of second order sections of conventional shelving and peak audio filters. The parameters (central frequency, gain, and quality factor) are numerically adjusted by iteratively fitting the frequency response of the filter to the desired HRTF. Besides allowing for low-order binaural models, the proposed approach provides an efficient way to synthesize HRTFs for non-measured angles by applying a simple interpolation between the parameters from neighboring responses. Additionally, the HRTF database size is significantly reduced.

  3. Age-Related Employment Costs at the Travelers Companies in 1981.

    ERIC Educational Resources Information Center

    Billings, A. E., Jr.

    1983-01-01

    The Travelers Companies studied its work force in 1981 and discovered that some employment costs, such as health insurance claims, increase as employees age, while other costs, such as those associated with turnover, decrease. (SK)

  4. Making a case for telehealth: measuring the carbon cost of health-related travel.

    PubMed

    Ellis, Isabelle; Cheek, Colleen; Jaffray, Linda; Skinner, Timothy

    2013-01-01

    Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions. A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e). Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time. Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas.

  5. The effects of enhanced external counterpulsation on health-related quality of life in patients with angina pectoris

    PubMed Central

    Ziaeirad, Marzieh; Ziaei, Gholam Reza; Sadeghi, Narges; Motaghi, Minoo; Torkan, Behnaz

    2012-01-01

    Background: The complicated concept of quality of life (QOL) has been considered as an important criterion for health outcomes in chronic diseases, such as heart disease, in recent years. The aim of this study was to evaluate the QOL of patients with angina pectoris after treatment with enhanced external counterpulsation (EECP). Materials and Methods: This quasi-experimental study was conducted on 64 patients with angina pectoris undergoing EECP who came to Shahid Chamran and Sina Hospitals in Isfahan. Sampling was performed by the convenient method. Data were collected using a questionnaire containing socio-demographic and clinical data. A standard questionnaire called 36-item Short-Form Health Survey was also used. Questionnaires were completed through interviews and phone calls in three stages (before, immediately and three months after the treatment). The results were analyzed using descriptive statistics (frequency, mean, and standard deviation) and analytical statistics (paired t-test and repeated measures test) in SPSS11.5. Findings: The obtained results demonstrated that the majority of patients were men (59.4%) and aged 56-71 years. In addition, 57.8% had hypertension and 56.3% had hyperlipidemia. A history of myocardial infarction was found in 70.3% of the subjects and the familial history of coronary artery disease was detected in73.4%. Although QOL evaluations showed improvements in all subscales immediately and three months after the treatment, the changes were not statistically significant in case of general health, role limitations due to physical problems and role limitations due to mental problems Conclusions: Similar to previous research, this study showed QOL to improve in patients who undergo EECP. This improvement will remain stable three months after the treatment in all subscales. Therefore, EECP is an efficient noninvasive method in treating patients with angina pectoris and in developing their QOL. PMID:23493242

  6. 77 FR 11778 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-28

    ... below that threshold and is not required to file under current Cost Accounting Standards Board (CASB... and nonprofit organizations. To the extent that current OMB circulars on cost principles cover all...'' under the Cost Accounting Standards (CAS) as defined at 48 CFR 9903.201. CAS-covered contracts...

  7. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... houses (but see subparagraph (f)(5) of this subsection). (5) Costs of keel laying, ship launching... advertising costs. 31.205-1 Section 31.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial...

  8. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... houses (but see subparagraph (f)(5) of this subsection). (5) Costs of keel laying, ship launching... advertising costs. 31.205-1 Section 31.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial...

  9. 48 CFR 31.205-1 - Public relations and advertising costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... houses (but see subparagraph (f)(5) of this subsection). (5) Costs of keel laying, ship launching... advertising costs. 31.205-1 Section 31.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial...

  10. An Educational Intervention to Decrease Drug Costs Related to Terminal Secretions in a Hospice Organization.

    PubMed

    Brock, Cara; Cooper, Sarah; Herndon, Christopher M

    2017-03-01

    Terminal secretions is a common symptom seen in hospice patients. Antimuscarinic drugs are commonly used to treat this symptom despite a lack of supporting data. Wide variability in cost exists among these treatments. Hospice program data were assessed to identify high-use and high-cost medications. An educational intervention (EI) was developed to target one such medication, transdermal scopolamine. The EI focused on efficacy, safety, and actual cost (by unit and total expenditure) for each possible treatment of terminal secretions. Following the EI, drug utilization data was re-evaluated. Prior to the deployment of the EI, total monthly hospice drug costs averaged $91,405 (SD 1,444) with an average drug cost per patient per day of $11.42 (SD 0.54). Monthly costs of drugs frequently employed to treat terminal secretions averaged $7,187.67 (SD 2,253) pre-intervention. Following the EI, monthly drug costs decreased 22.5%, average daily patient drug costs decreased 11.1%, and total anti-secretion costs decreased 28.5% after adjusting for difference in census. Education regarding the use and cost of medications to treat symptoms at end-of-life in hospice patients can be an intervention used to lead to significant cost savings to hospice organizations while maintaining appropriate symptom management for patients. Future interventions to target additional high-cost medications are warranted.

  11. Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review.

    PubMed

    Bargiacchi, O; Rossati, A; Car, P; Brustia, D; Brondolo, R; Rosa, F; Garavelli, P L; De Rosa, F G

    2014-10-01

    We report three cases of external ventricular derivation infections caused by multidrug-resistant Gram-negative rods and treated successfully with intraventricular colistin. The intrathecal or intraventricular use of colistin have been reported in more than 100 cases without any consensus on dosage, duration and type (monotherapy or combination therapy) of treatment. Based on our comprehensive review of the relevant literature relating to both clinical and pharmacokinetic data, we conclude that the intrathecal/intraventricular administration of colistin is a safe and effective option to treat central nervous system infections caused by multidrug-resistant Gram-negative bacteria.

  12. Are educational interventions to prevent catheter-related bloodstream infections in intensive care unit cost-effective?

    PubMed

    Cooper, K; Frampton, G; Harris, P; Jones, J; Cooper, T; Graves, N; Cleland, J; Shepherd, J; Clegg, A; Cuthbertson, B H

    2014-01-01

    There is increasing interest in evidence-based educational interventions in central venous catheter care. It is unclear how effective these are at reducing the risk of bloodstream infections from the use of intravascular catheters (catheter-BSIs) and the associated costs and health benefits. To estimate the additional costs and health benefits from introducing such interventions and the costs associated with catheter-BSIs. A comprehensive epidemiological and economic review was performed to develop the parameters for an economic model to assess the cost-effectiveness of introducing an educational intervention compared with clinical practice without the intervention. The model follows the clinical pathway of cohorts of patients from their admission to an intensive care unit (ICU), where some may acquire catheter-BSI, and estimates the associated costs, mortality and life expectancy. The additional cost per catheter-BSI episode was £3940. The results of this model demonstrate that introducing an additional educational intervention to prevent catheter-BSI improved patient life expectancy and reduced overall costs. Introducing evidence-based education is likely to reduce the incidence of catheter-BSI and the model results suggest that the cost of introducing the interventions will be outweighed by savings related to reduced ICU bed occupancy costs. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    2010-01-01

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

  14. What Drives Spacecraft Cost: A Look Into How Material Characteristics Relate to the Material Complexity Multipliers

    NASA Technical Reports Server (NTRS)

    Rosmait, Russell L.

    1996-01-01

    Today a variety of engineered materials are used to build the space vehicles and satellites that NASA, DOD and the aerospace community will use in future projects. These materials can be a significant part of the cost when designing and building these systems. Current cost models such as NASCOM, SEER-H and PRICE allow the cost analysis to select materials requirements during the development of the cost model. It should be noted however that some of these models do not always give the most detailed information with respect to material specifications for the given cost model. Instead the materials are defined within broad classification, giving questionable data with regard to specific material cost. It is the objective of this paper to present a summary of basic information on materials to assist the cost analyst in the development of their models. Specifically, this paper will compare materials and their complexity multipliers to some specific material properties.

  15. Should female relatives of factor V Leiden carriers be screened prior to oral contraceptive use? A cost-effectiveness analysis.

    PubMed

    Smith, Kenneth J; Monsef, Brenna S; Ragni, Margaret V

    2008-09-01

    Venous thromboembolism (VTE) is three-fold higher among FV Leiden (FVL) carriers receiving oral contraceptives (OCPs) than in the general population. FVL screening, however, is not routinely performed before prescribing OCP, and the cost-effectiveness of this strategy is unknown. A decision tree model was constructed to evaluate FVL screening and prophylactic anticoagulation (AC) strategies in female relatives of FVL carriers. In the model, AC was low molecular weight heparin, given warfarin embryopathy risks. VTE morbidity, mortality, and other clinical parameters were obtained from published studies. Drug costs were based on average wholesale price, and counseling included VTE risk with OCP use and FVL status. Outcomes included medical costs, effectiveness measured as quality-adjusted-life-years (QALY), and the incremental cost-effectiveness ratio (ICER) over 30 years, with cost and effectiveness discounted at 3%/year. FVL screening and counselling without prophylactic AC cost less and was more effective than no screening in this population, but was less effective than screening, counselling, and prophylaxis during high-risk periods, which gained 0.083 QALY, for an ICER of $147/QALY gained. Screening with counselling and long-term AC cost $3,536 with minimal QALY gain and an ICER >$600,000/QALY. Screening, OCP counseling, and prophylactic AC during high-risk periods was favoured and cost <$20,000/QALY, unless: (a) high-risk prophylaxis cost >$4,231 (base $932), (b) long-term prophylaxis cost <$1199 (base $6,546), or (c) VTE relative risk reduction with prophylaxis was <21% (base 90%). In conclusion, screening, counselling and prophylactic AC during high-risk periods in female relatives of FVL carriers is an economically favourable strategy.

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

    PubMed Central

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

    2012-01-01

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

  17. Relative controls of external and internal variability on time-variable transit time distributions, and the importance of StorAge Selection function approaches

    NASA Astrophysics Data System (ADS)

    Kim, M.; Pangle, L. A.; Cardoso, C.; Lora, M.; Meira, A.; Volkmann, T. H. M.; Wang, Y.; Harman, C. J.; Troch, P. A. A.

    2015-12-01

    Transit time distributions (TTDs) are an efficient way of characterizing complex transport dynamics of a hydrologic system. Time-invariant TTD has been studied extensively, but TTDs are time-varying under unsteady hydrologic systems due to both external variability (e.g., time-variability in fluxes), and internal variability (e.g., time-varying flow pathways). The use of "flow-weighted time" has been suggested to account for the effect of external variability on TTDs, but neglects the role of internal variability. Recently, to account both types of variability, StorAge Selection (SAS) function approaches were developed. One of these approaches enables the transport characteristics of a system - how the different aged water in the storage is sampled by the outflow - to be parameterized by time-variable probability distribution called the rank SAS (rSAS) function, and uses it directly to determine the time-variable TTDs resulting from a given timeseries of fluxes in and out of a system. Unlike TTDs, the form of the rSAS function varies only due to changes in flow pathways, but is not affected by the timing of fluxes alone. However, the relation between physical mechanisms and the time-varying rSAS functions are not well understood. In this study, relative effects of internal and external variability on the TTDs are examined using observations from a homogeneously packed 1 m3 sloping soil lysimeter. The observations suggest the importance of internal variability on TTDs, and reinforce the need to account for this variability using time-variable rSAS functions. Furthermore, the relative usefulness of two other formulations of SAS functions and the mortality rate (which plays a similar role to SAS functions in the McKendrick-von Foerster model of age-structured population dynamics) are also discussed. Finally, numerical modeling is used to explore the role of internal and external variability for hydrologic systems with diverse geomorphic and climate characteristics

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

    PubMed Central

    2012-01-01

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

  19. Examining the Relations Among the DSM-5 Alternative Model of Personality, the Five-Factor Model, and Externalizing and Internalizing Behavior.

    PubMed

    Sleep, Chelsea E; Hyatt, Courtland S; Lamkin, Joanna; Maples-Keller, Jessica L; Miller, Joshua D

    2017-01-26

    Given long-standing criticisms of the DSM's reliance on categorical models of psychopathology, including the poor reliability and validity of personality-disorder diagnoses, the American Psychiatric Association (APA) published an alternative model (AM) of personality disorders in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), which, in part, comprises 5 pathological trait domains based on the 5-factor model (FFM). However, the empirical profiles and discriminant validity of the AM traits remain in question. We recruited a sample of undergraduates (N = 340) for the current study to compare the relations found between a measure of the DSM-5 AM traits (i.e., the Personality Inventory for DSM-5; PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) and a measure of the FFM (i.e., the International Personality Item Pool; IPIP; Goldberg, 1999) in relation to externalizing and internalizing symptoms. In general, the domains from the 2 measures were significantly related and demonstrated similar patterns of relations with these criteria, such that Antagonism/low Agreeableness and Disinhibition/low Conscientiousness were related to externalizing behaviors, whereas Negative Affectivity/Neuroticism was most significantly related to internalizing symptoms. However, the PID-5 demonstrated large interrelations among its domains and poorer discriminant validity than the IPIP. These results provide additional support that the conception of the trait model included in the DSM-5 AM is an extension of the FFM, but highlight some of the issues that arise due to the PID-5's more limited discriminant validity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Externalities and the Coase Theorem: A Diagrammatic Presentation

    ERIC Educational Resources Information Center

    Halteman, James

    2005-01-01

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

  1. [Cost-effectiveness analysis of a genetic screening program in the close relatives of Spanish patients with familial hypercholesterolemia].

    PubMed

    Oliva, Juan; López-Bastida, Julio; Moreno, Santiago G; Mata, Pedro; Alonso, Rodrigo

    2009-01-01

    The aim was to assess the cost-effectiveness of a genetic screening program for first-degree relatives of patients with familial hypercholesterolemia (FH), followed by treatment when necessary, compared with the alternative of no screening. The cost-effectiveness analysis modeled the effect of statin treatment on individuals who were diagnosed with FH after genetic screening. The impact of uncertainty was evaluated using univariate probabilistic sensitivity analysis. The alternate strategy considered was no screening. In the cost-effectiveness analysis, the number of life-years gained (LYG) was regarded as the health outcome and the costs of screening, statin treatment, specialist consultations and hospital visits were all included. In addition, the expected value of perfect information was calculated as part of the sensitivity analysis. In the base case, the incremental cost of the screening program for close relatives was 3423 euros per LYG. Although the sensitivity analysis gave a range of results, the conclusions were not affected by changes in the parameters considered. The screening program was found to be better than the alternative considered at a probability level of 95% if the acceptable level of health-care costs was at least 7400 euros per LYG. This analysis indicates that a genetic screening program, supplemented by treatment, for the close relatives of individuals with FH is preferable to the alternative of no screening in terms of incremental cost-effectiveness.

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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