Ecosystem Succession and Nutrient Retention: A Hypothesis

ERIC Educational Resources Information Center

Vitousek, Peter M.; Reiners, William A.

1975-01-01

A hypothesis is presented for the regulation of elemental losses from terrestrial ecosystems. Losses of elements are controlled by the net increment of biomass growth and the elemental composition of this net increment. According to this hypothesis, loss rates are highest in early succession and in steady state ecosystems. (Author/EB)

Effects of monetary reserves and rate of gain on human risky choice under budget constraints.

PubMed

Pietras, Cynthia J; Searcy, Gabriel D; Huitema, Brad E; Brandt, Andrew E

2008-07-01

The energy-budget rule is an optimal foraging model that predicts that choice should be risk averse when net gains plus reserves meet energy requirements (positive energy-budget conditions) and risk prone when net gains plus reserves fall below requirements (negative energy-budget conditions). Studies have shown that the energy-budget rule provides a good description of risky choice in humans when choice is studied under economic conditions (i.e., earnings budgets) that simulate positive and negative energy budgets. In previous human studies, earnings budgets were manipulated by varying earnings requirements, but in most nonhuman studies, energy budgets have been manipulated by varying reserves and/or mean rates of reinforcement. The present study therefore investigated choice in humans between certain and variable monetary outcomes when earnings budgets were manipulated by varying monetary reserves and mean rates of monetary gain. Consistent with the energy-budget rule, choice tended to be risk averse under positive-budget conditions and risk neutral or risk prone under negative-budget conditions. Sequential choices were also well described by a dynamic optimization model, especially when expected earnings for optimal choices were high. These results replicate and extend the results of prior experiments in showing that humans' choices are generally consistent with the predictions of the energy-budget rule when studied under conditions analogous to those used in nonhuman energy-budget studies, and that choice patterns tend to maximize reinforcement.

An Analysis of the President’s Budgetary Proposals for Fiscal Year 1993

DTIC Science & Technology

1992-03-01

exchange value of determining the appropriate monetary policy . the dollar will provide a mild stimulus to net At the same time, the conduct of monetary...in function 3M0. and the proposed payout to Alaska of its share of receipts is shown in function 800. Proposed Changes Pay-As-You-Go Policy Changes The... firms through the over the next five years. Over the long term, formation of financial -services holding com- they should lead to a more diversified, more

Socioeconomic Factors and Personal Characteristics Affecting the Retention of Officers in the United States Army and United States Marine Corps.

DTIC Science & Technology

1987-06-01

compared to his net preference for civilian life (the difference between the annual monetary equivalent of the non -pecuniary aspects of a military job... equivalent of non -pecuniary aspects of service life (military less civilian aspects), and the monetary equivalent of "transient shocks" (unexpected events...predictions (cutoff P = .5) Grouo overall careerists non -careerists all Army 90.2% 97.5% 32.6% Army tactical operations 90.7 94.8 43.5 Army medical

Guideline adherence is worth the effort: a cost-effectiveness analysis in intrauterine insemination care.

PubMed

Haagen, E C; Nelen, W L D M; Adang, E M; Grol, R P T M; Hermens, R P M G; Kremer, J A M

2013-02-01

Is optimal adherence to guideline recommendations in intrauterine insemination (IUI) care cost-effective from a societal perspective when compared with suboptimal adherence to guideline recommendations? Optimal guideline adherence in IUI care has substantial economic benefits when compared with suboptimal guideline adherence. Fertility guidelines are tools to help health-care professionals, and patients make better decisions about clinically effective, safe and cost-effective care. Up to now, there has been limited published evidence about the association between guideline adherence and cost-effectiveness in fertility care. In a retrospective cohort study involving medical record analysis and a patient survey (n = 415), interviews with staff members (n = 13) and a review of hospitals' financial department reports and literature, data were obtained about patient characteristics, process aspects and clinical outcomes of IUI care and resources consumed. In the cost-effectiveness analyses, restricted to four relevant guideline recommendations, the ongoing pregnancy rate per couple (effectiveness), the average medical and non-medical costs of IUI care, possible additional IVF treatment, pregnancy, delivery and period from birth up to 6 weeks after birth for both mother and offspring per couple (costs) and the incremental net monetary benefits were calculated to investigate if optimal guideline adherence is cost-effective from a societal perspective when compared with suboptimal guideline adherence. Seven hundred and sixty five of 1100 randomly selected infertile couples from the databases of the fertility laboratories of 10 Dutch hospitals, including 1 large university hospital providing tertiary care and 9 public hospitals providing secondary care, were willing to participate, but 350 couples were excluded because of ovulatory disorders or the use of donated spermatozoa (n = 184), still ongoing IUI treatment (n = 143) or no access to their medical records (n = 23). As a result, 415 infertile couples who started a total of 1803 IUI cycles were eligible for the cost-effectiveness analyses. Optimal adherence to the guideline recommendations about sperm quality, the total number of IUI cycles and dose of human chorionic gonadotrophin was cost-effective with an incremental net monetary benefit between € 645 and over € 7500 per couple, depending on the recommendation and assuming a willingness to pay € 20 000 for an ongoing pregnancy. Because not all recommendations applied to all 415 included couples, smaller groups were left for some of the cost-effectiveness analyses, and one integrated analysis with all recommendations within one model was impossible. Optimal guideline adherence in IUI care has substantial economic benefits when compared with suboptimal guideline adherence. For Europe, where over 144,000 IUI cycles are initiated each year to treat ≈ 32 000 infertile couples, this could mean a possible cost saving of at least 20 million euro yearly. Therefore, it is valuable to make an effort to improve guideline development and implementation.

50 CFR 403.02 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... largest supportable within the ecosystem to the population level that results in maximum net productivity. Maximum net productivity is the greatest net annual increment in population numbers or biomass resulting...

12 CFR 614.4900 - Foreign exchange.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Cooperatives and Agricultural Credit Banks Financing International Trade § 614.4900 Foreign exchange. (a... international financial activities. The bank's policies should include established guidelines for: (1) Net... Department of the Treasury pertaining to currency exchange activities and international transfers of monetary...

Decision theory for computing variable and value ordering decisions for scheduling problems

NASA Technical Reports Server (NTRS)

Linden, Theodore A.

1993-01-01

Heuristics that guide search are critical when solving large planning and scheduling problems, but most variable and value ordering heuristics are sensitive to only one feature of the search state. One wants to combine evidence from all features of the search state into a subjective probability that a value choice is best, but there has been no solid semantics for merging evidence when it is conceived in these terms. Instead, variable and value ordering decisions should be viewed as problems in decision theory. This led to two key insights: (1) The fundamental concept that allows heuristic evidence to be merged is the net incremental utility that will be achieved by assigning a value to a variable. Probability distributions about net incremental utility can merge evidence from the utility function, binary constraints, resource constraints, and other problem features. The subjective probability that a value is the best choice is then derived from probability distributions about net incremental utility. (2) The methods used for rumor control in Bayesian Networks are the primary way to prevent cycling in the computation of probable net incremental utility. These insights lead to semantically justifiable ways to compute heuristic variable and value ordering decisions that merge evidence from all available features of the search state.

Sex-Steroid Hormone Manipulation Reduces Brain Response to Reward.

PubMed

Macoveanu, Julian; Henningsson, Susanne; Pinborg, Anja; Jensen, Peter; Knudsen, Gitte M; Frokjaer, Vibe G; Siebner, Hartwig R

2016-03-01

Mood disorders are twice as frequent in women than in men. Risk mechanisms for major depression include adverse responses to acute changes in sex-steroid hormone levels, eg, postpartum in women. Such adverse responses may involve an altered processing of rewards. Here, we examine how women's vulnerability for mood disorders is linked to sex-steroid dynamics by investigating the effects of a pharmacologically induced fluctuation in ovarian sex steroids on the brain response to monetary rewards. In a double-blinded placebo controlled study, healthy women were randomized to receive either placebo or the gonadotropin-releasing hormone agonist (GnRHa) goserelin, which causes a net decrease in sex-steroid levels. Fifty-eight women performed a gambling task while undergoing functional MRI at baseline, during the mid-follicular phase, and again following the intervention. The gambling task enabled us to map regional brain activity related to the magnitude of risk during choice and to monetary reward. The GnRHa intervention caused a net reduction in ovarian sex steroids (estradiol and testosterone) and increased depression symptoms. Compared with placebo, GnRHa reduced amygdala's reactivity to high monetary rewards. There was a positive association between the individual changes in testosterone and changes in bilateral insula response to monetary rewards. Our data provide evidence for the involvement of sex-steroid hormones in reward processing. A blunted amygdala response to rewarding stimuli following a rapid decline in sex-steroid hormones may reflect a reduced engagement in positive experiences. Abnormal reward processing may constitute a neurobiological mechanism by which sex-steroid fluctuations provoke mood disorders in susceptible women.

Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis.

PubMed

Thavorn, Kednapa; Kugathasan, Howsikan; Tan, Darrell H S; Moqueet, Nasheed; Baral, Stefan D; Skidmore, Becky; MacFadden, Derek; Simkin, Anna; Mishra, Sharmistha

2018-03-15

Pre-exposure prophylaxis (PrEP) with antiretrovirals is an efficacious and effective intervention to decrease the risk of HIV (human immunodeficiency virus) acquisition. Yet drug and delivery costs prohibit access in many jurisdictions. In the absence of guidelines for the synthesis of economic evaluations, we developed a protocol for a systematic review of economic evaluation studies for PrEP by drawing on best practices in systematic reviews and the conduct and reporting of economic evaluations. We aim to estimate the incremental cost per health outcome of PrEP compared with placebo, no PrEP, or other HIV prevention strategies; assess the methodological variability in, and quality of, economic evaluations of PrEP; estimate the incremental cost per health outcome of different PrEP implementation strategies; and quantify the potential sources of heterogeneity in outcomes. We will systematically search electronic databases (MEDLINE, Embase) and the gray literature. We will include economic evaluation studies that assess both costs and health outcomes of PrEP in HIV-uninfected individuals, without restricting language or year of publication. Two reviewers will independently screen studies using predefined inclusion criteria, extract data, and assess methodological quality using the Philips checklist, Second Panel on the Cost-effectiveness of Health and Medicines, and the International Society for Pharmacoeconomics and Outcomes Research recommendations. Outcomes of interest include incremental costs and outcomes in natural units or utilities, cost-effectiveness ratios, and net monetary benefit. We will perform descriptive and quantitative syntheses using sensitivity analyses of outcomes by population subgroups, HIV epidemic settings, study designs, baseline intervention contexts, key parameter inputs and assumptions, type of outcomes, economic perspectives, and willingness to pay values. Findings will guide future economic evaluation of PrEP strategies in terms of methodological and knowledge gaps, and will inform decisions on the efficient integration of PrEP into public health programs across epidemiologic and health system contexts. PROSPERO CRD42016038440 .

Effects of monetary reward and punishment on information checking behaviour: An eye-tracking study.

PubMed

Li, Simon Y W; Cox, Anna L; Or, Calvin; Blandford, Ann

2018-07-01

The aim of the present study was to investigate the effect of error consequence, as reward or punishment, on individuals' checking behaviour following data entry. This study comprised two eye-tracking experiments that replicate and extend the investigation of Li et al. (2016) into the effect of monetary reward and punishment on data-entry performance. The first experiment adopted the same experimental setup as Li et al. (2016) but additionally used an eye tracker. The experiment validated Li et al. (2016) finding that, when compared to no error consequence, both reward and punishment led to improved data-entry performance in terms of reducing errors, and that no performance difference was found between reward and punishment. The second experiment extended the earlier study by associating error consequence to each individual trial by providing immediate performance feedback to participants. It was found that gradual increment (i.e. reward feedback) also led to significantly more accurate performance than no error consequence. It is unclear whether gradual increment is more effective than gradual decrement because of the small sample size tested. However, this study reasserts the effectiveness of reward on data-entry performance. Copyright © 2018 Elsevier Ltd. All rights reserved.

DALYs, dollars and dogs: how best to analyse the economics of controlling zoonoses.

PubMed

Shaw, A P M; Rushton, J; Roth, F; Torgerson, P R

2017-04-01

Decision-makers increasingly require comprehensive economic metrics summarising and comparing the benefits and costs of controlling zoonotic diseases. The impact of disease in people is conventionally quantified in non-monetary terms, usually a disability-adjusted life year (DALY), whereas the losses due to disease in animals, particularly livestock, are quantified in monetary terms. The potential for the development of a non-monetary metric for ill health in animals, based on life years lost and disability, is discussed and rejected. Within and across animal species and livestock production systems, maximising life spans is not a consistent goal and morbidity/disabilities have very different weights and often lead to culling. By relating livestock losses to a measure of national income forgone, the recently developed alternative of converting monetary losses due to livestock illness into an animal loss equivalent (ALE) provides a viable solution. Based on this, the literature on the economics of controlling zoonoses is revisited and four options for quantifying and comparing benefits and costs are examined and illustrated using numerical examples. These are i) the simplistic grouping of all monetary elements and their comparison to DALYs averted (described as the aggregate net cost method), ii) the separable costs method, iii) the use of ALEs to convert all benefits to a non-monetary equivalent, termed the zoonotic DALY (zDALY), or iv) the use of a full monetary cost-benefit analysis, based on converting DALYs to a monetary equivalent. The strengths and weaknesses of each are discussed. For effective prioritisation and decision-making, it is vital that an analytical approach is widely adopted which yields consistent results and which supports the control of zoonoses.

Monetary policy and the effects of oil price shocks on the Japanese economy

NASA Astrophysics Data System (ADS)

Lee, Byung Rhae

1998-12-01

The evidence of output decreases and price level increases following oil price shocks in the Japanese economy is presented in this paper. These negative effects of oil shocks are better explained by Hamilton's (1996) net oil price increase measure (NOPI) than by other oil measures. The fact that an oil shock has a statistically significant effect on the call money rate and real output and that the call money rate also has a statistically significant effect on real output appears to explain that the effects of oil price shocks on economic activity are partially attributed to contractionary monetary policy responses. The asymmetric effects of positive and negative oil shocks are also found in the Japanese economy and this asymmetry can also be partially explained by monetary policy responses. To assess the relative contribution of oil shocks and endogenous monetary policy responses to the economic downturns, I shut off the responses of the call money rate to oil shocks utilizing the impulse response results from the VAR model. Then, I re-run the VAR with the adjusted call money rate series. The empirical results show that around 30--40% of the negative effects of oil price shocks on the Japanese economy can be accounted for by oil shock induced monetary tightening.

Efficiency of two nitrification inhibitors (dicyandiamide and 3, 4-dimethypyrazole phosphate) on soil nitrogen transformations and plant productivity: a meta-analysis

PubMed Central

Yang, Ming; Fang, Yunting; Sun, Di; Shi, Yuanliang

2016-01-01

Dicyandiamide (DCD) and 3, 4-dimethypyrazole phosphate (DMPP) are often claimed to be efficient in regulating soil N transformations and influencing plant productivity, but the difference of their performances across field sites is less clear. Here we applied a meta-analysis approach to compare effectiveness of DCD and DMPP across field trials. Our results showed that DCD and DMPP were equally effective in altering soil inorganic N content, dissolve inorganic N (DIN) leaching and nitrous oxide (N2O) emissions. DCD was more effective than DMPP on increasing plant productivity. An increase of crop yield by DMPP was generally only observed in alkaline soil. The cost and benefit analysis (CBA) showed that applying fertilizer N with DCD produced additional revenues of $109.49 ha−1 yr−1 for maize farms, equivalent to 6.02% increase in grain revenues. In comparisons, DMPP application produced less monetary benefit of $15.67 ha−1 yr−1. Our findings showed that DCD had an advantage of bringing more net monetary benefit over DMPP. But this may be weakened by the higher toxicity of DCD than DMPP especially after continuous DCD application. Alternatively, an option related to net monetary benefit may be achieved through applying DMPP in alkaline soil and reducing the cost of purchasing DMPP products. PMID:26902689

Efficiency of two nitrification inhibitors (dicyandiamide and 3, 4-dimethypyrazole phosphate) on soil nitrogen transformations and plant productivity: a meta-analysis.

PubMed

Yang, Ming; Fang, Yunting; Sun, Di; Shi, Yuanliang

2016-02-23

Dicyandiamide (DCD) and 3, 4-dimethypyrazole phosphate (DMPP) are often claimed to be efficient in regulating soil N transformations and influencing plant productivity, but the difference of their performances across field sites is less clear. Here we applied a meta-analysis approach to compare effectiveness of DCD and DMPP across field trials. Our results showed that DCD and DMPP were equally effective in altering soil inorganic N content, dissolve inorganic N (DIN) leaching and nitrous oxide (N2O) emissions. DCD was more effective than DMPP on increasing plant productivity. An increase of crop yield by DMPP was generally only observed in alkaline soil. The cost and benefit analysis (CBA) showed that applying fertilizer N with DCD produced additional revenues of $109.49 ha(-1) yr(-1) for maize farms, equivalent to 6.02% increase in grain revenues. In comparisons, DMPP application produced less monetary benefit of $15.67 ha(-1) yr(-1). Our findings showed that DCD had an advantage of bringing more net monetary benefit over DMPP. But this may be weakened by the higher toxicity of DCD than DMPP especially after continuous DCD application. Alternatively, an option related to net monetary benefit may be achieved through applying DMPP in alkaline soil and reducing the cost of purchasing DMPP products.

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

PubMed

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

2017-10-01

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

Investment appraisal using quantitative risk analysis.

PubMed

Johansson, Henrik

2002-07-01

Investment appraisal concerned with investments in fire safety systems is discussed. Particular attention is directed at evaluating, in terms of the Bayesian decision theory, the risk reduction that investment in a fire safety system involves. It is shown how the monetary value of the change from a building design without any specific fire protection system to one including such a system can be estimated by use of quantitative risk analysis, the results of which are expressed in terms of a Risk-adjusted net present value. This represents the intrinsic monetary value of investing in the fire safety system. The method suggested is exemplified by a case study performed in an Avesta Sheffield factory.

The impact of using informative priors in a Bayesian cost-effectiveness analysis: an application of endovascular versus open surgical repair for abdominal aortic aneurysms in high-risk patients.

PubMed

McCarron, C Elizabeth; Pullenayegum, Eleanor M; Thabane, Lehana; Goeree, Ron; Tarride, Jean-Eric

2013-04-01

Bayesian methods have been proposed as a way of synthesizing all available evidence to inform decision making. However, few practical applications of the use of Bayesian methods for combining patient-level data (i.e., trial) with additional evidence (e.g., literature) exist in the cost-effectiveness literature. The objective of this study was to compare a Bayesian cost-effectiveness analysis using informative priors to a standard non-Bayesian nonparametric method to assess the impact of incorporating additional information into a cost-effectiveness analysis. Patient-level data from a previously published nonrandomized study were analyzed using traditional nonparametric bootstrap techniques and bivariate normal Bayesian models with vague and informative priors. Two different types of informative priors were considered to reflect different valuations of the additional evidence relative to the patient-level data (i.e., "face value" and "skeptical"). The impact of using different distributions and valuations was assessed in a sensitivity analysis. Models were compared in terms of incremental net monetary benefit (INMB) and cost-effectiveness acceptability frontiers (CEAFs). The bootstrapping and Bayesian analyses using vague priors provided similar results. The most pronounced impact of incorporating the informative priors was the increase in estimated life years in the control arm relative to what was observed in the patient-level data alone. Consequently, the incremental difference in life years originally observed in the patient-level data was reduced, and the INMB and CEAF changed accordingly. The results of this study demonstrate the potential impact and importance of incorporating additional information into an analysis of patient-level data, suggesting this could alter decisions as to whether a treatment should be adopted and whether more information should be acquired.

A cost-effectiveness analysis of school-based suicide prevention programmes.

PubMed

Ahern, Susan; Burke, Lee-Ann; McElroy, Brendan; Corcoran, Paul; McMahon, Elaine M; Keeley, Helen; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina W; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Banzer, Raphaela; Bobes, Julio; Brunner, Romuald; Cosman, Doina; Haring, Christian; Kaess, Michael; Kahn, Jean-Pierre; Kereszteny, Agnes; Postuvan, Vita; Sáiz, Pilar A; Varnik, Peeter; Wasserman, Danuta

2018-02-14

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer's perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation.Trial registration number DRKS00000214.

Cost-utility analysis of stenting versus endarterectomy in the International Carotid Stenting Study.

PubMed

Morris, Stephen; Patel, Nishma V; Dobson, Joanna; Featherstone, Roland L; Richards, Toby; Luengo-Fernandez, Ramon; Rothwell, Peter M; Brown, Martin M

2016-06-01

The International Carotid Stenting Study was a multicenter randomized trial in which patients with symptomatic carotid artery stenosis were randomly allocated to treatment by carotid stenting or endarterectomy. Economic evidence comparing these treatments is limited and inconsistent. We compared the cost-effectiveness of stenting versus endarterectomy using International Carotid Stenting Study data. We performed a cost-utility analysis estimating mean costs and quality-adjusted life years per patient for both treatments over a five-year time horizon based on resource use data and utility values collected in the trial. Costs of managing stroke events were estimated using individual patient data from a UK population-based study (Oxford Vascular Study). Mean costs per patient (95% CI) were US$10,477 ($9669 to $11,285) in the stenting group (N = 853) and $9669 ($8835 to $10,504) in the endarterectomy group (N = 857). There were no differences in mean quality-adjusted life years per patient (3.247 (3.160 to 3.333) and 3.228 (3.150 to 3.306), respectively). There were no differences in adjusted costs between groups (mean incremental costs for stenting versus endarterectomy $736 (95% CI -$353 to $1826)) or adjusted outcomes (mean quality-adjusted life years gained -0.010 (95% CI -0.117 to 0.097)). The incremental net monetary benefit for stenting versus endarterectomy was not significantly different from zero at the maximum willingness to pay for a quality-adjusted life year commonly used in the UK. Sensitivity analyses showed little uncertainty in these findings. Economic considerations should not affect whether patients with symptomatic carotid stenosis undergo stenting or endarterectomy. © 2016 World Stroke Organization.

Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia

PubMed Central

Ford, Emily; Adams, Jon; Graves, Nicholas

2012-01-01

Objective An economic model was developed to evaluate the cost-effectiveness of hawthorn extract as an adjunctive treatment for heart failure in Australia. Methods A Markov model of chronic heart failure was developed to compare the costs and outcomes of standard treatment and standard treatment with hawthorn extract. Health states were defined by the New York Heart Association (NYHA) classification system and death. For any given cycle, patients could remain in the same NYHA class, experience an improvement or deterioration in NYHA class, be hospitalised or die. Model inputs were derived from the published medical literature, and the output was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis was conducted. The expected value of perfect information (EVPI) and the expected value of partial perfect information (EVPPI) were conducted to establish the value of further research and the ideal target for such research. Results Hawthorn extract increased costs by $1866.78 and resulted in a gain of 0.02 QALYs. The incremental cost-effectiveness ratio was $85 160.33 per QALY. The cost-effectiveness acceptability curve indicated that at a threshold of $40 000 the new treatment had a 0.29 probability of being cost-effective. The average incremental net monetary benefit (NMB) was −$1791.64, the average NMB for the standard treatment was $92 067.49, and for hawthorn extract $90 275.84. Additional research is potentially cost-effective if research is not proposed to cost more than $325 million. Utilities form the most important target parameter group for further research. Conclusions Hawthorn extract is not currently considered to be cost-effective in as an adjunctive treatment for heart failure in Australia. Further research in the area of utilities is warranted. PMID:22942231

Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia.

PubMed

Ford, Emily; Adams, Jon; Graves, Nicholas

2012-01-01

An economic model was developed to evaluate the cost-effectiveness of hawthorn extract as an adjunctive treatment for heart failure in Australia. A Markov model of chronic heart failure was developed to compare the costs and outcomes of standard treatment and standard treatment with hawthorn extract. Health states were defined by the New York Heart Association (NYHA) classification system and death. For any given cycle, patients could remain in the same NYHA class, experience an improvement or deterioration in NYHA class, be hospitalised or die. Model inputs were derived from the published medical literature, and the output was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis was conducted. The expected value of perfect information (EVPI) and the expected value of partial perfect information (EVPPI) were conducted to establish the value of further research and the ideal target for such research. Hawthorn extract increased costs by $1866.78 and resulted in a gain of 0.02 QALYs. The incremental cost-effectiveness ratio was $85 160.33 per QALY. The cost-effectiveness acceptability curve indicated that at a threshold of $40 000 the new treatment had a 0.29 probability of being cost-effective. The average incremental net monetary benefit (NMB) was -$1791.64, the average NMB for the standard treatment was $92 067.49, and for hawthorn extract $90 275.84. Additional research is potentially cost-effective if research is not proposed to cost more than $325 million. Utilities form the most important target parameter group for further research. Hawthorn extract is not currently considered to be cost-effective in as an adjunctive treatment for heart failure in Australia. Further research in the area of utilities is warranted.

Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis.

PubMed

Dawoud, Dalia; Fenu, Elisabetta; Higgins, Bernard; Wonderling, David; Amiel, Stephanie A

2017-12-01

To assess the cost-effectiveness of basal insulin regimens for adults with type 1 diabetes mellitus in England. A cost-utility analysis was conducted in accordance with the National Institute for Health and Care Excellence reference case. The UK National Health Service and personal and social services perspective was used and a 3.5% discount rate was applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis. The IMS CORE Diabetes Model was used, in which net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. A wide range of sensitivity analyses were conducted. Insulin detemir (twice daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared with the lowest cost strategy (insulin neutral protamine Hagedorn once daily), it had an incremental cost-effectiveness ratio of £7844/QALY gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMBs of £180,893 and £180,423, respectively. iDet (bid) remained the most cost-effective treatment in all the sensitivity analyses performed except when high doses were assumed (>30% increment compared with other regimens), where iGlarg (od) ranked first. iDet (bid) is the most cost-effective regimen, providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the iDet (bid) regimen is not acceptable or does not achieve required glycemic control. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

True metabolisable energy, heat increment and net energy values of two high fibre foodstuffs in cockerels.

PubMed

Sarmiento-Franco, L; MacLeod, M G; McNab, J M

2000-12-01

1. The yields of true metabolisable energy (TME) and net energy (NE) from chaya leaf meal and wheatfeed were mcasured in tube-fed cockerels. 2. TME, 5.76 MJ/kg, from chava leaf meal was lower than from wheatfeed, 8.39 MJ/kg. The total heat increment attributable to the feeding of chaya leaf meal was 1-7 times greater than that of wheatfeed. 3. The net efficiency of utilisation of ME (k) from chaya leaf meal was 0.64, while that from wheatfeed was 0.86. The role of different chemical composition, especially the high fibre content of the materials, is discussed. 4. The metabolisable energy and net energy values derived from chava leaf meal represented 0.34 and 0.23 respectively of its gross energy content. The combination of lower TME and lower net efficiency of utilisation led to chaya having a NE value, 3.86 MJ/kg, which was only 0.53 that of wheatfeed.

Incremental Net Effects in Multiple Regression

ERIC Educational Resources Information Center

Lipovetsky, Stan; Conklin, Michael

2005-01-01

A regular problem in regression analysis is estimating the comparative importance of the predictors in the model. This work considers the 'net effects', or shares of the predictors in the coefficient of the multiple determination, which is a widely used characteristic of the quality of a regression model. Estimation of the net effects can be a…

Growth response of 35-year-old, site V Douglas-fir to nitrogen fertilizer

Treesearch

Donald L. Reukema

1968-01-01

During the first 4 years following application, addition of 200 to 600 pounds of nitrogen per acre increased height increment 62 percent and d.b.h. increment 79 to 160 percent. Gross basal area increment was greater with heavier fertilizer applications, but severe snowbreakage wa also increased. Thus, net production tended to be greatest with the addition of 200...

Cost-effectiveness analysis of fecal microbiota transplantation for inflammatory bowel disease.

PubMed

Zhang, Ting; Xiang, Jie; Cui, Bota; He, Zhi; Li, Pan; Chen, Hai; Xu, Lijuan; Ji, Guozhong; Nie, Yongzhan; Wu, Kaichun; Fan, Daiming; Huang, Guangming; Bai, Jianling; Zhang, Faming

2017-10-24

There is a lack of health economics evidence on the use of fecal microbiota transplantation (FMT) for inflammatory bowel disease (IBD). This study aims to evaluate the cost-effectiveness before (with conventional therapy) and after introducing FMT for treating IBD. 104 patients with IBD received FMT were recruited. Health status was evaluated by European dimension health table (ED-5Q). Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NB) were calculated by different age groups, genders, smoking status, and disease subtypes. The willingness-to-pay threshold was set to the value equal to three times China's per capita GDP (141240 CNY/QALY, 2014). From the health-care perspective, FMT strategy was 73% likely to be cost-effective compared with the conventional therapy before FMT with an ICER of -185712 CNY/QALY and a positive NB of CNY 45150. From the societal perspective, FMT strategy was 75% likely to be cost-effective with an ICER of -207417 CNY/QALY and a positive NB of CNY 48395. Moreover, younger patients (≤ 24), females, non-smokers and Crohn's disease (CD) achieved more benefits. This study for the first time demonstrated that FMT showed its cost-effectiveness, especially on improving the life quality and decreasing the medical and societal cost, for the moderate to severe IBD in a Chinese cohort.

[Economic effects of integrated RIS-PACS solution in the university environment].

PubMed

Kröger, M; Nissen-Meyer, S; Wetekam, V; Reiser, M

1999-04-01

The goal of the current article is to demonstrate how qualitative and monetary effects resulting from an integrated RIS/PACS installation can be evaluated. First of all, the system concept of a RIS/PACS solution for a university hospital is defined and described. Based on this example, a generic method for the evaluation of qualitative and monetary effects as well as associated risks is depicted and demonstrated. To this end, qualitative analyses, investment calculations and risk analysis are employed. The sample analysis of a RIS/PACS solution specially designed for a university hospital demonstrates positive qualitative and monetary effects of the system. Under ideal conditions the payoff time of the investments is reached after 4 years of an assumed 8 years effective life of the system. Furthermore, under conservative assumptions, the risk analysis shows a probability of 0% for realising a negative net present value at the end of the payoff time period. It should be pointed out that the positive result of this sample analysis will not necessarily apply to other clinics or hospitals. However, the same methods may be used for the individual evaluation of the qualitative and monetary effects of a RIS/PACS installation in any clinic.

Enlistment Decisions of Young Men.

DTIC Science & Technology

1985-07-01

14Employment status is not the usual one of employed, unemployed , or out of the labor force but instead indicates currently employed, not currently employed...worker with high firm- specific human capital, so he is less likely to be unemployed during a downturn at the firm. Job matching theory (Mincer and...returns) as well as the value one attaches to greater under- standing or appreciation of the world ( psychic returns). The monetary increment will tend to

Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study.

PubMed

Bernabé, Eduardo; Vehkalahti, Miira M; Sheiham, Aubrey; Aromaa, Arpo; Suominen, Anna L

2014-08-01

To explore the association between frequency of consumption of sugar-sweetened beverages (SSB) and caries increment over 4 years in adults. A second objective was to explore whether the association between frequency of SSB consumption and caries increment varied by socio-demographic characteristics and use of fluoride toothpaste. Data from 939 dentate adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours, including two questions on frequency of SSB consumption. The 4-year net DMFT increment was calculated using data from baseline and follow-up clinical oral examinations. The association was tested in negative binomial regression models and the moderating role of sex, age, education and use of fluoride toothpaste was examined by adding their two-way interaction with SSB consumption to the main effects model. A positive association was found between frequency of SBS consumption and 4-year net DMFT increment, regardless of participants' socio-demographic and behavioural characteristics. Adults drinking 1-2 and 3+ SSB daily had, respectively, 31% (Incidence Rate Ratio: 1.31; 95%CI: 1.02-1.67) and 33% (IRR: 1.33; 95%CI; 1.03-1.72) greater net DMFT increments than those not drinking any SSB. None of the four two-way interaction terms was significant (all p>0.05). There seems to be a dose-response relationship between frequency of SSB consumption and caries increment in adults. That association was consistent across socio-demographic characteristics, and more importantly, use of fluoride toothpaste. Drinking sugar-sweetened beverages on a daily basis is related to greater caries risk in adults. Copyright © 2014 Elsevier Ltd. All rights reserved.

A cost-benefit analysis of peer coaching for overhead lift use in the long-term care sector in Canada.

PubMed

Tompa, Emile; Dolinschi, Roman; Alamgir, Hasanat; Sarnocinska-Hart, Anna; Guzman, Jaime

2016-05-01

To evaluate whether a peer-coaching programme for patient lift use in British Columbia, Canada, was effective and cost-beneficial. We used monthly panel data from 15 long-term care facilities from 2004 to 2011 to estimate the number of patient-handling injuries averted by the peer-coaching programme using a generalised estimating equation model. Facilities that had not yet introduced the programme served as concurrent controls. Accepted lost-time claim counts related to patient handling were the outcome of interest with a denominator of full-time equivalents of nursing staff. A cost-benefit approach was used to estimate the net monetary gains at the system level. The coaching programme was found to be associated with a reduction in the injury rate of 34% during the programme and 56% after the programme concluded with an estimated 62 lost-time injury claims averted. 2 other factors were associated with changes in injury rates: larger facilities had a lower injury rate, and the more care hours per bed the lower the injury rate. We calculated monetary benefits to the system of $748 431 and costs of $894 000 (both in 2006 Canadian dollars) with a benefit-to-cost ratio of 0.84. The benefit-to-cost ratio was -0.05 in the worst case scenario and 2.31 in the best case scenario. The largest cost item was peer coaches' time. A simulation of the programme continuing for 5 years with the same coaching intensity would result in a benefit-to-cost ratio of 0.63. A peer-coaching programme to increase effective use of overhead lifts prevented additional patient-handling injuries but added modest incremental cost to the system. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Competition in Weapon Systems Acquisition: Cost Analyses of Some Issues

DTIC Science & Technology

1990-09-01

10% increments , also known as the step-ladder bids) submitted by the contractor in the first year of dual source procurement. The triangles represent...savings by subtracting annual incremental government costs, stated in constant dollars, from (3). (5) Estimate nonrecurring start-up costs, stated in...constant dollars, by fiscal year. (6) Estimate incremental logistic support costs, stated in constant dollars. by fiscal year. (7) Calculate a net

Cost-Utility Analysis of Pharmaceutical Care Intervention Versus Usual Care in Management of Nigerian Patients with Type 2 Diabetes.

PubMed

Adibe, Maxwell O; Aguwa, Cletus N; Ukwe, Chinwe V

To assess the cost-effectiveness of pharmaceutical care (PC) intervention versus usual care (UC) in the management of type 2 diabetes. This study was a randomized, controlled study with a 12-month patient follow-up in two Nigerian tertiary hospitals. One hundred and ten patients were randomly assigned to each of the "intervention" (PC) and the "control" (UC) groups. Patients in the UC group received the usual/conventional care offered by the hospitals. Patients in the PC group received UC and PC in the form of structural self-care education and training for 12 months. The economic evaluation was based on patients' perspective. Costs of management of individual complications were calculated from activities involved in their management by using activity-based costing. The impact of the interventions on quality of life was estimated by using the HUI23S4EN.40Q (Mark index 3) questionnaire. The primary outcomes were incremental cost-utility ratio and net monetary benefit. An intention-to-treat approach was used. Two-sample comparisons were made by using Student's t tests for normally distributed variables data at baseline, 6 months, and 12 months. Comparisons of proportions were done by using the chi-square test. The PC intervention led to incremental cost and effect of Nigerian naira (NGN) 10,623 ($69) and 0.12 quality-adjusted life-year (QALY) gained, respectively, with an associated incremental cost-utility ratio of NGN 88,525 ($571) per QALY gained. In the cost-effectiveness acceptability curve, the probability that PC was more cost-effective than UC was 95% at the NGN 250,000 ($1613) per QALY gained threshold and 52% at the NGN 88,600 ($572) per QALY gained threshold. The PC intervention was very cost-effective among patients with type 2 diabetes at the NGN 88,525 ($571.13) per QALY gained threshold, although considerable uncertainty surrounds these estimates. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Nitrous oxide abatement potential from the wastewater sector and the monetary value of the emissions credits

NASA Astrophysics Data System (ADS)

Wang, J. S.; Hamburg, S. P.; Pryor, D.

2009-12-01

As an illustration of the monetary opportunities afforded by greenhouse gas emissions markets, we estimated the potential value of greenhouse gas credits generated in the wastewater sector by switching from secondary to tertiary treatment. Our methodology for estimating emissions is a modification of that used by the Environmental Protection Agency for the U.S. greenhouse gas inventories. Focusing on N2O, we found that tertiary treatment in some situations will result in a net decrease in emissions, though the full range of reported emission factors for treatment plants and effluent in receiving waters could result in a net increase as well. Implementation of tertiary treatment across the U.S. could reduce emissions by up to 800,000 tonnes of N2O per year, generating greenhouse gas emissions credits worth up to 10 billion per year (assuming a market price of 10-40/tonne CO2 equivalents). In practice, it will be important to account for potential increases in CO2 emissions associated with the additional power consumption and chemical use required by tertiary treatment that would reduce the net climatic benefit. The net credits would reduce the cost of operating and maintaining tertiary treatment plants and provide an incentive for managers to optimize operating conditions for N2O reductions, a critical benefit of raising awareness of the link between tertiary treatment and N2O emissions. We outline a strategy for minimizing the uncertainty in quantifying N2O reductions in the hopes of accelerating implementation of a N2O crediting system for tertiary wastewater treatment plants.

Cost-effectiveness of health research study participant recruitment strategies: a systematic review.

PubMed

Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A

2014-10-01

A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of cost and effectiveness of recruitment strategies from randomized comparisons is required to aid investigators to select cost-efficient strategies for recruiting participants to health research studies including clinical trials. © The Author(s) 2014.

50 CFR 403.02 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Maximum net productivity is the greatest net annual increment in population numbers or biomass resulting... term species includes any population stock. (b) Optimum Sustainable Population or OSP means a population size which falls within a range from the population level of a given species or stock which is the...

50 CFR 403.02 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... Maximum net productivity is the greatest net annual increment in population numbers or biomass resulting... term species includes any population stock. (b) Optimum Sustainable Population or OSP means a population size which falls within a range from the population level of a given species or stock which is the...

50 CFR 403.02 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Maximum net productivity is the greatest net annual increment in population numbers or biomass resulting... term species includes any population stock. (b) Optimum Sustainable Population or OSP means a population size which falls within a range from the population level of a given species or stock which is the...

50 CFR 403.02 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Maximum net productivity is the greatest net annual increment in population numbers or biomass resulting... term species includes any population stock. (b) Optimum Sustainable Population or OSP means a population size which falls within a range from the population level of a given species or stock which is the...

The impact of two pharmaceutical risk-sharing agreements on pricing, promotion, and net health benefits.

PubMed

Zaric, Gregory S; Xie, Bin

2009-01-01

Health insurers are increasingly making use of risk-sharing agreements with drug manufacturers to manage uncertainties regarding the costs and effectiveness of new drugs. Several risk-sharing models exist including those based on sales volume, achievement of clinical thresholds, and achievement of cost-effectiveness thresholds. The objective of this article is to compare two risk-sharing arrangements and to investigate conditions under which each is preferable from the perspective of the payer and the manufacturer. We develop two two-period models to compare two risk-sharing arrangements between a payer and a drug manufacturer in which there is uncertainty about the effectiveness of the new drug. In the first risk-sharing agreement, the drug is listed on a formulary in the first period but delisted in the second period if the net monetary benefit in the first period is negative. In the second risk-sharing agreement, the manufacturer pays a rebate in each period if the net monetary benefit in that period is negative. We show that the relative performance of the two arrangements depends on several factors and that neither arrangement is always preferred. Additionally, we are able to identify situations in which a payer and a manufacturer would prefer the same plan and other situations in which the two parties would disagree on which plan was most desirable. Because neither risk-sharing arrangement is always preferred, payers and manufacturers must carefully consider the characteristics of their individual situation when entering into such contracts.

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

PubMed

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

2013-12-01

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

Cost-Effectiveness of a Short Message Service Intervention to Prevent Type 2 Diabetes from Impaired Glucose Tolerance.

PubMed

Wong, Carlos K H; Jiao, Fang-Fang; Siu, Shing-Chung; Fung, Colman S C; Fong, Daniel Y T; Wong, Ka-Wai; Yu, Esther Y T; Lo, Yvonne Y C; Lam, Cindy L K

2016-01-01

Aims. To investigate the costs and cost-effectiveness of a short message service (SMS) intervention to prevent the onset of type 2 diabetes mellitus (T2DM) in subjects with impaired glucose tolerance (IGT). Methods. A Markov model was developed to simulate the cost and effectiveness outcomes of the SMS intervention and usual clinical practice from the health provider's perspective. The direct programme costs and the two-year SMS intervention costs were evaluated in subjects with IGT. All costs were expressed in 2011 US dollars. The incremental cost-effectiveness ratio was calculated as cost per T2DM onset prevented, cost per life year gained, and cost per quality adjusted life year (QALY) gained. Results. Within the two-year trial period, the net intervention cost of the SMS group was $42.03 per subject. The SMS intervention managed to reduce 5.05% onset of diabetes, resulting in saving $118.39 per subject over two years. In the lifetime model, the SMS intervention dominated the control by gaining an additional 0.071 QALY and saving $1020.35 per person. The SMS intervention remained dominant in all sensitivity analyses. Conclusions. The SMS intervention for IGT subjects had the superiority of lower monetary cost and a considerable improvement in preventing or delaying the T2DM onset. This trial is registered with ClinicalTrials.gov NCT01556880.

Cost-effectiveness analysis of fecal microbiota transplantation for inflammatory bowel disease

PubMed Central

Zhang, Ting; Xiang, Jie; Cui, Bota; He, Zhi; Li, Pan; Chen, Hai; Xu, Lijuan; Ji, Guozhong; Nie, Yongzhan; Wu, Kaichun; Fan, Daiming; Huang, Guangming; Bai, Jianling; Zhang, Faming

2017-01-01

There is a lack of health economics evidence on the use of fecal microbiota transplantation (FMT) for inflammatory bowel disease (IBD). This study aims to evaluate the cost-effectiveness before (with conventional therapy) and after introducing FMT for treating IBD. 104 patients with IBD received FMT were recruited. Health status was evaluated by European dimension health table (ED-5Q). Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NB) were calculated by different age groups, genders, smoking status, and disease subtypes. The willingness-to-pay threshold was set to the value equal to three times China’s per capita GDP (141240 CNY/QALY, 2014). From the health-care perspective, FMT strategy was 73% likely to be cost-effective compared with the conventional therapy before FMT with an ICER of -185712 CNY/QALY and a positive NB of CNY 45150. From the societal perspective, FMT strategy was 75% likely to be cost-effective with an ICER of -207417 CNY/QALY and a positive NB of CNY 48395. Moreover, younger patients (≤ 24), females, non-smokers and Crohn’s disease (CD) achieved more benefits. This study for the first time demonstrated that FMT showed its cost-effectiveness, especially on improving the life quality and decreasing the medical and societal cost, for the moderate to severe IBD in a Chinese cohort. PMID:29179485

Wood volume increment in thinned, 50- to 55-year-old, mixed-species Allegheny hardwoods

Treesearch

Christopher A. Nowak

1996-01-01

A thinning study in 50- to 55-year-old, even-aged, mixed species Allegheny hardwoods produced highly variable merchantable stemwood volume increment responses. Regression equations relating parameters of stand growth (ingrowth, mortality, survivor growth, net growth, and gross growth) to relative stand density had R2 values ranging from 0.07 to 0...

43 CFR 418.36 - Incentives for additional long term conservation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... be reduced by the incremental amount of evaporation which occurs as a result of the increased surface area of the reservoir due to the additional storage. The evaporation rate used will be either the net evaporation measured or the net historical average after precipitation is taken into account. The method of...

43 CFR 418.36 - Incentives for additional long term conservation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... be reduced by the incremental amount of evaporation which occurs as a result of the increased surface area of the reservoir due to the additional storage. The evaporation rate used will be either the net evaporation measured or the net historical average after precipitation is taken into account. The method of...

43 CFR 418.36 - Incentives for additional long term conservation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... be reduced by the incremental amount of evaporation which occurs as a result of the increased surface area of the reservoir due to the additional storage. The evaporation rate used will be either the net evaporation measured or the net historical average after precipitation is taken into account. The method of...

Cost-effectiveness of breast cancer screening using mammography in Vietnamese women

PubMed Central

2018-01-01

Background The incidence rate of breast cancer is increasing and has become the most common cancer in Vietnamese women while the survival rate is lower than that of developed countries. Early detection to improve breast cancer survival as well as reducing risk factors remains the cornerstone of breast cancer control according to the World Health Organization (WHO). This study aims to evaluate the costs and outcomes of introducing a mammography screening program for Vietnamese women aged 45–64 years, compared to the current situation of no screening. Methods Decision analytical modeling using Markov chain analysis was used to estimate costs and health outcomes over a lifetime horizon. Model inputs were derived from published literature and the results were reported as incremental cost-effectiveness ratios (ICERs) and/or incremental net monetary benefits (INMBs). One-way sensitivity analyses and probabilistic sensitivity analyses were performed to assess parameter uncertainty. Results The ICER per life year gained of the first round of mammography screening was US$3647.06 and US$4405.44 for women aged 50–54 years and 55–59 years, respectively. In probabilistic sensitivity analyses, mammography screening in the 50–54 age group and the 55–59 age group were cost-effective in 100% of cases at a threshold of three times the Vietnamese Gross Domestic Product (GDP) i.e., US$6332.70. However, less than 50% of the cases in the 60–64 age group and 0% of the cases in the 45–49 age group were cost effective at the WHO threshold. The ICERs were sensitive to the discount rate, mammography sensitivity, and transition probability from remission to distant recurrence in stage II for all age groups. Conclusion From the healthcare payer viewpoint, offering the first round of mammography screening to Vietnamese women aged 50–59 years should be considered, with the given threshold of three times the Vietnamese GDP per capita. PMID:29579131

Cost-Effectiveness of Ranibizumab Versus Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion: A UK Healthcare Perspective.

PubMed

Adedokun, Lola; Burke, Colin

2016-01-01

Ranibizumab and aflibercept are anti-vascular endothelial growth factor agents licensed for the treatment of visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO). The aim of this study was to estimate, from a UK healthcare payer's perspective, the cost-effectiveness of ranibizumab versus aflibercept in this indication. A Markov model was used to simulate the outcomes and costs of treating BRVO. Patient baseline characteristics and efficacy data for ranibizumab were obtained from the BRAVO trial. The relative efficacy of aflibercept was derived from a published network meta-analysis. Injection frequencies were derived from ranibizumab and aflibercept studies included in the network meta-analysis. Health states were defined by increments of 10 letters in best corrected visual acuity (BCVA). Patients could gain or lose a maximum of two health states between cycles. The first cycle was 6 months, followed by monthly cycles. Different utility values were assigned to the better-seeing and worse-seeing eyes based on BCVA. A 2-year treatment time frame and a lifetime time horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Sensitivity analyses were used to test the robustness of the model. The lifetime cost per patient treated was £15,273 with ranibizumab and £17,347 with aflibercept. Ranibizumab was dominant over aflibercept, producing incremental health gains of 0.0120 quality-adjusted life-years (QALYs) and cost savings of £2074. Net monetary benefit for ranibizumab at a willingness-to-pay threshold of £20,000/QALY was £2314. Sensitivity analyses showed that the results were robust to variations in model parameters. Ranibizumab provides greater health gains at a lower overall cost than aflibercept in the treatment of visual impairment due to macular edema secondary to BRVO. Ranibizumab is therefore cost-effective from a UK healthcare payer's perspective. Novartis Pharma AG, Basel, Switzerland.

The Lifetime Economic Burden of Inaccurate HER2 Testing: Estimating the Costs of False-Positive and False-Negative HER2 Test Results in US Patients with Early-Stage Breast Cancer.

PubMed

Garrison, Louis P; Babigumira, Joseph B; Masaquel, Anthony; Wang, Bruce C M; Lalla, Deepa; Brammer, Melissa

2015-06-01

Patients with breast cancer whose tumors test positive for human epidermal growth factor receptor 2 (HER2) are treated with HER2-targeted therapies such as trastuzumab, but limitations with HER2 testing may lead to false-positive (FP) or false-negative (FN) results. To develop a US-level model to estimate the effect of tumor misclassification on health care costs and patient quality-adjusted life-years (QALYs). Decision analysis was used to estimate the number of patients with early-stage breast cancer (EBC) whose HER2 status was misclassified in 2012. FP results were assumed to generate unnecessary trastuzumab costs and unnecessary cases of trastuzumab-related cardiotoxicity. FN results were assumed to save money on trastuzumab, but with a loss of QALYs and greater risk of disease recurrence and its associated costs. QALYs were valued at $100,000 under a net monetary benefit approach. Among 226,870 women diagnosed with EBC in 2012, 3.12% (n = 7,070) and 2.18% (n = 4,955) were estimated to have had FP and FN test results, respectively. Approximately 8400 QALYs (discounted, lifetime) were lost among women not receiving trastuzumab because of FN results. The estimated incremental per-patient lifetime burden of FP or FN results was $58,900 and $116,000, respectively. The implied incremental losses to society were $417 million and $575 million, respectively. HER2 tests result in misclassification and nonoptimal treatment of approximately 12,025 US patients with EBC annually. The total economic societal loss of nearly $1 billion suggests that improvements in HER2 testing accuracy are needed and that further clinical and economic studies are warranted. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost effectiveness of fingolimod, teriflunomide, dimethyl fumarate and intramuscular interferon-β1a in relapsing-remitting multiple sclerosis.

PubMed

Zhang, Xinke; Hay, Joel W; Niu, Xiaoli

2015-01-01

The aim of the study was to compare the cost effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and intramuscular (IM) interferon (IFN)-β(1a) as first-line therapies in the treatment of patients with relapsing-remitting multiple sclerosis (RRMS). A Markov model was developed to evaluate the cost effectiveness of disease-modifying drugs (DMDs) from a US societal perspective. The time horizon in the base case was 5 years. The primary outcome was incremental net monetary benefit (INMB), and the secondary outcome was incremental cost-effectiveness ratio (ICER). The base case INMB willingness-to-pay (WTP) threshold was assumed to be US$150,000 per quality-adjusted life year (QALY), and the costs were in 2012 US dollars. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted to test the robustness of the model results. Dimethyl fumarate dominated all other therapies over the range of WTPs, from US$0 to US$180,000. Compared with IM IFN-β(1a), at a WTP of US$150,000, INMBs were estimated at US$36,567, US$49,780, and US$80,611 for fingolimod, teriflunomide, and dimethyl fumarate, respectively. The ICER of fingolimod versus teriflunomide was US$3,201,672. One-way sensitivity analyses demonstrated the model results were sensitive to the acquisition costs of DMDs and the time horizon, but in most scenarios, cost-effectiveness rankings remained stable. Probabilistic sensitivity analysis showed that for more than 90% of the simulations, dimethyl fumarate was the optimal therapy across all WTP values. The three oral therapies were favored in the cost-effectiveness analysis. Of the four DMDs, dimethyl fumarate was a dominant therapy to manage RRMS. Apart from dimethyl fumarate, teriflunomide was the most cost-effective therapy compared with IM IFN-β(1a), with an ICER of US$7,115.

Inefficiencies and high-value improvements in U.S. cervical cancer screening practice: A cost-effectiveness analysis

PubMed Central

Kim, Jane J.; Campos, Nicole G.; Sy, Stephen; Burger, Emily A.; Cuzick, Jack; Castle, Philip E.; Hunt, William C.; Waxman, Alan; Wheeler, Cosette M.

2016-01-01

Background Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. Objective To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design Model-based cost-effectiveness analysis. Data Sources New Mexico HPV Pap Registry; medical literature. Target Population Cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Societal. Interventions Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome Measures Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Results of Base-Case Analysis Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Results of Sensitivity Analysis Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitations The impact of HPV vaccination was not considered. Conclusions The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Funding Source U.S. National Cancer Institute. PMID:26414147

Estimating the economic value and impacts of recreational trails: a case study of the Virginia creeper rail trail

Treesearch

J. Michael Bowker; John C. Bergstrom; Joshua Gill

2007-01-01

Many communities are interested in developing and maintaining recreational trails to benefit trail users and as tourist attractions to stimulate economic growth. In this paper, a study is described which estimates the net economic value to trail users and the local economic impacts of the Virginia Creeper Rail Trail in south-western Virginia, USA. The monetary...

An Analysis of the Monetary Benefits and Costs of Higher Education in New Jersey in 1975-1976.

ERIC Educational Resources Information Center

New Jersey State Commission on Financing Postsecondary Education, Trenton.

The equitability of current New Jersey State programs supporting higher education is the primary focus of this study. Taxpayer equity is defined as the distribution of higher education costs on the basis of ability to pay and commensurate with the distribution of higher education subsidies. The net effect of all state programs on each income group…

Space Fence Ground-Based Radar System Increment 1 (Space Fence Inc 1)

DTIC Science & Technology

2015-12-01

Net - Centric Data Strategy and Net-Centric Services Strategy, and the principles and rules identified in the DoD IEA, excepting tactical and...Centric Data Strategy and Net- Centric Services Strategy, and the principles and rules identified in the DoD IEA, excepting tactical and non-IP...Strategy, and the principles and rules identified in the DoD IEA, excepting tactical and non-IP communi- cations. Compliant with TBD Space Fence must

Cost-effectiveness of negative pressure wound therapy in patients with many comorbidities and severe wounds of various etiology.

PubMed

Driver, Vickie R; Eckert, Kristen A; Carter, Marissa J; French, Michael A

2016-11-01

This study analyzed a cross-section of patients with severe chronic wounds and multiple comorbidities at an outpatient wound clinic, with regard to the cost-effectiveness and cost-benefit of negative pressure wound therapy (intervention) vs. no negative pressure wound therapy (control) at 1 and 2 years. Medicare reimbursement charges for wound care were used to calculate costs. Amputation charges were assessed using diagnosis-related groups. Cost-benefit analysis was based on ulcer-free months and cost-effectiveness on quality-adjusted life-years. Undiscounted costs, benefits, quality-adjusted life-years, undiscounted and discounted incremental net health benefits, and incremental cost-effectiveness ratios were calculated for unmatched and matched cohorts. There were 150 subjects in the intervention group and 154 controls before matching and 103 subjects in each of the matched cohorts. Time to heal for the intervention cohort was significantly shorter compared to the controls (270 vs. 635 days, p = 1.0 × 10 -7 , matched cohorts). The intervention cohort had higher benefits and quality-adjusted life-year gains compared to the control cohort at years 1 and 2; by year 2, the gains were 68-73% higher. In the unmatched cohorts, the incremental net health benefit was $9,933 per ulcer-free month at year 2 for the intervention; the incremental cost-effectiveness ratio was -825,271 per quality-adjusted life-year gained (undiscounted costs and benefits). For the matched cohorts, the incremental net health benefits was only $1,371 per ulcer-free month for the intervention, but the incremental cost-effectiveness ratio was $366,683 per quality-adjusted life-year gained for year 2 (discounted costs and benefits). In a patient population with severe chronic wounds and serious comorbidities, negative pressure wound therapy resulted in faster healing wounds and was more cost-effective with greater cost-benefits than not using negative pressure wound therapy. Regarding overall cost-effectiveness, the intervention was still expensive, but that is the reality amidst limited treatment options for such serious cases of chronic wounds. © 2016 by the Wound Healing Society.

Employment preferences of public sector nurses in Malawi: results from a discrete choice experiment.

PubMed

Mangham, Lindsay J; Hanson, Kara

2008-12-01

To understand the employment preferences of Malawian public sector registered nurses, and to ascertain whether salary increases significantly affect how nurses regard their employment. A discrete choice experiment was used to assess the significance of six job attributes on nurses' preferences over pairs of job descriptions: net monthly pay, provision of government housing, opportunities to upgrade their qualifications, typical workload, availability of resources and place of work. A multivariate model was used to estimate the extent to which nurses were willing to trade between their monetary benefits, non-monetary benefits, and working conditions, and to determine the relative importance of the job attributes. Most nurses were willing to trade among attributes, and very few appeared to have preferences that were dominated by a single job attribute. All attributes had a statistically significant influence on nurses' preferences, and further analysis showed the rate at which they were willing to forego pay increases for other improvements in their employment conditions. Opportunities to upgrade professional qualifications, government housing and the increases in net monthly pay had the greatest impact on nurses' employment choices. Salary enhancement can improve the motivation and retention of nurses, as well as improvements of employment conditions, which support existing efforts to address the health worker shortage.

Asymmetry of Reinforcement and Punishment in Human Choice

PubMed Central

Rasmussen, Erin B; Newland, M Christopher

2008-01-01

The hypothesis that a penny lost is valued more highly than a penny earned was tested in human choice. Five participants clicked a computer mouse under concurrent variable-interval schedules of monetary reinforcement. In the no-punishment condition, the schedules arranged monetary gain. In the punishment conditions, a schedule of monetary loss was superimposed on one response alternative. Deviations from generalized matching using the free parameters c (sensitivity to reinforcement) and log k (bias) were compared in the no-punishment and punishment conditions. The no-punishment conditions yielded values of log k that approximated zero for all participants, indicating no bias. In the punishment condition, values of log k deviated substantially from zero, revealing a 3-fold bias toward the unpunished alternative. Moreover, the c parameters were substantially smaller in punished conditions. The values for bias and sensitivity under punishment did not change significantly when the measure of net reinforcers (gains minus losses) was applied to the analysis. These results mean that punishment reduced the sensitivity of behavior to reinforcement and biased performance toward the unpunished alternative. We concluded that a single punisher subtracted more value than a single reinforcer added, indicating an asymmetry in the law of effect. PMID:18422016

e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison

PubMed Central

2015-01-01

Background The economic cost of depression is becoming an ever more important determinant for health policy and decision makers. Internet-based interventions with and without therapist support have been found to be effective options for the treatment of mild to moderate depression. With increasing demands on health resources and shortages of mental health care professionals, the integration of cost-effective treatment options such as Internet-based programs into primary health care could increase efficiency in terms of resource use and costs. Objective Our aim was to evaluate the cost-effectiveness of an Internet-based intervention (myCompass) for the treatment of mild-to-moderate depression compared to treatment as usual and cognitive behavior therapy in a stepped care model. Methods A decision model was constructed using a cost utility framework to show both costs and health outcomes. In accordance with current treatment guidelines, a stepped care model included myCompass as the first low-intervention step in care for a proportion of the model cohort, with participants beginning from a low-intensity intervention to increasing levels of treatment. Model parameters were based on data from the recent randomized controlled trial of myCompass, which showed that the intervention reduced symptoms of depression, anxiety, and stress and improved work and social functioning for people with symptoms in the mild-to-moderate range. Results The average net monetary benefit (NMB) was calculated, identifying myCompass as the strategy with the highest net benefit. The mean incremental NMB per individual for the myCompass group was AUD 1165.88 compared to treatment as usual and AUD 522.58 for the cognitive behavioral therapy model. Conclusions Internet-based interventions can provide cost-effective access to treatment when provided as part of a stepped care model. Widespread dissemination of Internet-based programs can potentially reduce demands on primary and tertiary services and reduce unmet need. PMID:26561555

e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison.

PubMed

Solomon, Daniela; Proudfoot, Judith; Clarke, Janine; Christensen, Helen

2015-11-11

The economic cost of depression is becoming an ever more important determinant for health policy and decision makers. Internet-based interventions with and without therapist support have been found to be effective options for the treatment of mild to moderate depression. With increasing demands on health resources and shortages of mental health care professionals, the integration of cost-effective treatment options such as Internet-based programs into primary health care could increase efficiency in terms of resource use and costs. Our aim was to evaluate the cost-effectiveness of an Internet-based intervention (myCompass) for the treatment of mild-to-moderate depression compared to treatment as usual and cognitive behavior therapy in a stepped care model. A decision model was constructed using a cost utility framework to show both costs and health outcomes. In accordance with current treatment guidelines, a stepped care model included myCompass as the first low-intervention step in care for a proportion of the model cohort, with participants beginning from a low-intensity intervention to increasing levels of treatment. Model parameters were based on data from the recent randomized controlled trial of myCompass, which showed that the intervention reduced symptoms of depression, anxiety, and stress and improved work and social functioning for people with symptoms in the mild-to-moderate range. The average net monetary benefit (NMB) was calculated, identifying myCompass as the strategy with the highest net benefit. The mean incremental NMB per individual for the myCompass group was AUD 1165.88 compared to treatment as usual and AUD 522.58 for the cognitive behavioral therapy model. Internet-based interventions can provide cost-effective access to treatment when provided as part of a stepped care model. Widespread dissemination of Internet-based programs can potentially reduce demands on primary and tertiary services and reduce unmet need.

Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.

PubMed

Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V

2010-01-01

Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for ceiling values

The cost-effectiveness of air bags by seating position.

PubMed

Graham, J D; Thompson, K M; Goldie, S J; Segui-Gomez, M; Weinstein, M C

1997-11-05

Motor vehicle crashes continue to cause significant mortality and morbidity in the United States. Installation of air bags in new passenger vehicles is a major initiative in the field of injury prevention. To assess the net health consequences and cost-effectiveness of driver's side and front passenger air bags from a societal perspective, taking into account the increased risk to children who occupy the front passenger seat and the diminished effectiveness for older adults. A deterministic state transition model tracked a hypothetical cohort of new vehicles over a 20-year period for 3 strategies: (1) installation of safety belts, (2) installation of driver's side air bags in addition to safety belts, and (3) installation of front passenger air bags in addition to safety belts and driver's side air bags. Changes in health outcomes, valued in terms of quality-adjusted life-years (QALYs) and costs (in 1993 dollars), were projected following the recommendations of the Panel on Cost-effectiveness in Health and Medicine. US population-based and convenience sample data were used. Incremental cost-effectiveness ratios. Safety belts are cost saving, even at 50% use. The addition of driver's side air bags to safety belts results in net health benefits at an incremental cost of $24000 per QALY saved. The further addition of front passenger air bags results in an incremental net benefit at a higher incremental cost of $61000 per QALY saved. Results were sensitive to the unit cost of air bag systems, their effectiveness, baseline fatality rates, the ratio of injuries to fatalities, and the real discount rate. Both air bag systems save life-years at costs that are comparable to many medical and public health practices. Immediate steps can be taken to enhance the cost-effectiveness of front passenger air bags, such as moving children to the rear seat.

Projecting the impact of a nationwide school plain water access intervention on childhood obesity: a cost-benefit analysis.

PubMed

An, R; Xue, H; Wang, L; Wang, Y

2017-09-22

This study aimed to project the societal cost and benefit of an expansion of a water access intervention that promotes lunchtime plain water consumption by placing water dispensers in New York school cafeterias to all schools nationwide. A decision model was constructed to simulate two events under Markov chain processes - placing water dispensers at lunchtimes in school cafeterias nationwide vs. no action. The incremental cost pertained to water dispenser purchase and maintenance, whereas the incremental benefit was resulted from cases of childhood overweight/obesity prevented and corresponding lifetime direct (medical) and indirect costs saved. Based on the decision model, the estimated incremental cost of the school-based water access intervention is $18 per student, and the corresponding incremental benefit is $192, resulting in a net benefit of $174 per student. Subgroup analysis estimates the net benefit per student to be $199 and $149 among boys and girls, respectively. Nationwide adoption of the intervention would prevent 0.57 million cases of childhood overweight, resulting in a lifetime cost saving totalling $13.1 billion. The estimated total cost saved per dollar spent was $14.5. The New York school-based water access intervention, if adopted nationwide, may have a considerably favourable benefit-cost portfolio. © 2017 World Obesity Federation.

Applying the net-benefit framework for assessing cost-effectiveness of interventions towards universal health coverage

PubMed Central

2012-01-01

In assessing the cost-effectiveness of an intervention, the interpretation and handling of uncertainties of the traditional summary measure, the Incremental Cost Effectiveness Ratio (ICER), can be problematic. This is particularly the case with strategies towards universal health coverage in which the decision makers are typically concerned with coverage and equity issues. We explored the feasibility and relative advantages of the net-benefit framework (NBF) (compared to the more traditional Incremental Cost-Effectiveness Ratio, ICER) in presenting results of cost-effectiveness analysis of a community based health insurance (CBHI) scheme in Nouna, a rural district of Burkina Faso. Data were collected from April to December 2007 from Nouna’s longitudinal Demographic Surveillance System on utilization of health services, membership of the CBHI, covariates, and CBHI costs. The incremental cost of a 1 increase in utilization of health services by household members of the CBHI was 433,000 XOF ($1000 approximately). The incremental cost varies significantly by covariates. The probability of the CBHI achieving a 1% increase in utilization of health services, when the ceiling ratio is $1,000, is barely 30% for households in Nouna villages compared to 90% for households in Nouna town. Compared to the ICER, the NBF provides more useful information for policy making. PMID:22800192

Cost-Savings Analysis of the Better Beginnings, Better Futures Community-Based Project for Young Children and Their Families: A 10-Year Follow-up.

PubMed

Peters, Ray DeV; Petrunka, Kelly; Khan, Shahriar; Howell-Moneta, Angela; Nelson, Geoffrey; Pancer, S Mark; Loomis, Colleen

2016-02-01

This study examined the long-term cost-savings of the Better Beginnings, Better Futures (BBBF) initiative, a community-based early intervention project for young children living in socioeconomically disadvantaged neighborhoods during their transition to primary school. A quasi-experimental, longitudinal two-group design was used to compare costs and outcomes for children and families in three BBBF project neighborhoods (n = 401) and two comparison neighborhoods (n = 225). A cost-savings analysis was conducted using all project costs for providing up to 4 years of BBBF programs when children were in junior kindergarten (JK) (4 years old) to grade 2 (8 years old). Data on 19 government service cost measures were collected from the longitudinal research sample from the time the youth were in JK through to grade 12 (18 years old), 10 years after ending project participation. The average family incremental net savings to government of providing the BBBF project was $6331 in 2014 Canadian dollars. When the BBBF monetary return to government as a ratio of savings to costs was calculated, for every dollar invested by the government, a return of $2.50 per family was saved. Findings from this study have important implications for government investments in early interventions focused on a successful transition to primary school as well as parenting programs and community development initiatives in support of children's development.

A multi-criteria decision analysis perspective on the health economic evaluation of medical interventions.

PubMed

Postmus, Douwe; Tervonen, Tommi; van Valkenhoef, Gert; Hillege, Hans L; Buskens, Erik

2014-09-01

A standard practice in health economic evaluation is to monetize health effects by assuming a certain societal willingness-to-pay per unit of health gain. Although the resulting net monetary benefit (NMB) is easy to compute, the use of a single willingness-to-pay threshold assumes expressibility of the health effects on a single non-monetary scale. To relax this assumption, this article proves that the NMB framework is a special case of the more general stochastic multi-criteria acceptability analysis (SMAA) method. Specifically, as SMAA does not restrict the number of criteria to two and also does not require the marginal rates of substitution to be constant, there are problem instances for which the use of this more general method may result in a better understanding of the trade-offs underlying the reimbursement decision-making problem. This is illustrated by applying both methods in a case study related to infertility treatment.

Graphical assessment of incremental value of novel markers in prediction models: From statistical to decision analytical perspectives.

PubMed

Steyerberg, Ewout W; Vedder, Moniek M; Leening, Maarten J G; Postmus, Douwe; D'Agostino, Ralph B; Van Calster, Ben; Pencina, Michael J

2015-07-01

New markers may improve prediction of diagnostic and prognostic outcomes. We aimed to review options for graphical display and summary measures to assess the predictive value of markers over standard, readily available predictors. We illustrated various approaches using previously published data on 3264 participants from the Framingham Heart Study, where 183 developed coronary heart disease (10-year risk 5.6%). We considered performance measures for the incremental value of adding HDL cholesterol to a prediction model. An initial assessment may consider statistical significance (HR = 0.65, 95% confidence interval 0.53 to 0.80; likelihood ratio p < 0.001), and distributions of predicted risks (densities or box plots) with various summary measures. A range of decision thresholds is considered in predictiveness and receiver operating characteristic curves, where the area under the curve (AUC) increased from 0.762 to 0.774 by adding HDL. We can furthermore focus on reclassification of participants with and without an event in a reclassification graph, with the continuous net reclassification improvement (NRI) as a summary measure. When we focus on one particular decision threshold, the changes in sensitivity and specificity are central. We propose a net reclassification risk graph, which allows us to focus on the number of reclassified persons and their event rates. Summary measures include the binary AUC, the two-category NRI, and decision analytic variants such as the net benefit (NB). Various graphs and summary measures can be used to assess the incremental predictive value of a marker. Important insights for impact on decision making are provided by a simple graph for the net reclassification risk. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Landfill mining: Developing a comprehensive assessment method.

PubMed

Hermann, Robert; Wolfsberger, Tanja; Pomberger, Roland; Sarc, Renato

2016-11-01

In Austria, the first basic technological and economic examinations of mass-waste landfills with the purpose to recover secondary raw materials have been carried out by the 'LAMIS - Landfill Mining Österreich' pilot project. A main focus of its research, and the subject of this article, is the first conceptual design of a comprehensive assessment method for landfill mining plans, including not only monetary factors (like costs and proceeds) but also non-monetary ones, such as the concerns of adjoining owners or the environmental impact. Detailed reviews of references, the identification of influences and system boundaries to be included in planning landfill mining, several expert workshops and talks with landfill operators have been performed followed by a division of the whole assessment method into preliminary and main assessment. Preliminary assessment is carried out with a questionnaire to rate juridical feasibility, the risk and the expenditure of a landfill mining project. The results of this questionnaire are compiled in a portfolio chart that is used to recommend, or not, further assessment. If a detailed main assessment is recommended, defined economic criteria are rated by net present value calculations, while ecological and socio-economic criteria are examined in a utility analysis and then transferred into a utility-net present value chart. If this chart does not support making a definite statement on the feasibility of the project, the results must be further examined in a cost-effectiveness analysis. Here, the benefit of the particular landfill mining project per capital unit (utility-net present value ratio) is determined to make a final distinct statement on the general benefit of a landfill mining project. © The Author(s) 2016.

Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention: The Importance of Time Nurses Spend on the Front Line of Implementation.

PubMed

Nuckols, Teryl K; Needleman, Jack; Grogan, Tristan R; Liang, Li-Jung; Worobel-Luk, Pamela; Anderson, Laura; Czypinski, Linda; Coles, Courtney; Walsh, Catherine M

2017-11-01

The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals. Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions. We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year. Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities. Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.

Applying and Individual-Based Model to Simultaneously Evaluate Net Ecosystem Production and Tree Diameter Increment

NASA Astrophysics Data System (ADS)

Fang, F. J.

2017-12-01

Reconciling observations at fundamentally different scales is central in understanding the global carbon cycle. This study investigates a model-based melding of forest inventory data, remote-sensing data and micrometeorological-station data ("flux towers" estimating forest heat, CO2 and H2O fluxes). The individual tree-based model FORCCHN was used to evaluate the tree DBH increment and forest carbon fluxes. These are the first simultaneous simulations of the forest carbon budgets from flux towers and individual-tree growth estimates of forest carbon budgets using the continuous forest inventory data — under circumstances in which both predictions can be tested. Along with the global implications of such findings, this also improves the capacity for forest sustainable management and the comprehensive understanding of forest ecosystems. In forest ecology, diameter at breast height (DBH) of a tree significantly determines an individual tree's cross-sectional sapwood area, its biomass and carbon storage. Evaluation the annual DBH increment (ΔDBH) of an individual tree is central to understanding tree growth and forest ecology. Ecosystem Carbon flux is a consequence of key ecosystem processes in the forest-ecosystem carbon cycle, Gross and Net Primary Production (GPP and NPP, respectively) and Net Ecosystem Respiration (NEP). All of these closely relate with tree DBH changes and tree death. Despite advances in evaluating forest carbon fluxes with flux towers and forest inventories for individual tree ΔDBH, few current ecological models can simultaneously quantify and predict the tree ΔDBH and forest carbon flux.

[Parameter of evidence-based medicine in health care economics].

PubMed

Wasem, J; Siebert, U

1999-08-01

In the view of scarcity of resources, economic evaluations in health care, in which not only effects but also costs related to a medical intervention are examined and a incremental cost-outcome-ratio is build, are an important supplement to the program of evidence based medicine. Outcomes of a medical intervention can be measured by clinical effectiveness, quality-adjusted life years, and monetary evaluation of benefits. As far as costs are concerned, direct medical costs, direct non-medical costs and indirect costs have to be considered in an economic evaluation. Data can be used from primary studies or secondary analysis; metaanalysis for synthesizing of data may be adequate. For calculation of incremental cost-benefit-ratios, models of decision analysis (decision tree models, Markov-models) often are necessary. Methodological and ethical limits for application of the results of economic evaluation in resource allocation decision in health care have to be regarded: Economic evaluations and the calculation of cost-outcome-rations should only support decision making but cannot replace it.

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

PubMed

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

2015-08-15

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

The Cost Effectiveness of Docetaxel and Active Symptom Control versus Active Symptom Control Alone for Refractory Oesophagogastric Adenocarcinoma: Economic Analysis of the COUGAR-02 Trial.

PubMed

Meads, David M; Marshall, Andrea; Hulme, Claire T; Dunn, Janet A; Ford, Hugo E R

2016-01-01

The COUGAR-02 trial recently showed survival and quality-of-life benefits of docetaxel and active symptom control (DXL + ASC) over active symptom control (ASC) alone in patients with refractory oesophagogastric adenocarcinoma. The aim of this study was to conduct an economic evaluation conforming to National Institute for Health and Care Excellence (NICE) technology appraisal guidance to evaluate the cost effectiveness of DXL + ASC versus ASC from the perspective of the English National Health Service (NHS). Cost-utility analyses were conducted using trial data. Utility values were captured using the EQ-5D completed by patients at 3- and 6-weekly intervals, while resource use was captured using nurse-completed report forms and patient reports. Incremental cost-effectiveness ratios (ICERs) were calculated and the main outcome was cost per incremental quality-adjusted life-year (QALY). Nonparametric bootstrapping was conducted to capture sampling uncertainty and to generate a cost-effectiveness acceptability curve (CEAC). The analysis horizon was the trial period (median follow-up 12 months) and no modelling or discounting of future costs and benefits was conducted. Average costs were £9352 and £6218 for DXL + ASC and ASC, respectively, and average QALYs were 0.302 and 0.186, respectively. This yielded an ICER of £27,180 for DXL + ASC. DXL + ASC had a 24 % chance of being cost effective at a £20,000 QALY threshold (lambda) and a mean net monetary benefit of -£821; this rose to 59 % and £332 when the threshold was raised to £30,000. If NICE end-of-life criteria are applied, the probability of cost effectiveness increases to 90 % (at lambda = £50,000). Results were robust to sensitivity analyses. DXL + ASC is likely to be cost effective if an end-of-life premium is applied. Further research should determine the impact of different utility measurement strategies and different chemotherapy delivery modes on estimates of cost effectiveness.

Cost-effectiveness of subdermal implantable buprenorphine versus sublingual buprenorphine to treat opioid use disorder.

PubMed

Carter, John A; Dammerman, Ryan; Frost, Michael

2017-08-01

Subdermal implantable buprenorphine (BSI) was recently approved to treat opioid use disorder (OUD) in clinically-stable adults. In the pivotal clinical trial, BSI was associated with a higher proportion of completely-abstinent patients (85.7% vs 71.9%; p = .03) vs sublingual buprenorphine (SL-BPN). Elsewhere, relapse to illicit drug use is associated with diminished treatment outcomes and increased costs. This study evaluated the cost-effectiveness of BSI vs SL-BPN from a US societal perspective. A Markov model simulated BSI and SL-BPN cohorts (clinically-stable adults) transiting through four mutually-exclusive health states for 12 months. Cohorts accumulated direct medical costs from drug acquisition/administration; treatment-diversion/abuse; newly-acquired hepatitis-C; emergency room, hospital, and rehabilitation services; and pediatric poisonings. Non-medical costs of criminality, lost wages/work-productivity, and out-of-pocket expenses were also included. Transition probabilities to a relapsed state were derived from the aforementioned trial. Other transition probabilities, costs, and health-state utilities were derived from observational studies and adjusted for trial characteristics. Outcomes included incremental cost per quality-adjusted-life-year (QALY) gained and incremental net-monetary-benefit (INMB). Uncertainty was assessed by univariate and probabilistic sensitivity analysis (PSA). BSI was associated with lower total costs (-$4,386), more QALYs (+0.031), and favorable INMB at all willingness-to-pay (WTP) thresholds considered. Higher drug acquisition costs for BSI (+$6,492) were outpaced, primarily by reductions in emergency room/hospital utilization (-$8,040) and criminality (-$1,212). BSI was cost-effective in 89% of PSA model replicates, and had a significantly higher NMB at $50,000/QALY ($20,783 vs $15,007; p < .05). BSI was preferred over SL-BPN from a health-economic perspective for treatment of OUD in clinically-stable adults. These findings should be interpreted carefully, due to some relationships having been modeled from inputs derived from multiple sources, and would benefit from comparison with outcomes from studies that employ administrative claims data or a naturalistic comparative design.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial.

PubMed

Dodd, Jodie M; Ahmed, Sharmina; Karnon, Jonathan; Umberger, Wendy; Deussen, Andrea R; Tran, Thach; Grivell, Rosalie M; Crowther, Caroline A; Turnbull, Deborah; McPhee, Andrew J; Wittert, Gary; Owens, Julie A; Robinson, Jeffrey S

2015-01-01

Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10(+0)-20(+0) weeks, and BMI ≥25 kg/m(2) were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles. Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group $11261.19±$14573.97 versus Standard Care Group $11306.70±$14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to $45,000. Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes. Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

Incremental cost effectiveness evaluation in clinical research.

PubMed

Krummenauer, Frank; Landwehr, I

2005-01-28

The health economic evaluation of therapeutic and diagnostic strategies is of increasing importance in clinical research. Therefore also clinical trialists have to involve health economic aspects more frequently. However, whereas they are quite familiar with classical effect measures in clinical trials, the corresponding parameters in health economic evaluation of therapeutic and diagnostic procedures are still not this common. The concepts of incremental cost effectiveness ratios (ICERs) and incremental net health benefit (INHB) will be illustrated and contrasted along the cost effectiveness evaluation of cataract surgery with monofocal and multifocal intraocular lenses. ICERs relate the costs of a treatment to its clinical benefit in terms of a ratio expression (indexed as Euro per clinical benefit unit). Therefore ICERs can be directly compared to a pre-specified willingness to pay (WTP) benchmark, which represents the maximum costs, health insurers would invest to achieve one clinical benefit unit. INHBs estimate a treatment's net clinical benefit after accounting for its cost increase versus an established therapeutic standard. Resource allocation rules can be formulated by means of both effect measures. Both the ICER and the INHB approach enable the definition of directional resource allocation rules. The allocation decisions arising from these rules are identical, as long as the willingness to pay benchmark is fixed in advance. Therefore both strategies crucially call for a priori determination of both the underlying clinical benefit endpoint (such as gain in vision lines after cataract surgery or gain in quality-adjusted life years) and the corresponding willingness to pay benchmark. The use of incremental cost effectiveness and net health benefit estimates provides a rationale for health economic allocation discussions and founding decisions. It implies the same requirements on trial protocols as yet established for clinical trials, that is the a priori definition of primary hypotheses (formulated as an allocation rule involving a pre-specified willingness to pay benchmark) and the primary clinical benefit endpoint (as a rationale for effectiveness evaluation).

Multilevel models for estimating incremental net benefits in multinational studies.

PubMed

Grieve, Richard; Nixon, Richard; Thompson, Simon G; Cairns, John

2007-08-01

Multilevel models (MLMs) have been recommended for estimating incremental net benefits (INBs) in multicentre cost-effectiveness analysis (CEA). However, these models have assumed that the INBs are exchangeable and that there is a common variance across all centres. This paper examines the plausibility of these assumptions by comparing various MLMs for estimating the mean INB in a multinational CEA. The results showed that the MLMs that assumed the INBs were exchangeable and had a common variance led to incorrect inferences. The MLMs that included covariates to allow for systematic differences across the centres, and estimated different variances in each centre, made more plausible assumptions, fitted the data better and led to more appropriate inferences. We conclude that the validity of assumptions underlying MLMs used in CEA need to be critically evaluated before reliable conclusions can be drawn. Copyright 2006 John Wiley & Sons, Ltd.

Largely ignored: the impact of the threshold value for a QALY on the importance of a transferability factor.

PubMed

Vemer, Pepijn; Rutten-van Mölken, Maureen P M H

2011-10-01

Recently, several checklists systematically assessed factors that affect the transferability of cost-effectiveness (CE) studies between jurisdictions. The role of the threshold value for a QALY has been given little consideration in these checklists, even though the importance of a factor as a cause of between country differences in CE depends on this threshold. In this paper, we study the impact of the willingness-to-pay (WTP) per QALY on the importance of transferability factors in the case of smoking cessation support (SCS). We investigated, for several values of the WTP, how differences between six countries affect the incremental net monetary benefit (INMB) of SCS. The investigated factors were demography, smoking prevalence, mortality, epidemiology and costs of smoking-related diseases, resource use and unit costs of SCS, utility weights and discount rates. We found that when the WTP decreased, factors that mainly affect health outcomes became less important and factors that mainly effect costs became more important. With a WTP below 1,000, the factors most responsible for between country differences in INMB were resource use and unit costs of SCS and the costs of smoking-related diseases. Utility values had little impact. At a threshold above 10,000, between country differences were primarily due to different discount rates, utility weights and epidemiology of smoking-related diseases. Costs of smoking-related diseases had little impact. At all thresholds, demography had little impact. We concluded that, when judging the transferability of a CE study, we should consider the between country differences in WTP threshold values.

Economic evaluation of intravenous iodinated contrast media in Italy.

PubMed

Iannazzo, Sergio; Vandekerckhove, Stijn; De Francesco, Maria; Nayak, Akash; Ronco, Claudio; Morana, Giovanni; Valentino, Massimo

2014-01-01

Contrast-induced acute kidney injury (CI-AKI) is defined as a deterioration in renal function after administration of radiologic iodinated contrast media (CM). Iodixanol, showed a lower CI-AKI incidence than low-osmolar contrast media (LOCM). A cost-effectiveness analysis was performed comparing iodixanol and LOCM in intravenous (IV) setting in Italy. A Markov model was developed. Patients moved across four health states: CI-AKI free, CI-AKI, myocardial infarction, and death. The simulation horizon was lifetime with 1-month cycles. Costs and outcomes were discounted at 3.5 percent rate. CI-AKI incidence was considered from published literature across different definitions. Cost-effectiveness of iodixanol was assessed in terms of incremental cost per life-year gained. Net monetary benefit (NMB) was also calculated. Both deterministic and probabilistic sensitivity analyses were performed. Base-case results showed an average survival increase of 0.51 life-years and a savings of €7.25 for iodixanol versus LOCM. The cost-effectiveness of iodixanol was confirmed when other scenarios were explored, such as varying CI-AKI definition, sub-populations with specified risk factors, CM hospital bids prices, and inclusion of adverse drug reactions of allergic nature. An NMB ranging between €6,007.25 and €30,007.25 was calculated. Base-case results show that IV iodixanol is cost-effective compared with LOCM in the Italian clinical setting of a hospital computed tomography radiology practice. However, some caution is due, mainly linked to inherent limitations of the modeling technique and to the lack of agreement on CI-AKI incidence data in the clinical literature.

Economic evaluation of Helicobacter pylori eradication in the CADET-Hp randomized controlled trial of H. pylori-positive primary care patients with uninvestigated dyspepsia.

PubMed

Chiba, N; Veldhuyzen Van Zanten, S J O; Escobedo, S; Grace, E; Lee, J; Sinclair, P; Barkun, A; Armstrong, D; Thomson, A B R

2004-02-01

Adult Helicobacter pylori-positive patients by 13C-urea breath test with uninvestigated dyspepsia symptoms were randomized to 1-week eradication treatment with omeprazole, metronidazole and clarithromycin (OMC) vs. omeprazole and placebo antimicrobials (OPP) in the Canadian Adult Dyspepsia Empiric Treatment-H. pylori-positive (CADET-Hp) study. To perform an economic evaluation of this 1-year study. Following blind eradication treatment, family practitioners managed patients according to their usual practices. Health resource utilization information was collected prospectively. From the mean costs of the health resources consumed and the treatment outcomes, the incremental cost-effectiveness ratios and incremental net benefits of eradication treatment vs. OPP were determined. Eradication therapy significantly improved dyspepsia symptoms (treatment success: OMC, 50%; OPP, 36%; P = 0.02). The incremental cost-effectiveness ratio of OMC vs. OPP was - 387 Canadian dollars (CAD$) per treatment success (90% CI, - CAD$1707, CAD$607), indicating a lower cost with treatment success. The incremental net benefit analysis showed that H. pylori eradication was cost-effective if the willingness-to-pay value exceeded a nominal figure of CAD$100 from a health service perspective or CAD$607 from the societal perspective. In uninvestigated patients presenting with dyspepsia at the primary care level, eradication of H. pylori in those who are H. pylori positive leads to a cost-effective improvement in dyspepsia symptoms compared with a strategy of not eradicating H. pylori in these patients.

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

PubMed

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

2014-02-01

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

Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study

PubMed Central

Fitzgerald, Sarah; Murphy, Aileen; Kirby, Ann; Geaney, Fiona; Perry, Ivan J

2018-01-01

Objective To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Design Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Setting Four multinational manufacturing workplaces in Cork, Ireland. Participants 517 randomly selected employees (18–65 years) from four workplaces. Interventions Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. Outcomes The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. Results The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost–benefit analysis, whereby the system-level intervention yields the highest net benefit (€56.56 per employee). Conclusions System-level dietary modification alone offers the most value per improving employee health-related quality of life and generating net benefit for employers by reducing absenteeism. While system-level dietary modification strategies are potentially sustainable obesity prevention interventions, future research should include long-term outcomes to determine if improvements in outcomes persist. Trial registration number ISRCTN35108237; Post-results. PMID:29502090

Disease activity-guided dose optimisation of adalimumab and etanercept is a cost-effective strategy compared with non-tapering tight control rheumatoid arthritis care: analyses of the DRESS study.

PubMed

Kievit, Wietske; van Herwaarden, Noortje; van den Hoogen, Frank Hj; van Vollenhoven, Ronald F; Bijlsma, Johannes Wj; van den Bemt, Bart Jf; van der Maas, Aatke; den Broeder, Alfons A

2016-11-01

A disease activity-guided dose optimisation strategy of adalimumab or etanercept (TNFi (tumour necrosis factor inhibitors)) has shown to be non-inferior in maintaining disease control in patients with rheumatoid arthritis (RA) compared with usual care. However, the cost-effectiveness of this strategy is still unknown. This is a preplanned cost-effectiveness analysis of the Dose REduction Strategy of Subcutaneous TNF inhibitors (DRESS) study, a randomised controlled, open-label, non-inferiority trial performed in two Dutch rheumatology outpatient clinics. Patients with low disease activity using TNF inhibitors were included. Total healthcare costs were measured and quality adjusted life years (QALY) were based on EQ5D utility scores. Decremental cost-effectiveness analyses were performed using bootstrap analyses; incremental net monetary benefit (iNMB) was used to express cost-effectiveness. 180 patients were included, and 121 were allocated to the dose optimisation strategy and 59 to control. The dose optimisation strategy resulted in a mean cost saving of -€12 280 (95 percentile -€10 502; -€14 104) per patient per 18 months. There is an 84% chance that the dose optimisation strategy results in a QALY loss with a mean QALY loss of -0.02 (-0.07 to 0.02). The decremental cost-effectiveness ratio (DCER) was €390 493 (€5 085 184; dominant) of savings per QALY lost. The mean iNMB was €10 467 (€6553-€14 037). Sensitivity analyses using 30% and 50% lower prices for TNFi remained cost-effective. Disease activity-guided dose optimisation of TNFi results in considerable cost savings while no relevant loss of quality of life was observed. When the minimal QALY loss is compensated with the upper limit of what society is willing to pay or accept in the Netherlands, the net savings are still high. NTR3216; Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

PubMed

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

2015-04-01

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

Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England.

PubMed

Gomes, Manuel; Pennington, Mark; Wittenberg, Raphael; Knapp, Martin; Black, Nick; Smith, Sarah

2017-01-01

Background Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients' health-related quality of life (HRQL) compares with the associated costs. Aims To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. Method We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n = 944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and six months after referral to MAS. We also assessed the cost-effectiveness of MAS across different patient subgroups and clinic characteristics. Results Referral to MAS was associated with gains in DEMQOL (mean gain: 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01). Mean total cost over six months, assuming a societal perspective, was £1899 (£1277 to £2539). This yielded a negative incremental net monetary benefit of -£1724 (-£2388 to -£1085), assuming NICE's recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL. There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p < 0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 over six months were relatively more cost-effective (p < 0.01) than MAS with fewer new monthly patients or higher cost per patient. Conclusions Diagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective, in the six months after diagnosis. Longer term evidence is required before drawing conclusions about the cost-effectiveness of MAS.

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

PubMed Central

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

2015-01-01

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

The Value of Medical and Pharmaceutical Interventions for Reducing Obesity

PubMed Central

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

2012-01-01

This paper attempts to quantify the social, private, and public-finance values of reducing obesity through pharmaceutical and medical interventions. We find that the total social value of bariatric surgery is large for treated patients, with incremental social cost-effectiveness ratios typically under $10,000 per life-year saved. On the other hand, pharmaceutical interventions against obesity yield much less social value with incremental social cost-effectiveness ratios around $50,000. Our approach accounts for: competing risks to life expectancy; health care costs; and a variety of non-medical economic consequences (pensions, disability insurance, taxes, and earnings), which account for 20% of the total social cost of these treatments. On balance, bariatric surgery generates substantial private value for those treated, in the form of health and other economic consequences. The net public fiscal effects are modest, primarily because the size of the population eligible for treatment is small while the net social effect is large once improvements in life expectancy are taken into account. PMID:22705389

The value of medical and pharmaceutical interventions for reducing obesity.

PubMed

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

2012-07-01

This paper attempts to quantify the social, private, and public-finance values of reducing obesity through pharmaceutical and medical interventions. We find that the total social value of bariatric surgery is large for treated patients, with incremental social cost-effectiveness ratios typically under $10,000 per life-year saved. On the other hand, pharmaceutical interventions against obesity yield much less social value with incremental social cost-effectiveness ratios around $50,000. Our approach accounts for: competing risks to life expectancy; health care costs; and a variety of non-medical economic consequences (pensions, disability insurance, taxes, and earnings), which account for 20% of the total social cost of these treatments. On balance, bariatric surgery generates substantial private value for those treated, in the form of health and other economic consequences. The net public fiscal effects are modest, primarily because the size of the population eligible for treatment is small. The net social effect is large once improvements in life expectancy are taken into account. Copyright © 2012 Elsevier B.V. All rights reserved.

Using Decision-Analytic Modeling to Isolate Interventions That Are Feasible, Efficient and Optimal: An Application from the Norwegian Cervical Cancer Screening Program.

PubMed

Pedersen, Kine; Sørbye, Sveinung Wergeland; Burger, Emily Annika; Lönnberg, Stefan; Kristiansen, Ivar Sønbø

2015-12-01

Decision makers often need to simultaneously consider multiple criteria or outcomes when deciding whether to adopt new health interventions. Using decision analysis within the context of cervical cancer screening in Norway, we aimed to aid decision makers in identifying a subset of relevant strategies that are simultaneously efficient, feasible, and optimal. We developed an age-stratified probabilistic decision tree model following a cohort of women attending primary screening through one screening round. We enumerated detected precancers (i.e., cervical intraepithelial neoplasia of grade 2 or more severe (CIN2+)), colposcopies performed, and monetary costs associated with 10 alternative triage algorithms for women with abnormal cytology results. As efficiency metrics, we calculated incremental cost-effectiveness, and harm-benefit, ratios, defined as the additional costs, or the additional number of colposcopies, per additional CIN2+ detected. We estimated capacity requirements and uncertainty surrounding which strategy is optimal according to the decision rule, involving willingness to pay (monetary or resources consumed per added benefit). For ages 25 to 33 years, we eliminated four strategies that did not fall on either efficiency frontier, while one strategy was efficient with respect to both efficiency metrics. Compared with current practice in Norway, two strategies detected more precancers at lower monetary costs, but some required more colposcopies. Similar results were found for women aged 34 to 69 years. Improving the effectiveness and efficiency of cervical cancer screening may necessitate additional resources. Although efficient and feasible, both society and individuals must specify their willingness to accept the additional resources and perceived harms required to increase effectiveness before a strategy can be considered optimal. Copyright © 2015. Published by Elsevier Inc.

An exploratory case study of the impact of expanding cost-effectiveness analysis for second-line nivolumab for patients with squamous non-small cell lung cancer in Canada: Does it make a difference?

PubMed

Shafrin, Jason; Skornicki, Michelle; Brauer, Michelle; Villeneuve, Julie; Lees, Michael; Hertel, Nadine; Penrod, John R; Jansen, Jeroen

2018-04-26

Health technology appraisal agencies often rely on cost-effectiveness analyses to inform coverage decisions for new treatments. These assessments, however, frequently measure a treatment's value from the payer's perspective, and may not capture value generated from reduced caregiving costs, increased productivity, value based on patient risk preferences, option value or the insurance value to non-patients. To examine how using a broader societal perspective of treatment value affects cost-effectiveness estimates, this case study analyzed the net monetary benefit (NMB) of second-line nivolumab treatment of patients with squamous non-small cell lung cancer (NSCLC) in Canada. The comparator was treatment with docetaxel. NMB was measured from three perspectives: (i) traditional payer, (ii) traditional societal and (iii) broad societal. Nivolumab was more effective (increased quality-adjusted life years by 0.66 versus docetaxel), but also increased costs by $100,168 CAD. When valuing a quality-adjusted life year at $150,000, the net monetary benefit from the payer perspective suggested that costs modestly exceed benefits (NMB: -$1031). Adopting a societal perspective, however, nivolumab's benefits outweighed its costs (NMB: +$6752 and +$91,084 from the traditional and broad societal perspectives, respectively). Broadening cost-effectiveness analysis beyond the traditional payer perspective had a significant impact on the result and should be considered in order to capture all treatment benefits and costs of societal relevance. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

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

PubMed

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

2017-04-27

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

Identifying Cost-Effective Dynamic Policies to Control Epidemics

PubMed Central

Yaesoubi, Reza; Cohen, Ted

2016-01-01

We describe a mathematical decision model for identifying dynamic health policies for controlling epidemics. These dynamic policies aim to select the best current intervention based on accumulating epidemic data and the availability of resources at each decision point. We propose an algorithm to approximate dynamic policies that optimize the population’s net health benefit, a performance measure which accounts for both health and monetary outcomes. We further illustrate how dynamic policies can be defined and optimized for the control of a novel viral pathogen, where a policy maker must decide (i) when to employ or lift a transmission-reducing intervention (e.g. school closure) and (ii) how to prioritize population members for vaccination when a limited quantity of vaccines first become available. Within the context of this application, we demonstrate that dynamic policies can produce higher net health benefit than more commonly described static policies that specify a pre-determined sequence of interventions to employ throughout epidemics. PMID:27449759

Invasive urodynamic testing prior to surgical treatment for stress urinary incontinence in women: cost-effectiveness and value of information analyses in the context of a mixed methods feasibility study.

PubMed

Homer, Tara; Shen, Jing; Vale, Luke; McColl, Elaine; Tincello, Douglas G; Hilton, Paul

2018-01-01

INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?) was a mixed methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing (IUT) prior to surgery for stress urinary incontinence (SUI) in women. Here we report one of the study's five components, with the specific objectives of (i) exploring the cost-effectiveness of IUT compared with clinical assessment plus non-invasive tests (henceforth described as 'IUT' and 'no IUT' respectively) in women with SUI or stress-predominant mixed urinary incontinence (MUI) prior to surgery, and (ii) determining the expected net gain (ENG) from additional research. Study participants were women with SUI or stress-predominant MUI who had failed to respond to conservative treatments recruited from seven UK urogynaecology and female urology units. They were randomised to receive either 'IUT' or 'no IUT' before undergoing further treatment. Data from 218 women were used in the economic analysis. Cost utility, net benefit and value of information (VoI) analyses were performed within a randomised controlled pilot trial. Costs and quality-adjusted life years (QALYs) were estimated over 6 months to determine the incremental cost per QALY of 'IUT' compared to 'no IUT'. Net monetary benefit informed the VoI analysis. The VoI estimated the ENG and optimal sample size for a future definitive trial. At 6 months, the mean difference in total average cost was £138 ( p  = 0.071) in favour of 'IUT'; there was no difference in QALYs estimated from the SF-12 (difference 0.004; p  = 0.425) and EQ-5D-3L (difference - 0.004; p  = 0.725); therefore, the probability of IUT being cost-effective remains uncertain. The estimated ENG was positive for further research to address this uncertainty with an optimal sample size of 404 women. This is the largest economic evaluation of IUT. On average, up to 6 months after treatment, 'IUT' may be cost-saving compared to 'no IUT' because of the reduction in surgery following invasive investigation. However, uncertainty remains over the probability of 'IUT' being considered cost-effective, especially in the longer term. The VoI analysis indicated that further research would be of value. ISRCTN. ISRCTN71327395. Registered 7 June 2010.

Estimating the returns to United Kingdom publicly funded musculoskeletal disease research in terms of net value of improved health outcomes.

PubMed

Glover, Matthew; Montague, Erin; Pollitt, Alexandra; Guthrie, Susan; Hanney, Stephen; Buxton, Martin; Grant, Jonathan

2018-01-10

Building on an approach applied to cardiovascular and cancer research, we estimated the economic returns from United Kingdom public- and charitable-funded musculoskeletal disease (MSD) research that arise from the net value of the improved health outcomes in the United Kingdom. To calculate the economic returns from MSD-related research in the United Kingdom, we estimated (1) the public and charitable expenditure on MSD-related research in the United Kingdom between 1970 and 2013; (2) the net monetary benefit (NMB), derived from the health benefit in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of £25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1994 to 2013; (3) the proportion of NMB attributable to United Kingdom research; and (4) the elapsed time between research funding and health gain. The data collected from these four key elements were used to estimate the internal rate of return (IRR) from MSD-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using a one-way sensitivity analysis. Expressed in 2013 prices, total expenditure on MSD-related research from 1970 to 2013 was £3.5 billion, and for the period used to estimate the rate of return, 1978-1997, was £1.4 billion. Over the period 1994-2013 the key interventions analysed produced 871,000 QALYs with a NMB of £16 billion, allowing for the net NHS costs resulting from them and valuing a QALY at £25,000. The proportion of benefit attributable to United Kingdom research was 30% and the elapsed time between funding and impact of MSD treatments was 16 years. Our best estimate of the IRR from MSD-related research was 7%, which is similar to the 9% for CVD and 10% for cancer research. Our estimate of the IRR from the net health gain to public and charitable funding of MSD-related research in the United Kingdom is substantial, and justifies the research investments made between 1978 and 1997. We also demonstrated the applicability of the approach previously used in assessing the returns from cardiovascular and cancer research. Inevitably, with a study of this kind, there are a number of important assumptions and caveats that we highlight, and these can inform future research.

Cost-effectiveness analysis: role and implications.

PubMed

Marsden, G; Wonderling, D

2013-03-01

Cost-effectiveness analysis (CEA) is often misperceived to be a cost-cutting exercise. The intention of CEA is not to identify and implement cheap technologies, but rather those which offer maximum health gain, subject to available funds. Such analysis is crucial for decision making in health care, as tight budget constraints mean spending in one area of healthcare displaces spending elsewhere. Therefore in order to achieve the greatest health gain for the overall population, treatments must be selected which provide the greatest health gain within the available funds. The relevance of CEA in health care systems is explained, using varicose vein treatment in the UK NHS as an example. Treatment for varicose veins is often not commissioned to at a local level, most likely because it is misperceived to be a cosmetic problem. However, this view does not take into account the impact of quality of life. CEA balances costs against a quantitative measure of health related quality of life, and could therefore be used to determine whether it is cost-effective to provide varicose vein treatment. The current literature on the cost-effectiveness of varicose vein treatment is reviewed, and an overview of cost-effectiveness principles is provided. Concepts such as economic modelling, incremental cost-effectiveness ratios (ICERs), net monetary benefit (NMB) and sensitivity analysis are explained, using examples relevant to varicose veins where appropriate. This article explains how, far from cutting costs and sacrificing patient health, CEA provides a useful tool to maximise the health of the population in the face of ever tightening budget constraints. CEA could be used to compare the cost-effectiveness of the various treatment options for varicose veins, and efficiencies realised.

Implementing Generalized Additive Models to Estimate the Expected Value of Sample Information in a Microsimulation Model: Results of Three Case Studies.

PubMed

Rabideau, Dustin J; Pei, Pamela P; Walensky, Rochelle P; Zheng, Amy; Parker, Robert A

2018-02-01

The expected value of sample information (EVSI) can help prioritize research but its application is hampered by computational infeasibility, especially for complex models. We investigated an approach by Strong and colleagues to estimate EVSI by applying generalized additive models (GAM) to results generated from a probabilistic sensitivity analysis (PSA). For 3 potential HIV prevention and treatment strategies, we estimated life expectancy and lifetime costs using the Cost-effectiveness of Preventing AIDS Complications (CEPAC) model, a complex patient-level microsimulation model of HIV progression. We fitted a GAM-a flexible regression model that estimates the functional form as part of the model fitting process-to the incremental net monetary benefits obtained from the CEPAC PSA. For each case study, we calculated the expected value of partial perfect information (EVPPI) using both the conventional nested Monte Carlo approach and the GAM approach. EVSI was calculated using the GAM approach. For all 3 case studies, the GAM approach consistently gave similar estimates of EVPPI compared with the conventional approach. The EVSI behaved as expected: it increased and converged to EVPPI for larger sample sizes. For each case study, generating the PSA results for the GAM approach required 3 to 4 days on a shared cluster, after which EVPPI and EVSI across a range of sample sizes were evaluated in minutes. The conventional approach required approximately 5 weeks for the EVPPI calculation alone. Estimating EVSI using the GAM approach with results from a PSA dramatically reduced the time required to conduct a computationally intense project, which would otherwise have been impractical. Using the GAM approach, we can efficiently provide policy makers with EVSI estimates, even for complex patient-level microsimulation models.

Cost-utility of a specific collaborative group intervention for patients with functional somatic syndromes.

PubMed

Konnopka, Alexander; König, Hans-Helmut; Kaufmann, Claudia; Egger, Nina; Wild, Beate; Szecsenyi, Joachim; Herzog, Wolfgang; Schellberg, Dieter; Schaefert, Rainer

2016-11-01

Collaborative group intervention (CGI) in patients with functional somatic syndromes (FSS) has been shown to improve mental quality of life. To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS. An economic evaluation alongside a cluster-randomised controlled trial was performed. 35 general practitioners (GPs) recruited 300 FSS patients. Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline. Costs were assessed via questionnaire. Quality adjusted life years (QALYs) were calculated using the SF-6D index, derived from the 36-item short-form health survey (SF-36). We calculated patients' net-monetary-benefit (NMB), estimated the treatment effect via regression, and generated cost-effectiveness acceptability curves. Using intention-to-treat analysis, total costs during the 12-month study period were 5777EUR in the intervention, and 6858EUR in the control group. Controlling for possible confounders, we found a small, but significant positive intervention effect on QALYs (+0.017; p=0.019) and an insignificant cost saving resulting from a cost-increase in the control group (-10.5%; p=0.278). NMB regression showed that the probability of CGI to be cost-effective was 69% for a willingness to pay (WTP) of 0EUR/QALY, increased to 92% for a WTP of 50,000EUR/QALY and reached the level of 95% at a WTP of 70,375EUR/QALY. Subgroup analyses yielded that CGI was only cost-effective in severe somatic symptom severity (PHQ-15≥15). CGI has a high probability to be a cost-effective treatment for FSS, in particular for patients with severe somatic symptom severity. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost-effectiveness of a multicomponent primary care program targeting frail elderly people.

PubMed

Ruikes, Franca G H; Adang, Eddy M; Assendelft, Willem J J; Schers, Henk J; Koopmans, Raymond T C M; Zuidema, Sytse U

2018-05-16

Over the last 20 years, integrated care programs for frail elderly people aimed to prevent functional dependence and reduce hospitalization and institutionalization. However, results have been inconsistent and merely modest. To date, evidence on the cost-effectiveness of these programs is scarce. We evaluated the cost-effectiveness of the CareWell program, a multicomponent integrated care program for frail elderly people. Economic evaluation from a healthcare perspective embedded in a cluster controlled trial of 12 months in 12 general practices in (the region of) Nijmegen. Two hundred and four frail elderly from 6 general practices in the intervention group received care according to the CareWell program, consisting of multidisciplinary team meetings, proactive care planning, case management, and medication reviews; 165 frail elderly from 6 general practices in the control group received usual care. In cost-effectiveness analyses, we related costs to daily functioning (Katz-15 change score i.e. follow up score minus baseline score) and quality adjusted life years (EQ-5D-3 L). Adjusted mean costs directly related to the intervention were €456 per person. Adjusted mean total costs, i.e. intervention costs plus healthcare utilization costs, were €1583 (95% CI -4647 to 1481) higher in the intervention group than in the control group. Incremental Net Monetary Benefits did not show significant differences between groups, but on average tended to favour usual care. The CareWell primary program was not cost-effective after 12 months. From a cost-effectiveness perspective, widespread implementation of the program in its current form cannot be recommended. The study was registered in the ClinicalTrials.govProtocol Registration System: ( NCT01499797 ; December 26, 2011). Retrospectively registered.

The effect of changes in hospital reimbursement on nurse staffing decisions at safety net and nonsafety net hospitals.

PubMed

Lindrooth, Richard C; Bazzoli, Gloria J; Needleman, Jack; Hasnain-Wynia, Romana

2006-06-01

The financial savings from the Balanced Budget Act (BBA) are attractive to policy makers, but such savings come at a cost. We measure changes in nurse staffing at hospitals related to potential declines in reimbursement through the BBA. Following Hadley, Zuckerman, and Feder (1989), we define a fiscal pressure index (FPI) to measure the differential effect of the BBA. We estimate the effect of the FPI on the number of full-time equivalent registered nurses (RN) and licensed practical nurses (LPN) per adjusted patient day using American Hospital Association (AHA) data of a panel of hospitals from 1996 to 2001. The AHA data are combined with the Area Resource Files and health maintenance organizations penetration data. We control for hospital heterogeneity using fixed effects. All urban short-term general hospitals that responded to the staffing and uncompensated care questions in the AHA survey between 1996 and 2001. We define safety net hospitals as those with a high ratio of uncompensated costs to total hospital expenses (see, e.g., Zuckerman et al. 2001). We find that the nonsafety net hospitals that were most susceptible to the provisions of the BBA experienced a decline in RN staffing ratios about twice the rate of the nonsafety net hospitals that were least susceptible to the BBA. We are unable to detect an effect of the BBA on staffing at safety net hospitals. RN and LPN staffing levels per adjusted patient day declined, on average, between 1996 and 2001. Within the context of the general decline, we find that RN staffing per adjusted patient day declined even more at nonsafety net hospitals that were most susceptible to lower reimbursement related to the BBA. Thus, there was a small but statistically significant incremental effect of potential BBA losses on RN staffing at hospitals that were expected to be affected most. This incremental decline represented about a 6 percent increase in nurse workload that in isolation might not affect quality. Nevertheless, the BBA contributed to the contemporaneous trends toward higher nurse workloads that could have deleterious effects on quality. In contrast, safety net hospitals did not respond to the provisions of the BBA by reducing staffing ratios. This conclusion is tempered by the fact that we have few safety net hospitals in the sample.

Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling.

PubMed

Borisenko, Oleg; Mann, Oliver; Duprée, Anna

2017-08-03

The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective. State-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€). Over 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs. Bariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.

Comparing cost-effectiveness of X-Stop with minimally invasive decompression in lumbar spinal stenosis: a randomized controlled trial.

PubMed

Lønne, Greger; Johnsen, Lars Gunnar; Aas, Eline; Lydersen, Stian; Andresen, Hege; Rønning, Roar; Nygaard, Øystein P

2015-04-15

Randomized clinical trial with 2-year follow-up. To compare the cost-effectiveness of X-stop to minimally invasive decompression in patients with symptomatic lumbar spinal stenosis. Lumbar spinal stenosis is the most common indication for operative treatment in elderly. Although surgery is more costly than nonoperative treatment, health outcomes for more than 2 years were shown to be significantly better. Surgical treatment with minimally invasive decompression is widely used. X-stop is introduced as another minimally invasive technique showing good results compared with nonoperative treatment. We enrolled 96 patients aged 50 to 85 years, with symptoms of neurogenic intermittent claudication within 250-m walking distance and 1- or 2-level lumbar spinal stenosis, randomized to either minimally invasive decompression or X-stop. Quality-adjusted life-years were based on EuroQol EQ-5D. The hospital unit costs were estimated by means of the top-down approach. Each cost unit was converted into a monetary value by dividing the overall cost by the amount of cost units produced. The analysis of costs and health outcomes is presented by the incremental cost-effectiveness ratio. The study was terminated after a midway interim analysis because of significantly higher reoperation rate in the X-stop group (33%). The incremental cost for X-stop compared with minimally invasive decompression was &OV0556;2832 (95% confidence interval: 1886-3778), whereas the incremental health gain was 0.11 quality-adjusted life-year (95% confidence interval: -0.01 to 0.23). Based on the incremental cost and effect, the incremental cost-effectiveness ratio was &OV0556;25,700. The majority of the bootstrap samples displayed in the northeast corner of the cost-effectiveness plane, giving a 50% likelihood that X-stop is cost-effective at the extra cost of &OV0556;25,700 (incremental cost-effectiveness ratio) for a quality-adjusted life-year. The significantly higher cost of X-stop is mainly due to implant cost and the significantly higher reoperation rate. 2.

Acid retention with reduced glomerular filtration rate increases urine biomarkers of kidney and bone injury.

PubMed

Wesson, Donald E; Pruszynski, Jessica; Cai, Wendy; Simoni, Jan

2017-04-01

Diets high in acid of developed societies that do not cause metabolic acidosis in patients with chronic kidney disease nevertheless appear to cause acid retention with associated morbidity, particularly in those with reduced glomerular filtration rate. Here we used a rat 2/3 nephrectomy model of chronic kidney disease to study induction and maintenance of acid retention and its consequences on indicators of kidney and bone injury. Dietary acid was increased in animals eating base-producing soy protein with acid-producing casein and in casein-eating animals with added ammonium chloride. Using microdialysis to measure the kidney cortical acid content, we found that nephrectomized animals had greater acid retention than sham-operated animals when both ate the soy diet. Each increment in dietary acid further increased acid retention more in nephrectomized than in sham rats. Nephrectomized and sham animals achieved similar steady-state daily urine net acid excretion in response to increments in dietary acid but nephrectomized animals took longer to do so, contributing to greater acid retention that was maintained until the increased dietary acid was stopped. Acid retention was associated with increased urine excretion of both N-acetyl-β-D-glucosaminidase and deoxypyridinoline, greater in nephrectomized than control rats, consistent with kidney tubulointerstitial and bone matrix injury, respectively. Greater acid retention in nephrectomized than control animals was induced by a slower increase in urinary net acid excretion rate in response to the increment in dietary acid and also maintained until the dietary acid increment was stopped. Thus, acid retention increased biomarkers of kidney and bone injury in the urine, supporting untoward consequences to these two tissues. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Economic analysis of the global polio eradication initiative.

PubMed

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

2010-12-16

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

Net reclassification index at event rate: properties and relationships.

PubMed

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

2017-12-10

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

The net effect of smoking on healthcare and welfare costs. A cohort study.

PubMed

Tiihonen, Jari; Ronkainen, Kimmo; Kangasharju, Aki; Kauhanen, Jussi

2012-01-01

To study the net economic effect of smoking on society. Prospective cohort study. Eastern Finland. We studied mortality, paid income and tobacco taxes, and the cumulative costs due to pensions and medical care among tobacco smoking and non-smoking individuals in a 27-year prospective cohort study of 1976 men from Eastern Finland. These individuals were 54-60 years old at the beginning of the follow-up. The net contribution of smoking versus non-smoking individuals to public finance balance (euros). Smoking was associated with a greater mean annual healthcare cost of €1600 per living individual during follow-up. However, due to a shorter lifespan of 8.6 years, smokers' mean total healthcare costs during the entire study period were actually €4700 lower than for non-smokers. For the same reason, each smoker missed 7.3 years (€126 850) of pension. Overall, smokers' average net contribution to the public finance balance was €133 800 greater per individual compared with non-smokers. However, if each lost quality adjusted life year is considered to be worth €22 200, the net effect is reversed to be €70 200 (€71.600 when adjusted with propensity score) per individual in favour of non-smoking. Smoking was associated with a moderate decrease in healthcare costs, and a marked decrease in pension costs due to increased mortality. However, when a monetary value for life years lost was taken into account, the beneficial net effect of non-smoking to society was about €70 000 per individual.

Comparison of Timed Automata with Discrete Event Simulation for Modeling of Biomarker-Based Treatment Decisions: An Illustration for Metastatic Castration-Resistant Prostate Cancer.

PubMed

Degeling, Koen; Schivo, Stefano; Mehra, Niven; Koffijberg, Hendrik; Langerak, Rom; de Bono, Johann S; IJzerman, Maarten J

2017-12-01

With the advent of personalized medicine, the field of health economic modeling is being challenged and the use of patient-level dynamic modeling techniques might be required. To illustrate the usability of two such techniques, timed automata (TA) and discrete event simulation (DES), for modeling personalized treatment decisions. An early health technology assessment on the use of circulating tumor cells, compared with prostate-specific antigen and bone scintigraphy, to inform treatment decisions in metastatic castration-resistant prostate cancer was performed. Both modeling techniques were assessed quantitatively, in terms of intermediate outcomes (e.g., overtreatment) and health economic outcomes (e.g., net monetary benefit). Qualitatively, among others, model structure, agent interactions, data management (i.e., importing and exporting data), and model transparency were assessed. Both models yielded realistic and similar intermediate and health economic outcomes. Overtreatment was reduced by 6.99 and 7.02 weeks by applying circulating tumor cell as a response marker at a net monetary benefit of -€1033 and -€1104 for the TA model and the DES model, respectively. Software-specific differences were observed regarding data management features and the support for statistical distributions, which were considered better for the DES software. Regarding method-specific differences, interactions were modeled more straightforward using TA, benefiting from its compositional model structure. Both techniques prove suitable for modeling personalized treatment decisions, although DES would be preferred given the current software-specific limitations of TA. When these limitations are resolved, TA would be an interesting modeling alternative if interactions are key or its compositional structure is useful to manage multi-agent complex problems. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial.

PubMed

Sturkenboom, Ingrid H W M; Hendriks, Jan C M; Graff, Maud J L; Adang, Eddy M M; Munneke, Marten; Nijhuis-van der Sanden, Maria W G; Bloem, Bastiaan R

2015-07-01

A large randomized clinical trial (the Occupational Therapy in Parkinson's Disease [OTiP] study) recently demonstrated that home-based occupational therapy improves perceived performance in daily activities of people with Parkinson's disease (PD). The aim of the current study was to evaluate the cost-effectiveness of this intervention. We performed an economic evaluation over a 6-month period for both arms of the OTiP study. Participants were 191 community-dwelling PD patients and 180 primary caregivers. The intervention group (n = 124 patients) received 10 weeks of home-based occupational therapy; the control group (n = 67 patients) received usual care (no occupational therapy). Costs were assessed from a societal perspective including healthcare use, absence from work, informal care, and intervention costs. Health utilities were evaluated using EuroQol-5d. We estimated cost differences and cost utility using linear mixed models and presented the net monetary benefit at different values for willingness to pay per quality-adjusted life-year gained. In our primary analysis, we excluded informal care hours because of substantial missing data for this item. The estimated mean total costs for the intervention group compared with controls were €125 lower for patients, €29 lower for caregivers, and €122 higher for patient-caregiver pairs (differences not significant). At a value of €40,000 per quality-adjusted life-year gained (reported threshold for PD), the net monetary benefit of the intervention per patient was €305 (P = 0.74), per caregiver €866 (P = 0.01) and per patient-caregiver pair €845 (P = 0.24). In conclusion, occupational therapy did not significantly impact on total costs compared with usual care. Positive cost-effectiveness of the intervention was only significant for caregivers. © 2015 International Parkinson and Movement Disorder Society.

Ecological compensation and Environmental Impact Assessment in Spain

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

Villarroya, Ana, E-mail: avillarroya@alumni.unav.e; Puig, Jordi, E-mail: jpbaguer@unav.e

2010-11-15

To achieve meaningful sustainable development, Environmental Impact Assessment (EIA) should avoid the net losses in the environment resource base. But EIA practice does not always avoid the losses caused by the implementation of the projects under EIA regulation. Some environmental impacts are, simply, admitted, even without enforcing any form of compensation. When applied, compensation is sometimes just a monetary payment to offset the environmental loss. This paper looks for evidence on the role that compensation is given at present in EIA practice in Spain, and for some of its conceptual and regulatory roots. Specifically, it explores how compensation is addressedmore » in 1302 records of decision (RODs) on those projects subject to the Spanish EIA regulation published during the years 2006 and 2007, to know how far Spain is from preserving the environmental resource base managed through this particular aspect of EIA practice. As a result, it is concluded that the practice of ecological compensation in EIA in Spain is much lower than it could be expected in a theoretical sustainability context committed to avoid net losses in the environment resource base, mainly due to an EIA practice focused on on-site mitigation that allows these net losses.« less

Integrating Monetary and Non-monetary Reenlistment Incentives Utilizing the Combinatorial Retention Auction Mechanism (CRAM)

DTIC Science & Technology

2008-12-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS INTEGRATING MONETARY AND NON-MONETARY REENLISTMENT INCENTIVES UTILIZING THE...Monetary and Non- monetary Reenlistment Incentives Utilizing the Combinatorial Retention Auction Mechanism (CRAM) 6. AUTHOR(S) Brooke Zimmerman 5...iii Approved for public release; distribution is unlimited INTEGRATING MONETARY AND NON-MONETARY REENLISTMENT INCENTIVES UTILIZING THE

Transformation of the Urban Health Care Safety Net: The Devolution of a Public Responsibility.

PubMed

Kulesher, Robert

2015-01-01

Reduced spending in both federal and state programs and the closure of public hospitals have serious consequences for the health of urban dwellers, especially the poor and uninsured. Through a combination of economic factors, many municipalities have formed public-private partnerships and launched community initiatives to preserve some of the elements of the health care safety net. What once was a responsibility of municipal governments, the provision of health care to poor and uninsured populations, is now posing challenges for private-sector providers. This article identifies several factors that have contributed to the incremental demise of the publicly funded urban health care safety net and how local entities and the federal government are responding to the care of the poor and uninsured.

Cost-effectiveness of everolimus vs sunitinib in treating patients with advanced, progressive pancreatic neuroendocrine tumors in the United States.

PubMed

Casciano, Roman; Chulikavit, Maruit; Perrin, Allison; Liu, Zhimei; Wang, Xufang; Garrison, Louis P

2012-01-01

Everolimus (Afinitor) and sunitinib (Sutent) were recently approved to treat patients with advanced, progressive pancreatic neuroendocrine tumors (pNETs). (Afinitor is a registered trademark of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; Sutent is a registered trademark of Pfizer Inc., New York, NY, USA.) This analysis examined the projected cost-effectiveness of everolimus vs sunitinib in this setting from a US payer perspective. A semi-Markov model was developed to simulate a cohort of patients with advanced, progressive pNET and to estimate the cost per life-year gained (LYG) and per quality-adjusted life-year (QALY) gained when treating with everolimus vs sunitinib. Efficacy data were based on a weight-adjusted indirect comparison of the agents using phase 3 trial data. Model health states included: stable disease with no adverse events, stable disease with adverse events, disease progression, and death. Therapy costs were based on wholesale acquisition cost. Other costs such as physician visits, tests, hospitalizations, and adverse event costs were obtained from literature and/or primary research. Utility inputs were based on primary research. Sensitivity analyses were conducted to test the model's robustness. In the base-case analysis, everolimus was associated with an incremental 0.448 LYG (0.304 QALYs) at an incremental cost of $12,673, resulting in an incremental cost-effectiveness ratio (ICER) of $28,281/LYG ($41,702/QALY gained). The ICER fell within the cost per QALY range for many widely used oncology drugs. Sensitivity analyses demonstrated that, overall, there is a trend that everolimus is cost-effective compared to sunitinib in this setting. Results of the indirect analysis were not statistically significant (p > 0.05). Assumptions that treatment patterns are the same across therapies may not represent real-world practice. While the analysis is limited by its reliance on an indirect comparison of two phase 3 studies, everolimus is expected to be cost-effective relative to sunitinib in advanced, progressive pNET.

Revised Framingham Stroke Risk Score, Nontraditional Risk Markers, and Incident Stroke in a Multiethnic Cohort.

PubMed

Flueckiger, Peter; Longstreth, Will; Herrington, David; Yeboah, Joseph

2018-02-01

Limited data exist on the performance of the revised Framingham Stroke Risk Score (R-FSRS) and the R-FSRS in conjunction with nontraditional risk markers. We compared the R-FSRS, original FSRS, and the Pooled Cohort Equation for stroke prediction and assessed the improvement in discrimination by nontraditional risk markers. Six thousand seven hundred twelve of 6814 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) were included. Cox proportional hazard, area under the curve, net reclassification improvement, and integrated discrimination increment analysis were used to assess and compare each stroke prediction risk score. Stroke was defined as fatal/nonfatal strokes (hemorrhagic or ischemic). After mean follow-up of 10.7 years, 231 of 6712 (3.4%) strokes were adjudicated (2.7% ischemic strokes). Mean stroke risks using the R-FSRS, original FSRS, and Pooled Cohort Equation were 4.7%, 5.9%, and 13.5%. The R-FSRS had the best calibration (Hosmer-Lemeshow goodness-of-fit, χ 2 =6.55; P =0.59). All risk scores were predictive of incident stroke. C statistics of R-FSRS (0.716) was similar to Pooled Cohort Equation (0.716), but significantly higher than the original FSRS (0.653; P =0.01 for comparison with R-FSRS). Adding nontraditional risk markers individually to the R-FSRS did not improve discrimination of the R-FSRS in the area under the curve analysis, but did improve category-less net reclassification improvement and integrated discrimination increment for incident stroke. The addition of coronary artery calcium to R-FSRS produced the highest category-less net reclassification improvement (0.36) and integrated discrimination increment (0.0027). Similar results were obtained when ischemic strokes were used as the outcome. The R-FSRS downgraded stroke risk but had better calibration and discriminative ability for incident stroke compared with the original FSRS. Nontraditional risk markers modestly improved the discriminative ability of the R-FSRS, with coronary artery calcium performing the best. © 2018 American Heart Association, Inc.

Value of Excess Pressure Integral for Predicting 15-Year All-Cause and Cardiovascular Mortalities in End-Stage Renal Disease Patients.

PubMed

Huang, Jui-Tzu; Cheng, Hao-Min; Yu, Wen-Chung; Lin, Yao-Ping; Sung, Shih-Hsien; Wang, Jiun-Jr; Wu, Chung-Li; Chen, Chen-Huan

2017-11-29

The excess pressure integral (XSPI), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high-risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long-term mortality in end-stage renal disease patients undergoing regular hemodialysis. A total of 267 uremic patients (50.2% female; mean age 54.2±14.9 years) receiving regular hemodialysis for more than 6 months were enrolled. Cardiovascular parameters were obtained by echocardiography and applanation tonometry. Calibrated carotid arterial pressure waveforms were analyzed according to the wave-transmission and reservoir-wave theories. Multivariable Cox proportional hazard models were constructed to account for age, sex, diabetes mellitus, albumin, body mass index, and hemodialysis treatment adequacy. Incremental utility of the parameters to risk stratification was assessed by net reclassification improvement. During a median follow-up of 15.3 years, 124 deaths (46.4%) incurred. Baseline XSPI was significantly predictive of all-cause (hazard ratio per 1 SD 1.4, 95% confidence interval 1.15-1.70, P =0.0006) and cardiovascular mortalities (1.47, 1.18-1.84, P =0.0006) after accounting for the covariates. The addition of XSPI to the base prognostic model significantly improved prediction of both all-cause mortality (net reclassification improvement=0.1549, P =0.0012) and cardiovascular mortality (net reclassification improvement=0.1535, P =0.0033). XSPI was superior to carotid-pulse wave velocity, forward and backward wave amplitudes, and left ventricular ejection fraction in consideration of overall independent and incremental prognostics values. In end-stage renal disease patients undergoing regular hemodialysis, XSPI was significantly predictive of long-term mortality and demonstrated an incremental value to conventional prognostic factors. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

A benefit-cost analysis of retrofitting diesel vehicles with particulate filters in the Mexico City metropolitan area.

PubMed

Stevens, Gretchen; Wilson, Andrew; Hammitt, James K

2005-08-01

In the Mexico City metropolitan area, poor air quality is a public health concern. Diesel vehicles contribute significantly to the emissions that are most harmful to health. Harmful diesel emissions can be reduced by retrofitting vehicles with one of several technologies, including diesel particulate filters. We quantified the social costs and benefits, including health benefits, of retrofitting diesel vehicles in Mexico City with catalyzed diesel particulate filters, actively regenerating diesel particulate filters, or diesel oxidation catalysts, either immediately or in 2010, when capital costs are expected to be lower. Retrofit with either type of diesel particulate filter or an oxidation catalyst is expected to provide net benefits to society beginning immediately and in 2010. At current prices, retrofit with an oxidation catalyst provides greatest net benefits. However, as capital costs decrease, retrofit with diesel particulate filters is expected to provide greater net benefits. In both scenarios, retrofit of older, dirtier vehicles that circulate only within the city provides greatest benefits, and retrofit with oxidation catalysts provides greater health benefits per dollar spent than retrofit with particulate filters. Uncertainty about the magnitude of net benefits of a retrofit program is significant. Results are most sensitive to values used to calculate benefits, such as the concentration-response coefficient, intake fraction (a measure of exposure), and the monetary value of health benefits.

Cost-benefit evaluation of a decentralized water system for wastewater reuse and environmental protection.

PubMed

Chen, R; Wang, X C

2009-01-01

This paper proposed a net benefit value (NBV) model for cost-benefit evaluation of wastewater treatment and reuse projects, and attention was mainly paid to decentralized systems which are drawing wide interests all over the world especially in the water-deficient countries and regions. In the NBV model, all the factors related to project costs are monetary ones which can be calculated by using traditional methods, while many of the factors related to project benefits are non-monetary ones which need sophisticated methods for monetization. In this regard, the authors elaborated several methods for monetization of the benefits from wastewater discharge reduction, local environment improvement, and human health protection. The proposed model and methods were applied for the cost-benefit evaluation of a decentralized water reclamation and reuse project in a newly developed residential area in Xi'an, China. The system with dual-pipe collection and grey water treatment and reuse was found to be economically ineligible (NBV > 0) when all the treated water is reused for artificial pond replenishment, gardening and other non-potable purposes by taking into account the benefit of water saving. As environmental benefits are further considered, the economic advantage of the project is more significant.

Punitive preferences, monetary incentives and tacit coordination in the punishment of defectors promote cooperation in humans

PubMed Central

Diekmann, Andreas; Przepiorka, Wojtek

2015-01-01

Peer-punishment is effective in promoting cooperation, but the costs associated with punishing defectors often exceed the benefits for the group. It has been argued that centralized punishment institutions can overcome the detrimental effects of peer-punishment. However, this argument presupposes the existence of a legitimate authority and leaves an unresolved gap in the transition from peer-punishment to centralized punishment. Here we show that the origins of centralized punishment could lie in individuals’ distinct ability to punish defectors. In our laboratory experiment, we vary the structure of the punishment situation to disentangle the effects of punitive preferences, monetary incentives, and individual punishment costs on the punishment of defectors. We find that actors tacitly coordinate on the strongest group member to punish defectors, even if the strongest individual incurs a net loss from punishment. Such coordination leads to a more effective and more efficient provision of a cooperative environment than we observe in groups of all equals. Our results show that even an arbitrary assignment of an individual to a focal position in the social hierarchy can trigger the endogenous emergence of more centralized forms of punishment. PMID:25988875

Costs and Consequences of a Cash Transfer for Hospital Births in a Rural District of Uttar Pradesh, India

PubMed Central

Coffey, Diane

2014-01-01

The Janani Suraksha Yojana, India’s “safe motherhood program,” is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program’s apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. PMID:24911512

Punitive preferences, monetary incentives and tacit coordination in the punishment of defectors promote cooperation in humans

NASA Astrophysics Data System (ADS)

Diekmann, Andreas; Przepiorka, Wojtek

2015-05-01

Peer-punishment is effective in promoting cooperation, but the costs associated with punishing defectors often exceed the benefits for the group. It has been argued that centralized punishment institutions can overcome the detrimental effects of peer-punishment. However, this argument presupposes the existence of a legitimate authority and leaves an unresolved gap in the transition from peer-punishment to centralized punishment. Here we show that the origins of centralized punishment could lie in individuals’ distinct ability to punish defectors. In our laboratory experiment, we vary the structure of the punishment situation to disentangle the effects of punitive preferences, monetary incentives, and individual punishment costs on the punishment of defectors. We find that actors tacitly coordinate on the strongest group member to punish defectors, even if the strongest individual incurs a net loss from punishment. Such coordination leads to a more effective and more efficient provision of a cooperative environment than we observe in groups of all equals. Our results show that even an arbitrary assignment of an individual to a focal position in the social hierarchy can trigger the endogenous emergence of more centralized forms of punishment.

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

PubMed

Coffey, Diane

2014-08-01

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Punitive preferences, monetary incentives and tacit coordination in the punishment of defectors promote cooperation in humans.

PubMed

Diekmann, Andreas; Przepiorka, Wojtek

2015-05-19

Peer-punishment is effective in promoting cooperation, but the costs associated with punishing defectors often exceed the benefits for the group. It has been argued that centralized punishment institutions can overcome the detrimental effects of peer-punishment. However, this argument presupposes the existence of a legitimate authority and leaves an unresolved gap in the transition from peer-punishment to centralized punishment. Here we show that the origins of centralized punishment could lie in individuals' distinct ability to punish defectors. In our laboratory experiment, we vary the structure of the punishment situation to disentangle the effects of punitive preferences, monetary incentives, and individual punishment costs on the punishment of defectors. We find that actors tacitly coordinate on the strongest group member to punish defectors, even if the strongest individual incurs a net loss from punishment. Such coordination leads to a more effective and more efficient provision of a cooperative environment than we observe in groups of all equals. Our results show that even an arbitrary assignment of an individual to a focal position in the social hierarchy can trigger the endogenous emergence of more centralized forms of punishment.

The net effect of smoking on healthcare and welfare costs. A cohort study

PubMed Central

Tiihonen, Jari; Ronkainen, Kimmo; Kangasharju, Aki; Kauhanen, Jussi

2012-01-01

Objective To study the net economic effect of smoking on society. Design Prospective cohort study. Setting Eastern Finland. Patients We studied mortality, paid income and tobacco taxes, and the cumulative costs due to pensions and medical care among tobacco smoking and non-smoking individuals in a 27-year prospective cohort study of 1976 men from Eastern Finland. These individuals were 54–60 years old at the beginning of the follow-up. Main outcome measures The net contribution of smoking versus non-smoking individuals to public finance balance (euros). Results Smoking was associated with a greater mean annual healthcare cost of €1600 per living individual during follow-up. However, due to a shorter lifespan of 8.6 years, smokers’ mean total healthcare costs during the entire study period were actually €4700 lower than for non-smokers. For the same reason, each smoker missed 7.3 years (€126 850) of pension. Overall, smokers’ average net contribution to the public finance balance was €133 800 greater per individual compared with non-smokers. However, if each lost quality adjusted life year is considered to be worth €22 200, the net effect is reversed to be €70 200 (€71.600 when adjusted with propensity score) per individual in favour of non-smoking. Conclusions Smoking was associated with a moderate decrease in healthcare costs, and a marked decrease in pension costs due to increased mortality. However, when a monetary value for life years lost was taken into account, the beneficial net effect of non-smoking to society was about €70 000 per individual. PMID:23233699

Rotations

Treesearch

John R. Jones; Wayne D. Shepperd

1985-01-01

The rotation, in forestry, is the planned number of years between formation of a crop or stand and its final harvest at a specified stage of maturity (Ford-Robertson 1971). The rotation used for many species is the age of culmination of mean usable volume growth [net mean annual increment (MAI)]. At that age, usable volume divided by age reaches its highest level. That...

FY 1979 Unit Cost Analysis for the Public Community Colleges of Illinois.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

A unit cost analysis for fiscal year (FY) 1979 was conducted by the Illinois Community College Board using mid-term enrollment data and uniform accounting information from each of the state's 51 community colleges. Unit costs for instructional areas were determined at three incremental levels: (1) net instructional cost (NIC), which includes…

Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study.

PubMed

Fitzgerald, Sarah; Murphy, Aileen; Kirby, Ann; Geaney, Fiona; Perry, Ivan J

2018-03-03

To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Four multinational manufacturing workplaces in Cork, Ireland. 517 randomly selected employees (18-65 years) from four workplaces. Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost-benefit analysis, whereby the system-level intervention yields the highest net benefit (€56.56 per employee). System-level dietary modification alone offers the most value per improving employee health-related quality of life and generating net benefit for employers by reducing absenteeism. While system-level dietary modification strategies are potentially sustainable obesity prevention interventions, future research should include long-term outcomes to determine if improvements in outcomes persist. ISRCTN35108237; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact assessment of climate change and human activities on net runoff in the Yellow River Basin from 1951 to 2012

NASA Astrophysics Data System (ADS)

Kong, D.

2017-12-01

Runoff in the Yellow River Basin (YRB) has changed constantly during the past six decades. This study investigates the features of variations in runoff increment in the YRB and evaluates the impact of climate change and human activities on the mean annual net runoff. Residual analysis based on double mass curves (RA-DMC) was performed to quantitatively assess the separate contributions of climate change and human activities to the changes in net runoff. There was a significant downward trend in annual net runoff for each of the Yellow River sub-basins. For the basin as a whole, net runoff decreased at a rate of 0.721 × 109 m3 yr-1, with the upper, middle, and lower sub-basins separately accounting for 28.4%, 40.5% and 31.1% of the decrease. Human activities were responsible for more than 90% of the change in runoff in each separate sub-basin between 1960 and 2012. For the entire YRB, 91.7% of the change in net runoff from baseline was attributed to human activities. This indicates that human activities have become the dominant factor in net runoff changes in the Yellow River Basin. Among the upper, middle, and lower reaches, the effect of human activities was greatest in the lower reaches.

Costs to Community Mental Health Agencies to Sustain an Evidence-Based Practice.

PubMed

Roundfield, Katrina D; Lang, Jason M

2017-09-01

Dissemination of evidence-based practices (EBPs) has become a priority in children's mental health services. Although implementation approaches and initiatives are proliferating, little is known about sustainment of EBPs, but evidence suggests that most EBPs are not sustained for more than a few years. Cost is the most frequently cited barrier to sustainment, yet very little is known about these costs. This study provides a method for quantifying incremental costs of an EBP compared with usual care and preliminary data on the costs in staff time, lost revenue, and other expenses of sustaining an EBP (trauma-focused cognitive-behavioral therapy [TF-CBT]) in community mental health settings. Fourteen community mental health agencies (CMHAs) completed a measure developed for this study to collect administrative data on implementation costs to sustain TF-CBT. Survey items captured activities that were related specifically to TF-CBT and that would not otherwise be conducted for usual care, such as TF-CBT training. Staff time in hours was converted to monetary estimates. Costs varied widely across agencies. Preliminary results indicated that agencies spent on average $65,192 per year (2014 U.S.$) on incremental costs for TF-CBT sustainment (excluding costs of external trainers and other support); the average incremental cost per client was $1,896. The costs to sustain the EBP suggest that maintaining an EBP is a financial burden for CMHAs and that these costs can be a potential barrier to broader EBP uptake. Implications for public policy include providing reimbursement rates and financial incentives to offset potential implementation costs and promote sustainment of EBPs.

Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes

PubMed Central

2014-01-01

Background Building on an approach developed to assess the economic returns to cardiovascular research, we estimated the economic returns from UK public and charitable funded cancer-related research that arise from the net value of the improved health outcomes. Methods To assess these economic returns from cancer-related research in the UK we estimated: 1) public and charitable expenditure on cancer-related research in the UK from 1970 to 2009; 2) net monetary benefit (NMB), that is, the health benefit measured in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of GB£25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1991 to 2010; 3) the proportion of NMB attributable to UK research; 4) the elapsed time between research funding and health gain; and 5) the internal rate of return (IRR) from cancer-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using sensitivity analyses to illustrate the effect of some key parameters. Results In 2011/12 prices, total expenditure on cancer-related research from 1970 to 2009 was £15 billion. The NMB of the 5.9 million QALYs gained from the prioritised interventions from 1991 to 2010 was £124 billion. Calculation of the IRR incorporated an estimated elapsed time of 15 years. We related 17% of the annual NMB estimated to be attributable to UK research (for each of the 20 years 1991 to 2010) to 20 years of research investment 15 years earlier (that is, for 1976 to 1995). This produced a best-estimate IRR of 10%, compared with 9% previously estimated for cardiovascular disease research. The sensitivity analysis demonstrated the importance of smoking reduction as a major source of improved cancer-related health outcomes. Conclusions We have demonstrated a substantive IRR from net health gain to public and charitable funding of cancer-related research in the UK, and further validated the approach that we originally used in assessing the returns from cardiovascular research. In doing so, we have highlighted a number of weaknesses and key assumptions that need strengthening in further investigations. Nevertheless, these cautious estimates demonstrate that the returns from past cancer research have been substantial, and justify the investments made during the period 1976 to 1995. PMID:24930803

The impact of economic evaluation on quality management in spine surgery

PubMed Central

2009-01-01

Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer’s monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits. PMID:19337760

The impact of economic evaluation on quality management in spine surgery.

PubMed

Boos, Norbert

2009-08-01

Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.

Benefits and costs of oil palm expansion in Central Kalimantan, Indonesia, under different policy scenarios.

PubMed

Sumarga, Elham; Hein, Lars

Deforestation and oil palm expansion in Central Kalimantan province are among the highest in Indonesia. This study examines the physical and monetary impacts of oil palm expansion in Central Kalimantan up to 2025 under three policy scenarios. Our modelling approach combines a spatial logistic regression model with a set of rules governing land use change as a function of the policy scenario. Our physical and monetary analyses include palm oil expansion and five other ecosystem services: timber, rattan, paddy rice, carbon sequestration, and orangutan habitat (the last service is analysed in physical units only). In monetary terms, our analysis comprises the contribution of land and ecosystems to economic production, as measured according to the valuation approach of the System of National Accounts. We focus our analysis on government-owned land which covers around 97 % of the province, where the main policy issues are. We show that, in the business-as-usual scenario, the societal costs of carbon emissions and the loss of other ecosystem services far exceed the benefits from increased oil palm production. This is, in particular, related to the conversion of peatlands. We also show that, for Central Kalimantan, the moratorium scenario, which is modelled based on the moratorium currently in place in Indonesia, generates important economic benefits compared to the business-as-usual scenario. In the moratorium scenario, however, there is still conversion of forest to plantation and associated loss of ecosystem services. We developed an alternative, sustainable production scenario based on an ecosystem services approach and show that this policy scenario leads to higher net social benefits including some more space for oil palm expansion.

Profitability of precommercially thinning oak stump sprouts

Treesearch

John P. Dwyer; Daniel C. Dey; William B. Kurtz

1993-01-01

Thinning oak stump sprouts to a single stem at an early age will increase diameter growth of the released stem. However, precommercial thinning represents a substantial investment which must be carried for many years before any returns are realized. We estimated the incremental gains in yield and the present net worth for five crop-tree release treatments of 5-year-old...

Permanent sample plots

Treesearch

Theodore S. Woolsey

1912-01-01

As early as 1906 the need for a systematic study of cut-over areas on the National Forests was keenly felt. It was impossible to predict to any degree of accuracy the net increment of the trees left after cutting, the height and diameter growth of individual trees, the death rate of some of the older trees nor was it possible to foretell the actual effect on...

Profitability of Precommericially Thinning Oak Stump Sprouts

Treesearch

John P. Dwyer; Daniel C. Dey; William B. Kurtz

1993-01-01

Thinning oak stump sprouts to a single stem at an early age will increase diameter growth of the released stem. However, percommercial thinning represents a substantial investment which must be carried for many years before any returns are realized. We estimated the incremental gains in yield and the present net worth for five crop-tree release treatments of 5-yr-old...

Estimating parameters of a forest ecosystem C model with measurements of stocks and fluxes as joint constraints

Treesearch

Andrew D. Richardson; Mathew Williams; David Y. Hollinger; David J.P. Moore; D. Bryan Dail; Eric A. Davidson; Neal A. Scott; Robert S. Evans; Holly. Hughes

2010-01-01

We conducted an inverse modeling analysis, using a variety of data streams (tower-based eddy covariance measurements of net ecosystem exchange, NEE, of CO2, chamber-based measurements of soil respiration, and ancillary ecological measurements of leaf area index, litterfall, and woody biomass increment) to estimate parameters and initial carbon (C...

Reproductive biology of Lutzomyia shannoni (Dyar) (Diptera: Psychodidae) under experimental conditions.

PubMed

Cárdenas, E; Ferro, C; Corredor, D; Martínez, O; Munstermann, L E

1999-12-01

Baseline biological growth data of Lutzomyia shannoni (Dyar) were compared under two experimental conditions within insulated styrofoam chests and in standard laboratory incubators. The developmental time from egg to adult was 67 and 52 days, respectively. Based on cohorts of 100 females in each experiment, horizontal life tables were constructed. The following predictive parameters were obtained under each of the two conditions: net rate of reproduction (23.5 and 18.0 females per cohort female), generation time (11.4 and 9.4 weeks), intrinsic rate of population increase (0.27 and 0.30), and finite rate of population increment (1.31 and 1.36). The reproductive value for each class age of the cohort females was calculated. The observed parameters were obtained under each experimental condition: net rate of reproduction (1.9 and 2.5 females per cohort female), generation time (11.7 and 9.6 weeks), intrinsic rate of population increase (0.05 and 0.09), and finite rate of population increment (1.06 and 1.10). Vertical life tables were elaborated and mortality was described for every generation in each cohort. In addition, for two successive generations, additive variance and heritability for fecundity were estimated.

A Conceptual Framework for Assessment of the Benefits of a Global Earth Observation System of Systems

NASA Astrophysics Data System (ADS)

Fritz, S.; Scholes, R. J.; Obersteiner, M.; Bouma, J.

2007-12-01

The aim of the Global Earth Observation System of Systems (GEOSS) is to contribute to human wellbeing though improving the information available to decision-makers at all levels relating to human health and safety, protection of the global environment, the reduction of losses from natural disasters, and achieving sustainable development. Specifically, GEOSS proposes that better international co-operation in the collection, interpretation and sharing of Earth Observation information is an important and cost-effective mechanism for achieving this aim. While there is a widespread intuition that this proposition is correct, at some point the following question needs to be answered: how much additional investment in Earth Observation (and specifically, in its international integration) is enough? This leads directly to some challenging subsidiary questions, such as how can the benefits of Earth Observation be assessed? What are the incremental costs of GEOSS? Are there societal benefit areas where the return on investment is higher than in others? The Geo-Bene project has developed a `benefit chain' concept as a framework for addressing these questions. The basic idea is that an incremental improvement in the observing system (including its data collection, interpretation and information-sharing aspects) will result in an improvement in the quality of decisions based on that information. This will in turn lead to better societal outcomes, which have a value. This incremental value must be judged against the incremental cost of the improved observation system. Since in many cases there will be large uncertainties in the estimation of both the costs and the benefits, and it may not be possible to express one or both of them in monetary terms, we show how order-of-magnitude approaches and a qualitative understanding of the shape of the cost-benefit curves can help guide rational investment decision in Earth Observation systems.

Innovation and Transformation in California’s Safety-net Healthcare Settings: An Inside Perspective

PubMed Central

Lyles, Courtney R.; Aulakh, Veenu; Jameson, Wendy; Schillinger, Dean; Yee, Hal; Sarkar, Urmimala

2016-01-01

Background Health reform requires safety-net settings to transform care delivery, but how they will innovate in order to achieve this transformation is unknown. Methods We conducted two series of key informant interviews (N= 28) in 2012 with leadership from both California’s public hospital systems and community health centers. Interviews focused on how innovation was conceptualized and solicited examples of successful innovations. Results In contrast to disruptive innovation, interviewees often defined innovation as improving implementation, making incremental changes, and promoting integration. Many leaders gave examples of existing innovative practices such as patient-centered approaches to meeting their diverse patient needs. Participants expressed challenges to adapting quickly, but a desire to partner together. Conclusions Safety-net systems have already begun implementing innovative practices supporting their key priority areas. However, more support is needed, specifically to accelerate the change needed to succeed under health reform. PMID:24170938

Greek's health, waiting for the 'deus ex machina'.

PubMed

Fanourgiakis, John; Kanoupakis, Emmanuel

2014-10-01

Greece from May 2010 has been following Troika's (European Commission, European Central Bank and International Monetary Fund) austere policies in all over the public finance sector. Troika's instructions which are adopted by the politicians resulted to depressed and weak citizens. The consequences in health care sector are becoming visible across the society. A big part of Greek's society is uninsured without any access to public health care system. The vulnerable social groups confront catastrophic health care expenditures and impoverishment with no social net protection. Greeks are paying the price of their irrational way of living. The current paper has gathered from the literature the early effects of the implementation of these policies on public health and healthcare.

EPIRUS-NET: A Wireless Health Telematics Network in Greece

DTIC Science & Technology

2001-10-25

has also to be made. The system is represented of three basic layers: the database layer, the middleware and the Hospital Daily Progress Anamnesis ... Anamnesis . The Encounter entry is uniquely identified by the incremental ID, IID, attribute. Each encounter entry is associated with a clinical...the main entities of the system (Hospital, Patient, Anamnesis , Encounter, Clinical Examination, Daily Progress, Examination, Release Ticket), along

Site productivity - current estimates, change, and possible enhancements for the Northern Research Station

Treesearch

Scott A. Pugh

2012-01-01

Site productivity (SP) is the inherent capacity to grow crops of industrial wood. SP identifies the potential growth in cubic feet/acre/year and is based on the culmination of mean annual increment of fully stocked natural stands. Changes in SP were summarized for timberland and the associated effects on net growth and removal estimates were investigated using data...

Volume growth trends in a Douglas-fir levels-of-growing-stock study.

Treesearch

Robert O. Curtis

2006-01-01

Mean curves of increment and yield in gross total cubic volume and net merchantable cubic volume were derived from seven installations of the regional cooperative Levels-of-Growing-Stock Study (LOGS) in Douglas-fir. The technique used reduces the seven curves for each treatment for each variable of interest to a single set of readily interpretable mean curves. To a top...

High yields from young-growth ponderosa pine.

Treesearch

Edwin L. Mowat

1947-01-01

A ponderosa pine stand growing at a net rate of 618 board feet per acre per year may be rather amazing to foresters accustomed to the proverbial slow growth of this species in the virgin forest. Yet that is the average increment for the last 6 years of a 102-year-old even-aged stand on Lookout Mountain in the Pringle Falls Experimental Forest in central Oregon. During...

Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting.

PubMed

Thein, Hla-Hla; Qiao, Yao; Zaheen, Ahmad; Jembere, Nathaniel; Sapisochin, Gonzalo; Chan, Kelvin K W; Yoshida, Eric M; Earle, Craig C

2017-01-01

Hepatocellular carcinoma (HCC) presentation is heterogeneous necessitating a variety of therapeutic interventions with varying efficacies and associated prognoses. Poor prognostic patients often undergo non-curative palliative interventions including transarterial chemoembolization (TACE), sorafenib, chemotherapy, or purely supportive care. The decision to pursue one of many palliative interventions for HCC is complex and an economic evaluation comparing these interventions has not been done. This study evaluates the cost-effectiveness of non-curative palliative treatment strategies such as TACE alone or TACE+sorafenib, sorafenib alone, and non-sorafenib chemotherapy compared with no treatment or best supportive care (BSC) among patients diagnosed with HCC between 2007 and 2010 in a Canadian setting. Using person-level data, we estimated effectiveness in life years and quality-adjusted life years (QALYs) along with total health care costs (2013 US dollars) from the health care payer's perspective (3% annual discount). A net benefit regression approach accounting for baseline covariates with propensity score adjustment was used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 1,172 identified patients diagnosed with HCC, 4.5%, 7.9%, and 5.6%, received TACE alone or TACE+sorafenib, sorafenib, and non-sorafenib chemotherapy clone, respectively. Compared with no treatment or BSC (81.9%), ICER estimates for TACE alone or TACE+sorafenib was $6,665/QALY (additional QALY: 0.47, additional cost: $3,120; 95% CI: -$18,800-$34,500/QALY). The cost-effectiveness acceptability curve demonstrated that if the relevant threshold was $50,000/QALY, TACE alone or TACE+sorafenib, non-sorafenib chemotherapy, and sorafenib alone, would have a cost-effectiveness probability of 99.7%, 46.6%, and 5.5%, respectively. Covariates associated with the incremental net benefit of treatments are age, sex, comorbidity, and cancer stage. Findings suggest that TACE with or without sorafenib is currently the most cost-effective active non-curative palliative treatment approach to HCC. Further research into new combination treatment strategies that afford the best tumor response is needed.

Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants.

PubMed

Ganapathy, Vaidyanathan; Hay, Joel W; Kim, Jae H

2012-02-01

This study evaluated the cost-effectiveness of a 100% human milk-based diet composed of mother's milk fortified with a donor human milk-based human milk fortifier (HMF) versus mother's milk fortified with bovine milk-based HMF to initiate enteral nutrition among extremely premature infants in the neonatal intensive care unit (NICU). A net expected costs calculator was developed to compare the total NICU costs among extremely premature infants who were fed either a bovine milk-based HMF-fortified diet or a 100% human milk-based diet, based on the previously observed risks of overall necrotizing enterocolitis (NEC) and surgical NEC in a randomized controlled study that compared outcomes of these two feeding strategies among 207 very low birth weight infants. The average NICU costs for an extremely premature infant without NEC and the incremental costs due to medical and surgical NEC were derived from a separate analysis of hospital discharges in the state of California in 2007. The sensitivity of cost-effectiveness results to the risks and costs of NEC and to prices of milk supplements was studied. The adjusted incremental costs of medical NEC and surgical NEC over and above the average costs incurred for extremely premature infants without NEC, in 2011 US$, were $74,004 (95% confidence interval, $47,051-$100,957) and $198,040 (95% confidence interval, $159,261-$236,819) per infant, respectively. Extremely premature infants fed with 100% human-milk based products had lower expected NICU length of stay and total expected costs of hospitalization, resulting in net direct savings of 3.9 NICU days and $8,167.17 (95% confidence interval, $4,405-$11,930) per extremely premature infant (p < 0.0001). Costs savings from the donor HMF strategy were sensitive to price and quantity of donor HMF, percentage reduction in risk of overall NEC and surgical NEC achieved, and incremental costs of surgical NEC. Compared with feeding extremely premature infants with mother's milk fortified with bovine milk-based supplements, a 100% human milk-based diet that includes mother's milk fortified with donor human milk-based HMF may result in potential net savings on medical care resources by preventing NEC.

Norepinephrine transporter inhibition alters the hemodynamic response to hypergravitation.

PubMed

Strempel, Sebastian; Schroeder, Christoph; Hemmersbach, Ruth; Boese, Andrea; Tank, Jens; Diedrich, André; Heer, Martina; Luft, Friedrich C; Jordan, Jens

2008-03-01

Sympathetically mediated tachycardia and vasoconstriction maintain blood pressure during hypergravitational stress, thereby preventing gravitation-induced loss of consciousness. Norepinephrine transporter (NET) inhibition prevents neurally mediated (pre)syncope during gravitational stress imposed by head-up tilt testing. Thus it seems reasonable that NET inhibition could increase tolerance to hypergravitational stress. We performed a double-blind, randomized, placebo-controlled crossover study in 11 healthy men (26 +/- 1 yr, body mass index 24 +/- 1 kg/m2), who ingested the selective NET inhibitor reboxetine (4 mg) or matching placebo 25, 13, and 1 h before testing on separate days. We monitored heart rate, blood pressure, and thoracic impedance in three different body positions (supine, seated, standing) and during a graded centrifuge run (incremental steps of 0.5 g for 3 min each, up to a maximal vertical acceleration load of 3 g). NET inhibition increased supine blood pressure and heart rate. With placebo, blood pressure increased in the seated position and was well maintained during standing. However, with NET inhibition, blood pressure decreased in the seated and standing position. During hypergravitation, blood pressure increased in a graded fashion with placebo. With NET inhibition, the increase in blood pressure during hypergravitation was profoundly diminished. Conversely, the tachycardic responses to sitting, standing, and hypergravitation all were greatly increased with NET inhibition. In contrast to our expectation, short-term NET inhibition did not improve tolerance to hypergravitation. Redistribution of sympathetic activity to the heart or changes in baroreflex responses could explain the excessive tachycardia that we observed.

Assessment of ecosystem productivity damage due to land use.

PubMed

Kaenchan, Piyanon; Guinée, Jeroen; Gheewala, Shabbir H

2018-04-15

Land use can affect ecosystems on land and their services. Because land use has mainly local effects, damage to ecosystem productivity due to land use should be modelled spatially dependent. Unfortunately, even though land use of impacts are particular importance for countries whose economies are highly agriculture-based, ecosystem productivity damage due to land use has not yet been assessed in Thailand so far. This study presents the method for assessing the damage to ecosystem productivity due to land use (land occupation and land transformation) in Thailand. Ecosystem productivity damage is expressed through net primary production (NPP). To convert the damage into monetary units, this study performs an economic valuation of NPP using the production function approach. The results show that the value of marginal product of NPP is around 10-15 Thai baht (THB) (1 USD≈36 THB), per tonne dry weight biomass. The results are applied to the case of biodiesel production. The method presented in this paper could be a guideline for future land use impact assessment research. In addition, converting the NPP damage results into monetary units facilitates integration of impact assessment and economic analysis results for supporting decision support tools such as cost benefit analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

Invariant-feature-based adaptive automatic target recognition in obscured 3D point clouds

NASA Astrophysics Data System (ADS)

Khuon, Timothy; Kershner, Charles; Mattei, Enrico; Alverio, Arnel; Rand, Robert

2014-06-01

Target recognition and classification in a 3D point cloud is a non-trivial process due to the nature of the data collected from a sensor system. The signal can be corrupted by noise from the environment, electronic system, A/D converter, etc. Therefore, an adaptive system with a desired tolerance is required to perform classification and recognition optimally. The feature-based pattern recognition algorithm architecture as described below is particularly devised for solving a single-sensor classification non-parametrically. Feature set is extracted from an input point cloud, normalized, and classifier a neural network classifier. For instance, automatic target recognition in an urban area would require different feature sets from one in a dense foliage area. The figure above (see manuscript) illustrates the architecture of the feature based adaptive signature extraction of 3D point cloud including LIDAR, RADAR, and electro-optical data. This network takes a 3D cluster and classifies it into a specific class. The algorithm is a supervised and adaptive classifier with two modes: the training mode and the performing mode. For the training mode, a number of novel patterns are selected from actual or artificial data. A particular 3D cluster is input to the network as shown above for the decision class output. The network consists of three sequential functional modules. The first module is for feature extraction that extracts the input cluster into a set of singular value features or feature vector. Then the feature vector is input into the feature normalization module to normalize and balance it before being fed to the neural net classifier for the classification. The neural net can be trained by actual or artificial novel data until each trained output reaches the declared output within the defined tolerance. In case new novel data is added after the neural net has been learned, the training is then resumed until the neural net has incrementally learned with the new novel data. The associative memory capability of the neural net enables the incremental learning. The back propagation algorithm or support vector machine can be utilized for the classification and recognition.

Cost-effectiveness analysis of docetaxel versus weekly paclitaxel in adjuvant treatment of regional breast cancer in New Zealand.

PubMed

Webber-Foster, Rachel; Kvizhinadze, Giorgi; Rivalland, Gareth; Blakely, Tony

2014-07-01

There have been recent important changes to adjuvant regimens and costs of taxanes for the treatment of early breast cancer, requiring a re-evaluation of comparative cost effectiveness. In particular, weekly paclitaxel is now commonly used but has not been subjected to cost-effectiveness analysis. Our aim was to estimate the cost effectiveness of adjuvant docetaxel and weekly paclitaxel versus each other, and compared with standard 3-weekly paclitaxel, in women aged ≥25 years diagnosed with regional breast cancer in New Zealand. A macrosimulation Markov model was used, with a lifetime horizon and health system perspective. The model compared 3-weekly docetaxel and weekly paclitaxel versus standard 3-weekly paclitaxel (E1199 regimen) in the hospital setting. Data on overall survival and toxicities (febrile neutropenia and peripheral neuropathy) were derived from relevant published clinical trials. Epidemiological and cost data were derived from New Zealand datasets. Health outcomes were measured with health-adjusted life-years (HALYs), similar to quality-adjusted life-years (QALYs). Costs included intervention and health system costs in year 2011 values, with 3% per annum discounting on costs and HALYs. The mean HALY gain per patient compared with standard 3-weekly paclitaxel was 0.51 with weekly paclitaxel and 0.21 with docetaxel, while incremental costs were $NZ 12,284 and $NZ 4,021, respectively. The incremental cost-effectiveness ratio (ICER) of docetaxel versus 3-weekly paclitaxel was $NZ 19,400 (purchasing power parity [PPP]-adjusted $US 13,100) per HALY gained, and the ICER of weekly paclitaxel versus docetaxel was $NZ 27,100 ($US 18,300) per HALY gained. In terms of net monetary benefit, weekly paclitaxel was the optimal strategy for willingness-to-pay (WTP) thresholds >$NZ 27,000 per HALY gained. However, the model was highly sensitive to uncertainty around survival differences, while toxicity-related morbidity had little impact. Thus, if it was assumed that weekly paclitaxel and docetaxel had the same efficacy, docetaxel would be favoured over weekly paclitaxel. Both weekly paclitaxel and docetaxel are likely to be cost effective compared with standard 3-weekly paclitaxel. Weekly paclitaxel was the optimal choice for WTP thresholds greater than $NZ27,000 per HALY gained (PPP-adjusted $US 18,000). However, uncertainty remains around relative survival benefits, and weekly paclitaxel becomes cost ineffective versus docetaxel if it is assumed that the two regimens have equal effectiveness. Reduced uncertainty about the relative survival benefits may improve decision making for funding.

Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment.

PubMed

van de Wetering, Liesbet; van Exel, Job; Bobinac, Ana; Brouwer, Werner B F

2015-12-01

To judge whether an intervention offers value for money, the incremental costs per gained quality-adjusted life-year (QALY) need to be compared with some relevant threshold, which ideally reflects the monetary value of health gains. Literature suggests that this value may depend on the equity context in which health gains are produced, but the value of a QALY in relation to equity considerations has remained largely unexplored. The objective of this study was to estimate the social marginal willingness to pay (MWTP) for QALY gains in different equity subgroups, using a discrete choice experiment (DCE). Both severity of illness (operationalized as proportional shortfall) and fair innings (operationalized as age) were considered as grounds for differentiating the value of health gains. We obtained a sample of 1205 respondents, representative of the adult population of the Netherlands. The data was analysed using panel mixed multinomial logit (MMNL) and latent class models. The panel MMNL models showed counterintuitive results, with more severe health states reducing the probability of receiving treatment. The latent class models revealed distinct preference patterns in the data. MWTP per QALY was sensitive to severity of disease among a substantial proportion of the public, but not to the age of care recipients. These findings emphasize the importance of accounting for preference heterogeneity among the public on value-laden issues such as prioritizing health care, both in research and decision making. This study emphasises the need to further explore the monetary value of a QALY in relation to equity considerations.

[The Probabilistic Efficiency Frontier: A Value Assessment of Treatment Options in Hepatitis C].

PubMed

Mühlbacher, Axel C; Sadler, Andrew

2017-06-19

Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV). This case study shows how methodological challenges could be overcome in order to use the efficiency frontier for economic analysis and health care decision-making. Method The operationalization of patient benefit was carried out on several patient-relevant endpoints. Preference data from a discrete choice experiment (DCE) study and clinical data based on clinical trials, which reflected the patient and the clinical perspective, respectively, were used for the aggregation of an overall benefit score. A probabilistic efficiency frontier was constructed in a Monte Carlo simulation with 10000 random draws. Patient-relevant endpoints were modeled with a beta distribution and preference data with a normal distribution. The assessment of overall benefit and costs provided information about the adequacy of the treatment prices. The parameter uncertainty was illustrated by the price-acceptability-curve and the net monetary benefit. Results Based on the clinical and preference data in Germany, the interferon-free treatment options proved to be efficient for the current price level. The interferon-free therapies of the latest generation achieved a positive net cost-benefit. Within the decision model, these therapies showed a maximum overall benefit. Due to their high additional benefit and approved prices, the therapies lie above of the extrapolated efficiency frontier, which suggests that these options have efficient reimbursement prices. Considering uncertainty, even a higher price would have resulted in a positive cost-benefit ratio. Conclusion IQWiG's efficiency frontier was used to assess the value of different treatment options in HCV. This study demonstrates that the probabilistic efficiency frontier, price-acceptability-curve and the net monetary benefit can contribute essential information to reimbursement decisions and price negotiations. © Georg Thieme Verlag KG Stuttgart · New York.

Impact of monetary policy changes on the Chinese monetary and stock markets

NASA Astrophysics Data System (ADS)

Tang, Yong; Luo, Yong; Xiong, Jie; Zhao, Fei; Zhang, Yi-Cheng

2013-10-01

The impact of monetary policy changes on the monetary market and stock market in China is investigated in this study. The changes of two major monetary policies, the interest rate and required reserve ratio, are analyzed in a study period covering seven years on the interbank monetary market and Shanghai stock market. We find that the monetary market is related to the macro economy trend and we also find that the monetary change surprises both of lowering and raising bring significant impacts to the two markets and the two markets respond to the changes differently. The results suggest that the impact of fluctuations is much larger for raising policy changes than lowering changes in the monetary market on policy announcing and effective dates. This is consistent with the “sign effect”, i.e. bad news brings a greater impact than good news. By studying the event window of each policy change, we also find that the “sign effect” still exists before and after each change in the monetary market. A relatively larger fluctuation is observed before the event date, which indicates that the monetary market might have a certain ability to predict a potential monetary change, while it is kept secret by the central bank before official announcement. In the stock market, we investigate how the returns and spreads of the Shanghai stock market index respond to the monetary changes. Evidences suggest the stock market is influenced but in a different way than the monetary market. The climbing of returns after the event dates for the lowering policy agrees with the theory that lowering changes can provide a monetary supply to boost the market and drive the stock returns higher but with a delay of 2 to 3 trading days on average. While in the bear market, the lowering policy brings larger volatility to the market on average than the raising ones. These empirical findings are useful for policymakers to understand how monetary policy changes impact the monetary and stock markets especially in an emerging market like China where the economy is booming and the policy changes impact the markets as surprises by the central bank without a pre-decided schedule. This is totally different from previous studies on FED, which follows pre-decided schedules for monetary policy changes.

Value of biologic therapy: a forecasting model in three disease areas.

PubMed

Paramore, L Clark; Hunter, Craig A; Luce, Bryan R; Nordyke, Robert J; Halbert, R J

2010-01-01

Forecast the return on investment (ROI) for advances in biologic therapies in years 2015 and 2030, based upon impact on disease prevalence, morbidity, and mortality for asthma, diabetes, and colorectal cancer. A deterministic, spreadsheet-based, forecasting model was developed based on trends in demographics and disease epidemiology. 'Return' was defined as reductions in disease burden (prevalence, morbidity, mortality) translated into monetary terms; 'investment' was defined as the incremental costs of biologic therapy advances. Data on disease prevalence, morbidity, mortality, and associated costs were obtained from government survey statistics or published literature. Expected impact of advances in biologic therapies was based on expert opinion. Gains in quality-adjusted life years (QALYs) were valued at $100,000 per QALY. The base case analysis, in which reductions in disease prevalence and mortality predicted by the expert panel are not considered, shows the resulting ROIs remain positive for asthma and diabetes but fall below $1 for colorectal cancer. Analysis involving expert panel predictions indicated positive ROI results for all three diseases at both time points, ranging from $207 for each incremental dollar spent on biologic therapies to treat asthma in 2030, to $4 for each incremental dollar spent on biologic therapies to treat colorectal cancer in 2015. If QALYs are not considered, the resulting ROIs remain positive for all three diseases at both time points. Society may expect substantial returns from investments in innovative biologic therapies. These benefits are most likely to be realized in an environment of appropriate use of new molecules. The potential variance between forecasted (from expert opinion) and actual future health outcomes could be significant. Similarly, the forecasted growth in use of biologic therapies relied upon unvalidated market forecasts.

46 CFR 506.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 9 2012-10-01 2012-10-01 false Cost of living adjustments of civil monetary penalties... MONETARY PENALTY INFLATION ADJUSTMENT § 506.4 Cost of living adjustments of civil monetary penalties. (a... penalty for each civil monetary penalty by the cost-of-living adjustment. Any increase determined under...

46 CFR 506.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 9 2014-10-01 2014-10-01 false Cost of living adjustments of civil monetary penalties... MONETARY PENALTY INFLATION ADJUSTMENT § 506.4 Cost of living adjustments of civil monetary penalties. (a... penalty for each civil monetary penalty by the cost-of-living adjustment. Any increase determined under...

46 CFR 506.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 9 2011-10-01 2011-10-01 false Cost of living adjustments of civil monetary penalties... MONETARY PENALTY INFLATION ADJUSTMENT § 506.4 Cost of living adjustments of civil monetary penalties. (a... penalty for each civil monetary penalty by the cost-of-living adjustment. Any increase determined under...

46 CFR 506.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Cost of living adjustments of civil monetary penalties... MONETARY PENALTY INFLATION ADJUSTMENT § 506.4 Cost of living adjustments of civil monetary penalties. (a... penalty for each civil monetary penalty by the cost-of-living adjustment. Any increase determined under...

46 CFR 506.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 9 2013-10-01 2013-10-01 false Cost of living adjustments of civil monetary penalties... MONETARY PENALTY INFLATION ADJUSTMENT § 506.4 Cost of living adjustments of civil monetary penalties. (a... penalty for each civil monetary penalty by the cost-of-living adjustment. Any increase determined under...

European cost-effectiveness study of uPA/PAI-1 biomarkers to guide adjuvant chemotherapy decisions in breast cancer.

PubMed

Marguet, Sophie; Mazouni, Chafika; Ramaekers, Bram L T; Dunant, Ariane; Kates, Ronald; Jacobs, Volker R; Joore, Manuela A; Harbeck, Nadia; Bonastre, Julia

2016-08-01

This study investigated the cost effectiveness of guideline-recommended (American Society of Clinical Oncology, European Society of Medical Oncology) urokinase plasminogen activator (uPA)/plasminogen activator inhibitor-1 (PAI-1) biomarkers to guide adjuvant chemotherapy decisions for hormone receptor-positive, node-negative early breast cancer patients at intermediate risk of relapse, in France, Germany, and The Netherlands. uPA/PAI-1 testing was compared to chemotherapy for all patients and to no chemotherapy in two age-related subgroups (35-49 and 50-75 years). A partitioned survival analysis was performed using patient-level data for survival outcomes and secondary sources. Mean quality-adjusted life years (QALYs) and costs were estimated over a lifetime horizon to calculate the incremental net monetary benefit (INMB) at a willingness-to-pay of €50,000/QALY. Uncertainty was explored through bootstrap and probabilistic sensitivity analysis using 5000 replicates. In the 35-49 year age group, INMBs were negative when uPA/PAI-1 testing was compared to chemotherapy for all patients but positive when it was compared to no chemotherapy for the three countries. In the 50-75 year age group, INMBs of uPA/PAI-1 testing compared to both reference strategies were positive in the three countries, with cost-effectiveness probabilities for the uPA/PAI-1 strategy of 65%, 70%, and 59% for France, Germany, and the Netherlands, respectively, compared with chemotherapy for all patients, and 64%, 58%, and 65%, respectively, compared with no chemotherapy. uPA/PAI-1 testing could allow the selection of patients older than 50 years requiring chemotherapy in this population, but the cost effectiveness of this strategy is uncertain. Chemotherapy for all patients is the most cost-effective strategy for patients younger than 50 years. Copyright © 2016 Elsevier Ltd. All rights reserved.

An Economic Evaluation of Stopping versus Continuing TNF-Inhibitor Treatment in Rheumatoid Arthritis Patients in Remission or Low Disease Activity: results from the POET randomized trial.

PubMed

Tran-Duy, An; Ghiti Moghadam, Marjan; Oude Voshaar, Martijn A H; Vonkeman, Harald E; Boonen, Annelies; Clarke, Philip; McColl, Geoff; Ten Klooster, Peter M; Zijlstra, T R; Lems, Willem F; Riyazi, N; Griep, E N; Hazes, J M W; Landewé, Robert; Bernelot Moens, Hein J; van Riel, Piet L C M; van de Laar, Mart A F J; Jansen, T L

2018-05-09

To evaluate, from a societal perspective, the incremental cost-effectiveness of withdrawing tumor necrosis factor inhibitors (TNFis) compared to continuation of these drugs within a one-year randomized trial among patients with rheumatoid arthritis (RA) having longstanding stable disease activity or remission. Data were collected from a pragmatic, open label trial. Cost-utility analysis was performed using the non-parametric bootstrapping method and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit (NMB) framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost. 531 patients were randomized to the Stop Group and 186 patients to the Continue Group. Withdrawal of TNFis resulted in more than 60% reduction of the total drug cost, but led to an increase of about 30% in the other healthcare expenditure. Compared to continuation, stopping TNFis resulted in a mean yearly cost saving of €7,133 (95% CI, [€6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI, [0.002, 0.040]). Mean saved cost [95% CI] per QALY lost and per extra flare incurred in the Stop group compared to the Continuation group was €368,269 [€155,132, €1,675,909] and €17,670 [€13,650, €22,721], respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFis is cost-effective was 100%. Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on the willingness-to-pay. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Cost-effective primary care-based strategies to improve smoking cessation: more value for money.

PubMed

Salize, Hans Joachim; Merkel, Silke; Reinhard, Iris; Twardella, Dorothee; Mann, Karl; Brenner, Hermann

2009-02-09

Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95% level of certainty of cost-effectiveness against TAU, euro 9.80 or euro 6.96, respectively, had to be paid for each additional 1% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, euro 92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to euro 39.10 paid per patient during the trial). In intervention 2, the cost was euro 82.82, as opposed to euro 50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; euro1 = $1.17.) Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy.

Comparative economic evaluation of data from the ACRIN National CT Colonography Trial with three cancer intervention and surveillance modeling network microsimulations.

PubMed

Vanness, David J; Knudsen, Amy B; Lansdorp-Vogelaar, Iris; Rutter, Carolyn M; Gareen, Ilana F; Herman, Benjamin A; Kuntz, Karen M; Zauber, Ann G; van Ballegooijen, Marjolein; Feuer, Eric J; Chen, Mei-Hsiu; Johnson, C Daniel

2011-11-01

To estimate the cost-effectiveness of computed tomographic (CT) colonography for colorectal cancer (CRC) screening in average-risk asymptomatic subjects in the United States aged 50 years. Enrollees in the American College of Radiology Imaging Network National CT Colonography Trial provided informed consent, and approval was obtained from the institutional review board at each site. CT colonography performance estimates from the trial were incorporated into three Cancer Intervention and Surveillance Modeling Network CRC microsimulations. Simulated survival and lifetime costs for screening 50-year-old subjects in the United States with CT colonography every 5 or 10 years were compared with those for guideline-concordant screening with colonoscopy, flexible sigmoidoscopy plus either sensitive unrehydrated fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT), and no screening. Perfect and reduced screening adherence scenarios were considered. Incremental cost-effectiveness and net health benefits were estimated from the U.S. health care sector perspective, assuming a 3% discount rate. CT colonography at 5- and 10-year screening intervals was more costly and less effective than FOBT plus flexible sigmoidoscopy in all three models in both 100% and 50% adherence scenarios. Colonoscopy also was more costly and less effective than FOBT plus flexible sigmoidoscopy, except in the CRC-SPIN model assuming 100% adherence (incremental cost-effectiveness ratio: $26,300 per life-year gained). CT colonography at 5- and 10-year screening intervals and colonoscopy were net beneficial compared with no screening in all model scenarios. The 5-year screening interval was net beneficial over the 10-year interval except in the MISCAN model when assuming 100% adherence and willingness to pay $50,000 per life-year gained. All three models predict CT colonography to be more costly and less effective than non-CT colonographic screening but net beneficial compared with no screening given model assumptions. RSNA, 2011

Ciclosporin compared with prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial.

PubMed

Mason, J M; Thomas, K S; Ormerod, A D; Craig, F E; Mitchell, E; Norrie, J; Williams, H C

2017-12-01

Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomized controlled trial (RCT). To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG. Quality of life (QoL, EuroQoL five dimensions three level questionnaire, EQ-5D-3L) and resource data were collected as part of the STOP GAP trial: a multicentre, parallel-group, observer-blind RCT. Within-trial analysis used bivariate regression of costs and quality-adjusted life years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective. In the base case analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs [net cost: -£1160; 95% confidence interval (CI) -2991 to 672] and improvement in QoL (net QALYs: 0·055; 95% CI 0·018-0·093). However, this finding appears driven by a minority of patients with large lesions (≥ 20 cm 2 ) (net cost: -£5310; 95% CI -9729 to -891; net QALYs: 0·077; 95% CI 0·004-0·151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23 374/QALY, although the estimate is imprecise: the probability of being cost-effective at a willingness-to-pay of £20 000/QALY was 43%. Consistent with the clinical findings of the STOP GAP trial, patients with small lesions should receive treatment guided by the side-effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of National Health Service resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions. © 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Space availability in confined sheep during pregnancy, effects in movement patterns and use of space.

PubMed

Averós, Xavier; Lorea, Areta; Beltrán de Heredia, Ignacia; Arranz, Josune; Ruiz, Roberto; Estevez, Inma

2014-01-01

Space availability is essential to grant the welfare of animals. To determine the effect of space availability on movement and space use in pregnant ewes (Ovis aries), 54 individuals were studied during the last 11 weeks of gestation. Three treatments were tested (1, 2, and 3 m2/ewe; 6 ewes/group). Ewes' positions were collected for 15 minutes using continuous scan samplings two days/week. Total and net distance, net/total distance ratio, maximum and minimum step length, movement activity, angular dispersion, nearest, furthest and mean neighbour distance, peripheral location ratio, and corrected peripheral location ratio were calculated. Restriction in space availability resulted in smaller total travelled distance, net to total distance ratio, maximum step length, and angular dispersion but higher movement activity at 1 m2/ewe as compared to 2 and 3 m2/ewe (P<0.01). On the other hand, nearest and furthest neighbour distances increased from 1 to 3 m2/ewe (P<0.001). Largest total distance, maximum and minimum step length, and movement activity, as well as lowest net/total distance ratio and angular dispersion were observed during the first weeks (P<0.05) while inter-individual distances increased through gestation. Results indicate that movement patterns and space use in ewes were clearly restricted by limitations of space availability to 1 m2/ewe. This reflected in shorter, more sinuous trajectories composed of shorter steps, lower inter-individual distances and higher movement activity potentially linked with higher restlessness levels. On the contrary, differences between 2 and 3 m2/ewe, for most variables indicate that increasing space availability from 2 to 3 m2/ewe would appear to have limited benefits, reflected mostly in a further increment in the inter-individual distances among group members. No major variations in spatial requirements were detected through gestation, except for slight increments in inter-individual distances and an initial adaptation period, with ewes being restless and highly motivated to explore their new environment.

A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome

PubMed Central

Macario, Alex; Chow, John L; Dexter, Franklin

2006-01-01

Background Management of acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS). The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker)? Methods The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. Results Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be $62,238 (5% – 95% percentiles $42,259 – $83,766), with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost $267 more) hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. Conclusion ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS. PMID:16539706

Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy.

PubMed

Cosse, C; Rebibo, L; Brazier, F; Hakim, S; Delcenserie, R; Regimbeau, J M

2018-04-01

Gastric leak is the most feared surgical postoperative complication after sleeve gastrectomy. An endoscopic procedure is usually required to treat the leak. No data are available on the cost-effectiveness of different stent types in this procedure. Between April 2005 and July 2016, patients with a confirmed gastric leak undergoing endoscopic treatment using a covered stent (CS) or double-pigtail stent (DPS) were included. The primary objective of the study was to assess overall costs of the stent types after primary sleeve gastrectomy. Secondary objectives were the cost-effectiveness of each stent type expressed as an incremental cost-effectiveness ratio (ICER); the incremental net benefit; the probability of efficiency, defined as the probability of being cost-effective at a threshold of €30 000, and identification of the key drivers of ICER derived from a multivariable analysis. One hundred and twelve patients were enrolled. The overall mean costs of gastric leak were €22 470; the mean(s.d.) cost was €24 916(12 212) in the CS arm and €20 024(3352) in the DPS arm (P = 0·018). DPS was more cost-effective than CS (ICER €4743 per endoscopic procedure avoided), with an incremental net benefit of €25 257 and a 27 per cent probability of efficiency. Key drivers of the ICER were the inpatient ward after diagnosis of gastric leak (surgery versus internal medicine), type of institution (private versus public) and duration of hospital stay per endoscopic procedure. DPS for the treatment of gastric leak is more cost-effective than CS and should be proposed as the standard regimen whenever possible. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.

PubMed

Shao, Hui; Brown, Lisanne; Diana, Mark L; Schmidt, Laura A; Mason, Karen; Oronce, Carlos Irwin; Shi, Lizheng

2016-09-01

There is a need to understand the costs associated with supporting, implementing, and maintaining the system redesign of small and medium-sized safety-net clinics. The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation.The sample was 74 clinics in Greater New Orleans that received funds from the Primary Care Access and Stabilization Grant program between 2007 and 2010 to support their transformation. The study period was divided into baseline (September 21, 2007-March 21, 2008), transformation (March 22, 2008-March 21, 2009), and maintenance (March 22, 2009-September 20, 2010) periods, and data were collected at 6-month intervals. Baseline characteristics for the clinics that transformed were compared to those that did not. Fixed-effect models were conducted for cost estimation, controlling for baseline differences, using propensity score weights.Half of the 74 primary care clinics achieved transformation by the end of the study period. The clinics that transformed had higher total cost, more clinic visits, and a larger female patient proportion at baseline. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation.Larger-sized clinics and those with a higher female proportion were more likely to transform. The Primary Care Access and Stabilization Grant program provided approximately $24.86 per visit over the 2 and 1/2 years. This estimated incremental cost could be used to guide policy recommendations to support primary care transformation in the United States.

Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans

PubMed Central

Shao, Hui; Brown, Lisanne; Diana, Mark L.; Schmidt, Laura A.; Mason, Karen; Oronce, Carlos Irwin; Shi, Lizheng

2016-01-01

Abstract There is a need to understand the costs associated with supporting, implementing, and maintaining the system redesign of small and medium-sized safety-net clinics. The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation. The sample was 74 clinics in Greater New Orleans that received funds from the Primary Care Access and Stabilization Grant program between 2007 and 2010 to support their transformation. The study period was divided into baseline (September 21, 2007–March 21, 2008), transformation (March 22, 2008–March 21, 2009), and maintenance (March 22, 2009–September 20, 2010) periods, and data were collected at 6-month intervals. Baseline characteristics for the clinics that transformed were compared to those that did not. Fixed-effect models were conducted for cost estimation, controlling for baseline differences, using propensity score weights. Half of the 74 primary care clinics achieved transformation by the end of the study period. The clinics that transformed had higher total cost, more clinic visits, and a larger female patient proportion at baseline. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation. Larger-sized clinics and those with a higher female proportion were more likely to transform. The Primary Care Access and Stabilization Grant program provided approximately $24.86 per visit over the 2 and 1/2 years. This estimated incremental cost could be used to guide policy recommendations to support primary care transformation in the United States. PMID:27684855

Cost-effectiveness of thrombolysis within 4.5 hours of acute ischemic stroke: experience from Australian stroke center.

PubMed

Tan Tanny, Sharman P; Busija, Lucy; Liew, Danny; Teo, Sarah; Davis, Stephen M; Yan, Bernard

2013-08-01

Previous economic studies outside Australia have demonstrated that patients treated with tissue-type plasminogen activator (tPA) within 4.5 hours of stroke onset have lower healthcare costs than those not. We aim to perform cost-effectiveness analysis of intravenous tPA in an Australian setting. Data on clinical outcomes and costs were derived for 378 patients who received intravenous tPA within 4.5 hours of stroke onset at Royal Melbourne Hospital (Australia) between January 2003 and December 2011. To simulate clinical outcomes and costs for a hypothetical control group assumed not to have received tPA, we applied efficacy data from a meta-analysis of randomized trials to outcomes observed in the tPA group. During a 1-year time-horizon, net costs, years of life lived, and quality-adjusted life-years were compared and incremental cost-effectiveness ratios derived for tPA versus no tPA. In the study population, mean (SD) age was 68.2 (13.5) years and 206 (54.5%) were men. Median National Institutes of Health Stroke Scale score (interquartile range) at presentation was 12.5 (8-18). Compared with no tPA, we estimated that tPA would result in 0.02 life-years and 0.04 quality-adjusted life-years saved per person>1 year. The net cost of tPA was AUD $55.61 per patient. The incremental cost-effectiveness ratios were AUD $2377 per life-year saved and AUD $1478 per quality-adjusted life-years saved. Because the costs of tPA are incurred only once, the incremental cost-effectiveness ratios would decrease with increasing time-horizon. Uncertainty analyses indicated the results to be robust. Intravenous tPA within 4.5 hours represents a cost-effective intervention for acute ischemic stroke.

The net value of health care for patients with type 2 diabetes, 1997 to 2005.

PubMed

Eggleston, Karen N; Shah, Nilay D; Smith, Steven A; Wagie, Amy E; Williams, Arthur R; Grossman, Jerome H; Berndt, Ernst R; Long, Kirsten Hall; Banerjee, Ritesh; Newhouse, Joseph P

2009-09-15

The net economic value of increased health care spending remains unclear, especially for chronic diseases. To assess the net value of health care for patients with type 2 diabetes. Economic analysis of observational cohort data. Mayo Clinic, Rochester, Minnesota, a not-for-profit integrated health care delivery system. 613 patients with type 2 diabetes. Changes in inflation-adjusted annual health care spending and in health status between 1997 and 2005 (with health status defined as 10-year cardiovascular risk), holding age and diabetes duration constant across the observation period ("modifiable risk"), and simulated outcomes for all diabetes complications based on the UKPDS (United Kingdom Perspective Diabetes Study) Outcomes Model. Net value was estimated as the present discounted monetary value of improved survival and avoided treatment spending for coronary heart disease minus the increase in annual spending per patient. Assuming that 1 life-year is worth $200,000 and accounting for changes in modifiable cardiovascular risk, the net value of changes in health care for patients with type 2 diabetes was $10,911 per patient (95% CI, -$8480 to $33,402) between 1997 and 2005, a positive dollar value that suggests the value of health care has improved despite increased spending. A second approach based on diabetes complications yielded a net value of $6931 per patient (CI, -$186,901 to $211,980). The patient population was homogeneous and small, and the wide CIs of the estimates are compatible with a decrease as well as an increase in value. The economic value of improvements in health status for patients with type 2 diabetes seems to exceed or equal increases in health care spending, suggesting that those increases were worth the extra cost. However, the possibility that society is getting less value for its money could not be statistically excluded, and there is opportunity to improve the value of diabetes-related health care. None.

Agile-Lean Software Engineering (ALSE) Evaluating Kanban in Systems Engineering

DTIC Science & Technology

2013-03-06

Boeing)  Garry Roedler (Lockheed Martin)  Karl Scotland (Rally Software, UK)  Alan Shalloway (NetObjectives)  Neil Shirk (Lockheed Martin... Neil Siegel (Northrop Grumman)  James Sutton (Jubata Group) Thanks are also due to the members of the SERC Research Council, particularly Barry...Incremental Commitment Model to Brownfield Systems Development, Proceedings, CSER 2009, April 2009. 16. Heath , B. et al. (2009). A survey of agent-based

Modeling the costs and benefits of temporary recommendations for poliovirus exporting countries to vaccinate international travelers.

PubMed

Duintjer Tebbens, Radboud J; Thompson, Kimberly M

2017-07-05

Recognizing that infectious agents readily cross international borders, the International Health Regulations Emergency Committee issues Temporary Recommendations (TRs) that include vaccination of travelers from countries affected by public health emergencies, including serotype 1 wild polioviruses (WPV1s). This analysis estimates the costs and benefits of TRs implemented by countries with reported WPV1 during 2014-2016 while accounting for numerous uncertainties. We estimate the TR costs based on programmatic data and prior economic analyses and TR benefits by simulating potential WPV1 outbreaks in the absence of the TRs using the rate and extent of WPV1 importation outbreaks per reported WPV1 case during 2004-2013 and the number of reported WPV1 cases that occurred in countries with active TRs. The benefits of TRs outweigh the costs in 77% of model iterations, resulting in expected incremental net economic benefits of $210 million. Inclusion of indirect costs increases the costs by 13%, the expected savings from prevented outbreaks by 4%, and the expected incremental net benefits by 3%. Despite the considerable costs of implementing TRs, this study provides health and economic justification for these investments in the context of managing a disease in advanced stages of its global eradication. Copyright © 2017 The Auhors. Published by Elsevier Ltd.. All rights reserved.

Methods for evaluating and ranking transportation energy conservation programs

NASA Astrophysics Data System (ADS)

Santone, L. C.

1981-04-01

The energy conservation programs are assessed in terms of petroleum savings, incremental costs to consumers probability of technical and market success, and external impacts due to environmental, economic, and social factors. Three ranking functions and a policy matrix are used to evaluate the programs. The net present value measure which computes the present worth of petroleum savings less the present worth of costs is modified by dividing by the present value of DOE funding to obtain a net present value per program dollar. The comprehensive ranking function takes external impacts into account. Procedures are described for making computations of the ranking functions and the attributes that require computation. Computations are made for the electric vehicle, Stirling engine, gas turbine, and MPG mileage guide program.

Environmental cost-effectiveness analysis in intertemporal natural resource policy: evaluation of selective fishing gear.

PubMed

Kronbak, Lone Grønbæk; Vestergaard, Niels

2013-12-15

In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included. Copyright © 2013 Elsevier Ltd. All rights reserved.

Energy taxation as a policy instrument to reduce CO{sub 2} emissions: A net benefit analysis

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

Boyd, R.; Krutilla, K.; Viscusi, W.K.

1995-07-01

This study evaluates the costs and benefits of energy taxation as a policy instrument to conserve energy and reduce CO{sub 2} emissions. The study combines economic cost estimates generated with a CGE model and monetary estimates of environmental damages in a comprehensive cost/benefit framework. We find that optimal CO{sub 2} emissions reductions range from 5 to 38%, depending on different assumptions about energy substitution elasticities and environmental damages. CO{sub 2} emissions reductions of between 8 and 64% can be attained at no additional welfare cost relative to a policy of not undertaking any action to control CO{sub 2} emissions. 33more » refs., 7 figs., 8 tabs.« less

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

PubMed

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

2013-11-04

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

Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial.

PubMed

Mori, Amani Thomas; Kampata, Linda; Musonda, Patrick; Johansson, Kjell Arne; Robberstad, Bjarne; Sandøy, Ingvild

2017-12-19

Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living. The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives. While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be considered seriously when evaluating whether such a program can justify the required investments in a setting with scarce resources. The economic evaluations outlined in this paper will generate valuable information that can be used to guide large-scale implementation of programs to address the problem of the high prevalence of adolescent childbirth and school drop-outs in similar settings. ClinicalTrials.gov, NCT02709967. Registered on 2 March 2016. ISRCTN, ISRCTN12727868. Registered on 4 March 2016.

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

PubMed

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

2014-01-01

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

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

PubMed Central

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

2017-01-01

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

Applied economics: The use of monetary incentives to modulate behavior.

PubMed

Strang, S; Park, S Q; Strombach, T; Kenning, P

2016-01-01

According to standard economic theory higher monetary incentives will lead to higher performance and higher effort independent of task, context, or individual. In many contexts this standard economic advice is implemented. Monetary incentives are, for example, used to enhance performance at workplace or to increase health-related behavior. However, the fundamental positive impact of monetary incentives has been questioned by psychologists as well as behavioral economists during the last decade, arguing that monetary incentives can sometimes even backfire. In this chapter, studies from proponents as well as opponents of monetary incentives will be presented. Specifically, the impact of monetary incentives on performance, prosocial, and health behavior will be discussed. Furthermore, variables determining whether incentives have a positive or negative impact will be identified. © 2016 Elsevier B.V. All rights reserved.

Effects of Taxing Sugar-Sweetened Beverages on Caries and Treatment Costs.

PubMed

Schwendicke, F; Thomson, W M; Broadbent, J M; Stolpe, M

2016-11-01

Caries increment is affected by sugar-sweetened beverage (SSB) consumption. Taxing SSBs could reduce sugar consumption and caries increment. The authors aimed to estimate the impact of a 20% SSB sales tax on caries increment and associated treatment costs (as well as the resulting tax revenue) in the context of Germany. A model-based approach was taken, estimating the effects for the German population aged 14 to 79 y over a 10-y period. Taxation was assumed to affect beverage-associated sugar consumption via empirical demand elasticities. Altered consumption affected caries increments and treatment costs, with cost estimates being calculated under the perspective of the statutory health insurance. National representative consumption and price data were used to estimate tax revenue. Microsimulations were performed to estimate health outcomes, costs, and revenue impact in different age, sex, and income groups. Implementing a 20% SSB sales tax reduced sugar consumption in nearly all male groups but in fewer female groups. The reduction was larger among younger than older individuals and among those with low income. Taxation reduced caries increment and treatment costs especially in younger (rather than older) individuals and those with low income. Over 10 y, mean (SD) net caries increments at the population level were 82.27 (1.15) million and 83.02 (1.08) million teeth at 20% and 0% SSB tax, respectively. These generated treatment costs of 2.64 (0.39) billion and 2.72 (0.35) billion euro, respectively. Additional tax revenue was 37.99 (3.41) billion euro over the 10 y. In conclusion and within the limitations of this study's perspective, database, and underlying assumptions, implementing a 20% sales tax on SSBs is likely to reduce caries increment, especially in young low-income males, thereby also reducing inequalities in the distribution of caries experience. Taxation would also reduce treatment costs. However, these reductions might be limited in the total population.

32 CFR 269.3 - Civil monetary penalty inflation adjustment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Civil monetary penalty inflation adjustment. 269.3 Section 269.3 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 269.3 Civil monetary...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2011 CFR

2011-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2013 CFR

2013-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2012 CFR

2012-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2014 CFR

2014-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2010 CFR

2010-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka

PubMed Central

Häsler, Barbara; Hiby, Elly; Gilbert, Will; Obeyesekere, Nalinika; Bennani, Houda; Rushton, Jonathan

2014-01-01

Background One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management. Methodology/Principal Findings A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate. Conclusions The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control. PMID:25340771

46 CFR 506.3 - Civil monetary penalty inflation adjustment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Civil monetary penalty inflation adjustment. 506.3... PENALTY INFLATION ADJUSTMENT § 506.3 Civil monetary penalty inflation adjustment. The Commission shall... each civil monetary penalty provided by law within the jurisdiction of the Commission by the inflation...

16 CFR 0.5 - Laws authorizing monetary claims.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Laws authorizing monetary claims. 0.5... ORGANIZATION § 0.5 Laws authorizing monetary claims. The Commission is authorized to entertain monetary claims..., unless the adjudicative officer finds that the party has committed a willful violation of law or...

16 CFR 0.5 - Laws authorizing monetary claims.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Laws authorizing monetary claims. 0.5... ORGANIZATION § 0.5 Laws authorizing monetary claims. The Commission is authorized to entertain monetary claims..., unless the adjudicative officer finds that the party has committed a willful violation of law or...

32 CFR 269.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Cost of living adjustments of civil monetary... DEFENSE (CONTINUED) MISCELLANEOUS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 269.4 Cost of living.... Maximum civil monetary penalties within the jurisdiction of the Department of Defense are adjusted for...

78 FR 672 - Civil Monetary Penalties

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-04

... Part 3560 RIN 0575AC93 Civil Monetary Penalties AGENCY: Rural Housing Service, USDA. ACTION: Proposed rule. SUMMARY: The Rural Housing Service (RHS or Agency) proposes to implement two civil monetary... civil monetary penalties under the authority of 42 U.S.C. 1490s (section 543 of the Housing Act of 1949...

Learning the ropes at Richard B. Russell Dam: Net systems for medium head hydropower pumpback and generation fish sampling

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

Schilt, C.R.; Vu, P.D.; Nestler, J.M.

1995-12-31

At Richard B. Russell Dam on the Savannah River we have been monitoring the magnitude (numbers and masses) and species compositions as well as possible survival of fish entrained in operation of four 85 MW Francis pump turbines. In this paper we review our progress in net design for hydropower application. We also discuss basic net handling and introduce a method for net management in a very turbulent tailrace. This report is meant to share what we have learned at Russell Dam in hopes that it will facilitate similar efforts elsewhere. The commercial fishing industry has evolved methods of netmore » construction and handling that may be applied, with appropriate modification, at dams. The nets we use are most appropriately called trawls in that they have the form of a long sock placed over the penstock or draft tube. These nets are superficially similar to those used in commercial trawling for fish. Important differences are that: (1) the net remains relatively stationary while the water moves through it, not vice versa; (2) water velocities and turbulence are much greater at dams than in commercial fishing operations and (3) mesh sizes are much smaller for environmental sampling than for commercial trawling. And while a fouled trawl may stop the boat that pulls it, the water passed in generation or pumpback (about 140 ft. head at Russell) is for all practical purposes unstoppable. Our nets fish in a very turbulent discharge at 7,000 cu. ft./sec/turbine. Their strength and their ability to pass water effectively under all possible operating conditions are primary concerns. Trawl length, mesh sizes, and hanging ratios are important factors. Although we have had setbacks (usually in the form of torn nets) as this study has developed, we have incrementally improved our net design and handling. We review our net failures and the solutions we have found thus far in both construction and handling.« less

Evaluation of an emergency department-based enrollment program for uninsured children.

PubMed

Mahajan, Prashant; Stanley, Rachel; Ross, Kevin W; Clark, Linda; Sandberg, Keisha; Lichtenstein, Richard

2005-03-01

We evaluate the effectiveness of an emergency department (ED)-based outreach program in increasing the enrollment of uninsured children. The study involved placing a full-time worker trained to enroll uninsured children into Medicaid or the State Children's Health Insurance Program in an inner-city academic children's hospital ED. Analysis was carried out for outpatient ED visits by insurance status, average revenue per patient from uninsured and insured children, proportion of patients enrolled in Medicaid and State Children's Health Insurance Program through this program, estimated incremental revenue from new enrollees, and program-specific incremental costs. A cost-benefit analysis and breakeven analysis was conducted to determine the impact of this intervention on ED revenues. Five thousand ninety-four uninsured children were treated during the 10 consecutive months assessed, and 4,667 were treated during program hours. One thousand eight hundred and three applications were filed, giving a program penetration rate of 39%. Eighty-four percent of applications filed were resolved (67% of these were Medicaid). Average revenue from each outpatient ED visit for Medicaid was US135.68 dollars, other insurance was US210.43 dollars, and uninsured was US15.03 dollars. Estimated incremental revenue for each uninsured patient converted to Medicaid was US120.65 dollars. Total annualized incremental revenue was US224,474 dollars, and the net incremental revenue, after accounting for program costs, was US157,414 dollars per year. A program enrolling uninsured children at an inner-city pediatric ED into government insurance was effective and generated revenue that paid for program costs.

FERC examines transmission access pricing policies

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

Burkhart, L.A.

1993-02-15

The Federal Energy Regulatory Commission (FERC) has approved two orders dealing with transmission pricing issues that evolved from its March 1992 Pennsylvania Electric Co. (Penelec) decision dealing with cost recovery of transmission plant expansion. Commissioner Betsy Moler said the cases represented the first time the FERC has used incremental rates for wheeling transactions. In the first new order, Public Service Electric Gas Co. proposed charging for third-party transmission services to recover the sum of its standard embedded cost rate and the net incremental cost of making upgrades to its integrated transmission system. Public Service sought to provide service to EEAmore » I Limited, which proposed building and operating a cogeneration facility at a United States Gypsum Co. plant in New Jersey. Consolidated Edison Company of New York Inc. had agreed to purchase the project's output. In rejecting Public Service's proposal, the FERC ruled the utility must charge a transmission rate that is the higher of either its embedded cost rate or its incremental cost rate of accelerated expansion. (In this instance, the incremental rate was higher). In the second new order, Public Service Co. of Colorado (PSCC) filed a proposed open access transmission service tariff related to its acquisition of facilities from Colorado-Ute Electric Association Inc. The FERC rejected PSCC's tariff request that would have required a new transmission customer (in the event PSCC modified its integrated transmission grid) to pay the sum of PSCC's standard transmission rate (reflecting the average cost of the grid facilities) plus the expansion cost (reflecting the incremental facility cost).« less

How Financial Innovation Has Made Textbook Monetary Theory Obsolete.

ERIC Educational Resources Information Center

Gilbody, John

1988-01-01

Argues that much of the monetary theory in economics textbooks has not changed in accordance with the facts of monetary history. Contends that by neglecting institutional changes in the monetary system in the 50 years since the publication of Keynes' General Theory, many textbooks are now in danger of seriously misleading their readers. (GEA)

22 CFR 123.23 - Monetary value of shipments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Monetary value of shipments. 123.23 Section 123... EXPORT OF DEFENSE ARTICLES § 123.23 Monetary value of shipments. Port Directors of U.S. Customs and... value of the export does not exceed the aggregate monetary value (not quantity) stated on the license by...

Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries.

PubMed

Rongen, Jan J; Govers, Tim M; Buma, Pieter; Grutters, Janneke P C; Hannink, Gerjon

2016-07-01

Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Economic and decision analysis; Level of evidence, 2. Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental cost-effectiveness ratio of €7876 per QALY. Model 2 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €297,727 per QALY (€9825/0.033). On the basis of the current efficacy data, a meniscus scaffold provides a relative risk reduction of "limited benefit" postoperatively of 0.37 compared with standard treatment. A threshold analysis revealed that assuming a willingness to pay of €20,000, a meniscus scaffold would not be cost-effective within a period of 5 years. Most influential variables on the cost-effectiveness of meniscus scaffolds were the cost of the scaffold procedure, cost associated with osteoarthritis, and quality of life before and after the scaffold procedure. Results of the current health technology assessment emphasize that the monetary value of meniscus scaffold procedures is very much dependent on a number of influential variables. Therefore, before implementing the technology in the health care system, it is important to critically assess these variables in a relevant context. The models can be improved as additional clinical data regarding the efficacy of the meniscus scaffold become available. © 2016 The Author(s).

BOLD responses in reward regions to hypothetical and imaginary monetary rewards

PubMed Central

Miyapuram, Krishna P.; Tobler, Philippe N.; Gregorios-Pippas, Lucy; Schultz, Wolfram

2015-01-01

Monetary rewards are uniquely human. Because money is easy to quantify and present visually, it is the reward of choice for most fMRI studies, even though it cannot be handed over to participants inside the scanner. A typical fMRI study requires hundreds of trials and thus small amounts of monetary rewards per trial (e.g. 5p) if all trials are to be treated equally. However, small payoffs can have detrimental effects on performance due to their limited buying power. Hypothetical monetary rewards can overcome the limitations of smaller monetary rewards but it is less well known whether predictors of hypothetical rewards activate reward regions. In two experiments, visual stimuli were associated with hypothetical monetary rewards. In Experiment 1, we used stimuli predicting either visually presented or imagined hypothetical monetary rewards, together with non-rewarding control pictures. Activations to reward predictive stimuli occurred in reward regions, namely the medial orbitofrontal cortex and midbrain. In Experiment 2, we parametrically varied the amount of visually presented hypothetical monetary reward keeping constant the amount of actually received reward. Graded activation in midbrain was observed to stimuli predicting increasing hypothetical rewards. The results demonstrate the efficacy of using hypothetical monetary rewards in fMRI studies. PMID:21985912

BOLD responses in reward regions to hypothetical and imaginary monetary rewards.

PubMed

Miyapuram, Krishna P; Tobler, Philippe N; Gregorios-Pippas, Lucy; Schultz, Wolfram

2012-01-16

Monetary rewards are uniquely human. Because money is easy to quantify and present visually, it is the reward of choice for most fMRI studies, even though it cannot be handed over to participants inside the scanner. A typical fMRI study requires hundreds of trials and thus small amounts of monetary rewards per trial (e.g. 5p) if all trials are to be treated equally. However, small payoffs can have detrimental effects on performance due to their limited buying power. Hypothetical monetary rewards can overcome the limitations of smaller monetary rewards but it is less well known whether predictors of hypothetical rewards activate reward regions. In two experiments, visual stimuli were associated with hypothetical monetary rewards. In Experiment 1, we used stimuli predicting either visually presented or imagined hypothetical monetary rewards, together with non-rewarding control pictures. Activations to reward predictive stimuli occurred in reward regions, namely the medial orbitofrontal cortex and midbrain. In Experiment 2, we parametrically varied the amount of visually presented hypothetical monetary reward keeping constant the amount of actually received reward. Graded activation in midbrain was observed to stimuli predicting increasing hypothetical rewards. The results demonstrate the efficacy of using hypothetical monetary rewards in fMRI studies. Copyright © 2011 Elsevier Inc. All rights reserved.

Department of Defense Command and Control Implementation Plan, Version 1.0

DTIC Science & Technology

2009-10-01

needs • Be maintained by the C2 Capability Portfolio Manager ( CPM ) and updated every 2 years to address emerging C2 operational concepts, changing and...including sources managed by the C2 CPM as well as other CPMs (e.g., Net- Centric, Battlespace Awareness, and Logistics). C2 platforms and facilities with...incremental delivery of improved capabilities over time. Implementation planning is a C2 CPM -facilitated activity that involves identifying and

Client relations in South Asia: programmatic and societal determinants.

PubMed

Simmons, R; Koblinsky, M A; Phillips, J F

1986-01-01

Client relations constitute a neglected area of research in family planning. Findings from studies in northern India and Bangladesh reveal considerable variation in both the quantity and quality of contacts in programs that function under roughly comparable socioeconomic conditions. Client relations are determined by a complex set of forces in which both programmatic factors and conditions pertaining to the societal environment play a key role. Worker-client exchanges have a net, incremental effect on contraceptive use.

The MAL: A Malware Analysis Lexicon

DTIC Science & Technology

2013-02-01

we feel that further exploration of the open source literature is a promising avenue for enlarging the corpus. 2.3 Publishing the MAL Early in the...MAL. We feel that the advantages of this format are well worth the small incremental cost. The distribution of the MAL in this format is under...dictionary. We feel that moving to a richer format such as WordNet or WordVis would greatly improve the usability of the lexicon. 3.5 Improved Hosting The

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

PubMed

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

2017-10-01

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

Using Net-Zero Energy Projects to Enable Sustainable Economic Redevelopment at the Former Brunswick Air Naval Base

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

Huffman, S.

A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites. The Brunswick Naval Air Station is a naval air facility and Environmental Protection Agency (EPA) Super Fund site that is being cleaned up, and closed down. The objective of this report is not only to look at the economics of individual renewable energy technologies, but also to look at the systemic benefits that can be gained when cost-effective renewable energy technologies are integrated with other systems and businesses in a community; thus multiplying themore » total monetary, employment, and quality-of-life benefits they can provide to a community.« less

Net primary productivity, allocation pattern and carbon use efficiency in an apple orchard assessed by integrating eddy-covariance, biometric and continuous soil chamber measurements

NASA Astrophysics Data System (ADS)

Zanotelli, D.; Montagnani, L.; Manca, G.; Tagliavini, M.

2012-10-01

Carbon use efficiency (CUE) is a functional parameter that could possibly link the current increasingly accurate global estimates of gross primary production with those of net ecosystem exchange, for which global predictors are still unavailable. Nevertheless, CUE estimates are actually available for only a few ecosystem types, while information regarding agro-ecosystems is scarce, in spite of the simplified spatial structure of these ecosystems that facilitates studies on allocation patterns and temporal growth dynamics. We combined three largely deployed methods, eddy covariance, soil respiration and biometric measurements, to assess monthly values of CUE, net primary production (NPP) and allocation patterns in different plant organs in an apple orchard during a complete year (2010). We applied a~measurement protocol optimized for quantifying monthly values of carbon fluxes in this ecosystem type, which allows for a cross-check between estimates obtained from different methods. We also attributed NPP components to standing biomass increments, detritus cycle feeding and lateral exports. We found that in the apple orchard both net ecosystem production and gross primary production on yearly basis, 380 ± 30 g C m-2 and 1263 ± 189 g C m-2 respectively, were of a magnitude comparable to those of natural forests growing in similar climate conditions. The largest differences with respect to forests are in the allocation pattern and in the fate of produced biomass. The carbon sequestered from the atmosphere was largely allocated to production of fruits: 49% of annual NPP was taken away from the ecosystem through apple production. Organic material (leaves, fine root litter, pruned wood and early fruit falls) contributing to the detritus cycle was 46% of the NPP. Only 5% was attributable to standing biomass increment, while this NPP component is generally the largest in forests. The CUE, with an annual average of 0.71 ± 0.09, was higher than the previously suggested constant values of 0.47-0.50. Low nitrogen investment in fruits, the limited root-apparatus, and the optimal growth temperature and nutritional condition observed at the site are suggested to be explanatory variables for the high CUE observed.

Space Availability in Confined Sheep during Pregnancy, Effects in Movement Patterns and Use of Space

PubMed Central

Averós, Xavier; Lorea, Areta; Beltrán de Heredia, Ignacia; Arranz, Josune; Ruiz, Roberto; Estevez, Inma

2014-01-01

Space availability is essential to grant the welfare of animals. To determine the effect of space availability on movement and space use in pregnant ewes (Ovis aries), 54 individuals were studied during the last 11 weeks of gestation. Three treatments were tested (1, 2, and 3 m2/ewe; 6 ewes/group). Ewes' positions were collected for 15 minutes using continuous scan samplings two days/week. Total and net distance, net/total distance ratio, maximum and minimum step length, movement activity, angular dispersion, nearest, furthest and mean neighbour distance, peripheral location ratio, and corrected peripheral location ratio were calculated. Restriction in space availability resulted in smaller total travelled distance, net to total distance ratio, maximum step length, and angular dispersion but higher movement activity at 1 m2/ewe as compared to 2 and 3 m2/ewe (P<0.01). On the other hand, nearest and furthest neighbour distances increased from 1 to 3 m2/ewe (P<0.001). Largest total distance, maximum and minimum step length, and movement activity, as well as lowest net/total distance ratio and angular dispersion were observed during the first weeks (P<0.05) while inter-individual distances increased through gestation. Results indicate that movement patterns and space use in ewes were clearly restricted by limitations of space availability to 1 m2/ewe. This reflected in shorter, more sinuous trajectories composed of shorter steps, lower inter-individual distances and higher movement activity potentially linked with higher restlessness levels. On the contrary, differences between 2 and 3 m2/ewe, for most variables indicate that increasing space availability from 2 to 3 m2/ewe would appear to have limited benefits, reflected mostly in a further increment in the inter-individual distances among group members. No major variations in spatial requirements were detected through gestation, except for slight increments in inter-individual distances and an initial adaptation period, with ewes being restless and highly motivated to explore their new environment. PMID:24733027

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

PubMed

Canfield, Casey Inez; Fischhoff, Baruch

2018-04-01

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

It's Not Your Mother and Father's Monetary Policy Anymore: The Federal Reserve and Financial Crisis Relief

ERIC Educational Resources Information Center

Hill, Andrew T.; Wood, William C.

2011-01-01

The recent financial crisis brought about dramatic changes in the way that the Federal Reserve, the nation's central bank, conducts monetary policy. One challenge for high school educators going forward will be to strike a balance between the teaching of traditional monetary policy and the teaching of the monetary policy used during these…

Major depressive disorder is characterized by greater reward network activation to monetary than pleasant image rewards

PubMed Central

Smoski, Moria J.; Rittenberg, Alison; Dichter, Gabriel S.

2011-01-01

Anhedonia, the loss of interest or pleasure in normally rewarding activities, is a hallmark feature of unipolar Major Depressive Disorder (MDD). A growing body of literature has identified frontostriatal dysfunction during reward anticipation and outcomes in MDD. However, no study to date has directly compared responses to different types of rewards such as pleasant images and monetary rewards in MDD. To investigate the neural responses to monetary and pleasant image rewards in MDD, a modified Monetary Incentive Delay task was used during fMRI scanning to assess neural responses during anticipation and receipt of monetary and pleasant image rewards. Participants included nine adults with MDD and thirteen affectively healthy controls. The MDD group showed lower activation than controls when anticipating monetary rewards in right orbitofrontal cortex and subcallosal cortex, and when anticipating pleasant image rewards in paracingulate and supplementary motor cortex. The MDD group had relatively greater activation in right putamen when anticipating monetary versus pleasant image rewards, relative to the control group. Results suggest reduced reward network activation in MDD when anticipating rewards, as well as relatively greater hypoactivation to pleasant image than monetary rewards. PMID:22079658

Real and hypothetical monetary rewards modulate risk taking in the brain.

PubMed

Xu, Sihua; Pan, Yu; Wang, You; Spaeth, Andrea M; Qu, Zhe; Rao, Hengyi

2016-07-07

Both real and hypothetical monetary rewards are widely used as reinforcers in risk taking and decision making studies. However, whether real and hypothetical monetary rewards modulate risk taking and decision making in the same manner remains controversial. In this study, we used event-related potentials (ERP) with a balloon analogue risk task (BART) paradigm to examine the effects of real and hypothetical monetary rewards on risk taking in the brain. Behavioral data showed reduced risk taking after negative feedback (money loss) during the BART with real rewards compared to those with hypothetical rewards, suggesting increased loss aversion with real monetary rewards. The ERP data demonstrated a larger feedback-related negativity (FRN) in response to money loss during risk taking with real rewards compared to those with hypothetical rewards, which may reflect greater prediction error or regret emotion after real monetary losses. These findings demonstrate differential effects of real versus hypothetical monetary rewards on risk taking behavior and brain activity, suggesting a caution when drawing conclusions about real choices from hypothetical studies of intended behavior, especially when large rewards are used. The results have implications for future utility of real and hypothetical monetary rewards in studies of risk taking and decision making.

Major depressive disorder is characterized by greater reward network activation to monetary than pleasant image rewards.

PubMed

Smoski, Moria J; Rittenberg, Alison; Dichter, Gabriel S

2011-12-30

Anhedonia, the loss of interest or pleasure in normally rewarding activities, is a hallmark feature of unipolar Major Depressive Disorder (MDD). A growing body of literature has identified frontostriatal dysfunction during reward anticipation and outcomes in MDD. However, no study to date has directly compared responses to different types of rewards such as pleasant images and monetary rewards in MDD. To investigate the neural responses to monetary and pleasant image rewards in MDD, a modified Monetary Incentive Delay task was used during functional magnetic resonance imaging to assess neural responses during anticipation and receipt of monetary and pleasant image rewards. Participants included nine adults with MDD and 13 affectively healthy controls. The MDD group showed lower activation than controls when anticipating monetary rewards in right orbitofrontal cortex and subcallosal cortex, and when anticipating pleasant image rewards in paracingulate and supplementary motor cortex. The MDD group had relatively greater activation in right putamen when anticipating monetary versus pleasant image rewards, relative to the control group. Results suggest reduced reward network activation in MDD when anticipating rewards, as well as relatively greater hypoactivation to pleasant image than monetary rewards. 2011 Elsevier Ireland Ltd. All rights reserved.

A comparison of the electrocortical response to monetary and social reward

PubMed Central

Distefano, Amanda; Jackson, Felicia; Levinson, Amanda R; Infantolino, Zachary P; Jarcho, Johanna M; Nelson, Brady D

2018-01-01

Abstract Affective science research on reward processing has primarily focused on monetary rewards. There has been a growing interest in evaluating the neural basis of social decision-making and reward processing. The present study employed a within-subject design and compared the reward positivity (RewP), an event-related potential component that is present following favorable feedback and absent or reduced following unfavorable feedback, during monetary and social reward tasks. Specifically, 114 participants (75 females) completed a monetary reward task and a novel social reward task that were matched on trial structure, timing, and feedback stimuli in a counterbalanced order. Results indicated that the monetary and social RewP were of similar magnitude, positively correlated and demonstrated comparable psychometric properties, including reliability and dependability. Across both the monetary and social tasks, women demonstrated a greater RewP compared with men. This study provides a novel methodological approach toward examining the electrocortical response to social reward that is comparable to monetary reward. PMID:29373743

16 CFR 1.98 - Adjustment of civil monetary penalty amounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF PRACTICE GENERAL PROCEDURES Civil Penalty Adjustments Under the Federal Civil Penalties Inflation... monetary penalty amounts. This section makes inflation adjustments in the dollar amounts of civil monetary...

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

PubMed

Fatoye, Francis; Haigh, Carol

2016-05-01

To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. Economic evaluation based on cost-utility analysis. Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle sprains. © 2016 John Wiley & Sons Ltd.

Houston-Galveston Navigation Channel Shoaling Study

DTIC Science & Technology

2014-12-01

compared to data collected at other times during the year. If this is the case, sediment would tend to collect farther down the channel toward Red Fish ...27 28 29 30 31 32 33 Location along channel (1000 m increments) Pe rc en t ( % ) Bayport Red Fish Reef Pe rc en t ( % ) ERDC/CHL TR-14-14 12...in the bay tends to evacuate. For the wind and flow conditions that were investigated previously, the net drift in the channel upland from Red Fish

Improving Stochastic Communication Network Performance: Reliability vs. Throughput

DTIC Science & Technology

1991-12-01

increased to one. 2) arc survivabil.. ities will be increased in increments of one tenths. and 3) the costs to increase- arc si’rvivabilities were equal and...This reliability value is leni used to maximize the associated expected flow. For Net work A. a bIdget of (8)() pro(duces a tradcoff point at (.58.37...Network B for a buidgel of 2000 which allows a nel \\\\ork relial)ilitv of one to be achieved and a bidget of 1200 which allows for ;, maximum 57

Joint Aerospace Weapon System Support, Sensors And Simulation Symposium (5th Annual). Held In San Diego, California on 13-18 June 1999

DTIC Science & Technology

1999-06-18

and 1.54 microns and to compute the spectral extinction coefficient. 3. Near IR (1.54 um) Laser rangefinders measure the time-of-flight of a short...quantitative understanding n n Research ( long term) n Encourage research in adaptive systems : evolutionary programming, genetic algorithms, neural nets... measures , such as false alarm rate , are not measurable in field applications. Other measures such as Incremental Fault Resolution, Operational Isolation

Basic research and data analysis for the National Geodetic Satellite program and for the Earth Surveys program

NASA Technical Reports Server (NTRS)

1972-01-01

Current research is reported on precise and accurate descriptions of the earth's surface and gravitational field and on time variations of geophysical parameters. A new computer program was written in connection with the adjustment of the BC-4 worldwide geometric satellite triangulation net. The possibility that an increment to accuracy could be transferred from a super-control net to the basic geodetic (first-order triangulation) was investigated. Coordinates of the NA9 solution were computed and were transformed to the NAD datum, based on GEOS 1 observations. Normal equations from observational data of several different systems and constraint equations were added and a single solution was obtained for the combined systems. Transformation parameters with constraints were determined, and the impact of computers on surveying and mapping is discussed.

Influence of paper color and a monetary incentive on response rate.

PubMed

King, Keith A; Vaughan, Jennifer L

2004-10-01

This study examined whether survey response rate differed based on the color of the paper the survey was printed on (blue vs green) and presence of a monetary incentive. A 4-page survey on eating disorders was mailed to Division 1A and 1AA college head athletic trainers (N=223) with half of the surveys on blue paper and half on green paper. Half of the athletic trainers (n = 111) received a $1.00 monetary incentive, and half (n = 112) received no monetary incentive. A total of 166 (71%) athletic trainers returned completed surveys. Response rates did not differ based on survey color but did differ based on presence of a monetary incentive. Athletic trainers who received a monetary incentive were significantly more likely than those who did not to return completed surveys (86% vs 63%, respectively).

Fatigue level estimation of monetary bills based on frequency band acoustic signals with feature selection by supervised SOM

NASA Astrophysics Data System (ADS)

Teranishi, Masaru; Omatu, Sigeru; Kosaka, Toshihisa

Fatigued monetary bills adversely affect the daily operation of automated teller machines (ATMs). In order to make the classification of fatigued bills more efficient, the development of an automatic fatigued monetary bill classification method is desirable. We propose a new method by which to estimate the fatigue level of monetary bills from the feature-selected frequency band acoustic energy pattern of banking machines. By using a supervised self-organizing map (SOM), we effectively estimate the fatigue level using only the feature-selected frequency band acoustic energy pattern. Furthermore, the feature-selected frequency band acoustic energy pattern improves the estimation accuracy of the fatigue level of monetary bills by adding frequency domain information to the acoustic energy pattern. The experimental results with real monetary bill samples reveal the effectiveness of the proposed method.

Mathematical evaluation of community level impact of combining bed nets and indoor residual spraying upon malaria transmission in areas where the main vectors are Anopheles arabiensis mosquitoes.

PubMed

Okumu, Fredros O; Kiware, Samson S; Moore, Sarah J; Killeen, Gerry F

2013-01-16

Indoor residual insecticide spraying (IRS) and long-lasting insecticide treated nets (LLINs) are commonly used together even though evidence that such combinations confer greater protection against malaria than either method alone is inconsistent. A deterministic model of mosquito life cycle processes was adapted to allow parameterization with results from experimental hut trials of various combinations of untreated nets or LLINs (Olyset, PermaNet 2.0, Icon Life nets) with IRS (pirimiphos methyl, lambda cyhalothrin, DDT), in a setting where vector populations are dominated by Anopheles arabiensis, so that community level impact upon malaria transmission at high coverage could be predicted. Intact untreated nets alone provide equivalent personal protection to all three LLINs. Relative to IRS plus untreated nets, community level protection is slightly higher when Olyset or PermaNet 2.0 nets are added onto IRS with pirimiphos methyl or lambda cyhalothrin but not DDT, and when Icon Life nets supplement any of the IRS insecticides. Adding IRS onto any net modestly enhances communal protection when pirimiphos methyl is sprayed, while spraying lambda cyhalothrin enhances protection for untreated nets but not LLINs. Addition of DDT reduces communal protection when added to LLINs. Where transmission is mediated primarily by An. arabiensis, adding IRS to high LLIN coverage provides only modest incremental benefit (e.g. when an organophosphate like pirimiphos methyl is used), but can be redundant (e.g. when a pyrethroid like lambda cyhalothin is used) or even regressive (e.g. when DDT is used for the IRS). Relative to IRS plus untreated nets, supplementing IRS with LLINs will only modestly improve community protection. Beyond the physical protection that intact nets provide, additional protection against transmission by An. arabiensis conferred by insecticides will be remarkably small, regardless of whether they are delivered as LLINs or IRS. The insecticidal action of LLINs and IRS probably already approaches their absolute limit of potential impact upon this persistent vector so personal protection of nets should be enhanced by improving the physical integrity and durability. Combining LLINs and non-pyrethroid IRS in residual transmission systems may nevertheless be justified as a means to manage insecticide resistance and prevent potential rebound of not only An. arabiensis, but also more potent, vulnerable and historically important species such as Anopheles gambiae and Anopheles funestus.

Neural markers of social and monetary rewards in children with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder.

PubMed

Gonzalez-Gadea, Maria Luz; Sigman, Mariano; Rattazzi, Alexia; Lavin, Claudio; Rivera-Rei, Alvaro; Marino, Julian; Manes, Facundo; Ibanez, Agustin

2016-07-28

Recent theories of decision making propose a shared value-related brain mechanism for encoding monetary and social rewards. We tested this model in children with Attention-Deficit/Hyperactivity Disorder (ADHD), children with Autism Spectrum Disorder (ASD) and control children. We monitored participants' brain dynamics using high density-electroencephalography while they played a monetary and social reward tasks. Control children exhibited a feedback Error-Related Negativity (fERN) modulation and Anterior Cingulate Cortex (ACC) source activation during both tasks. Remarkably, although cooperation resulted in greater losses for the participants, the betrayal options generated greater fERN responses. ADHD subjects exhibited an absence of fERN modulation and reduced ACC activation during both tasks. ASD subjects exhibited normal fERN modulation during monetary choices and inverted fERN/ACC responses in social options than did controls. These results suggest that in neurotypicals, monetary losses and observed disloyal social decisions induced similar activity in the brain value system. In ADHD children, difficulties in reward processing affected early brain signatures of monetary and social decisions. Conversely, ASD children showed intact neural markers of value-related monetary mechanisms, but no brain modulation by prosociality in the social task. These results offer insight into the typical and atypical developments of neural correlates of monetary and social reward processing.

Endogenous cortisol levels are associated with an imbalanced striatal sensitivity to monetary versus non-monetary cues in pathological gamblers

PubMed Central

Li, Yansong; Sescousse, Guillaume; Dreher, Jean-Claude

2014-01-01

Pathological gambling is a behavioral addiction characterized by a chronic failure to resist the urge to gamble. It shares many similarities with drug addiction. Glucocorticoid hormones including cortisol are thought to play a key role in the vulnerability to addictive behaviors, by acting on the mesolimbic reward pathway. Based on our previous report of an imbalanced sensitivity to monetary versus non-monetary incentives in the ventral striatum of pathological gamblers (PGs), we investigated whether this imbalance was mediated by individual differences in endogenous cortisol levels. We used functional magnetic resonance imaging (fMRI) and examined the relationship between cortisol levels and the neural responses to monetary versus non-monetary cues, while PGs and healthy controls were engaged in an incentive delay task manipulating both monetary and erotic rewards. We found a positive correlation between cortisol levels and ventral striatal responses to monetary versus erotic cues in PGs, but not in healthy controls. This indicates that the ventral striatum is a key region where cortisol modulates incentive motivation for gambling versus non-gambling related stimuli in PGs. Our results extend the proposed role of glucocorticoid hormones in drug addiction to behavioral addiction, and help understand the impact of cortisol on reward incentive processing in PGs. PMID:24723862

Advertising energy saving programs: The potential environmental cost of emphasizing monetary savings.

PubMed

Schwartz, Daniel; Bruine de Bruin, Wändi; Fischhoff, Baruch; Lave, Lester

2015-06-01

Many consumers have monetary or environmental motivations for saving energy. Indeed, saving energy produces both monetary benefits, by reducing energy bills, and environmental benefits, by reducing carbon footprints. We examined how consumers' willingness and reasons to enroll in energy-savings programs are affected by whether advertisements emphasize monetary benefits, environmental benefits, or both. From a normative perspective, having 2 noteworthy kinds of benefit should not decrease a program's attractiveness. In contrast, psychological research suggests that adding external incentives to an intrinsically motivating task may backfire. To date, however, it remains unclear whether this is the case when both extrinsic and intrinsic motivations are inherent to the task, as with energy savings, and whether removing explicit mention of extrinsic motivation will reduce its importance. We found that emphasizing a program's monetary benefits reduced participants' willingness to enroll. In addition, participants' explanations about enrollment revealed less attention to environmental concerns when programs emphasized monetary savings, even when environmental savings were also emphasized. We found equal attention to monetary motivations in all conditions, revealing an asymmetric attention to monetary and environmental motives. These results also provide practical guidance regarding the positioning of energy-saving programs: emphasize intrinsic benefits; the extrinsic ones may speak for themselves. (c) 2015 APA, all rights reserved).

The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema.

PubMed

Brown, Gary C; Brown, Melissa M; Turpcu, Adam; Rajput, Yamina

2015-07-01

To assess the incremental, comparative effectiveness (patient value gain) and cost effectiveness (financial value gain) associated with 0.3-mg intravitreal ranibizumab injection therapy versus sham therapy for diabetic macular edema (DME). Value-Based Medicine (Center for Value-Based Medicine, Flourtown, PA) 14-year, cost-utility analysis using patient preferences and 2012 United States real dollars. Published data from the identical Ranibizumab Injection in Subjects with Clinically Significant Macular Edema with Center Involvement Secondary to Diabetes Mellitus (RISE and RIDE) clinical trials. An incremental cost-utility analysis was performed using societal and third-party insurer cost perspectives. Costs and outcomes were discounted with net present value analysis at 3% per annum. The incremental comparative effectiveness was measured in: (1) quality-adjusted life year (QALY) gain and (2) percent patient value (quality-of-life) gain. Cost effectiveness was quantified with the cost-utility ratio (CUR) measured as $/QALY. The 14-year, incremental patient value gain conferred by intravitreal ranibizumab therapy for diabetic maculopathy was 0.9981 QALY, equating to an 11.6% improvement in quality of life. The direct, ophthalmic medical cost for ranibizumab therapy in 1 eye was $30 116, whereas for 2 eyes it was $56 336. The direct, nonophthalmic, medical costs saved from decreased depression, injury, skilled nursing facility admissions, nursing home admissions, and other vision-associated costs totaled $51 758, resulting in an overall direct medical cost of $4578. The net mean societal cost for bilateral ranibizumab therapy was -$30 807. Of this total, decreased caregiver costs accrued a $31 406 savings against the direct medical costs, whereas decreased wage losses accrued a $3978 savings. The third-party insurer CUR for bilateral ranibizumab therapy was $4587/QALY. The societal cost perspective for bilateral therapy was -$30 807/QALY, indicating that ranibizumab therapy dominated sham therapy because it conferred both a positive QALY gain of 0.9981 and a financial value gain (positive financial return on investment) of $30 807 referent to the direct ophthalmic medical costs expended. Intravitreal ranibizumab therapy for the treatment of DME confers considerable patient (human) value gain. It also accrues financial value to patients, public and private insurers, and society. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Environmental impact assessment and monetary ecosystem service valuation of an ecosystem under different future environmental change and management scenarios; a case study of a Scots pine forest.

PubMed

Schaubroeck, Thomas; Deckmyn, Gaby; Giot, Olivier; Campioli, Matteo; Vanpoucke, Charlotte; Verheyen, Kris; Rugani, Benedetto; Achten, Wouter; Verbeeck, Hans; Dewulf, Jo; Muys, Bart

2016-05-15

For a sustainable future, we must sustainably manage not only the human/industrial system but also ecosystems. To achieve the latter goal, we need to predict the responses of ecosystems and their provided services to management practices under changing environmental conditions via ecosystem models and use tools to compare the estimated provided services between the different scenarios. However, scientific articles have covered a limited amount of estimated ecosystem services and have used tools to aggregate services that contain a significant amount of subjective aspects and that represent the final result in a non-tangible unit such as 'points'. To resolve these matters, this study quantifies the environmental impact (on human health, natural systems and natural resources) in physical units and uses an ecosystem service valuation based on monetary values (including ecosystem disservices with associated negative monetary values). More specifically, the paper also focuses on the assessment of ecosystem services related to pollutant removal/generation flows, accounting for the inflow of eutrophying nitrogen (N) when assessing the effect of N leached to groundwater. Regarding water use/provisioning, evapotranspiration is alternatively considered a disservice because it implies a loss of (potential) groundwater. These approaches and improvements, relevant to all ecosystems, are demonstrated using a Scots pine stand from 2010 to 2089 for a combination of three environmental change and three management scenarios. The environmental change scenarios considered interannual climate variability trends and included alterations in temperature, precipitation, nitrogen deposition, wind speed, Particulate matter (PM) concentration and CO2 concentration. The addressed flows/ecosystem services, including disservices, are as follows: particulate matter removal, freshwater loss, CO2 sequestration, wood production, NOx emissions, NH3 uptake and nitrogen pollution/removal. The monetary ecosystem service valuation yields a total average estimate of 361-1242 euro ha(-1) yr(-1). PM2.5 (<2.5 μm) removal is the key service, with a projected value of 622-1172 euro ha(-1) yr(-1). Concerning environmental impact assessment, with net CO2 uptake being the most relevant contributing flow, a loss prevention of 0.014-0.029 healthy life years ha(-1) yr(-1) is calculated for the respective flows. Both assessment methods favor the use of the least intensive management scenario due to its resulting higher CO2 sequestration and PM removal, which are the most important services of the considered ones. Copyright © 2016 Elsevier Ltd. All rights reserved.

Growth duration is a better predictor of stem increment than carbon supply in a Mediterranean oak forest: implications for assessing forest productivity under climate change.

PubMed

Lempereur, Morine; Martin-StPaul, Nicolas K; Damesin, Claire; Joffre, Richard; Ourcival, Jean-Marc; Rocheteau, Alain; Rambal, Serge

2015-08-01

Understanding whether tree growth is limited by carbon gain (source limitation) or by the direct effect of environmental factors such as water deficit or temperature (sink limitation) is crucial for improving projections of the effects of climate change on forest productivity. We studied the relationships between tree basal area (BA) variations, eddy covariance carbon fluxes, predawn water potential (Ψpd ) and temperature at different timescales using an 8-yr dataset and a rainfall exclusion experiment in a Quercus ilex Mediterranean coppice. At the daily timescale, during periods of low temperature (< 5°C) and high water deficit (< -1.1 MPa), gross primary productivity and net ecosystem productivity remained positive whereas the stem increment was nil. Thus, stem increment appeared limited by drought and temperature rather than by carbon input. Annual growth was accurately predicted by the duration of BA increment during spring (Δtt0-t1 ). The onset of growth (t0 ) was related to winter temperatures and the summer interruption of growth (t1 ) to a threshold Ψpd value of -1.1 MPa. We suggest that using environmental drivers (i.e. drought and temperature) to predict stem growth phenology can contribute to an improvement in vegetation models and may change the current projections of Mediterranean forest productivity under climate change scenarios. © 2015 CNRS-ADEME New Phytologist © 2015 New Phytologist Trust.

Non-Market Values in a Cost-Benefit World: Evidence from a Choice Experiment.

PubMed

Eppink, Florian V; Winden, Matthew; Wright, Will C C; Greenhalgh, Suzie

2016-01-01

In support of natural resource and ecosystem service policy, monetary value estimates are often presented to decision makers along with other types of information. There is some evidence that, presented with such 'mixed' information, people prioritise monetary over non-monetary information. We conduct a discrete choice experiment among New Zealand decision makers in which we manipulate the information presented to participants. We find that providing explicit monetary information strengthens the pursuit of economic benefits as well as the avoidance of environmental damage. Cultural impacts, of which we provided only qualitative descriptions, did not affect respondents' choices. Our study provides further evidence that concerns regarding the use of monetary information in decisions with complex, multi-value impacts are valid. Further research is needed to validate our results and find ways to reduce any bias in monetary and non-market information.

Non-Market Values in a Cost-Benefit World: Evidence from a Choice Experiment

PubMed Central

Eppink, Florian V.; Winden, Matthew; Wright, Will C. C.; Greenhalgh, Suzie

2016-01-01

In support of natural resource and ecosystem service policy, monetary value estimates are often presented to decision makers along with other types of information. There is some evidence that, presented with such ‘mixed’ information, people prioritise monetary over non-monetary information. We conduct a discrete choice experiment among New Zealand decision makers in which we manipulate the information presented to participants. We find that providing explicit monetary information strengthens the pursuit of economic benefits as well as the avoidance of environmental damage. Cultural impacts, of which we provided only qualitative descriptions, did not affect respondents’ choices. Our study provides further evidence that concerns regarding the use of monetary information in decisions with complex, multi-value impacts are valid. Further research is needed to validate our results and find ways to reduce any bias in monetary and non-market information. PMID:27783657

How do gamblers end gambling: longitudinal analysis of Internet gambling behaviors prior to account closure due to gambling related problems.

PubMed

Xuan, Ziming; Shaffer, Howard

2009-06-01

To examine behavioral patterns of actual Internet gamblers who experienced gambling-related problems and voluntarily closed their accounts. A nested case-control design was used to compare gamblers who closed their accounts because of gambling problems to those who maintained open accounts. Actual play patterns of in vivo Internet gamblers who subscribed to an Internet gambling site. 226 gamblers who closed accounts due to gambling problems were selected from a cohort of 47,603 Internet gamblers who subscribed to an Internet gambling site during February 2005; 226 matched-case controls were selected from the group of gamblers who did not close their accounts. Daily aggregates of behavioral data were collected during an 18-month study period. Main outcomes of interest were daily aggregates of stake, odds, and net loss, which were standardized by the daily aggregate number of bets. We also examined the number of bets to measure trajectory of gambling frequency. Account closers due to gambling problems experienced increasing monetary loss as the time to closure approached; they also increased their stake per bet. Yet they did not chase longer odds; their choices of wagers were more probabilistically conservative (i.e., short odds) compared with the controls. The changes of monetary involvement and risk preference occurred concurrently during the last few days prior to voluntary closing. Our finding of an involvement-seeking yet risk-averse tendency among self-identified problem gamblers challenges the notion that problem gamblers seek "long odds" during "chasing."

Imbalance in the sensitivity to different types of rewards in pathological gambling.

PubMed

Sescousse, Guillaume; Barbalat, Guillaume; Domenech, Philippe; Dreher, Jean-Claude

2013-08-01

Pathological gambling is an addictive disorder characterized by a persistent and compulsive desire to engage in gambling activities. This maladaptive behaviour has been suggested to result from a decreased sensitivity to experienced rewards, regardless of reward type. Alternatively, pathological gambling might reflect an imbalance in the sensitivity to monetary versus non-monetary incentives. To directly test these two hypotheses, we examined how the brain reward circuit of pathological gamblers responds to different types of rewards. Using functional magnetic resonance imaging, we compared the brain responses of 18 pathological gamblers and 20 healthy control subjects while they engaged in a simple incentive task manipulating both monetary and visual erotic rewards. During reward anticipation, the ventral striatum of pathological gamblers showed a differential response to monetary versus erotic cues, essentially driven by a blunted reactivity to cues predicting erotic stimuli. This differential response correlated with the severity of gambling symptoms and was paralleled by a reduced behavioural motivation for erotic rewards. During reward outcome, a posterior orbitofrontal cortex region, responding to erotic rewards in both groups, was further recruited by monetary gains in pathological gamblers but not in control subjects. Moreover, while ventral striatal activity correlated with subjective ratings assigned to monetary and erotic rewards in control subjects, it only correlated with erotic ratings in gamblers. Our results point to a differential sensitivity to monetary versus non-monetary rewards in pathological gambling, both at the motivational and hedonic levels. Such an imbalance might create a bias towards monetary rewards, potentially promoting addictive gambling behaviour.

Neural markers of social and monetary rewards in children with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder

PubMed Central

Gonzalez-Gadea, Maria Luz; Sigman, Mariano; Rattazzi, Alexia; Lavin, Claudio; Rivera-Rei, Alvaro; Marino, Julian; Manes, Facundo; Ibanez, Agustin

2016-01-01

Recent theories of decision making propose a shared value-related brain mechanism for encoding monetary and social rewards. We tested this model in children with Attention-Deficit/Hyperactivity Disorder (ADHD), children with Autism Spectrum Disorder (ASD) and control children. We monitored participants’ brain dynamics using high density-electroencephalography while they played a monetary and social reward tasks. Control children exhibited a feedback Error-Related Negativity (fERN) modulation and Anterior Cingulate Cortex (ACC) source activation during both tasks. Remarkably, although cooperation resulted in greater losses for the participants, the betrayal options generated greater fERN responses. ADHD subjects exhibited an absence of fERN modulation and reduced ACC activation during both tasks. ASD subjects exhibited normal fERN modulation during monetary choices and inverted fERN/ACC responses in social options than did controls. These results suggest that in neurotypicals, monetary losses and observed disloyal social decisions induced similar activity in the brain value system. In ADHD children, difficulties in reward processing affected early brain signatures of monetary and social decisions. Conversely, ASD children showed intact neural markers of value-related monetary mechanisms, but no brain modulation by prosociality in the social task. These results offer insight into the typical and atypical developments of neural correlates of monetary and social reward processing. PMID:27464551

Sensitivity of Seven Diverse Species to Blue and Green Light: Interactions with Photon Flux.

PubMed

Snowden, M Chase; Cope, Kevin R; Bugbee, Bruce

2016-01-01

Despite decades of research, the effects of spectral quality on plant growth, and development are not well understood. Much of our current understanding comes from studies with daily integrated light levels that are less than 10% of summer sunlight thus making it difficult to characterize interactions between light quality and quantity. Several studies have reported that growth is increased under fluorescent lamps compared to mixtures of wavelengths from LEDs. Conclusions regarding the effect of green light fraction range from detrimental to beneficial. Here we report the effects of eight blue and green light fractions at two photosynthetic photon fluxes (PPF; 200 and 500 μmol m-2 s-1; with a daily light integral of 11.5 and 29 mol m-2 d-1) on growth (dry mass), leaf expansion, stem and petiole elongation, and whole-plant net assimilation of seven diverse plant species. The treatments included cool, neutral, and warm white LEDs, and combinations of blue, green and/or red LEDs. At the higher PPF (500), increasing blue light in increments from 11 to 28% reduced growth in tomato, cucumber, and pepper by 22, 26, and 14% respectively, but there was no statistically significant effect on radish, soybean, lettuce or wheat. At the lower PPF (200), increasing blue light reduced growth only in tomato (41%). The effects of blue light on growth were mediated by changes in leaf area and radiation capture, with minimal effects on whole-plant net-assimilation. In contrast to the significant effects of blue light, increasing green light in increments from 0 to 30% had a relatively small effect on growth, leaf area and net assimilation at either low or high PPF. Surprisingly, growth of three of the seven species was not reduced by a treatment with 93% green light compared to the broad spectrum treatments. Collectively, these results are consistent with a shade avoidance response associated with either low blue or high green light fractions.

Sensitivity of Seven Diverse Species to Blue and Green Light: Interactions with Photon Flux

PubMed Central

Snowden, M. Chase; Cope, Kevin R.; Bugbee, Bruce

2016-01-01

Despite decades of research, the effects of spectral quality on plant growth, and development are not well understood. Much of our current understanding comes from studies with daily integrated light levels that are less than 10% of summer sunlight thus making it difficult to characterize interactions between light quality and quantity. Several studies have reported that growth is increased under fluorescent lamps compared to mixtures of wavelengths from LEDs. Conclusions regarding the effect of green light fraction range from detrimental to beneficial. Here we report the effects of eight blue and green light fractions at two photosynthetic photon fluxes (PPF; 200 and 500 μmol m-2 s-1; with a daily light integral of 11.5 and 29 mol m-2 d-1) on growth (dry mass), leaf expansion, stem and petiole elongation, and whole-plant net assimilation of seven diverse plant species. The treatments included cool, neutral, and warm white LEDs, and combinations of blue, green and/or red LEDs. At the higher PPF (500), increasing blue light in increments from 11 to 28% reduced growth in tomato, cucumber, and pepper by 22, 26, and 14% respectively, but there was no statistically significant effect on radish, soybean, lettuce or wheat. At the lower PPF (200), increasing blue light reduced growth only in tomato (41%). The effects of blue light on growth were mediated by changes in leaf area and radiation capture, with minimal effects on whole-plant net-assimilation. In contrast to the significant effects of blue light, increasing green light in increments from 0 to 30% had a relatively small effect on growth, leaf area and net assimilation at either low or high PPF. Surprisingly, growth of three of the seven species was not reduced by a treatment with 93% green light compared to the broad spectrum treatments. Collectively, these results are consistent with a shade avoidance response associated with either low blue or high green light fractions. PMID:27706176

The economic value of innovative treatments over the product life cycle: the case of targeted trastuzumab therapy for breast cancer.

PubMed

Garrison, Louis P; Veenstra, David L

2009-01-01

Pharmacoeconomic analyses typically project the expected cost-effectiveness of a new product for a specific indication. This analysis develops a dynamic life-cycle model to conduct a multi-indication evaluation using the case of trastuzumab licensed in the United States for both early-stage and metastatic (or late-stage) human epidermal growth factor receptor 2 (HER2)-positive breast cancer therapy (early breast cancer [EBC]; metastatic breast cancer [MBC]), approved in 2006 and 1998, respectively. This dynamic model combined information on expected incremental cost-utility ratios for specific indications with an epidemiologically based projection of utilization by indication over the product life cycle-from 1998 to 2016. Net economic value was estimated as the cumulative quality-adjusted life years (QALYs) gained over the life cycle multiplied by a societal valuation of health gains ($/QALY) minus cumulative net direct treatment costs. Sensitivity analyses were performed under a range of assumptions. We projected that the annual number of EBC patients receiving trastuzumab will be more than three times that of MBC by 2016, in part because adjuvant treatment reduces the future incidence of MBC. Over this life cycle, the estimated overall incremental cost-effectiveness ratio (ICER) was $35,590/QALY with a total of 432,547 discounted QALYs gained. Under sensitivity analyses, the overall ICER varied from $21,000 to $53,000/QALY, and the projected net economic value resulting from trastuzumab treatment ranged from $6.2 billion to $49.5 billion. Average ICERs for multi-indication compounds can increase or decrease over the product life cycle. In this example, the projected overall life-cycle ICER for trastuzumab was less than one half of that in the initial indication. This dynamic perspective-versus the usual static one-highlights the interdependence of drug development decisions and investment incentives, raising important reimbursement policy issues.

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

Ronald J. MacDonald; Charles M. Boyer; Joseph H. Frantz Jr

Stripper gas and oil well operators frequently face a dilemma regarding maximizing production from low-productivity wells. With thousands of stripper wells in the United States covering extensive acreage, it is difficult to identify easily and efficiently marginal or underperforming wells. In addition, the magnitude of reviewing vast amounts of data places a strain on an operator's work force and financial resources. Schlumberger DCS, in cooperation with the National Energy Technology Laboratory (NETL) and the U.S. Department of Energy (DOE), has created software and developed in-house analysis methods to identify remediation potential in stripper wells relatively easily. This software is referredmore » to as Stripper Well Analysis Remediation Methodology (SWARM). SWARM was beta-tested with data pertaining to two gas fields located in northwestern Pennsylvania and had notable results. Great Lakes Energy Partners, LLC (Great Lakes) and Belden & Blake Corporation (B&B) both operate wells in the first field studied. They provided data for 729 wells, and we estimated that 41 wells were candidates for remediation. However, for reasons unbeknownst to Schlumberger these wells were not budgeted for rework by the operators. The second field (Cooperstown) is located in Crawford, Venango, and Warren counties, Pa and has more than 2,200 wells operated by Great Lakes. This paper discusses in depth the successful results of a candidate recognition study of this area. We compared each well's historical production with that of its offsets and identified 339 underperformers before considering remediation costs, and 168 economically viable candidates based on restimulation costs of $50,000 per well. From this data, we prioritized a list based on the expected incremental recoverable gas and 10% discounted net present value (NPV). For this study, we calculated the incremental gas by subtracting the volumes forecasted after remediation from the production projected at its current configuration. Assuming that remediation efforts increased production from the 168 marginal wells to the average of their respective offsets, approximately 6.4 Bscf of gross incremental gas with a NPV approximating $4.9 million after investment, would be made available to the domestic market. Seventeen wells have successfully been restimulated to date and have already obtained significant production increases. At the time of this report, eight of these wells had enough post-rework production data available to forecast the incremental gas and verify the project's success. This incremental gas is estimated at 615 MMscf. The outcome of the other ten wells will be determined after more post-refrac production data becomes available. Plans are currently underway for future restimulations. The success of this project has shown the value of this methodology to recognize underperforming wells quickly and efficiently in fields containing hundreds or thousands of wells. This contributes considerably to corporate net income and domestic natural gas and/or oil reserves.« less

Components of reward-driven attentional capture.

PubMed

Sha, Li Z; Jiang, Yuhong V

2016-02-01

Recent research reported that task-irrelevant colors captured attention if these colors previously served as search targets and received high monetary reward. We showed that both monetary reward and value-independent mechanisms influenced selective attention. Participants searched for two potential target colors among distractor colors in the training phase. Subsequently, they searched for a shape singleton in a testing phase. Experiment 1 found that participants were slower in the testing phase if a distractor of a previous target color was present rather than absent. Such slowing was observed even when no monetary reward was used during training. Experiment 2 associated monetary rewards with the target colors during the training phase. Participants were faster finding the target associated with higher monetary reward. However, reward training did not yield value-dependent attentional capture in the testing phase. Attentional capture by the previous target colors was not significantly greater for the previously high-reward color than the previously low or no-reward color. These findings revealed both the power and limitations of monetary reward on attention. Although monetary reward can increase attentional priority for the high-reward target during training, subsequent attentional capture effects may not be reward-based, but reflect, in part, attentional capture by previous targets.

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

PubMed

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

2017-12-07

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

Cost-effectiveness of multidisciplinary care in mild to moderate chronic kidney disease in the United States: A modeling study

PubMed Central

Malcolm, Elizabeth; Goldhaber-Fiebert, Jeremy D.

2018-01-01

Background Multidisciplinary care (MDC) programs have been proposed as a way to alleviate the cost and morbidity associated with chronic kidney disease (CKD) in the US. Methods and findings We assessed the cost-effectiveness of a theoretical Medicare-based MDC program for CKD compared to usual CKD care in Medicare beneficiaries with stage 3 and 4 CKD between 45 and 84 years old in the US. The program used nephrologists, advanced practitioners, educators, dieticians, and social workers. From Medicare claims and published literature, we developed a novel deterministic Markov model for CKD progression and calibrated it to long-term risks of mortality and progression to end-stage renal disease. We then used the model to project accrued discounted costs and quality-adjusted life years (QALYs) over patients’ remaining lifetime. We estimated the incremental cost-effectiveness ratio (ICER) of MDC, or the cost of the intervention per QALY gained. MDC added 0.23 (95% CI: 0.08, 0.42) QALYs over usual care, costing $51,285 per QALY gained (net monetary benefit of $23,100 at a threshold of $150,000 per QALY gained; 95% CI: $6,252, $44,323). In all subpopulations analyzed, ICERs ranged from $42,663 to $72,432 per QALY gained. MDC was generally more cost-effective in patients with higher urine albumin excretion. Although ICERs were higher in younger patients, MDC could yield greater improvements in health in younger than older patients. MDC remained cost-effective when we decreased its effectiveness to 25% of the base case or increased the cost 5-fold. The program costed less than $70,000 per QALY in 95% of probabilistic sensitivity analyses and less than $87,500 per QALY in 99% of analyses. Limitations of our study include its theoretical nature and being less generalizable to populations at low risk for progression to ESRD. We did not study the potential impact of MDC on hospitalization (cardiovascular or other). Conclusions Our model estimates that a Medicare-funded MDC program could reduce the need for dialysis, prolong life expectancy, and meet conventional cost-effectiveness thresholds in middle-aged to elderly patients with mild to moderate CKD. PMID:29584720

Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States

PubMed Central

Adunlin, Georges; Ali, Askal A.; Zeichner, Simon B.; de Lima Lopes, Gilberto; Kohn, Christine G.; Montero, Alberto J.

2016-01-01

Purpose Based on available phase III trial data, we performed a cost-effectiveness analysis of different treatment strategies that can be used in patients with newly diagnosed HER2-positive metastatic breast cancer (mBC). Patients and Methods We constructed a Markov model to assess the cost-effectiveness of four different HER2 targeted treatment sequences in patients with HER2-positive mBC treated in the U.S. The model followed patients weekly over their remaining life expectancies. Health states considered were progression free survival (PFS) 1st to 3rd lines, and death. Transitional probabilities were based on published phase III trials. Cost data (2015 US dollars) was captured from the U.S. Centers for Medicare and Medicaid Services (CMS) drug payment table and physician fee schedule. Health utility data were extracted from published studies. The outcomes considered were PFS, OS, costs, QALYs, the incremental cost per QALY gained ratio, and the net monetary benefit. Deterministic and probabilistic sensitivity analyses assessed the uncertainty around key model parameters and their joint impact on the base-case results. Results The combination of trastuzumab, pertuzumab, and docetaxel (THP) as first-line therapy, trastuzumab emtansine (T-DM1) as second-line therapy, and lapatinib/capecitabine third-line resulted in 1.81 QALYs, at a cost of $335,231.35. The combination of trastuzumab/docetaxel as first line without subsequent T-DM1 or pertuzumab yielded 1.41 QALYs, at a cost of $175,240.69. The least clinically effective sequence (1.27 QALYs), but most cost-effective at a total cost of $149,250.19, was trastuzumab/docetaxel as first-line therapy, T-DM1 as second-line therapy, and trastuzumab/lapatinib as third line therapy. Conclusion Our results suggest that THP as first-line therapy, followed by T-DM1 as second-line therapy, would require at least a 50% reduction in the total drug acquisition cost for it to be considered a cost-effective strategy. PMID:27654970

Cost-effectiveness of oral agents in relapsing-remitting multiple sclerosis compared to interferon-based therapy in Saudi Arabia.

PubMed

Alsaqa'aby, Mai F; Vaidya, Varun; Khreis, Noura; Khairallah, Thamer Al; Al-Jedai, Ahmed H

2017-01-01

Promising clinical and humanistic outcomes are associated with the use of new oral agents in the treatment of relapsing-remitting multiple sclerosis (RRMS). This is the first cost-effectiveness study comparing these medications in Saudi Arabia. We aimed to compare the cost-effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and interferon (IFN)-b1a products (Avonex and Rebif) as first-line therapies in the treatment of patients with RRMS from a Saudi payer perspective. Cohort Simulation Model (Markov Model). Tertiary care hospital. A hypothetical cohort of 1000 RRMS Saudi patients was assumed to enter a Markov model model with a time horizon of 20 years and an annual cycle length. The model was developed based on an expanded disability status scale (EDSS) to evaluate the cost-effectiveness of the five disease-modifying drugs (DMDs) from a healthcare system perspective. Data on EDSS progression and relapse rates were obtained from the literature; cost data were obtained from King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Results were expressed as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB) in Saudi Riyals and converted to equivalent $US. The base-case willingness-to-pay (WTP) threshold was assumed to be $100000 (SAR375000). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model. ICERs and NMB. The base-case analysis results showed Rebif as the optimal therapy at a WTP threshold of $100000. Avonex had the lowest ICER value of $337282/QALY when compared to Rebif. One-way sensitivity analysis demonstrated that the results were sensitive to utility weights of health state three and four and the cost of Rebif. None of the DMDs were found to be cost-effective in the treatment of RRMS at a WTP threshold of $100000 in this analysis. The DMDs would only be cost-effective at a WTP above $300000. The current analysis did not reflect the Saudi population preference in valuation of health states and did not consider the societal perspective in terms of cost.

76 FR 74625 - Civil Monetary Penalties Inflation Adjustment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-01

...-2011] RIN 1125-AA69 Civil Monetary Penalties Inflation Adjustment AGENCIES: U.S. Customs and Border... adjust for inflation certain civil monetary penalties assessed under the Immigration and Nationality Act... assessed under the INA. The Federal Civil Penalties Inflation Adjustment Act of 1990 (Adjustment Act...

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

PubMed

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

2008-03-01

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

Accounting for the environment.

PubMed

Lutz, E; Munasinghe, M

1991-03-01

Environmental awareness in the 1980s has led to efforts to improve the current UN System of National Accounts (SNA) for better measurement of the value of environmental resources when estimating income. National governments, the UN, the International Monetary Fund, and the World Bank are interested in solving this issue. The World Bank relies heavily on national aggregates in income accounts compiled by means of the SNA that was published in 1968 and stressed gross domestic product (GDP). GDP measures mainly market activity, but it takes does not consider the consumption of natural capital, and indirectly inhibits sustained development. The deficiencies of the current method of accounting are inconsistent treatment of manmade and natural capital, the omission of natural resources and their depletion from balance sheets, and pollution cleanup costs from national income. In the calculation of GDP pollution is overlooked, and beneficial environmental inputs are valued at zero. The calculation of environmentally adjusted net domestic product (EDP) and environmentally adjusted net income (ENI) would lower income and growth rate, as the World Resources Institute found with respect to Indonesia for 1971-84. When depreciation for oil, timber, and top soil was included the net domestic product (NDP) was only 4% compared with a 7.1% GDP. The World Bank has advocated environmental accounting since 1983 in SNA revisions. The 1989 revised Blue Book of the SNA takes environment concerns into account. Relevant research is under way in Mexico and Papua New Guinea using the UN Statistical Office framework as a system for environmentally adjusted economic accounts that computes EDP and ENI and integrates environmental data with national accounts while preserving SNA concepts.

Greenhouse gas emission reductions from domestic anaerobic digesters linked with sustainable sanitation in rural China

PubMed Central

DHINGRA, RADHIKA; CHRISTENSEN, ERICK R.; LIU, YANG; ZHONG, BO; WU, CHANG-FU; YOST, MICHAEL G.; REMAIS, JUSTIN V.

2013-01-01

Anaerobic digesters provide clean, renewable energy (biogas) by converting organic waste to methane, and are a key part of China's comprehensive rural energy plan. Here, experimental and modeling results are used to quantify the net greenhouse gas (GHG) reduction from substituting a household anaerobic digester for traditional energy sources in Sichuan, China. Tunable diode laser absorption spectroscopy and radial plume mapping were used to estimate the mass flux of fugitive methane emissions from active digesters. Using household energy budgets, the net improvement in GHG emissions associated with biogas installation was estimated using global warming commitment (GWC) as a consolidated measure of the warming effects of GHG emissions from cooking. In all scenarios biogas households had lower GWC than non-biogas households, by as much as 54%. Even biogas households with methane leakage exhibited lower GWC than non-biogas households, by as much as 48%. Based only on the averted GHG emissions over 10 years, the monetary value of a biogas installation was conservatively estimated at US$28.30 ($16.07 ton−1 CO2-eq.), which is available to partly offset construction costs. The interaction of biogas installation programs with policies supporting improved stoves, renewable harvesting of biomass, and energy interventions with substantial health co-benefits, are discussed. PMID:21348471

Greenhouse gas emission reductions from domestic anaerobic digesters linked with sustainable sanitation in rural China.

PubMed

Dhingra, Radhika; Christensen, Erick R; Liu, Yang; Zhong, Bo; Wu, Chang-Fu; Yost, Michael G; Remais, Justin V

2011-03-15

Anaerobic digesters provide clean, renewable energy (biogas) by converting organic waste to methane, and are a key part of China's comprehensive rural energy plan. Here, experimental and modeling results are used to quantify the net greenhouse gas (GHG) reduction from substituting a household anaerobic digester for traditional energy sources in Sichuan, China. Tunable diode laser absorption spectroscopy and radial plume mapping were used to estimate the mass flux of fugitive methane emissions from active digesters. Using household energy budgets, the net improvement in GHG emissions associated with biogas installation was estimated using global warming commitment (GWC) as a consolidated measure of the warming effects of GHG emissions from cooking. In all scenarios biogas households had lower GWC than nonbiogas households, by as much as 54%. Even biogas households with methane leakage exhibited lower GWC than nonbiogas households, by as much as 48%. Based only on the averted GHG emissions over 10 years, the monetary value of a biogas installation was conservatively estimated at US$28.30 ($16.07 ton(-1) CO(2)-eq), which is available to partly offset construction costs. The interaction of biogas installation programs with policies supporting improved stoves, renewable harvesting of biomass, and energy interventions with substantial health cobenefits are discussed.

48 CFR 3045.508-3 - Quantitative and monetary control.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Quantitative and monetary control. 3045.508-3 Section 3045.508-3 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND... Management of Government Property in the Possession of Contractors 3045.508-3 Quantitative and monetary...

48 CFR 3045.508-3 - Quantitative and monetary control.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Quantitative and monetary control. 3045.508-3 Section 3045.508-3 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND... Management of Government Property in the Possession of Contractors 3045.508-3 Quantitative and monetary...

Mathematical evaluation of community level impact of combining bed nets and indoor residual spraying upon malaria transmission in areas where the main vectors are Anopheles arabiensis mosquitoes

PubMed Central

2013-01-01

Background Indoor residual insecticide spraying (IRS) and long-lasting insecticide treated nets (LLINs) are commonly used together even though evidence that such combinations confer greater protection against malaria than either method alone is inconsistent. Methods A deterministic model of mosquito life cycle processes was adapted to allow parameterization with results from experimental hut trials of various combinations of untreated nets or LLINs (Olyset®, PermaNet 2.0®, Icon Life® nets) with IRS (pirimiphos methyl, lambda cyhalothrin, DDT), in a setting where vector populations are dominated by Anopheles arabiensis, so that community level impact upon malaria transmission at high coverage could be predicted. Results Intact untreated nets alone provide equivalent personal protection to all three LLINs. Relative to IRS plus untreated nets, community level protection is slightly higher when Olyset® or PermaNet 2.0® nets are added onto IRS with pirimiphos methyl or lambda cyhalothrin but not DDT, and when Icon Life® nets supplement any of the IRS insecticides. Adding IRS onto any net modestly enhances communal protection when pirimiphos methyl is sprayed, while spraying lambda cyhalothrin enhances protection for untreated nets but not LLINs. Addition of DDT reduces communal protection when added to LLINs. Conclusions Where transmission is mediated primarily by An. arabiensis, adding IRS to high LLIN coverage provides only modest incremental benefit (e.g. when an organophosphate like pirimiphos methyl is used), but can be redundant (e.g. when a pyrethroid like lambda cyhalothin is used) or even regressive (e.g. when DDT is used for the IRS). Relative to IRS plus untreated nets, supplementing IRS with LLINs will only modestly improve community protection. Beyond the physical protection that intact nets provide, additional protection against transmission by An. arabiensis conferred by insecticides will be remarkably small, regardless of whether they are delivered as LLINs or IRS. The insecticidal action of LLINs and IRS probably already approaches their absolute limit of potential impact upon this persistent vector so personal protection of nets should be enhanced by improving the physical integrity and durability. Combining LLINs and non-pyrethroid IRS in residual transmission systems may nevertheless be justified as a means to manage insecticide resistance and prevent potential rebound of not only An. arabiensis, but also more potent, vulnerable and historically important species such as Anopheles gambiae and Anopheles funestus. PMID:23324456

International Monetary Policy Coordination in a New Keynesian Model with NICE Features

ERIC Educational Resources Information Center

Poutineau, Jean-Christophe; Vermandel, Gauthier

2018-01-01

The authors provide a static two-country new Keynesian model to teach two related questions in international macroeconomics: the international transmission of unilateral monetary policy decisions and the gains coming from the coordination monetary rules. They concentrate on "normal times" and use a thoroughly graphical approach to…

17 CFR 143.8 - Inflation-adjusted civil monetary penalties.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Inflation-adjusted civil... JURISDICTION General Provisions § 143.8 Inflation-adjusted civil monetary penalties. (a) Unless otherwise amended by an act of Congress, the inflation-adjusted maximum civil monetary penalty for each violation of...

8 CFR 280.53 - Civil monetary penalties inflation adjustment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Civil monetary penalties inflation... REGULATIONS IMPOSITION AND COLLECTION OF FINES § 280.53 Civil monetary penalties inflation adjustment. (a) In general. In accordance with the requirements of the Federal Civil Penalties Inflation Adjustment Act of...

78 FR 14179 - Adjustments to Civil Monetary Penalty Amounts

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

... SECURITIES AND EXCHANGE COMMISSION 17 CFR Part 201 [Release Nos. 33-9387; 34-68994; IA-3557; IC-30408] Adjustments to Civil Monetary Penalty Amounts AGENCY: Securities and Exchange Commission. ACTION... adjusting for inflation the maximum amount of civil monetary penalties under the Securities Act of 1933, the...

A Unified Framework for Monetary Theory and Policy Analysis.

ERIC Educational Resources Information Center

Lagos, Ricardo; Wright, Randall

2005-01-01

Search-theoretic models of monetary exchange are based on explicit descriptions of the frictions that make money essential. However, tractable versions of these models typically make strong assumptions that render them ill suited for monetary policy analysis. We propose a new framework, based on explicit micro foundations, within which macro…

31 CFR 103.58 - Forfeiture of currency or monetary instruments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... instruments. 103.58 Section 103.58 Money and Finance: Treasury Regulations Relating to Money and Finance FINANCIAL RECORDKEEPING AND REPORTING OF CURRENCY AND FOREIGN TRANSACTIONS General Provisions § 103.58 Forfeiture of currency or monetary instruments. Any currency or other monetary instruments which are in the...

20 CFR 498.102 - Basis for civil monetary penalties and assessments.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Basis for civil monetary penalties and... PENALTIES, ASSESSMENTS AND RECOMMENDED EXCLUSIONS § 498.102 Basis for civil monetary penalties and assessments. (a) The Office of the Inspector General may impose a penalty and assessment, as applicable...

20 CFR 498.102 - Basis for civil monetary penalties and assessments.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Basis for civil monetary penalties and... PENALTIES, ASSESSMENTS AND RECOMMENDED EXCLUSIONS § 498.102 Basis for civil monetary penalties and assessments. (a) The Office of the Inspector General may impose a penalty and assessment, as applicable...

20 CFR 498.102 - Basis for civil monetary penalties and assessments.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Basis for civil monetary penalties and... PENALTIES, ASSESSMENTS AND RECOMMENDED EXCLUSIONS § 498.102 Basis for civil monetary penalties and assessments. (a) The Office of the Inspector General may impose a penalty and assessment, as applicable...

20 CFR 498.102 - Basis for civil monetary penalties and assessments.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Basis for civil monetary penalties and... PENALTIES, ASSESSMENTS AND RECOMMENDED EXCLUSIONS § 498.102 Basis for civil monetary penalties and assessments. (a) The Office of the Inspector General may impose a penalty and assessment, as applicable...

Effects of alexithymia and empathy on the neural processing of social and monetary rewards.

PubMed

Goerlich, Katharina Sophia; Votinov, Mikhail; Lammertz, Sarah E; Winkler, Lina; Spreckelmeyer, Katja N; Habel, Ute; Gründer, Gerhard; Gossen, Anna

2017-07-01

Empathy has been found to affect the neural processing of social and monetary rewards. Alexithymia, a subclinical condition showing a close inverse relationship with empathy is linked to dysfunctions of socio-emotional processing in the brain. Whether alexithymia alters the neural processing of rewards, which is currently unknown. Here, we investigated the influence of both alexithymia and empathy on reward processing using a social incentive delay (SID) task and a monetary incentive delay (MID) task in 45 healthy men undergoing functional magnetic resonance imaging. Controlling for temperament-character dimensions and rejection sensitivity, the relationship of alexithymia and empathy with neural activity in several a priori regions of interest (ROIs) was examined by means of partial correlations, while participants anticipated and received social and monetary rewards. Results were considered significant if they survived Holm-Bonferroni correction for multiple comparisons. Alexithymia modulated neural activity in several ROIs of the emotion and reward network, both during the anticipation of social and monetary rewards and in response to the receipt of monetary rewards. In contrast, empathy did not affect reward anticipation and modulated ROI activity only in response to the receipt of social rewards. These results indicate a significant influence of alexithymia on the processing of social and monetary rewards in the healthy brain.

The monetary approach to the balance of payments: The case of the oil-based, small, open, developing economies of Libya, Kuwait and Saudi Arabia

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

Buzakuk, M.R.

1988-01-01

This study explores the determinants of foreign reserves flow in light of the oil-based small open economies of Libya, Kuwait, and Saudi Arabia. The period of study encompasses the major oil price increases of the 1970s and early 1980s, which had led to the huge transfers of foreign exchanges towards these, among other, developing economies. The framework of analysis is basically a monetary approach to the balance of payments. This study is of both a theoretical and empirical nature. It utilizes the monetary forces in the domestic money market to derive a basic balance of payments (BOP) equation that explainsmore » the monetary nature of the balance of payments. The study found that the data from those countries support the monetary relationships as hypothesized by the monetary approach, especially the negative one-to-one relation between domestic credit (DC) and the BOP. Results from the simultaneous estimations of the BOP and DC reported better estimates than the single-equation model. Findings from the reaction function indicated that the monetary authorities of these oil-based economies were actively sterilizing the effect of foreign reserve flows. Findings supported the integrated market hypothesis in Kuwait and Libya, but not in the Saudi case.« less

Net primary productivity, allocation pattern and carbon use efficiency in an apple orchard assessed by integrating eddy covariance, biometric and continuous soil chamber measurements

NASA Astrophysics Data System (ADS)

Zanotelli, D.; Montagnani, L.; Manca, G.; Tagliavini, M.

2013-05-01

Carbon use efficiency (CUE), the ratio of net primary production (NPP) over gross primary production (GPP), is a functional parameter that could possibly link the current increasingly accurate global GPP estimates with those of net ecosystem exchange, for which global predictors are still unavailable. Nevertheless, CUE estimates are actually available for only a few ecosystem types, while information regarding agro-ecosystems is scarce, in spite of the simplified spatial structure of these ecosystems that facilitates studies on allocation patterns and temporal growth dynamics. We combined three largely deployed methods, eddy covariance, soil respiration and biometric measurements, to assess monthly values of CUE, NPP and allocation patterns in different plant organs in an apple orchard during a complete year (2010). We applied a measurement protocol optimized for quantifying monthly values of carbon fluxes in this ecosystem type, which allows for a cross check between estimates obtained from different methods. We also attributed NPP components to standing biomass increments, detritus cycle feeding and lateral exports. We found that in the apple orchard, both net ecosystem production and gross primary production on a yearly basis, 380 ± 30 g C m-2 and 1263 ± 189 g C m-2 respectively, were of a magnitude comparable to those of natural forests growing in similar climate conditions. The largest differences with respect to forests are in the allocation pattern and in the fate of produced biomass. The carbon sequestered from the atmosphere was largely allocated to production of fruit: 49% of annual NPP was taken away from the ecosystem through apple production. Organic material (leaves, fine root litter, pruned wood and early fruit falls) contributing to the detritus cycle was 46% of the NPP. Only 5% was attributable to standing biomass increment, while this NPP component is generally the largest in forests. The CUE, with an annual average of 0.71 ± 0.12, was higher than the previously suggested constant values of 0.47-0.50. Low nitrogen investment in fruit, the limited root apparatus, and the optimal growth temperature and nutritional condition observed at the site are suggested to be explanatory variables for the high CUE observed.

Structure of analysis-minus-observation misfits within a global ocean reanalysis system: implications for atmospheric reanalyses

NASA Astrophysics Data System (ADS)

Carton, James; Chepurin, Gennady

2017-04-01

While atmospheric reanalyses do not ingest data from the subsurface ocean they must produce fluxes consistent with, for example, ocean storage and divergence of heat transport. Here we present a test of the consistency of two different atmospheric reanalyses with 2.5 million global ocean temperature observations during the data-rich eight year period 2007-2014. The examination is carried out by using atmospheric reanalysis variables to drive the SODA3 ocean reanalysis system, and then collecting and analyzing the temperature analysis increments (observation misfits). For the widely used MERRA2 and ERA-Int atmospheric reanalyses the temperature analysis increments reveal inconsistencies between those atmospheric fluxes and the ocean observations in the range of 10-30 W/m2. In the interior basins excess heat during a single assimilation cycle is stored primarily locally within the mixed layer, a simplification of the heat budget that allows us to identify the source of the error as the specified net surface heat flux. Along the equator the increments are primarily confined to thermocline depths indicating the primary source of the error is dominated by heat transport divergence. The error in equatorial heat transport divergence, in turn, can be traced to errors in the strength of the equatorial trade winds. We test our conclusions by introducing modifications of the atmospheric reanalyses based on analysis of ocean temperature analysis increments and repeating the ocean reanalysis experiments using the modified surface fluxes. Comparison of the experiments reveals that the modified fluxes reduce the misfit to ocean observations as well as the differences between the different atmospheric reanalyses.

Exposure to water fluoridation and caries increment.

PubMed

Spencer, A J; Armfield, J M; Slade, G D

2008-03-01

The objective of this cohort study was to examine the association between exposure to water fluoridation and the increment of dental caries in two Australian states: Queensland (Qld)--5 per cent fluoridation coverage; and South Australia (SA)--70 per cent fluoridation coverage. Stratified random samples were drawn from fluoridated Adelaide and the largely non-fluoridated rest-of-state in SA, and fluoridated Townsville and non-fluoridated Brisbane in Qld. Children were enrolled between 1991 and 1992 (SA: 5-15 yrs old, n = 9,980; Qld: 5-12 yrs old, n = 10,695). Follow-up caries status data for 3 years (+/- 1/2 year) were available on 8,183 children in SA and 6,711 children in Qld. Baseline data on lifetime exposure to fluoridated water, use of other fluorides and socio-economic status (SES) were collected by questionnaire, and tooth surface caries status by dental examinations in school dental service clinics. Higher per cent lifetime exposure to fluoridated water (6 categories: 0;1-24; 25-49; 50-74; 75-99; 100 per cent) was a significant predictor (ANOVA, p < 0.01) of lower annualised Net Caries Increment (NCI) for the deciduous dentition in SA and Qld, but only for Qld in the permanent dentition. These associations persisted in multiple linear regression analyses controlling for age, gender, exposure to other fluorides and SES (p < 0.05). Water fluoridation was effective in reducing caries increment, even in the presence of a dilution effect from other fluorides. The effect of fluoridated water consumption was strongest in the deciduous dentition and where diffusion of food and beverages from fluoridated to non-fluoridated areas was less likely.

Can money heal all wounds? Social exchange norm modulates the preference for monetary versus social compensation.

PubMed

Cao, Yulong; Yu, Hongbo; Wu, Yanhong; Zhou, Xiaolin

2015-01-01

Compensation is a kind of pro-social behavior that can restore a social relationship jeopardized by interpersonal transgression. The effectiveness of a certain compensation strategy (e.g., repaying money, sharing loss, etc.) may vary as a function of the social norm/relationship. Previous studies have shown that two types of norms (or relationships), monetary/exchange and social/communal, differentially characterize people's appraisal of and response to social exchanges. In this study, we investigated how individual differences in preference for these norms affect individuals' perception of others' as well as the selection of their own reciprocal behaviors. In a two-phase experiment with interpersonal transgression, we asked the participant to perform a dot-estimation task with two partners who occasionally and unintentionally inflicted noise stimulation upon the participant (first phase). As compensation one partner gave money to the participant 80% of the time (the monetary partner) and the other bore the noise for the participant 80% of the time (the social partner). Results showed that the individuals' preference for compensation (repaying money versus bearing noise) affected their relationship (exchange versus communal) with the partners adopting different compensation strategies: participants tended to form communal relationships and felt closer to the partner whose compensation strategy matched their own preference. The participants could be differentiated into a social group, who tended to form communal relationship with the social partner, and a monetary group, who tended to form communal relationship with the monetary partner. In the second phase of the experiment, when the participants became transgressors and were asked to compensate for their transgression with money, the social group offered more compensation to the social partners than to the monetary partners, while the monetary group compensated less than the social group in general and showed no difference in their offers to the monetary and social partners. These findings demonstrate that the effectiveness of compensation varies as a function of individuals' preference for communal versus monetary norm and that monetary compensation alone does not heal all wounds.

Can money heal all wounds? Social exchange norm modulates the preference for monetary versus social compensation

PubMed Central

Cao, Yulong; Yu, Hongbo; Wu, Yanhong; Zhou, Xiaolin

2015-01-01

Compensation is a kind of pro-social behavior that can restore a social relationship jeopardized by interpersonal transgression. The effectiveness of a certain compensation strategy (e.g., repaying money, sharing loss, etc.) may vary as a function of the social norm/relationship. Previous studies have shown that two types of norms (or relationships), monetary/exchange and social/communal, differentially characterize people’s appraisal of and response to social exchanges. In this study, we investigated how individual differences in preference for these norms affect individuals’ perception of others’ as well as the selection of their own reciprocal behaviors. In a two-phase experiment with interpersonal transgression, we asked the participant to perform a dot-estimation task with two partners who occasionally and unintentionally inflicted noise stimulation upon the participant (first phase). As compensation one partner gave money to the participant 80% of the time (the monetary partner) and the other bore the noise for the participant 80% of the time (the social partner). Results showed that the individuals’ preference for compensation (repaying money versus bearing noise) affected their relationship (exchange versus communal) with the partners adopting different compensation strategies: participants tended to form communal relationships and felt closer to the partner whose compensation strategy matched their own preference. The participants could be differentiated into a social group, who tended to form communal relationship with the social partner, and a monetary group, who tended to form communal relationship with the monetary partner. In the second phase of the experiment, when the participants became transgressors and were asked to compensate for their transgression with money, the social group offered more compensation to the social partners than to the monetary partners, while the monetary group compensated less than the social group in general and showed no difference in their offers to the monetary and social partners. These findings demonstrate that the effectiveness of compensation varies as a function of individuals’ preference for communal versus monetary norm and that monetary compensation alone does not heal all wounds. PMID:26441783

Ontological function annotation of long non-coding RNAs through hierarchical multi-label classification.

PubMed

Zhang, Jingpu; Zhang, Zuping; Wang, Zixiang; Liu, Yuting; Deng, Lei

2018-05-15

Long non-coding RNAs (lncRNAs) are an enormous collection of functional non-coding RNAs. Over the past decades, a large number of novel lncRNA genes have been identified. However, most of the lncRNAs remain function uncharacterized at present. Computational approaches provide a new insight to understand the potential functional implications of lncRNAs. Considering that each lncRNA may have multiple functions and a function may be further specialized into sub-functions, here we describe NeuraNetL2GO, a computational ontological function prediction approach for lncRNAs using hierarchical multi-label classification strategy based on multiple neural networks. The neural networks are incrementally trained level by level, each performing the prediction of gene ontology (GO) terms belonging to a given level. In NeuraNetL2GO, we use topological features of the lncRNA similarity network as the input of the neural networks and employ the output results to annotate the lncRNAs. We show that NeuraNetL2GO achieves the best performance and the overall advantage in maximum F-measure and coverage on the manually annotated lncRNA2GO-55 dataset compared to other state-of-the-art methods. The source code and data are available at http://denglab.org/NeuraNetL2GO/. leideng@csu.edu.cn. Supplementary data are available at Bioinformatics online.

Monetary Diet Cost, Diet Quality, and Parental Socioeconomic Status in Spanish Youth.

PubMed

Schröder, Helmut; Gomez, Santiago F; Ribas-Barba, Lourdes; Pérez-Rodrigo, Carmen; Bawaked, Rowaedh Ahmed; Fíto, Montserrat; Serra-Majem, Lluis

2016-01-01

Using a food-based analysis, healthy dietary patterns in adults are more expensive than less healthy ones; studies are needed in youth. Therefore, the objective of the present study was to determine relationships between monetary daily diet cost, diet quality, and parental socioeconomic status. Data were obtained from a representative national sample of 3534 children and young people in Spain, aged 2 to 24 years. Dietary assessment was performed with a 24-hour recall. Mediterranean diet adherence was measured by the KIDMED questionnaire. Average food cost was calculated from official Spanish government data. Monetary daily diet cost was expressed as euros per day (€/d) and euros per day standardized to a 1000kcal diet (€/1000kcal/d). Mean monetary daily diet cost was 3.16±1.57€/d (1.56±0.72€/1000kcal/d). Socioeconomic status was positively associated with monetary daily diet cost and diet quality measured by the KIDMED index (€/d and €/1000kcal/d, p<0.019). High Mediterranean diet adherence (KIDMED score 8-12) was 0.71 €/d (0.28€/1000kcal/d) more expensive than low compliance (KIDMED score 0-3). Analysis for nonlinear association between the KIDMED index and monetary daily diet cost per1000kcal showed no further cost increases beyond a KIDMED score of 8 (linear p<0.001; nonlinear p = 0.010). Higher monetary daily diet cost is associated with healthy eating in Spanish youth. Higher socioeconomic status is a determinant for higher monetary daily diet cost and quality.

Ambulatory patient classifications and the regressive nature of Medicare reform: is the reduction in outpatient health care reimbursement worth the price?

PubMed

Borgelt, B B; Stone, C

1999-10-01

To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare mix hospital-based radiation oncology departments to continue to deliver their current level of care could be compromised. APC reform may carry monetary and opportunity costs which far outweigh its apparent savings. As payment systems continue to place pressure on operating margins, it becomes even more critical that both academic and community radiation oncology practices know the cost of providing services.

Inertial attitude control of a bat-like morphing-wing air vehicle.

PubMed

Colorado, J; Barrientos, A; Rossi, C; Parra, C

2013-03-01

This paper presents a novel bat-like unmanned aerial vehicle inspired by the morphing-wing mechanism of bats. The goal of this paper is twofold. Firstly, a modelling framework is introduced for analysing how the robot should manoeuvre by means of changing wing morphology. This allows the definition of requirements for achieving forward and turning flight according to the kinematics of the wing modulation. Secondly, an attitude controller named backstepping+DAF is proposed. Motivated by biological evidence about the influence of wing inertia on the production of body accelerations, the attitude control law incorporates wing inertia information to produce desired roll (ϕ) and pitch (θ) acceleration commands (desired angular acceleration function (DAF)). This novel control approach is aimed at incrementing net body forces (F(net)) that generate propulsion. Simulations and wind-tunnel experimental results have shown an increase of about 23% in net body force production during the wingbeat cycle when the wings are modulated using the DAF as a part of the backstepping control law. Results also confirm accurate attitude tracking in spite of high external disturbances generated by aerodynamic loads at airspeeds up to 5 ms⁻¹.

42 CFR 420.410 - Establishment of a program to collect suggestions for improving Medicare program efficiency and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... for improving Medicare program efficiency and to reward suggesters for monetary savings. 420.410... Program Efficiency and to Reward Suggesters for Monetary Savings § 420.410 Establishment of a program to collect suggestions for improving Medicare program efficiency and to reward suggesters for monetary...

42 CFR 420.410 - Establishment of a program to collect suggestions for improving Medicare program efficiency and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... for improving Medicare program efficiency and to reward suggesters for monetary savings. 420.410... Program Efficiency and to Reward Suggesters for Monetary Savings § 420.410 Establishment of a program to collect suggestions for improving Medicare program efficiency and to reward suggesters for monetary...

25 CFR 162.553 - Must a WSR lease specify who receives monetary compensation payments?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Must a WSR lease specify who receives monetary compensation payments? 162.553 Section 162.553 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation...

25 CFR 162.553 - Must a WSR lease specify who receives monetary compensation payments?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Must a WSR lease specify who receives monetary compensation payments? 162.553 Section 162.553 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation...

Using Non-Monetary Deprivation Indicators to Analyze Poverty and Social Exclusion: Lessons from Europe?

ERIC Educational Resources Information Center

Nolan, Brian; Whelan, Christopher T.

2010-01-01

Non-monetary indicators of deprivation are now widely used in studying poverty in Europe. While measuring financial resources remains central, having reliable information about material deprivation adds to the ability to capture poverty and social exclusion. Non-monetary indicators can help improve the identification of those experiencing poverty…

31 CFR 103.60 - Enforcement authority with respect to transportation of currency or monetary instruments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... transportation of currency or monetary instruments. 103.60 Section 103.60 Money and Finance: Treasury Regulations Relating to Money and Finance FINANCIAL RECORDKEEPING AND REPORTING OF CURRENCY AND FOREIGN TRANSACTIONS... instruments. (a) If a customs officer has reasonable cause to believe that there is a monetary instrument...

Asymmetry of Reinforcement and Punishment in Human Choice

ERIC Educational Resources Information Center

Rasmussen, Erin B.; Newland, M. Christopher

2008-01-01

The hypothesis that a penny lost is valued more highly than a penny earned was tested in human choice. Five participants clicked a computer mouse under concurrent variable-interval schedules of monetary reinforcement. In the no-punishment condition, the schedules arranged monetary gain. In the punishment conditions, a schedule of monetary loss was…

Examining the reaction of monetary policy to exchange rate changes: A nonlinear ARDL approach

NASA Astrophysics Data System (ADS)

Manogaran, Lavaneesvari; Sek, Siok Kun

2017-04-01

Previous studies showed the exchange rate changes can have significant impacts on macroeconomic performance. Over fluctuation of exchange rate may lead to economic instability. Hence, monetary policy rule tends to react to exchange rate changes. Especially, in emerging economies where the policy-maker tends to limit the exchange rate movement through interventions. In this study, we seek to investigate how the monetary policy rule reacts to exchange rate changes. The nonlinear autoregressive distributed lag (NARDL) model is applied to capture the asymmetric effect of exchange rate changes on monetary policy reaction function (interest rate). We focus the study in ASEAN5 countries (Indonesia, Malaysia, Philippines, Thailand and Singapore). The results indicated the existence of asymmetric effect of exchange rates changes on the monetary reaction function for all ASEAN5 countries in the long-run. Where, in majority of the cases the monetary policy is reacting to the appreciation and depreciation of exchange rate by raising the policy rate. This affirms the intervention of policymakers with the `fear of floating' behavior.

Monetising the provision of informal long-term care by elderly people: estimates for European out-of-home caregivers based on the well-being valuation method.

PubMed

Schneider, Ulrike; Kleindienst, Julia

2016-09-01

Providing informal care can be both a burden and a source of satisfaction. To understand the welfare effect on caregivers, we need an estimate of the 'shadow value' of informal care, an imputed value for the non-market activity. We use data from the 2006-2007 Survey of Health Ageing and Retirement in Europe which offers the needed details on 29,471 individuals in Austria, Belgium, the Czech Republic, Denmark, France, Germany, Italy, the Netherlands, Poland, Spain, Sweden and Switzerland. Of these, 9768 are unpaid non-co-resident caregivers. To estimate net costs, we follow the subjective well-being valuation method, modelling respondents' life satisfaction as a product of informal care provision, income and personal characteristics, then expressing the relation between satisfaction and care as a monetary amount. We estimate a positive net effect of providing mode rate amounts of informal care, equivalent to €93 for an hour of care/week provided by a caregiver at the median income. The net effect appears to turn negative for greater high care burdens (over 30 hours/week). Interestingly, the effects of differences in care situation are at least an order of magnitude larger. We find that carers providing personal care are significantly more satisfied than those primarily giving help with housework, a difference equivalent to €811 a year at the median income. The article makes two unique contributions to knowledge. The first is its quantifying a net benefit to moderately time-intensive out-of-home caregivers. The second is its clear demonstration of the importance of heterogeneity of care burden on different subgroups. Care-giving context and specific activities matter greatly, pointing to the need for further work on targeting interventions at those caregivers most in need of them. © 2015 John Wiley & Sons Ltd.

Usefulness of a Regional Health Care Information System in primary care: a case study.

PubMed

Maass, Marianne C; Asikainen, Paula; Mäenpää, Tiina; Wanne, Olli; Suominen, Tarja

2008-08-01

The goal of this paper is to describe some benefits and possible cost consequences of computer based access to specialised health care information. A before-after activity analysis regarding 20 diabetic patients' clinical appointments was performed in a Health Centre in Satakunta region in Finland. Cost data, an interview, time-and-motion studies, and flow charts based on modelling were applied. Access to up-to-date diagnostic information reduced redundant clinical re-appointments, repeated tests, and mail orders for missing data. Timely access to diagnostic information brought about several benefits regarding workflow, patient care, and disease management. These benefits resulted in theoretical net cost savings. The study results indicated that Regional Information Systems may be useful tools to support performance and improve efficiency. However, further studies are required in order to verify how the monetary savings would impact the performance of Health Care Units.

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

PubMed

Bergevin, Anna; Zick, Cathleen D; McVicar, Stephanie Browning; Park, Albert H

2015-12-01

In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. The CMV education and treatment program costs are modest and show potential for significant cost savings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Cost-benefit analysis of the implementation of automated drug-dispensing systems in Critical Care and Emergency Units].

PubMed

Poveda Andrés, J L; García Gómez, C; Hernández Sansalvador, M; Valladolid Walsh, A

2003-01-01

To determine monetary impact when traditional drug floor stocks are replaced by Automated Drug Dispensing Systems (ADDS) in the Medical Intensive Care Unit, Surgical Intensive Care Unit and the Emergency Room. We analysed four different flows considered to be determinant when implementing ADDS in a hospital environment: capital investment, staff costs, inventory costs and costs related to drug use policies. Costs were estimated by calculation of the current net value. Its analysis shows that those expenses derived from initial investment are compensated by the three remaining flows, with costs related to drug use policies showing the most substantial savings. Five years after initial investment, global cash-flows have been estimated at 300.525 euros. Replacement of traditional floor stocks by ADDS in the Medical Intensive Care Unit, Surgery Intensive Care Unit and the Emergency Room produces a positive benefit/cost ratio (1.95).

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

Not Available

Developing nations that are not members of the Organization of Petroleum Exporting Countries (OPEC) are not expected to suffer as much economic disruption from oil price increases and a US recession as happened during the 1973--1975 period. The latest price increase represents about 0.7 percent of their gross national product (GNP) compared to 2.5 percent in the earlier period. More non-OPEC developing countries are producing commercial quantities of oil and at least 14 are now net exporters. The effects of a US recession may not be as severe this time because it will not be synchronized with the business cyclesmore » of the major industrial countries. Developing countries can counteract a US recession by tightening their monetary policies, imposing import control, and other measures. Most of these countries have improved their balance of payments since 1975 and are in a position to handle disruptions.« less

An Efficient, Noniterative Method of Identifying the Cost-Effectiveness Frontier.

PubMed

Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D

2016-01-01

Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we also provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem. © The Author(s) 2015.

An Efficient, Non-iterative Method of Identifying the Cost-Effectiveness Frontier

PubMed Central

Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D.

2015-01-01

Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we additionally provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem. PMID:25926282

Raising the Social Security Entitlement Age.

PubMed

Zissimopoulos, Julie; Blaylock, Barbara; Goldman, Dana P; Rowe, John W

2017-01-01

An aging America presents challenges but also brings social and economic capital. We quantify public revenues from, and public expenditures on, Americans aged 65 and older, the value of their unpaid, productive activities and financial gifts to family. Using microsimulation, we project the value of these activities, and government revenues and expenditures, under different scenarios of change to the Old Age and Survivors Insurance eligibility age through 2050. We find the value of unpaid productive activities and financial gifts are US$721 billion in 2010, while net (of tax revenues) spending on the 65 years and older is US$984 billion. Five-year delay in the full retirement age decreases federal spending by 10%, while 2-year delay in the early entitlement age increases it by 1.5%. The effect of 5-year delay on unpaid activities and transfers is small: US$4 billion decrease in services and US$4.5 billion increase in bequests and monetary gifts.

The co-movement of monetary policy and its time-varying nature: A DCCA approach

NASA Astrophysics Data System (ADS)

Rohit, Abhishek; Mitra, Subrata Kumar

2018-02-01

Employing a novel methodology of DCCA cross-correlation coefficient (ρDCCA), this study attempts to provide fresh evidences for the co-movement of monetary policies of the advanced (AEs) as well as the emerging economies (EMEs) vis-à-vis the United States. A higher degree of monetary co-movement as measured by ρDCCA values, is identified for the AEs as compared to the EMEs. Lower co-movement of monetary policy is especially noticeable in the short run for EMEs. We further investigate the time-varying nature of such co-movements for the AEs by splitting the period (1980-2014) into four sub periods and also by performing a rolling window estimation for the entire period to reveal smoother dynamics. Significant evidence of higher monetary coordination is revealed for sub-periods with stronger trade and financial linkages.

The Impact of Social Pressure and Monetary Incentive on Cognitive Control.

PubMed

Ličen, Mina; Hartmann, Frank; Repovš, Grega; Slapničar, Sergeja

2016-01-01

We compare the effects of two prominent organizational control mechanisms-social pressure and monetary incentive-on cognitive control. Cognitive control underlies the human ability to regulate thoughts and actions in the pursuit of behavioral goals. Previous studies show that monetary incentives can contribute to goal-oriented behavior by activating proactive control. There is, however, much less evidence of how social pressure affects cognitive control and task performance. In a within-subject experimental design, we tested 47 subjects performing the AX-CPT task to compare the activation of cognitive control modes under social pressure and monetary incentive beyond mere instructions to perform better. Our results indicate that instructing participants to improve their performance on its own leads to a significant shift from a reactive to a proactive control mode and that both social pressure and monetary incentive further enhance performance.

Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population.

PubMed

Bjermer, Leif; van Boven, Job F M; Costa-Scharplatz, Madlaina; Keininger, Dorothy L; Gutzwiller, Florian S; Lisspers, Karin; Mahon, Ronan; Olsson, Petter; Roche, Nicolas

2017-12-11

This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year. A previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer's perspective and were discounted at 3% annually. Uncertainty in model input values was studied through one-way and probabilistic sensitivity analyses. Subgroup analyses were also performed. IND/GLY was associated with lower costs and better outcomes compared with SFC over all the analysed time horizons. Use of IND/GLY resulted in additional 0.192 LYs and 0.134 QALYs with cost savings of €1211 compared with SFC over lifetime. The net monetary benefit (NMB) was estimated to be €8560 based on a willingness-to-pay threshold of €55,000/QALY. The NMB was higher in the following subgroups: severe (GOLD 3), high risk and more symptoms (GOLD D), females, and current smokers. IND/GLY is a cost-effective treatment compared with SFC in COPD patients with mMRC dyspnea grade ≥ 2, moderate to very severe airflow limitation, and ≥1 exacerbation in the preceding year.

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

PubMed

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

2016-01-01

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

Costs, benefits and effectiveness of worksite physical activity counseling from the employer's perspective.

PubMed

Proper, Karin I; de Bruyne, Martine C; Hildebrandt, Vincent H; van der Beek, Allard J; Meerding, Willem Jan; van Mechelen, Willem

2004-02-01

This study evaluated the impact of worksite physical activity counseling using cost-benefit and cost-effectiveness analyses. Civil servants (N = 299) were randomly assigned to an intervention (N = 131) or control (N = 168) group for 9 months. The intervention costs were compared with the monetary benefits gained from reduced sick leave. In addition, the intervention costs minus the monetary benefits from sick leave reduction were compared with the effects (percentage meeting the public health recommendation for moderate-intensity physical activity, energy expenditure, cardiorespiratory fitness, and upper extremity symptoms). The intervention costs were EUR 430 per participant, and the benefits were EUR 125 due to sick leave during the intervention period, for net total costs of EUR 305 for the intervention. During the same 9-month period the year after the intervention, the benefits from sick leave reduction were EUR 635. No statistically significant differences in costs and benefits were found between the groups. As to the cost-effectiveness, improvement in energy expenditure and cardiorespiratory fitness was observed at higher costs. The point estimates of the cost-effectiveness ratios were EUR 5.2 (without imputation of effect data) and EUR 2.7 (with imputation of effect data) per extra kilocalorie of energy expenditure per day and EUR 235 (without imputation of effect data) and EUR 45.9 (with imputation of effect data) per beat per minute of decrease in submaximal heart rate. This study does not provide a financial reason for implementing worksite counseling intervention on physical activity on the short-term. However, positive effects were shown for energy expenditure and cardiorespiratory fitness.

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

PubMed

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

2015-01-01

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

Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach.

PubMed

Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H Gregory; Gray, Stacey T; Shrime, Mark G

2015-10-01

Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care. Cost-benefit analysis based on contingent valuation surveys. An otolaryngology-specific ER in a tertiary care academic medical center. Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework. The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343. Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Children's Use of Meta-Cognition in Solving Everyday Problems: Children's Monetary Decision-Making

ERIC Educational Resources Information Center

Lee, Chwee Beng; Koh, Noi Keng; Cai, Xin Le; Quek, Choon Lang

2012-01-01

The purpose of this study was to understand how children use meta-cognition in their everyday problem-solving, particularly making monetary decisions. A particular focus was to identify components of meta-cognition, such as regulation of cognition and knowledge of cognition observed in children's monetary decision-making process, the roles of…

25 CFR 162.552 - When are monetary compensation payments due under a WSR lease?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false When are monetary compensation payments due under a WSR lease? 162.552 Section 162.552 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation Requirements...

25 CFR 162.552 - When are monetary compensation payments due under a WSR lease?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false When are monetary compensation payments due under a WSR lease? 162.552 Section 162.552 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation Requirements...

25 CFR 162.554 - What form of monetary compensation payment is acceptable under a WSR lease?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false What form of monetary compensation payment is acceptable under a WSR lease? 162.554 Section 162.554 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation...

25 CFR 162.554 - What form of monetary compensation payment is acceptable under a WSR lease?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false What form of monetary compensation payment is acceptable under a WSR lease? 162.554 Section 162.554 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation...

18 CFR 292.210 - Petition alleging commitment of substantial monetary resources before October 16, 1986.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER... substantial monetary resources (as that term is defined in § 292.202(r)) to the development of the project. (b... monetary resources will be presumed if the applicant held a preliminary permit for the project and had...

18 CFR 292.210 - Petition alleging commitment of substantial monetary resources before October 16, 1986.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER... substantial monetary resources (as that term is defined in § 292.202(r)) to the development of the project. (b... monetary resources will be presumed if the applicant held a preliminary permit for the project and had...

18 CFR 292.210 - Petition alleging commitment of substantial monetary resources before October 16, 1986.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER... substantial monetary resources (as that term is defined in § 292.202(r)) to the development of the project. (b... monetary resources will be presumed if the applicant held a preliminary permit for the project and had...

18 CFR 292.210 - Petition alleging commitment of substantial monetary resources before October 16, 1986.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER... substantial monetary resources (as that term is defined in § 292.202(r)) to the development of the project. (b... monetary resources will be presumed if the applicant held a preliminary permit for the project and had...

18 CFR 292.210 - Petition alleging commitment of substantial monetary resources before October 16, 1986.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER... substantial monetary resources (as that term is defined in § 292.202(r)) to the development of the project. (b... monetary resources will be presumed if the applicant held a preliminary permit for the project and had...

17 CFR Table V to Subpart E of... - Civil Monetary Penalty Inflation Adjustments

Code of Federal Regulations, 2013 CFR

2013-04-01

... Inflation Adjustments V Table V to Subpart E of Part 201 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Adjustment of Civil Monetary Penalties Pt. 201, Subpt. E, Table V Table V to Subpart E of Part 201—Civil Monetary Penalty Inflation Adjustments U.S. Code citation Civil...

17 CFR Table V to Subpart E of... - Civil Monetary Penalty Inflation Adjustments

Code of Federal Regulations, 2014 CFR

2014-04-01

... Inflation Adjustments V Table V to Subpart E of Part 201 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Adjustment of Civil Monetary Penalties Pt. 201, Subpt. E, Table V Table V to Subpart E of Part 201—Civil Monetary Penalty Inflation Adjustments U.S. Code citation Civil...

26 CFR 1.985-8 - Special rules applicable to the European Monetary Union (conversion to euro).

Code of Federal Regulations, 2012 CFR

2012-04-01

... Monetary Union (conversion to euro). 1.985-8 Section 1.985-8 Internal Revenue INTERNAL REVENUE SERVICE... Corporations § 1.985-8 Special rules applicable to the European Monetary Union (conversion to euro). (a... Community which is substituted for the euro in accordance with the Treaty establishing the European...

26 CFR 1.985-8 - Special rules applicable to the European Monetary Union (conversion to euro).

Code of Federal Regulations, 2011 CFR

2011-04-01

... Monetary Union (conversion to euro). 1.985-8 Section 1.985-8 Internal Revenue INTERNAL REVENUE SERVICE... Corporations § 1.985-8 Special rules applicable to the European Monetary Union (conversion to euro). (a... Community which is substituted for the euro in accordance with the Treaty establishing the European...

26 CFR 1.985-8 - Special rules applicable to the European Monetary Union (conversion to euro).

Code of Federal Regulations, 2013 CFR

2013-04-01

... Monetary Union (conversion to euro). 1.985-8 Section 1.985-8 Internal Revenue INTERNAL REVENUE SERVICE... Corporations § 1.985-8 Special rules applicable to the European Monetary Union (conversion to euro). (a... Community which is substituted for the euro in accordance with the Treaty establishing the European...

26 CFR 1.985-8 - Special rules applicable to the European Monetary Union (conversion to euro).

Code of Federal Regulations, 2014 CFR

2014-04-01

... Monetary Union (conversion to euro). 1.985-8 Section 1.985-8 Internal Revenue INTERNAL REVENUE SERVICE... Corporations § 1.985-8 Special rules applicable to the European Monetary Union (conversion to euro). (a... Community which is substituted for the euro in accordance with the Treaty establishing the European...

12 years of intensive management increases soil carbon stocks in Loblolly pine and Sweetgum stands

NASA Astrophysics Data System (ADS)

Sanchez, F. G.; Samuelson, L.; Johnsen, K.

2009-12-01

To achieve and maintain productivity goals, forest managers rely on intensive management strategies. These strategies have resulted in considerable gains in forest productivity. However, the impacts of these strategies on belowground carbon dynamics is less clear. Carbon dynamics are influenced by a multitude of factors including soil moisture, nutrient status, net primary productivity and carbon allocation patterns. In this study, we describe the impact of four management strategies on soil carbon and nitrogen stocks in 12-year-old loblolly pine and sweetgum plantations. The management strategies are: (1) complete understory control, (2) complete understory control + drip irrigation, (3) complete understory control + drip irrigation and fertilization and (4) complete understory control + drip irrigation and fertilization and pest control. These management strategies were replicated on 3 blocks in a randomized complete block design. After 12 years, soil carbon stocks increased with increasing management intensity for both tree species. This effect was consistent throughout the depth increments measured (0-10, 10-20, 20-30 cm). Alternatively, no significant effect was detected for soil nitrogen at any depth increment. Sweetgum had higher soil carbon and nitrogen stocks at each depth increment than loblolly pine. There was a greater difference in nitrogen stocks than carbon stocks between the two species resulting in lower soil C:N ratios in the sweetgum stands. These observations may be due to differences in net primary productivity, rooting structure and carbon allocation patterns of sweetgum compared with loblolly pine. To determine the relative stability of the carbon and nitrogen stocks for the different treatments and tree species, we sequentially fractionated the soil samples into six fractions of differing stability. Although soil carbon stocks for both species increased with management intensity, there was no detectable difference in the soil carbon fractions based on management intensity. Additionally, there was no difference between soil carbon fractions based on tree species. These observations suggest that although external inputs (i.e., moisture, carbon and nutrients) increase soil carbon stocks, they do not alter soil carbon stabilization mechanisms at these sites.

Modeling the Frequency and Costs Associated with Postsurgical Gastrointestinal Adverse Events for Tapentadol IR versus Oxycodone IR

PubMed Central

Paris, Andrew; Kozma, Chris M.; Chow, Wing; Patel, Anisha M.; Mody, Samir H.; Kim, Myoung S.

2013-01-01

Background Few studies have estimated the economic effect of using an opioid that is associated with lower rates of gastrointestinal (GI) adverse events (AEs) than another opioid for postsurgical pain. Objective To estimate the number of postsurgical GI events and incremental hospital costs, including potential savings, associated with lower GI AE rates, for tapentadol immediate release (IR) versus oxycodone IR, using a literature-based calculator. Methods An electronic spreadsheet–based cost calculator was developed to estimate the total number of GI AEs (ie, nausea, vomiting, or constipation) and incremental costs to a hospital when using tapentadol IR 100 mg versus oxycodone IR 15 mg, in a hypothetical cohort of 1500 hospitalized patients requiring short-acting opioids for postsurgical pain. Data inputs were chosen from recently published, well-designed studies, including GI AE rates from a previously published phase 3 clinical trial of postsurgical patients who received these 2 opioids; GI event–related incremental length of stay from a large US hospital database; drug costs using wholesale acquisition costs in 2011 US dollars; and average hospitalization cost from the 2009 Healthcare Cost and Utilization Project database. The base case assumed that 5% (chosen as a conservative estimate) of patients admitted to the hospital would shift from oxycodone IR to tapentadol IR. Results In this hypothetical cohort of 1500 hospitalized patients, replacing 5% of oxycodone IR 15-mg use with tapentadol IR 100-mg use predicted reductions in the total number of GI events from 1095 to 1085, and in the total cost of GI AEs from $2,978,400 to $2,949,840. This cost reduction translates to a net savings of $22,922 after factoring in drug cost. For individual GI events, the net savings were $26,491 for nausea; $12,212 for vomiting; and $7187 for constipation. Conclusion Using tapentadol IR in place of a traditional μ-opioid shows the potential for reduced GI events and subsequent cost-savings in the postsurgical hospital setting. In the absence of sufficient real-world data, this literature-based cost calculator may assist hospital Pharmacy & Therapeutics committees in their evaluation of the costs of opioid-related GI events. PMID:24991383

The Effect of Positive and Negative Feedback on Risk-Taking across Different Contexts.

PubMed

Losecaat Vermeer, Annabel B; Sanfey, Alan G

2015-01-01

Preferences for risky choices have often been shown to be unstable and context-dependent. Though people generally avoid gambles with mixed outcomes, a phenomenon often attributed to loss aversion, contextual factors can impact this dramatically. For example, people typically prefer risky options after a financial loss, while generally choosing safer options after a monetary gain. However, it is unclear what exactly contributes to these preference shifts as a function of prior outcomes, as these gain/loss outcomes are usually confounded with participant performance, and therefore it is unclear whether these effects are driven purely by the monetary gains or losses, or rather by success or failure at the actual task. Here, we experimentally separated the effects of monetary gains/losses from performance success/failure prior to a standard risky choice. Participants performed a task in which they experienced contextual effects: 1) monetary gain or loss based directly on performance, 2) monetary gain or loss that was randomly awarded and was, crucially, independent from performance, and 3) success or failure feedback based on performance, but without any monetary incentive. Immediately following these positive/negative contexts, participants were presented with a gain-loss gamble that they had to decide to either play or pass. We found that risk preferences for identical sets of gambles were biased by positive and negative contexts containing monetary gains and losses, but not by contexts containing performance feedback. This data suggests that the observed framing effects are driven by aversion for monetary losses and not simply by the positive or negative valence of the context, or by potential moods resulting from positive or negative contexts. These results highlight the specific context dependence of risk preferences.

Monetary Diet Cost, Diet Quality, and Parental Socioeconomic Status in Spanish Youth

PubMed Central

Ribas-Barba, Lourdes; Pérez-Rodrigo, Carmen; Bawaked, Rowaedh Ahmed; Fíto, Montserrat; Serra-Majem, Lluis

2016-01-01

Background Using a food-based analysis, healthy dietary patterns in adults are more expensive than less healthy ones; studies are needed in youth. Therefore, the objective of the present study was to determine relationships between monetary daily diet cost, diet quality, and parental socioeconomic status. Design and Methods Data were obtained from a representative national sample of 3534 children and young people in Spain, aged 2 to 24 years. Dietary assessment was performed with a 24-hour recall. Mediterranean diet adherence was measured by the KIDMED questionnaire. Average food cost was calculated from official Spanish government data. Monetary daily diet cost was expressed as euros per day (€/d) and euros per day standardized to a 1000kcal diet (€/1000kcal/d). Results Mean monetary daily diet cost was 3.16±1.57€/d (1.56±0.72€/1000kcal/d). Socioeconomic status was positively associated with monetary daily diet cost and diet quality measured by the KIDMED index (€/d and €/1000kcal/d, p<0.019). High Mediterranean diet adherence (KIDMED score 8–12) was 0.71 €/d (0.28€/1000kcal/d) more expensive than low compliance (KIDMED score 0–3). Analysis for nonlinear association between the KIDMED index and monetary daily diet cost per1000kcal showed no further cost increases beyond a KIDMED score of 8 (linear p<0.001; nonlinear p = 0.010). Conclusion Higher monetary daily diet cost is associated with healthy eating in Spanish youth. Higher socioeconomic status is a determinant for higher monetary daily diet cost and quality. PMID:27622518

Brain reward system's alterations in response to food and monetary stimuli in overweight and obese individuals.

PubMed

Verdejo-Román, Juan; Vilar-López, Raquel; Navas, Juan F; Soriano-Mas, Carles; Verdejo-García, Antonio

2017-02-01

The brain's reward system is crucial to understand obesity in modern society, as increased neural responsivity to reward can fuel the unhealthy food choices that are driving the growing obesity epidemic. Brain's reward system responsivity to food and monetary rewards in individuals with excessive weight (overweight and obese) versus normal weight controls, along with the relationship between this responsivity and body mass index (BMI) were tested. The sample comprised 21 adults with obesity (BMI > 30), 21 with overweight (BMI between 25 and 30), and 39 with normal weight (BMI < 25). Participants underwent a functional magnetic resonance imaging (fMRI) session while performing two tasks that involve the processing of food (Willing to Pay) and monetary rewards (Monetary Incentive Delay). Neural activations within the brain reward system were compared across the three groups. Curve fit analyses were conducted to establish the association between BMI and brain reward system's response. Individuals with obesity had greater food-evoked responsivity in the dorsal and ventral striatum compared with overweight and normal weight groups. There was an inverted U-shape association between BMI and monetary-evoked responsivity in the ventral striatum, medial frontal cortex, and amygdala; that is, individuals with BMIs between 27 and 32 had greater responsivity to monetary stimuli. Obesity is associated with greater food-evoked responsivity in the ventral and dorsal striatum, and overweight is associated with greater monetary-evoked responsivity in the ventral striatum, the amygdala, and the medial frontal cortex. Findings suggest differential reactivity of the brain's reward system to food versus monetary rewards in obesity and overweight. Hum Brain Mapp 38:666-677, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Monetary Incentives in Speeded Perceptual Decision: Effects of Penalizing Errors Versus Slow Responses

PubMed Central

Dambacher, Michael; Hübner, Ronald; Schlösser, Jan

2011-01-01

The influence of monetary incentives on performance has been widely investigated among various disciplines. While the results reveal positive incentive effects only under specific conditions, the exact nature, and the contribution of mediating factors are largely unexplored. The present study examined influences of payoff schemes as one of these factors. In particular, we manipulated penalties for errors and slow responses in a speeded categorization task. The data show improved performance for monetary over symbolic incentives when (a) penalties are higher for slow responses than for errors, and (b) neither slow responses nor errors are punished. Conversely, payoff schemes with stronger punishment for errors than for slow responses resulted in worse performance under monetary incentives. The findings suggest that an emphasis of speed is favorable for positive influences of monetary incentives, whereas an emphasis of accuracy under time pressure has the opposite effect. PMID:21980316

The Impact of Social Pressure and Monetary Incentive on Cognitive Control

PubMed Central

Ličen, Mina; Hartmann, Frank; Repovš, Grega; Slapničar, Sergeja

2016-01-01

We compare the effects of two prominent organizational control mechanisms—social pressure and monetary incentive—on cognitive control. Cognitive control underlies the human ability to regulate thoughts and actions in the pursuit of behavioral goals. Previous studies show that monetary incentives can contribute to goal-oriented behavior by activating proactive control. There is, however, much less evidence of how social pressure affects cognitive control and task performance. In a within-subject experimental design, we tested 47 subjects performing the AX-CPT task to compare the activation of cognitive control modes under social pressure and monetary incentive beyond mere instructions to perform better. Our results indicate that instructing participants to improve their performance on its own leads to a significant shift from a reactive to a proactive control mode and that both social pressure and monetary incentive further enhance performance. PMID:26903901

25 CFR 162.555 - May a WSR lease provide for non-monetary or varying types of compensation?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false May a WSR lease provide for non-monetary or varying types of compensation? 162.555 Section 162.555 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation...

25 CFR 162.555 - May a WSR lease provide for non-monetary or varying types of compensation?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false May a WSR lease provide for non-monetary or varying types of compensation? 162.555 Section 162.555 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation...

26 CFR 1.1001-5 - European Monetary Union (conversion to the euro).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 11 2010-04-01 2010-04-01 true European Monetary Union (conversion to the euro... § 1.1001-5 European Monetary Union (conversion to the euro). (a) Conversion of currencies. For purposes of § 1.1001-1(a), the conversion to the euro of legacy currencies (as defined in § 1.985-8(a)(1...

26 CFR 1.1001-5 - European Monetary Union (conversion to the euro).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 11 2011-04-01 2011-04-01 false European Monetary Union (conversion to the euro... Gain Or Loss § 1.1001-5 European Monetary Union (conversion to the euro). (a) Conversion of currencies. For purposes of § 1.1001-1(a), the conversion to the euro of legacy currencies (as defined in § 1.985...

26 CFR 1.1001-5 - European Monetary Union (conversion to the euro).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 11 2013-04-01 2013-04-01 false European Monetary Union (conversion to the euro... Gain Or Loss § 1.1001-5 European Monetary Union (conversion to the euro). (a) Conversion of currencies. For purposes of § 1.1001-1(a), the conversion to the euro of legacy currencies (as defined in § 1.985...

26 CFR 1.1001-5 - European Monetary Union (conversion to the euro).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 11 2014-04-01 2014-04-01 false European Monetary Union (conversion to the euro... Gain Or Loss § 1.1001-5 European Monetary Union (conversion to the euro). (a) Conversion of currencies. For purposes of § 1.1001-1(a), the conversion to the euro of legacy currencies (as defined in § 1.985...

26 CFR 1.1001-5 - European Monetary Union (conversion to the euro).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 11 2012-04-01 2012-04-01 false European Monetary Union (conversion to the euro... Gain Or Loss § 1.1001-5 European Monetary Union (conversion to the euro). (a) Conversion of currencies. For purposes of § 1.1001-1(a), the conversion to the euro of legacy currencies (as defined in § 1.985...

Monetary policy games and international migration of labor in interdependent economies.

PubMed

Agiomirgianakis, G M

1998-01-01

"In this paper we incorporate the possibility of international migration into a monetary policy game played by governments in unionized interdependent economies. We show that contrary to usual presumptions, established by earlier studies that ignore the possibility of international migration, inter-government cooperation in the monetary field may well turn out to be advantageous. This has important implications for the European economies, since it suggests that measures taken towards encouraging international migration within EU [the European Union] will not only harmonize the European labor markets but will also make monetary policy cooperation within Europe, as required by the Maastrict Treaty, more advantageous." excerpt

How does money memorize social interactions? Understanding time-homogeneity in monetary systems

NASA Astrophysics Data System (ADS)

Braun, Dieter; Schmitt, Matthias; Schacker, Andreas

2013-03-01

Understanding how money shapes and memorizes our social interactions is central to modern life. There are many schools of thought on as to how monetary systems contribute to crises or boom/bust cycles and how monetary policy can try to avert them. We find that statistical physics gives a refreshing perspective. We analyze how credit mechanisms introduce non-locality and time-heterogeneity to the monetary memory. Motivated by an analogy to particle physics, locality and time-homogeneity can be imposed to monetary systems. As a result, a full reserve banking system is complemented with a bi-currency system of non-bank assets (``money'') and bank assets (``antimoney''). Payment can either be made by passing on money or by receiving antimoney. As a result, a free floating exchange rate between non-bank assets and bank assets is established. Interestingly, this monetary memory allows for credit creation by the simultaneous transfer of money and antimoney at a negotiated exchange rate. We analyze this novel mechanism of liquidity transfer in a model of random social interactions, yielding analytical results for all relevant distributions and the price of liquidity under the conditions of a fully transparent credit market.

Money Affects Theory of Mind Differently by Gender

PubMed Central

Ridinger, Garret; McBride, Michael

2015-01-01

Theory of Mind (ToM) ─ the ability to understand other’s thoughts, intentions, and emotions ─ is important for navigating interpersonal relationships, avoiding conflict, and empathizing. Prior research has identified many factors that affect one’s ToM ability, but little work has examined how different kinds of monetary incentives affect ToM ability. We ask: Does money affect ToM ability? If so, how does the effect depend on the structure of monetary incentives? How do the differences depend on gender? We hypothesize that money will affect ToM ability differently by gender: monetary rewards increase males’ motivation to express ToM ability while simultaneously crowding out females’ motivation. This prediction is confirmed in an experiment that varies the structure of monetary rewards for correct answers in the Reading the Mind in the Eyes Test (RMET). RMET scores decrease for females and increase for males with individual payments, and this effect is stronger with competitively-structured payments. RMET scores do not significantly change when monetary earnings go to a charity. Whether money improves or hinders ToM ability, and, hence, success in social interactions, thus depends on the interaction of gender and monetary incentive structure. PMID:26633171

Money Affects Theory of Mind Differently by Gender.

PubMed

Ridinger, Garret; McBride, Michael

2015-01-01

Theory of Mind (ToM)--the ability to understand other's thoughts, intentions, and emotions--is important for navigating interpersonal relationships, avoiding conflict, and empathizing. Prior research has identified many factors that affect one's ToM ability, but little work has examined how different kinds of monetary incentives affect ToM ability. We ask: Does money affect ToM ability? If so, how does the effect depend on the structure of monetary incentives? How do the differences depend on gender? We hypothesize that money will affect ToM ability differently by gender: monetary rewards increase males' motivation to express ToM ability while simultaneously crowding out females' motivation. This prediction is confirmed in an experiment that varies the structure of monetary rewards for correct answers in the Reading the Mind in the Eyes Test (RMET). RMET scores decrease for females and increase for males with individual payments, and this effect is stronger with competitively-structured payments. RMET scores do not significantly change when monetary earnings go to a charity. Whether money improves or hinders ToM ability, and, hence, success in social interactions, thus depends on the interaction of gender and monetary incentive structure.

Benefits of investing in ecosystem restoration.

PubMed

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

2013-12-01

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

Identification of Flights for Cost-Efficient Climate Impact Reduction

NASA Technical Reports Server (NTRS)

Chen, Neil Y.; Kirschen, Philippe G.; Sridhar, Banavar; Ng, Hok K.

2014-01-01

The aircraft-induced climate impact has drawn attention in recent years. Aviation operations affect the environment mainly through the release of carbon-dioxide, nitrogen-oxides, and by the formation of contrails. Recent research has shown that altering trajectories can reduce aviation environmental cost by reducing Absolute Global Temperature Change Potential, a climate assessment metric that adapts a linear system for modeling the global temperature response to aviation emissions and contrails. However, these methods will increase fuel consumption that leads to higher fuel costs imposed on airlines. The goal of this work is to identify ights for which the environmental cost of climate impact reduction outweighs the increase in operational cost on an individual aircraft basis. Environmental cost is quanti ed using the monetary social cost of carbon. The increase in operational cost is considering cost of additional fuel usage only. For this paper, an algorithm has been developed that modi es the trajectories of ights to evaluate the e ect of environ- mental cost and operational cost of ights in the United States National Airspace System. The algorithm identi es ights for which the environmental cost of climate impact can be reduced and modi es their trajectories to achieve maximum environmental net bene t, which is the di erence between reduction in environmental cost and additional operational cost. The result shows on a selected day, 16% of the ights among eight major airlines, or 2,043 ights, can achieve environmental net bene t using weather forecast data, resulting in net bene t of around $500,000. The result also suggests that the long-haul ights would be better candidates for cost-ecient climate impact reduction than the short haul ights. The algorithm will help to identify the characteristics of ights that are capable of applying cost-ecient climate impact reduction strategy.

A behavioral economic reward index predicts drinking resolutions: moderation revisited and compared with other outcomes.

PubMed

Tucker, Jalie A; Roth, David L; Vignolo, Mary J; Westfall, Andrew O

2009-04-01

Data were pooled from 3 studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes. Moderation over 1- to 2-year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes than abstinence or relapse and to be predicted by more balanced preresolution monetary allocations between short-term and longer term objectives (i.e., drinking and saving for the future). Standardized odds ratios (ORs) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this "Alcohol-Savings Discretionary Expenditure" index predicted higher rates of abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p < .0001) compared with moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors. The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of preresolution spending patterns aids in predicting moderation.

Insula and striatum activity in effort-related monetary reward processing in gambling disorder: the role of depressive symptomatology.

PubMed

Fauth-Bühler, Mira; Zois, Evangelos; Vollstädt-Klein, Sabine; Lemenager, Tagrid; Beutel, Martin; Mann, Karl

2014-01-01

The neurobiological underpinnings of effort-related monetary reward processing of gambling disorder have not been previously studied. To date neuroimaging studies lack in large sample sizes and as a consequence less attention has been given to brain reward processing that could potentially be attributed to comorbid conditions such as depressive mood state. We assessed monetary reward processing using an effort-dependent task during 3 tesla functional magnetic resonance imaging. We investigated a large sample of male, right-handed, slot-machine-playing disordered gamblers (DGs; N = 80) as well as age- and smoking-matched male healthy controls (HCs; N = 89). Depressive symptoms were assessed using the Beck Depression Inventory (BDI). DGs and HCs were divided into subgroups ("high" and "low") based on their BDI scores. Effort-related monetary reward processing did not differ between the complete groups of HCs and DGs. Brain activation during receipt of monetary reward though revealed a significant Group × BDI interaction: DGs with higher BDI scores compared to DGs with lower BDI scores showed greater brain activity in the right insula cortex and dorsal striatum while no differences were observed for HCs with higher versus lower BDI scores. Our results suggest that effort-related aspects of monetary motivation, i.e. when monetary output is tied to performance, are not altered in DG. Additionally, our findings strengthen the need for subgroup comparisons in future investigations of the disorder as part of a personalized medicine approach.

Can more than one incremental cycling test be performed within one day?

PubMed

Scharhag-Rosenberger, Friederike; Carlsohn, Anja; Lundby, Carsten; Schüler, Stefan; Mayer, Frank; Scharhag, Jürgen

2014-01-01

Changes in performance parameters over four consecutive maximal incremental cycling tests were investigated to determine how many tests can be performed within one single day without negatively affecting performance. Sixteen male and female subjects (eight trained (T): 25 ± 3 yr, BMI 22.6 ± 2.5 kg·m(-2), maximal power output (P(max)) 4.6 ± 0.5 W·kg(-1); eight untrained (UT): 27 ± 3 yr, BMI 22.3 ± 1.2 kg·m(-2), P(max) 2.9 ± 0.3 W·kg(-1)) performed four successive maximal incremental cycling tests separated by 1.5 h of passive rest. Individual energy requirements were covered by standardised meals between trials. Maximal oxygen uptake (VO(2max)) remained unchanged over the four tests in both groups (P = 0.20 and P = 0.33, respectively). P(max) did not change in the T group (P = 0.32), but decreased from the third test in the UT group (P < 0.01). Heart rate responses to submaximal exercise were elevated from the third test in the T group and from the second test in the UT group (P < 0.05). The increase in blood lactate shifted rightward over the four tests in both groups (P < 0.001 and P < 0.01, respectively). Exercise-induced net increases in epinephrine and norepinephrine were not different between the tests in either group (P ≥ 0.15). If VO(2max) is the main parameter of interest, trained and untrained individuals can perform at least four maximal incremental cycling tests per day. However, because other parameters changed after the first and second test, respectively, no more than one test per day should be performed if parameters other than VO(2max) are the prime focus.

Incremental Predictive Value of Serum AST-to-ALT Ratio for Incident Metabolic Syndrome: The ARIRANG Study

PubMed Central

Ahn, Song Vogue; Baik, Soon Koo; Cho, Youn zoo; Koh, Sang Baek; Huh, Ji Hye; Chang, Yoosoo; Sung, Ki-Chul; Kim, Jang Young

2016-01-01

Aims The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is of great interest as a possible novel marker of metabolic syndrome. However, longitudinal studies emphasizing the incremental predictive value of the AST-to-ALT ratio in diagnosing individuals at higher risk of developing metabolic syndrome are very scarce. Therefore, our study aimed to evaluate the AST-to-ALT ratio as an incremental predictor of new onset metabolic syndrome in a population-based cohort study. Material and Methods The population-based cohort study included 2276 adults (903 men and 1373 women) aged 40–70 years, who participated from 2005–2008 (baseline) without metabolic syndrome and were followed up from 2008–2011. Metabolic syndrome was defined according to the harmonized definition of metabolic syndrome. Serum concentrations of AST and ALT were determined by enzymatic methods. Results During an average follow-up period of 2.6-years, 395 individuals (17.4%) developed metabolic syndrome. In a multivariable adjusted model, the odds ratio (95% confidence interval) for new onset of metabolic syndrome, comparing the fourth quartile to the first quartile of the AST-to-ALT ratio, was 0.598 (0.422–0.853). The AST-to-ALT ratio also improved the area under the receiver operating characteristic curve (AUC) for predicting new cases of metabolic syndrome (0.715 vs. 0.732, P = 0.004). The net reclassification improvement of prediction models including the AST-to-ALT ratio was 0.23 (95% CI: 0.124–0.337, P<0.001), and the integrated discrimination improvement was 0.0094 (95% CI: 0.0046–0.0143, P<0.001). Conclusions The AST-to-ALT ratio independently predicted the future development of metabolic syndrome and had incremental predictive value for incident metabolic syndrome. PMID:27560931

Disentangling the effect of atmospheric CO2 enrichment on the halophyte Salicornia ramosissima J. Woods physiological performance under optimal and suboptimal saline conditions.

PubMed

Pérez-Romero, Jesús Alberto; Idaszkin, Yanina Lorena; Barcia-Piedras, Jose-Maria; Duarte, Bernardo; Redondo-Gómez, Susana; Caçador, Isabel; Mateos-Naranjo, Enrique

2018-06-01

A mesocosm experiment was designed to assess the effect of atmospheric CO 2 increment on the salinity tolerance of the C 3 halophyte Salicornia ramosissima. Thus, the combined effect of 400 ppm and 700 ppm CO 2 at 0, 171 and 510 mM NaCl on plants growth, gas exchange, chlorophyll fluorescence parameters, pigments profiles, antioxidative enzyme activities and water relations was studied. Our results highlighted a positive effect of atmospheric CO 2 increment on plant physiological performance under suboptimal salinity concentration (510 mM NaCl). Thus, we recorded higher net photosynthetic rate (A N ) values under saline conditions and 700 ppm CO 2 , being this effect mainly mediated by a reduction of mesophyll (g m ) and biochemical limitation imposed to salt excess. In addition, rising atmospheric CO 2 led to a better plant water balance, linked with a reduction of stomatal conductante (g s ) and an overall increment of osmotic potential (Ѱ o ) with NaCl concentration increment. In spite of these positive effects, there were no significant biomass variations between any treatments. Being this fact ascribed by the investment of the higher energy fixed for salinity stress defence mechanisms, which allowed plants to maintain more active the photochemical machinery even at high salinities, reducing the risk of ROS production, as indicated an improvement of the electron flux and a rise of the energy dissipation. Finally, the positive effect of the CO 2 was also supported by the modulation of pigments profiles (mainly zeaxhantin and violaxhantin) concentrations and anti-oxidative stress enzymes, such as superoxide dismutase (SOD) and ascorbate peroxidase (APx). Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Diurnal and seasonal changes in stem increment and water use by yellow poplar trees in response to environmental stress.

PubMed

McLaughlin, Samuel B; Wullschleger, Stan D; Nosal, Miloslav

2003-11-01

To evaluate indicators of whole-tree physiological responses to climate stress, we determined seasonal, daily and diurnal patterns of growth and water use in 10 yellow poplar (Liriodendron tulipifera L.) trees in a stand recently released from competition. Precise measurements of stem increment and sap flow made with automated electronic dendrometers and thermal dissipation probes, respectively, indicated close temporal linkages between water use and patterns of stem shrinkage and swelling during daily cycles of water depletion and recharge of extensible outer-stem tissues. These cycles also determined net daily basal area increment. Multivariate regression models based on a 123-day data series showed that daily diameter increments were related negatively to vapor pressure deficit (VPD), but positively to precipitation and temperature. The same model form with slight changes in coefficients yielded coefficients of determination of about 0.62 (0.57-0.66) across data subsets that included widely variable growth rates and VPDs. Model R2 was improved to 0.75 by using 3-day running mean daily growth data. Rapid recovery of stem diameter growth following short-term, diurnal reductions in VPD indicated that water stored in extensible stem tissues was part of a fast recharge system that limited hydration changes in the cambial zone during periods of water stress. There were substantial differences in the seasonal dynamics of growth among individual trees, and analyses indicated that faster-growing trees were more positively affected by precipitation, solar irradiance and temperature and more negatively affected by high VPD than slower-growing trees. There were no negative effects of ozone on daily growth rates in a year of low ozone concentrations.

Cost-effectiveness analysis and HIV screening: the emergency medicine perspective.

PubMed

Hsu, Heather; Walensky, Rochelle P

2011-07-01

Cost-effectiveness analysis is a useful tool for decisionmakers charged with prioritizing of the myriad medical interventions in the emergency department (ED). This analytic approach may be especially helpful for ranking programs that are competing for scarce resources while attempting to maximize net health benefits. In this article, we review the health economics literature on HIV screening in EDs and introduce the methods of cost-effectiveness analysis for medical interventions. We specifically describe the incremental cost-effectiveness ratio--its calculation, the derivation of ratio components, and the interpretation of these ratios. Copyright © 2011. Published by Mosby, Inc.

Input-decomposition balance of heterotrophic processes in a warm-temperate mixed forest in Japan

NASA Astrophysics Data System (ADS)

Jomura, M.; Kominami, Y.; Ataka, M.; Makita, N.; Dannoura, M.; Miyama, T.; Tamai, K.; Goto, Y.; Sakurai, S.

2010-12-01

Carbon accumulation in forest ecosystem has been evaluated using three approaches. One is net ecosystem exchange (NEE) estimated by tower flux measurement. The second is net ecosystem production (NEP) estimated by biometric measurements. NEP can be expressed as the difference between net primary production and heterotrophic respiration. NEP can also be expressed as the annual increment in the plant biomass (ΔW) plus soil (ΔS) carbon pools defined as follows; NEP = ΔW+ΔS The third approach needs to evaluate annual carbon increment in soil compartment. Soil carbon accumulation rate could not be measured directly in a short term because of the small amount of annual accumulation. Soil carbon accumulation rate can be estimated by a model calculation. Rothamsted carbon model is a soil organic carbon turnover model and a useful tool to estimate the rate of soil carbon accumulation. However, the model has not sufficiently included variations in decomposition processes of organic matters in forest ecosystems. Organic matter in forest ecosystems have a different turnover rate that creates temporal variations in input-decomposition balance and also have a large variation in spatial distribution. Thus, in order to estimate the rate of soil carbon accumulation, temporal and spatial variation in input-decomposition balance of heterotrophic processes should be incorporated in the model. In this study, we estimated input-decomposition balance and the rate of soil carbon accumulation using the modified Roth-C model. We measured respiration rate of many types of organic matters, such as leaf litter, fine root litter, twigs and coarse woody debris using a chamber method. We can illustrate the relation of respiration rate to diameter of organic matters. Leaf and fine root litters have no diameter, so assumed to be zero in diameter. Organic matters in small size, such as leaf and fine root litter, have high decomposition respiration. It could be caused by the difference in structure of organic matter. Because coarse woody debris has shape of cylinder, microbes decompose from the surface of it. Thus, respiration rate of coarse woody debris is lower than that of leaf and fine root litter. Based on this result, we modified Roth-C model and estimate soil carbon accumulation rate in recent years. Based on the results from a soil survey, the forest soil stored 30tC ha-1 in O and A horizon. We can evaluate the modified model using this result. NEP can be expressed as the annual increment in the plant biomass plus soil carbon pools. So if we can estimate NEP using this approach, then we can evaluate NEP estimated by micrometeorological and ecological approaches and reduce uncertainty of NEP estimation.

Auction Mechanisms For Allocating Individualized Non-monetary Retention Incentives in Complex Decision Environments: Evaluation Via Laboratory Experimentation

DTIC Science & Technology

2010-03-01

MILITARY COMPENSATION .....................7 1. Basic Pay and Allowances ......................8 2. Other Monetary and Non-Monetary Benefits ......9...3. Deferred Benefits ............................10 4. Special Pays and Bonuses .....................10 C. THE SRB PROGRAM (MARINE CORPS...or flexible benefits packages, to military personnel. Much of the thesis builds on this prior research. Chapter II provides an overview of

Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange-based tuberculin skin testing.

PubMed

Perlman, David C; Friedmann, Patricia; Horn, Leslie; Nugent, Anne; Schoeb, Veronika; Carey, Jeanne; Salomon, Nadim; Des Jarlais, Don C

2003-09-01

Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence. We compared adherence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives. From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a $25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P<.0001; odds ratio [OR]=23; 95% confidence interval [CI]=9.5-57). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P<.0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR=22.9; 95% CI=10-52). Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchange-based tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When health care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.

How required reserve ratio affects distribution and velocity of money

NASA Astrophysics Data System (ADS)

Xi, Ning; Ding, Ning; Wang, Yougui

2005-11-01

In this paper the dependence of wealth distribution and the velocity of money on the required reserve ratio is examined based on a random transfer model of money and computer simulations. A fractional reserve banking system is introduced to the model where money creation can be achieved by bank loans and the monetary aggregate is determined by the monetary base and the required reserve ratio. It is shown that monetary wealth follows asymmetric Laplace distribution and latency time of money follows exponential distribution. The expression of monetary wealth distribution and that of the velocity of money in terms of the required reserve ratio are presented in a good agreement with simulation results.

How to measure monetary losses in gambling disorder? An evidence-based refinement.

PubMed

Medeiros, Gustavo C; Redden, Sarah A; Chamberlain, Samuel R; Grant, Jon E

2018-05-01

Diverse monetary measures have been utilized across different studies in gambling disorder (GD). However, there are limited evidence-based proposals regarding the best way to assess financial losses. We investigated how different variables of monetary losses correlate with validated assessments of gambling severity and overall functioning in a large sample of subjects with GD (n = 436). We found that relative monetary variables (i.e. when financial losses were evaluated in relation to personal income) showed the most robust correlations with gambling severity and overall psychosocial functioning. Percentage of monthly income lost from gambling was the variable with the best performance. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Return-to-work intervention versus usual care for sick-listed employees: health-economic investment appraisal alongside a cluster randomised trial.

PubMed

Lokman, Suzanne; Volker, Danielle; Zijlstra-Vlasveld, Moniek C; Brouwers, Evelien Pm; Boon, Brigitte; Beekman, Aartjan Tf; Smit, Filip; Van der Feltz-Cornelis, Christina M

2017-10-05

To evaluate the health-economic costs and benefits of a guided eHealth intervention (E-health module embedded in Collaborative Occupational healthcare (ECO)) encouraging sick-listed employees to a faster return to work. A two-armed cluster randomised trial with occupational physicians (OPs) (n=62), clustered and randomised by region into an experimental and a control group, to conduct a health-economic investment appraisal. Online self-reported data were collected from employees at baseline, after 3, 6, 9 and 12 months. Occupational health care in the Netherlands. Employees from small-sized and medium-sized companies (≥18 years), sick-listed between 4 and 26 weeks with (symptoms of) common mental disorders visiting their OP. In the intervention group, employees (N=131) received an eHealth module aimed at changing cognitions regarding return to work, while OPs were supported by a decision aid for treatment and referral options. Employees in the control condition (N=89) received usual sickness guidance. Net benefits and return on investment based on absenteeism, presenteeism, health care use and quality-adjusted life years (QALYs) gained. From the employer's perspective, the incremental net benefits were €3187 per employee over a single year, representing a return of investment of €11 per invested Euro, with a break-even point at 6 months. The economic case was also favourable from the employee's perspective, partly because of QALY health gains. The intervention was costing €234 per employee from a health service financier's perspective. The incremental net benefits from a social perspective were €4210. This amount dropped to €3559 in the sensitivity analysis trimming the 5% highest costs. The data suggest that the ECO intervention offers good value for money for virtually all stakeholders involved, because initial investments were more than recouped within a single year. The sometimes wide 95% CIs suggest that the costs and benefits are not always very precise estimates and real benefits could vary considerably. NTR2108; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Common alterations in sensitivity to type but not amount of reward in ADHD and autism spectrum disorders.

PubMed

Demurie, Ellen; Roeyers, Herbert; Baeyens, Dieter; Sonuga-Barke, Edmund

2011-11-01

Children with attention deficit/hyperactivity disorder (ADHD) display abnormalities in reward processing. Most reward studies have focused on the effects of material or monetary rewards. Studies with autism spectrum disorder (ASD) have focused on social rewards. In this study we compared the effects of amount and type of reward in children with ADHD and those with ASD. Two adapted versions of the Monetary Incentive Delay Task were used to study the effects of monetary and social reward anticipation on performance in 40 typically developing (TD) children and adolescents (8-16y), 35 children and adolescents with ADHD and 31 children and adolescents with ASD. Monetary and social reward improved accuracy and response time (RT) in all groups. The higher the anticipated reward, the more accurate and faster were responses. Independent of these effects, there was a differential effect of reward type. Both clinical groups, but not TD, responded faster for monetary than social rewards. The results, while not supporting hyposensitivity to changes in reward amount in ADHD and ASD, do suggest that both groups are generally less motivated in settings where social as opposed to monetary rewards can be earned. © 2011 The Authors. Journal of Child Psychology and Psychiatry. © 2011 Association for Child and Adolescent Mental Health.

Group-Wise Herding Behavior in Financial Markets: An Agent-Based Modeling Approach

PubMed Central

Kim, Minsung; Kim, Minki

2014-01-01

In this paper, we shed light on the dynamic characteristics of rational group behaviors and the relationship between monetary policy and economic units in the financial market by using an agent-based model (ABM), the Hurst exponent, and the Shannon entropy. First, an agent-based model is used to analyze the characteristics of the group behaviors at different levels of irrationality. Second, the Hurst exponent is applied to analyze the characteristics of the trend-following irrationality group. Third, the Shannon entropy is used to analyze the randomness and unpredictability of group behavior. We show that in a system that focuses on macro-monetary policy, steep fluctuations occur, meaning that the medium-level irrationality group has the highest Hurst exponent and Shannon entropy among all of the groups. However, in a system that focuses on micro-monetary policy, all group behaviors follow a stable trend, and the medium irrationality group thus remains stable, too. Likewise, in a system that focuses on both micro- and macro-monetary policies, all groups tend to be stable. Consequently, we find that group behavior varies across economic units at each irrationality level for micro- and macro-monetary policy in the financial market. Together, these findings offer key insights into monetary policy. PMID:24714635

Group-wise herding behavior in financial markets: an agent-based modeling approach.

PubMed

Kim, Minsung; Kim, Minki

2014-01-01

In this paper, we shed light on the dynamic characteristics of rational group behaviors and the relationship between monetary policy and economic units in the financial market by using an agent-based model (ABM), the Hurst exponent, and the Shannon entropy. First, an agent-based model is used to analyze the characteristics of the group behaviors at different levels of irrationality. Second, the Hurst exponent is applied to analyze the characteristics of the trend-following irrationality group. Third, the Shannon entropy is used to analyze the randomness and unpredictability of group behavior. We show that in a system that focuses on macro-monetary policy, steep fluctuations occur, meaning that the medium-level irrationality group has the highest Hurst exponent and Shannon entropy among all of the groups. However, in a system that focuses on micro-monetary policy, all group behaviors follow a stable trend, and the medium irrationality group thus remains stable, too. Likewise, in a system that focuses on both micro- and macro-monetary policies, all groups tend to be stable. Consequently, we find that group behavior varies across economic units at each irrationality level for micro- and macro-monetary policy in the financial market. Together, these findings offer key insights into monetary policy.

Human muscle net K(+) release during exercise is unaffected by elevated anaerobic metabolism, but reduced after prolonged acclimatization to 4,100 m.

PubMed

Nordsborg, Nikolai B; Calbet, José A L; Sander, Mikael; van Hall, Gerrit; Juel, Carsten; Saltin, Bengt; Lundby, Carsten

2010-07-01

It was investigated whether skeletal muscle K(+) release is linked to the degree of anaerobic energy production. Six subjects performed an incremental bicycle exercise test in normoxic and hypoxic conditions prior to and after 2 and 8 wk of acclimatization to 4,100 m. The highest workload completed by all subjects in all trials was 260 W. With acute hypoxic exposure prior to acclimatization, venous plasma [K(+)] was lower (P < 0.05) in normoxia (4.9 +/- 0.1 mM) than hypoxia (5.2 +/- 0.2 mM) at 260 W, but similar at exhaustion, which occurred at 400 +/- 9 W and 307 +/- 7 W (P < 0.05), respectively. At the same absolute exercise intensity, leg net K(+) release was unaffected by hypoxic exposure independent of acclimatization. After 8 wk of acclimatization, no difference existed in venous plasma [K(+)] between the normoxic and hypoxic trial, either at submaximal intensities or at exhaustion (360 +/- 14 W vs. 313 +/- 8 W; P < 0.05). At the same absolute exercise intensity, leg net K(+) release was less (P < 0.001) than prior to acclimatization and reached negative values in both hypoxic and normoxic conditions after acclimatization. Moreover, the reduction in plasma volume during exercise relative to rest was less (P < 0.01) in normoxic than hypoxic conditions, irrespective of the degree of acclimatization (at 260 W prior to acclimatization: -4.9 +/- 0.8% in normoxia and -10.0 +/- 0.4% in hypoxia). It is concluded that leg net K(+) release is unrelated to anaerobic energy production and that acclimatization reduces leg net K(+) release during exercise.

Effects of Motivation: Rewarding Hackers for Undetected Attacks Cause Analysts to Perform Poorly.

PubMed

Maqbool, Zahid; Makhijani, Nidhi; Pammi, V S Chandrasekhar; Dutt, Varun

2017-05-01

The aim of this study was to determine how monetary motivations influence decision making of humans performing as security analysts and hackers in a cybersecurity game. Cyberattacks are increasing at an alarming rate. As cyberattacks often cause damage to existing cyber infrastructures, it is important to understand how monetary rewards may influence decision making of hackers and analysts in the cyber world. Currently, only limited attention has been given to this area. In an experiment, participants were randomly assigned to three between-subjects conditions ( n = 26 for each condition): equal payoff, where the magnitude of monetary rewards for hackers and defenders was the same; rewarding hacker, where the magnitude of monetary reward for hacker's successful attack was 10 times the reward for analyst's successful defense; and rewarding analyst, where the magnitude of monetary reward for analyst's successful defense was 10 times the reward for hacker's successful attack. In all conditions, half of the participants were human hackers playing against Nash analysts and half were human analysts playing against Nash hackers. Results revealed that monetary rewards for human hackers and analysts caused a decrease in attack and defend actions compared with the baseline. Furthermore, rewarding human hackers for undetected attacks made analysts deviate significantly from their optimal behavior. If hackers are rewarded for their undetected attack actions, then this causes analysts to deviate from optimal defend proportions. Thus, analysts need to be trained not become overenthusiastic in defending networks. Applications of our results are to networks where the influence of monetary rewards may cause information theft and system damage.

The rewarding value of good motor performance in the context of monetary incentives.

PubMed

Lutz, Kai; Pedroni, Andreas; Nadig, Karin; Luechinger, Roger; Jäncke, Lutz

2012-07-01

Whether an agent receives positive task feedback or a monetary reward, neural activity in their striatum increases. In the latter case striatal activity reflects extrinsic reward processing, while in the former, striatal activity reflects the intrinsically rewarding effects of performing well. There can be a "hidden cost of reward", which is a detrimental effect of extrinsic on intrinsic reward value. This raises the question how these two types of reward interact. To address this, we applied a monetary incentive delay task: in all trials participants received feedback depending on their performance. In half of the trials they could additionally receive monetary reward if they performed well. This resulted in high performance trials, which were monetarily rewarded and high performance trials that were not. This made it possible to dissociate the neural correlates of performance feedback from the neural correlates of monetary reward that comes with high performance. Performance feedback alone elicits activation increases in the ventral striatum. This activation increases due to additional monetary reward. Neural response in the dorsal striatum on the other hand is only significantly increased by feedback when a monetary incentive is present. The quality of performance does not significantly influence dorsal striatum activity. In conclusion, our results indicate that the dorsal striatum is primarily sensitive to optional or actually received external rewards, whereas the ventral striatum may be coding intrinsic reward due to positive performance feedback. Thus the ventral striatum is suggested to be involved in the processing of intrinsically motivated behavior. Copyright © 2012 Elsevier Ltd. All rights reserved.

Facilitating responsible gambling: the relative effectiveness of education-based animation and monetary limit setting pop-up messages among electronic gaming machine players.

PubMed

Wohl, Michael J A; Gainsbury, Sally; Stewart, Melissa J; Sztainert, Travis

2013-12-01

Although most gamblers set a monetary limit on their play, many exceed this limit--an antecedent of problematic gambling. Responsible gambling tools may assist players to gamble within their means. Historically, however, the impact of such tools has been assessed in isolation. In the current research, two responsible gambling tools that target adherence to a monetary limit were assessed among 72 electronic gaming machine (EGM) players. Participants watched an educational animation explaining how EGMs work (or a neutral video) and then played an EGM in a virtual reality environment. All participants were asked to set a monetary limit on their play, but only half were reminded when that limit was reached. Results showed that both the animation and pop-up limit reminder helped gamblers stay within their preset monetary limit; however, an interaction qualified these main effects. Among participants who did not experience the pop-up reminder, those who watched the animation stayed within their preset monetary limits more than those who did not watch the animation. For those who were reminded of their limit, however, there was no difference in limit adherence between those who watched the animation and those who did not watch the animation. From a responsible gambling perspective, the current study suggests that there is no additive effect of exposure to both responsible gambling tools. Therefore, for minimal disruption in play, a pop-up message reminding gamblers of their preset monetary limit might be preferred over the lengthier educational animation.

Insula and striatum activity in effort-related monetary reward processing in gambling disorder: The role of depressive symptomatology

PubMed Central

Fauth-Bühler, Mira; Zois, Evangelos; Vollstädt-Klein, Sabine; Lemenager, Tagrid; Beutel, Martin; Mann, Karl

2014-01-01

The neurobiological underpinnings of effort-related monetary reward processing of gambling disorder have not been previously studied. To date neuroimaging studies lack in large sample sizes and as a consequence less attention has been given to brain reward processing that could potentially be attributed to comorbid conditions such as depressive mood state. We assessed monetary reward processing using an effort-dependent task during 3 tesla functional magnetic resonance imaging. We investigated a large sample of male, right-handed, slot-machine-playing disordered gamblers (DGs; N = 80) as well as age- and smoking-matched male healthy controls (HCs; N = 89). Depressive symptoms were assessed using the Beck Depression Inventory (BDI). DGs and HCs were divided into subgroups (“high” and “low”) based on their BDI scores. Effort-related monetary reward processing did not differ between the complete groups of HCs and DGs. Brain activation during receipt of monetary reward though revealed a significant Group × BDI interaction: DGs with higher BDI scores compared to DGs with lower BDI scores showed greater brain activity in the right insula cortex and dorsal striatum while no differences were observed for HCs with higher versus lower BDI scores. Our results suggest that effort-related aspects of monetary motivation, i.e. when monetary output is tied to performance, are not altered in DG. Additionally, our findings strengthen the need for subgroup comparisons in future investigations of the disorder as part of a personalized medicine approach. PMID:25379437

A cost-benefit analysis of a pellet boiler with electrostatic precipitator versus conventional biomass technology: A case study of an institutional boiler in Syracuse, New York.

PubMed

Levy, Jonathan I; Biton, Leiran; Hopke, Philip K; Zhang, K Max; Rector, Lisa

2017-07-01

Biomass facilities have received increasing attention as a strategy to increase the use of renewable fuels and decrease greenhouse gas emissions from the electric generation and heating sectors, but these facilities can potentially increase local air pollution and associated health effects. Comparing the economic costs and public health benefits of alternative biomass fuel, heating technology, and pollution control technology options provides decision-makers with the necessary information to make optimal choices in a given location. For a case study of a combined heat and power biomass facility in Syracuse, New York, we used stack testing to estimate emissions of fine particulate matter (PM 2.5 ) for both the deployed technology (staged combustion pellet boiler with an electrostatic precipitator) and a conventional alternative (wood chip stoker boiler with a multicyclone). We used the atmospheric dispersion model AERMOD to calculate the contribution of either fuel-technology configuration to ambient primary PM 2.5 in a 10km×10km region surrounding the facility, and we quantified the incremental contribution to population mortality and morbidity. We assigned economic values to health outcomes and compared the health benefits of the lower-emitting technology with the incremental costs. In total, the incremental annualized cost of the lower-emitting pellet boiler was $190,000 greater, driven by a greater cost of the pellet fuel and pollution control technology, offset in part by reduced fuel storage costs. PM 2.5 emissions were a factor of 23 lower with the pellet boiler with electrostatic precipitator, with corresponding differences in contributions to ambient primary PM 2.5 concentrations. The monetary value of the public health benefits of selecting the pellet-fired boiler technology with electrostatic precipitator was $1.7 million annually, greatly exceeding the differential costs even when accounting for uncertainties. Our analyses also showed complex spatial patterns of health benefits given non-uniform age distributions and air pollution levels. The incremental investment in a lower-emitting staged combustion pellet boiler with an electrostatic precipitator was well justified by the population health improvements over the conventional wood chip technology with a multicyclone, even given the focus on only primary PM 2.5 within a small spatial domain. Our analytical framework could be generalized to other settings to inform optimal strategies for proposed new facilities or populations. Copyright © 2017. Published by Elsevier Inc.

Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis.

PubMed

Hoch, Jeffrey S; Briggs, Andrew H; Willan, Andrew R

2002-07-01

Economic evaluation is often seen as a branch of health economics divorced from mainstream econometric techniques. Instead, it is perceived as relying on statistical methods for clinical trials. Furthermore, the statistic of interest in cost-effectiveness analysis, the incremental cost-effectiveness ratio is not amenable to regression-based methods, hence the traditional reliance on comparing aggregate measures across the arms of a clinical trial. In this paper, we explore the potential for health economists undertaking cost-effectiveness analysis to exploit the plethora of established econometric techniques through the use of the net-benefit framework - a recently suggested reformulation of the cost-effectiveness problem that avoids the reliance on cost-effectiveness ratios and their associated statistical problems. This allows the formulation of the cost-effectiveness problem within a standard regression type framework. We provide an example with empirical data to illustrate how a regression type framework can enhance the net-benefit method. We go on to suggest that practical advantages of the net-benefit regression approach include being able to use established econometric techniques, adjust for imperfect randomisation, and identify important subgroups in order to estimate the marginal cost-effectiveness of an intervention. Copyright 2002 John Wiley & Sons, Ltd.

Interpreting incremental value of markers added to risk prediction models.

PubMed

Pencina, Michael J; D'Agostino, Ralph B; Pencina, Karol M; Janssens, A Cecile J W; Greenland, Philip

2012-09-15

The discrimination of a risk prediction model measures that model's ability to distinguish between subjects with and without events. The area under the receiver operating characteristic curve (AUC) is a popular measure of discrimination. However, the AUC has recently been criticized for its insensitivity in model comparisons in which the baseline model has performed well. Thus, 2 other measures have been proposed to capture improvement in discrimination for nested models: the integrated discrimination improvement and the continuous net reclassification improvement. In the present study, the authors use mathematical relations and numerical simulations to quantify the improvement in discrimination offered by candidate markers of different strengths as measured by their effect sizes. They demonstrate that the increase in the AUC depends on the strength of the baseline model, which is true to a lesser degree for the integrated discrimination improvement. On the other hand, the continuous net reclassification improvement depends only on the effect size of the candidate variable and its correlation with other predictors. These measures are illustrated using the Framingham model for incident atrial fibrillation. The authors conclude that the increase in the AUC, integrated discrimination improvement, and net reclassification improvement offer complementary information and thus recommend reporting all 3 alongside measures characterizing the performance of the final model.

Quantitative model of the growth of floodplains by vertical accretion

USGS Publications Warehouse

Moody, J.A.; Troutman, B.M.

2000-01-01

A simple one-dimensional model is developed to quantitatively predict the change in elevation, over a period of decades, for vertically accreting floodplains. This unsteady model approximates the monotonic growth of a floodplain as an incremental but constant increase of net sediment deposition per flood for those floods of a partial duration series that exceed a threshold discharge corresponding to the elevation of the floodplain. Sediment deposition from each flood increases the elevation of the floodplain and consequently the magnitude of the threshold discharge resulting in a decrease in the number of floods and growth rate of the floodplain. Floodplain growth curves predicted by this model are compared to empirical growth curves based on dendrochronology and to direct field measurements at five floodplain sites. The model was used to predict the value of net sediment deposition per flood which best fits (in a least squares sense) the empirical and field measurements; these values fall within the range of independent estimates of the net sediment deposition per flood based on empirical equations. These empirical equations permit the application of the model to estimate of floodplain growth for other floodplains throughout the world which do not have detailed data of sediment deposition during individual floods. Copyright (C) 2000 John Wiley and Sons, Ltd.

Estimating the incremental net health benefit of requirements for cardiovascular risk evaluation for diabetes therapies

PubMed Central

Chawla, Anita J; Mytelka, Daniel S; McBride, Stephan D; Nellesen, Dave; Elkins, Benjamin R; Ball, Daniel E; Kalsekar, Anupama; Towse, Adrian; Garrison, Louis P

2014-01-01

Purpose To evaluate the advantages and disadvantages of pre-approval requirements for safety data to detect cardiovascular (CV) risk contained in the December 2008 U.S. Food and Drug Administration (FDA) guidance for developing type 2 diabetes drugs compared with the February 2008 FDA draft guidance from the perspective of diabetes population health. Methods We applied the incremental net health benefit (INHB) framework to quantify the benefits and risks of investigational diabetes drugs using a common survival metric (life-years [LYs]). We constructed a decision analytic model for clinical program development consistent with the requirements of each guidance and simulated diabetes drugs, some of which had elevated CV risk. Assuming constant research budgets, we estimate the impact of increased trial size on drugs investigated. We aggregate treatment benefit and CV risks for each approved drug over a 35-year horizon under each guidance. Results The quantitative analysis suggests that the December 2008 guidance adversely impacts diabetes population health. INHB was −1.80 million LYs, attributable to delayed access to diabetes therapies (−0.18 million LYs) and fewer drugs (−1.64 million LYs), but partially offset by reduced CV risk exposure (0.02 million LYs). Results were robust in sensitivity analyses. Conclusion The health outcomes impact of all potential benefits and risks should be evaluated in a common survival measure, including health gain from avoided adverse events, lost health benefits from delayed or forgone efficacious products, and impact of alternative policy approaches. Quantitative analysis of the December 2008 FDA guidance for diabetes therapies indicates that negative impact on patient health will result. © 2014 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd. PMID:24892175

Estimating the incremental net health benefit of requirements for cardiovascular risk evaluation for diabetes therapies.

PubMed

Chawla, Anita J; Mytelka, Daniel S; McBride, Stephan D; Nellesen, Dave; Elkins, Benjamin R; Ball, Daniel E; Kalsekar, Anupama; Towse, Adrian; Garrison, Louis P

2014-03-01

To evaluate the advantages and disadvantages of pre-approval requirements for safety data to detect cardiovascular (CV) risk contained in the December 2008 U.S. Food and Drug Administration (FDA) guidance for developing type 2 diabetes drugs compared with the February 2008 FDA draft guidance from the perspective of diabetes population health. We applied the incremental net health benefit (INHB) framework to quantify the benefits and risks of investigational diabetes drugs using a common survival metric (life-years [LYs]). We constructed a decision analytic model for clinical program development consistent with the requirements of each guidance and simulated diabetes drugs, some of which had elevated CV risk. Assuming constant research budgets, we estimate the impact of increased trial size on drugs investigated. We aggregate treatment benefit and CV risks for each approved drug over a 35-year horizon under each guidance. The quantitative analysis suggests that the December 2008 guidance adversely impacts diabetes population health. INHB was -1.80 million LYs, attributable to delayed access to diabetes therapies (-0 .18 million LYs) and fewer drugs (-1.64 million LYs), but partially offset by reduced CV risk exposure (0.02 million LYs). Results were robust in sensitivity analyses. The health outcomes impact of all potential benefits and risks should be evaluated in a common survival measure, including health gain from avoided adverse events, lost health benefits from delayed or for gone efficacious products, and impact of alternative policy approaches. Quantitative analysis of the December 2008 FDA guidance for diabetes therapies indicates that negative impact on patient health will result. Copyright © 2014 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd.

Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure.

PubMed

Wong, Frances Kam Yuet; So, Ching; Ng, Alina Yee Man; Lam, Po-Tin; Ng, Jeffrey Sheung Ching; Ng, Nancy Hiu Yim; Chau, June; Sham, Michael Mau Kwong

2018-02-01

Studies have shown positive clinical outcomes of specialist palliative care for end-stage heart failure patients, but cost-effectiveness evaluation is lacking. To examine the cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure patients as compared to the customary palliative care service. A cost-effectiveness analysis was conducted alongside a randomized controlled trial (Trial number: NCT02086305). The costs included pre-program training, intervention, and hospital use. Quality of life was measured using SF-6D. The study took place in three hospitals in Hong Kong. The inclusion criteria were meeting clinical indicators for end-stage heart failure patients including clinician-judged last year of life, discharged to home within the service area, and palliative care referral accepted. A total of 84 subjects (study = 43, control = 41) were recruited. When the study group was compared to the control group, the net incremental quality-adjusted life years gain was 0.0012 (28 days)/0.0077 (84 days) and the net incremental costs per case was -HK$7935 (28 days)/-HK$26,084 (84 days). The probability of being cost-effective was 85% (28 days)/100% (84 days) based on the cost-effectiveness thresholds recommended both by National Institute for Health and Clinical Excellence (£20,000/quality-adjusted life years) and World Health Organization (Hong Kong gross domestic product/capita in 2015, HK$328117). Results suggest that a transitional home-based palliative care program is more cost-effective than customary palliative care service. Limitations of the study include small sample size, study confined to one city, clinic consultation costs, and societal costs including patient costs and unpaid care-giving costs were not included.

Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: cost-utility and its determinants.

PubMed

Ribera, Aida; Slof, John; Andrea, Rut; Falces, Carlos; Gutiérrez, Enrique; Del Valle-Fernández, Raquel; Morís-de la Tassa, César; Mota, Pedro; Oteo, Juan Francisco; Cascant, Purificació; Altisent, Omar Abdul-Jawad; Sureda, Carlos; Serra, Vicente; García-Del Blanco, Bruno; Tornos, Pilar; Garcia-Dorado, David; Ferreira-González, Ignacio

2015-03-01

To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk. Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR. We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was €8800 higher than SAVR and the gain in QALY was 0.036. The ICER was €148,525/QALY. The cost of MC-TAVR was €9729 higher than SAVR and the QALY difference was -0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were €18,302/QALY and €179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to €32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant. In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Economic evaluation on CO₂-EOR of onshore oil fields in China

DOE PAGES

Wei, Ning; Li, Xiaochun; Dahowski, Robert T.; ...

2015-06-01

Carbon dioxide enhanced oil recovery (CO₂-EOR) and sequestration in depleted oil reservoirs is a plausible option for utilizing anthropogenic CO₂ to increase oil production while storing CO₂ underground. Evaluation of the storage resources and cost of potential CO₂-EOR projects is an essential step before the commencement of large-scale deployment of such activities. In this paper, a hybrid techno-economic evaluation method, including a performance model and cost model for onshore CO₂-EOR projects, has been developed based on previous studies. Total 296 onshore oil fields, accounting for about 70% of total mature onshore oil fields in China, were evaluated by the techno-economicmore » method. The key findings of this study are summarized as follows: (1) deterministic analysis shows there are approximately 1.1 billion tons (7.7 billion barrels) of incremental crude oil and 2.2 billion tons CO₂ storage resource for onshore CO₂-EOR at net positive revenue within the Chinese oil fields reviewed under the given operating strategy and economic assumptions. (2) Sensitivity study highlights that the cumulative oil production and cumulative CO₂ storage resource are very sensitive to crude oil price, CO₂ cost, project lifetime, discount rate and tax policy. High oil price, short project lifetime, low discount rate, low CO₂ cost, and low tax policy can greatly increase the net income of the oil enterprise, incremental oil recovery and CO₂ storage resource. (3) From this techno-economic evaluation, the major barriers to large-scale deployment of CO₂-EOR include complex geological conditions, low API of crude oil, high tax policy, and lack of incentives for the CO₂-EOR project.« less

Cost-effectiveness of everolimus for the treatment of advanced neuroendocrine tumours of gastrointestinal or lung origin in Canada.

PubMed

Chua, A; Perrin, A; Ricci, J F; Neary, M P; Thabane, M

2018-02-01

In 2016, everolimus was approved by Health Canada for the treatment of unresectable, locally advanced or metastatic, well-differentiated, non-functional, neuroendocrine tumours (NET) of gastrointestinal (GI) or lung origin in adult patients with progressive disease. This analysis evaluated the cost-effectiveness of everolimus in this setting from a Canadian societal perspective. A partitioned survival model was developed to compare the cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained of everolimus plus best supportive care (BSC) versus BSC alone in patients with advanced or metastatic NET of GI or lung origin. Model health states included stable disease, disease progression, and death. Efficacy inputs were based on the RADIANT-4 trial and utilities were mapped from quality-of-life data retrieved from RADIANT-4. Resource utilization inputs were derived from a Canadian physician survey, while cost inputs were obtained from official reimbursement lists from Ontario and other published sources. Costs and efficacy outcomes were discounted 5% annually over a 10-year time horizon, and sensitivity analyses were conducted to test the robustness of the base case results. Everolimus had an incremental gain of 0.616 QALYs (0.823 LYs) and CA$89,795 resulting in an incremental cost-effectiveness ratio of CA$145,670 per QALY gained (CA$109,166 per LY gained). The probability of cost-effectiveness was 52.1% at a willingness to pay (WTP) threshold of CA$150,000 per QALY. Results of the probabilistic sensitivity analysis indicate that everolimus has a 52.1% probability of being cost-effective at a WTP threshold of CA$150,000 per QALY gained in Canada.

Economic evaluation on CO₂-EOR of onshore oil fields in China

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

Wei, Ning; Li, Xiaochun; Dahowski, Robert T.

Carbon dioxide enhanced oil recovery (CO₂-EOR) and sequestration in depleted oil reservoirs is a plausible option for utilizing anthropogenic CO₂ to increase oil production while storing CO₂ underground. Evaluation of the storage resources and cost of potential CO₂-EOR projects is an essential step before the commencement of large-scale deployment of such activities. In this paper, a hybrid techno-economic evaluation method, including a performance model and cost model for onshore CO₂-EOR projects, has been developed based on previous studies. Total 296 onshore oil fields, accounting for about 70% of total mature onshore oil fields in China, were evaluated by the techno-economicmore » method. The key findings of this study are summarized as follows: (1) deterministic analysis shows there are approximately 1.1 billion tons (7.7 billion barrels) of incremental crude oil and 2.2 billion tons CO₂ storage resource for onshore CO₂-EOR at net positive revenue within the Chinese oil fields reviewed under the given operating strategy and economic assumptions. (2) Sensitivity study highlights that the cumulative oil production and cumulative CO₂ storage resource are very sensitive to crude oil price, CO₂ cost, project lifetime, discount rate and tax policy. High oil price, short project lifetime, low discount rate, low CO₂ cost, and low tax policy can greatly increase the net income of the oil enterprise, incremental oil recovery and CO₂ storage resource. (3) From this techno-economic evaluation, the major barriers to large-scale deployment of CO₂-EOR include complex geological conditions, low API of crude oil, high tax policy, and lack of incentives for the CO₂-EOR project.« less

Deep Energy Retrofits - Eleven California Case Studies

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

Less, Brennan; Fisher, Jeremy; Walker, Iain

2012-10-01

This research documents and demonstrates viable approaches using existing materials, tools and technologies in owner-conducted deep energy retrofits (DERs). These retrofits are meant to reduce energy use by 70% or more, and include extensive upgrades to the building enclosure, heating, cooling and hot water equipment, and often incorporate appliance and lighting upgrades as well as the addition of renewable energy. In this report, 11 Northern California (IECC climate zone 3) DER case studies are described and analyzed in detail, including building diagnostic tests and end-use energy monitoring results. All projects recognized the need to improve the home and its systemsmore » approximately to current building code-levels, and then pursued deeper energy reductions through either enhanced technology/ building enclosure measures, or through occupant conservation efforts, both of which achieved impressive energy performance and reductions. The beyond-code incremental DER costs averaged $25,910 for the six homes where cost data were available. DERs were affordable when these incremental costs were financed as part of a remodel, averaging a $30 per month increase in the net-cost of home ownership.« less

Growth Kinetics, Carbohydrate, and Leaf Phosphate Content of Clover (Trifolium subterraneum L.) after Transfer to a High CO2 Atmosphere or to High Light and Ambient Air 1

PubMed Central

Morin, Francoise; André, Marcel; Betsche, Thomas

1992-01-01

Intact air-grown (photosynthetic photon flux density, 400 microeinsteins per square meter per second) clover plants (Trifolium subterraneum L.) were transfered to high CO2 (4000 microliters CO2 per liter; photosynthetic photon flux density, 400 microeinsteins per square meter per second) or to high light (340 microliters CO2 per liter; photosynthetic photon flux density, 800 microeinsteins per square meter per second) to similarly stimulate photosynthetic net CO2 uptake. The daily increment of net CO2 uptake declined transiently in high CO2, but not in high light, below the values in air/standard light. After about 3 days in high CO2, the daily increment of net CO2 uptake increased but did not reach the high light values. Nightly CO2 release increased immediately in high light, whereas there was a 3-day lag phase in high CO2. During this time, starch accumulated to a high level, and leaf deterioration was observed only in high CO2. After 12 days, starch was two- to threefold higher in high CO2 than in high light, whereas sucrose was similar. Leaf carbohydrates were determined during the first and fourth day in high CO2. Starch increased rapidly throughout the day. Early in the day, sucrose was low and similar in high CO2 and ambient air (same light). Later, sucrose increased considerably in high CO2. The findings that (a) much more photosynthetic carbon was partitioned into the leaf starch pool in high CO2 than in high light, although net CO2 uptake was similar, and that (b) rapid starch formation occurred in high CO2 even when leaf sucrose was only slightly elevated suggest that low sink capacity was not the main constraint in high CO2. It is proposed that carbon partitioning between starch (chloroplast) and sucrose (cytosol) was perturbed by high CO2 because of the lack of photorespiration. Total phosphate pools were determined in leaves. Concentrations based on fresh weight of orthophosphate, soluble esterified phosphate, and total phosphate markedly declined during 13 days of exposure of the plants to high CO2 but changed little in high light/ambient air. During this time, the ratio of orthophosphate to soluble esterified phosphate decreased considerably in high CO2 and increased slightly in high light/ambient air. It appears that phosphate uptake and growth were similarly stimulated by high light, whereas the coordination was weak in high CO2. PMID:16668889

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

PubMed Central

2016-01-01

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

Increasing Coverage and Decreasing Inequity in Insecticide-Treated Bed Net Use among Rural Kenyan Children

PubMed Central

Noor, Abdisalan M; Amin, Abdinasir A; Akhwale, Willis S; Snow, Robert W

2007-01-01

Background Inexpensive and efficacious interventions that avert childhood deaths in sub-Saharan Africa have failed to reach effective coverage, especially among the poorest rural sectors. One particular example is insecticide-treated bed nets (ITNs). In this study, we present repeat observations of ITN coverage among rural Kenyan homesteads exposed at different times to a range of delivery models, and assess changes in coverage across socioeconomic groups. Methods and Findings We undertook a study of annual changes in ITN coverage among a cohort of 3,700 children aged 0–4 y in four districts of Kenya (Bondo, Greater Kisii, Kwale, and Makueni) annually between 2004 and 2006. Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidized nets through clinics (2005), and the introduction of free mass distributed ITNs (2006). The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach. ITN coverage was only 7.1% in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidized clinic distribution system, ITN coverage rose to 23.5%. In 2006 a large-scale mass distribution of ITNs was mounted providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3%. With each subsequent survey socioeconomic inequity in net coverage sequentially decreased: 2004 (most poor [2.9%] versus least poor [15.6%]; concentration index 0.281); 2005 (most poor [17.5%] versus least poor [37.9%]; concentration index 0.131), and 2006 with near-perfect equality (most poor [66.3%] versus least poor [66.6%]; concentration index 0.000). The free mass distribution method achieved highest coverage among the poorest children, the highly subsidised clinic nets programme was marginally in favour of the least poor, and the commercial social marketing favoured the least poor. Conclusions Rapid scaling up of ITN coverage among Africa's poorest rural children can be achieved through mass distribution campaigns. These efforts must form an important adjunct to regular, routine access to ITNs through clinics, and each complimentary approach should aim to make this intervention free to clients to ensure equitable access among those least able to afford even the cost of a heavily subsidized net. PMID:17713981

Investing in river health.

PubMed

Bennett, J

2002-01-01

Rivers provide society with numerous returns. These relate to both the passive and extractive uses of the resources embodied in river environments. Some returns are manifest in the form of financial gains whilst others are non-monetary. For instance, rivers are a source of monetary income for those who harvest their fish. The water flowing in rivers is extracted for drinking and to water crops and livestock that in turn yield monetary profits. However, rivers are also the source of non-monetary values arising from biological diversity. People who use them for recreation (picnicking, swimming, boating) also receive non-monetary returns. The use of rivers to yield these returns has had negative consequences. With extraction for financial return has come diminished water quantity and quality. The result has been a diminished capacity of rivers to yield (non-extractive) environmental returns and to continue to provide extractive values. A river is like any other asset. With use, the value of an asset depreciates because its productivity declines. In order to maintain the productive capacity of their assets, managers put aside from their profits depreciation reserves that can be invested in the repair or replacement of those assets. Society now faces a situation in which its river assets have depreciated in terms of their capacity to provide monetary and non-monetary returns. An investment in river "repair" is required. But, investment means that society gives up something now in order to achieve some benefit in the future. Society thus has to grapple wih the choice between investing in river health and other investments--such as in hospitals, schools, defence etc. - as well as between investing in river health and current consumption--such as on clothes, food, cars etc. A commonly used aid for investment decision making in the public sector is benefit cost analysis. However, its usefulness in tackling the river investment problem is restricted because it requires all benefits and costs to be measured in dollar terms, and many of the benefits arising from investments in river health are non-monetary. In this paper, techniques that enable non-monetary values to be estimated in dollar terms are described. Applications of the techniques to the estimation of the environmental values of rivers are demonstrated. The values estimated are used to demonstrate the extent of returns that are possible from investing in river health.

An Exploration of How Simulated Gambling Games May Promote Gambling with Money.

PubMed

Armstrong, Tess; Rockloff, Matthew; Browne, Matthew; Li, En

2018-01-10

Portable media devices, such as smartphones, have allowed gambling related content to infiltrate into a new market of potential consumers. Simulated gambling products are now readily available through multiple online platforms, and are becoming a popular form of entertainment for many young media users. Despite widespread use of these products, very little is known about how continued exposure to and involvement with simulated gambling may impact on real-money gambling attitudes and behaviours, particularly for young consumers. This paper reviews the literature exploring simulated gambling products and how consumption may promote monetary gambling, as well as fostering pro-gambling attitudes among youth and adolescents. Findings suggest that youth are highly exposed to simulated gambling games, and those who engage with these products are also more likely to be prone to monetary gambling and gambling problems. Virtual currency, in-game events and gambling themed content are also likely to promote biases about gambling or desensitise consumers to monetary losses. Simulated gambling products may therefore pose a risk to consumers, and particularly young consumers, rather than serve as a benign substitute for monetary gambling. To date, research has largely focused on correlational relationships between simulated and monetary gambling using cross-sectional methodologies. Future research should focus on determining the causal pathway between simulated gambling involvement and monetary gambling in order to identify and manage any risk associated simulated gambling participation.

Humans Integrate Monetary and Liquid Incentives to Motivate Cognitive Task Performance

PubMed Central

Yee, Debbie M.; Krug, Marie K.; Allen, Ariel Z.; Braver, Todd S.

2016-01-01

It is unequivocal that a wide variety of incentives can motivate behavior. However, few studies have explicitly examined whether and how different incentives are integrated in terms of their motivational influence. The current study examines the combined effects of monetary and liquid incentives on cognitive processing, and whether appetitive and aversive incentives have distinct influences. We introduce a novel task paradigm, in which participants perform cued task-switching for monetary rewards that vary parametrically across trials, with liquid incentives serving as post-trial performance feedback. Critically, the symbolic meaning of the liquid was held constant (indicating successful reward attainment), while liquid valence was blocked. In the first experiment, monetary rewards combined additively with appetitive liquid feedback to improve subject task performance. Aversive liquid feedback counteracted monetary reward effects in low monetary reward trials, particularly in a subset of participants who tended to avoid responding under these conditions. Self-report motivation ratings predicted behavioral performance above and beyond experimental effects. A follow-up experiment replicated the predictive power of motivation ratings even when only appetitive liquids were used, suggesting that ratings reflect idiosyncratic subjective values of, rather than categorical differences between, the liquid incentives. Together, the findings indicate an integrative relationship between primary and secondary incentives and potentially dissociable influences in modulating motivational value, while informing hypotheses regarding candidate neural mechanisms. PMID:26834668

Funny money: the attentional role of monetary feedback detached from expected value.

PubMed

Roper, Zachary J J; Vecera, Shaun P

2016-10-01

Stimuli associated with monetary reward can become powerful cues that effectively capture visual attention. We examined whether such value-driven attentional capture can be induced with monetary feedback in the absence of an expected cash payout. To this end, we implemented images of U.S. dollar bills as reward feedback. Participants knew in advance that they would not receive any money based on their performance. Our reward stimuli-$5 and $20 bill images-were thus dissociated from any practical utility. Strikingly, we observed a reliable attentional capture effect for the mere images of bills. Moreover, this finding generalized to Monopoly money. In two control experiments, we found no evidence in favor of nominal or symbolic monetary value. Hence, we claim that bill images are special monetary representations, such that there are strong associations between the defining visual features of bills and reward, probably due to a lifelong learning history. Together, we show that the motivation to earn cash plays a minor role when it comes to monetary rewards, while bill-defining visual features seem to be sufficient. These findings have the potential to influence human factor applications, such as gamification, and can be extended to novel value systems, such as the electronic cash Bitcoin being developed for use in mobile banking. Finally, our procedure represents a proof of concept on how images of money can be used to conserve expenditures in the experimental context.

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

PubMed

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

2015-05-01

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

Monetary reward magnitude effects on behavior and brain function during goal-directed behavior.

PubMed

Rosell-Negre, P; Bustamante, J C; Fuentes-Claramonte, P; Costumero, V; Benabarre, S; Barrós-Loscertales, A

2017-08-01

Reward may modulate the cognitive processes required for goal achievement, while individual differences in personality may affect reward modulation. Our aim was to test how different monetary reward magnitudes modulate brain activation and performance during goal-directed behavior, and whether individual differences in reward sensitivity affect this modulation. For this purpose, we scanned 37 subjects with a parametric design in which we varied the magnitude of monetary rewards (€0, €0.01, €0.5, €1 or €1.5) in a blocked fashion while participants performed an interference counting-Stroop condition. The results showed that the brain activity of left dorsolateral prefrontal cortex (DLPFC) and the striatum were modulated by increasing and decreasing reward magnitudes, respectively. Behavioral performance improved as the magnitude of monetary reward increased while comparing the non reward (€0) condition to any other reward condition, or the lower €0.01 to any other reward condition, and this improvement was related with individual differences in reward sensitivity. In conclusion, the locus of influence of monetary incentives overlaps the activity of the regions commonly involved in cognitive control.

Adaptive neural reward processing during anticipation and receipt of monetary rewards in mindfulness meditators.

PubMed

Kirk, Ulrich; Brown, Kirk Warren; Downar, Jonathan

2015-05-01

Reward seeking is ubiquitous and adaptive in humans. But excessive reward seeking behavior, such as chasing monetary rewards, may lead to diminished subjective well-being. This study examined whether individuals trained in mindfulness meditation show neural evidence of lower susceptibility to monetary rewards. Seventy-eight participants (34 meditators, 44 matched controls) completed the monetary incentive delay task while undergoing functional magnetic resonance imaging. The groups performed equally on the task, but meditators showed lower neural activations in the caudate nucleus during reward anticipation, and elevated bilateral posterior insula activation during reward anticipation. Meditators also evidenced reduced activations in the ventromedial prefrontal cortex during reward receipt compared with controls. Connectivity parameters between the right caudate and bilateral anterior insula were attenuated in meditators during incentive anticipation. In summary, brain regions involved in reward processing-both during reward anticipation and receipt of reward-responded differently in mindfulness meditators than in nonmeditators, indicating that the former are less susceptible to monetary incentives. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

A statistical human resources costing and accounting model for analysing the economic effects of an intervention at a workplace.

PubMed

Landstad, Bodil J; Gelin, Gunnar; Malmquist, Claes; Vinberg, Stig

2002-09-15

The study had two primary aims. The first aim was to combine a human resources costing and accounting approach (HRCA) with a quantitative statistical approach in order to get an integrated model. The second aim was to apply this integrated model in a quasi-experimental study in order to investigate whether preventive intervention affected sickness absence costs at the company level. The intervention studied contained occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The study is a quasi-experimental design with a non-randomized control group. Both groups involved cleaning jobs at predominantly female workplaces. The study plan involved carrying out before and after studies on both groups. The study included only those who were at the same workplace during the whole of the study period. In the HRCA model used here, the cost of sickness absence is the net difference between the costs, in the form of the value of the loss of production and the administrative cost, and the benefits in the form of lower labour costs. According to the HRCA model, the intervention used counteracted a rise in sickness absence costs at the company level, giving an average net effect of 266.5 Euros per person (full-time working) during an 8-month period. Using an analogue statistical analysis on the whole of the material, the contribution of the intervention counteracted a rise in sickness absence costs at the company level giving an average net effect of 283.2 Euros. Using a statistical method it was possible to study the regression coefficients in sub-groups and calculate the p-values for these coefficients; in the younger group the intervention gave a calculated net contribution of 605.6 Euros with a p-value of 0.073, while the intervention net contribution in the older group had a very high p-value. Using the statistical model it was also possible to study contributions of other variables and interactions. This study established that the HRCA model and the integrated model produced approximately the same monetary outcomes. The integrated model, however, allowed a deeper understanding of the various possible relationships and quantified the results with confidence intervals.

Incremental impact upon malaria transmission of supplementing pyrethroid-impregnated long-lasting insecticidal nets with indoor residual spraying using pyrethroids or the organophosphate, pirimiphos methyl.

PubMed

Hamainza, Busiku; Sikaala, Chadwick H; Moonga, Hawela B; Chanda, Javan; Chinula, Dingani; Mwenda, Mulenga; Kamuliwo, Mulakwa; Bennett, Adam; Seyoum, Aklilu; Killeen, Gerry F

2016-02-18

Long-lasting, insecticidal nets (LLINs) and indoor residual spraying (IRS) are the most widely accepted and applied malaria vector control methods. However, evidence that incremental impact is achieved when they are combined remains limited and inconsistent. Fourteen population clusters of approximately 1000 residents each in Zambia's Luangwa and Nyimba districts, which had high pre-existing usage rates (81.7 %) of pyrethroid-impregnated LLINs were quasi-randomly assigned to receive IRS with either of two pyrethroids, namely deltamethrin [Wetable granules (WG)] and lambdacyhalothrin [capsule suspension (CS)], with an emulsifiable concentrate (EC) or CS formulation of the organophosphate pirimiphos methyl (PM), or with no supplementary vector control measure. Diagnostic positivity of patients tested for malaria by community health workers in these clusters was surveyed longitudinally over pre- and post-treatment periods spanning 29 months, over which the treatments were allocated and re-allocated in advance of three sequential rainy seasons. Supplementation of LLINs with PM CS offered the greatest initial level of protection against malaria in the first 3 months of application (incremental protective efficacy (IPE) [95 % confidence interval (CI)] = 0.63 [CI 0.57, 0.69], P < 0.001), followed by lambdacyhalothrin (IPE [95 % CI] = 0.31 [0.10, 0.47], P = 0.006) and PM EC (IPE, 0.23 [CI 0.15, 0.31], P < 0.001) and then by deltamethrin (IPE [95 % CI] = 0.19 [-0.01, 0.35], P = 0.064). Neither pyrethroid formulation provided protection beyond 3 months after spraying, but the protection provided by both PM formulations persisted undiminished for longer periods: 6 months for CS and 12 months for EC. The CS formulation of PM provided greater protection than the combined pyrethroid IRS formulations throughout its effective life IPE [95 % CI] = 0.79 [0.75, 0.83] over 6 months. The EC formulation of PM provided incremental protection for the first 3 months (IPE [95 % CI] = 0.23 [0.15, 0.31]) that was approximately equivalent to the two pyrethroid formulations (lambdacyhalothrin, IPE [95 % CI] = 0.31 [0.10, 0.47] and deltamethrin, IPE [95 % CI] = 0.19 [-0.01, 0.35]) but the additional protection provided by the former, apparently lasted an entire year. Where universal coverage targets for LLIN utilization has been achieved, supplementing LLINs with IRS using pyrethroids may reduce malaria transmission below levels achieved by LLIN use alone, even in settings where pyrethroid resistance occurs in the vector population. However, far greater reduction of transmission can be achieved under such conditions by supplementing LLINs with IRS using non-pyrethroid insecticide classes, such as organophosphates, so this is a viable approach to mitigating and managing pyrethroid resistance.

Cross-correlations between the US monetary policy, US dollar index and crude oil market

NASA Astrophysics Data System (ADS)

Sun, Xinxin; Lu, Xinsheng; Yue, Gongzheng; Li, Jianfeng

2017-02-01

This paper investigates the cross-correlations between the US monetary policy, US dollar index and WTI crude oil market, using a dataset covering a period from February 4, 1994 to February 29, 2016. Our study contributes to the literature by examining the effect of the US monetary policy on US dollar index and WTI crude oil through the MF-DCCA approach. The empirical results show that the cross-correlations between the three sets of time series exhibit strong multifractal features with the strength of multifractality increasing over the sample period. Employing a rolling window analysis, our empirical results show that the US monetary policy operations have clear influences on the cross-correlated behavior of the three time series covered by this study.

Further insight into the incremental value of new markers: the interpretation of performance measures and the importance of clinical context.

PubMed

Kerr, Kathleen F; Bansal, Aasthaa; Pepe, Margaret S

2012-09-15

In this issue of the Journal, Pencina and et al. (Am J Epidemiol. 2012;176(6):492-494) examine the operating characteristics of measures of incremental value. Their goal is to provide benchmarks for the measures that can help identify the most promising markers among multiple candidates. They consider a setting in which new predictors are conditionally independent of established predictors. In the present article, the authors consider more general settings. Their results indicate that some of the conclusions made by Pencina et al. are limited to the specific scenarios the authors considered. For example, Pencina et al. observed that continuous net reclassification improvement was invariant to the strength of the baseline model, but the authors of the present study show this invariance does not hold generally. Further, they disagree with the suggestion that such invariance would be desirable for a measure of incremental value. They also do not see evidence to support the claim that the measures provide complementary information. In addition, they show that correlation with baseline predictors can lead to much bigger gains in performance than the conditional independence scenario studied by Pencina et al. Finally, the authors note that the motivation of providing benchmarks actually reinforces previous observations that the problem with these measures is they do not have useful clinical interpretations. If they did, researchers could use the measures directly and benchmarks would not be needed.

Simulating forest productivity and surface-atmosphere carbon exchange in the BOREAS study region.

PubMed

Kimball, John S.; Thornton, Peter E.; White, Mike A.; Running, Steven W.

1997-01-01

A process-based, general ecosystem model (BIOME-BGC) was used to simulate daily gross primary production, maintenance and heterotrophic respiration, net primary production and net ecosystem carbon exchange of boreal aspen, jack pine and black spruce stands. Model simulations of daily net carbon exchange of the ecosystem (NEE) explained 51.7% (SE = 1.32 g C m(-2) day(-1)) of the variance in daily NEE derived from stand eddy flux measurements of CO(2) during 1994. Differences between measured and simulated results were attributed to several factors including difficulties associated with measuring nighttime CO(2) fluxes and model assumptions of site homogeneity. However, comparisons between simulations and field data improved markedly at coarser time-scales. Model simulations explained 66.1% (SE = 0.97 g C m(-2) day(-1)) of the variance in measured NEE when 5-day means of daily results were compared. Annual simulations of aboveground net primary production ranged from 0.6-2.4 Mg C ha(-1) year(-1) and were concurrent with results derived from tree increment core measurements and allometric equations. Model simulations showed that all of the sites were net sinks (0.1-4.1 Mg C ha(-1) year(-1)) of atmospheric carbon for 1994. Older conifer stands showed narrow margins between uptake of carbon by net photosynthesis and carbon release through respiration. Younger stands were more productive than older stands, primarily because of lower maintenance respiration costs. However, all sites appeared to be less productive than temperate forests. Productivity simulations were strongly linked to stand morphology and site conditions. Old jack pine and aspen stands showed decreased productivity in response to simulated low soil water contents near the end of the 1994 growing season. Compared with the aspen stand, the jack pine stand appeared better adapted to conserve soil water through lower daily evapotranspiration losses but also exhibited a narrower margin between daily net photosynthesis and respiration. Stands subjected to water stress during the growing season may exist on the edge between being annual sources or sinks for atmospheric carbon.

Alternative Fuels Data Center

Science.gov Websites

renewable energy initiatives; Establish ZEV purchase targets for governmental agency fleets, explore , monetary incentives to reduce the upfront purchase price of ZEVs as well as non-monetary incentives, such

Alternative Fuels Data Center

Science.gov Websites

integrating ZEVs with renewable energy initiatives; Establish ZEV purchase targets for governmental agency effectiveness of, monetary incentives to reduce the upfront purchase price of ZEVs as well as non-monetary

[Cost-Fffectiveness of Two Antiviral Therapies for Chronic Hepatitis B in Peru: Entecavir and Tenofovir].

PubMed

Bolaños-Díaz, Rafael; Tejada, Romina A; Sanabria, César; Escobedo-Palza, Seimer

2017-01-01

To compare in terms of cost-effectiveness to entecavir (ETV) and tenofovir (TDF) in the treatment of hepatitis B virus (HBV) in public hospitals in Peru. We structured a Markov model. We define effectiveness adjusted life years for quality (QALY). We include the direct costs of treatment in soles from the perspective of the Ministry of Health of Peru. We estimate the relationship between cost and effectiveness ratios (ICER). We performed sensitivity analyzes considering a range of willingness to pay (WTP) from one to three times the Gross Domestic Product (GDP) per capita, and a tornado analysis regarding Monetary Net Profit (BMN) or ICER. Treatment with TDF is more effective and less expensive than ETV. The ETV had a cost per QALY of PEN 4482, and PEN 1526 TDF. The PTO maintains a progressively larger with increasing WTP BMN. The discount rate was the only variable with a significant effect on model uncertainty. Treatment with TDF is more cost-effective than ETV in public hospitals in Peru.

The pace of life in deep-dwelling squids

NASA Astrophysics Data System (ADS)

Hoving, H. J. T.; Robison, B. H.

2017-08-01

Coastal and epipelagic cephalopods are among the fastest growing invertebrates, with life cycles of typically 1 year or less. Evidence is accumulating that deep-sea taxa often live longer and grow slower than their shallow water relatives. We test the hypothesis that deep-sea squid show increased longevity and reduced growth rates compared to coastal and epipelagic species, by validation experiments and quantification of statolith increments of three deep-sea squids from the Monterey Submarine Canyon. The periodicity of statolith increment formation in coastal species is daily, but is unknown for deep-sea squid. Between 2010 and 2013, specimens of Chiroteuthis calyx, Galiteuthis phyllura and Octopoteuthis deletron were captured by remotely operated vehicles and trawl nets off California. ROV-captured living squid were immersed in tetracycline and kept alive in the lab for between 3 and 14 days. Correlating the number of elapsed days with the number of newly deposited statolith increments, and statolith growth after the fluorescent tetracycline mark, provided evidence of regular and daily increment deposition, in C. calyx and O. deletron. This relationship was less strong in G. phyllura and the one-increment-per-day hypothesis was not accepted for this species. Reconstructing growth rates based on statolith counts and wet weights from animals of a wide size range suggest that O. deletron is a slower growing squid (0.59% BW/day) than C. calyx (1.3% BW/day) and G. phyllura (1.2% BW/day). Octopoteuthis deletron matures at around two years, the oldest C. calyx was a mature male of 1.5 years and the eldest G. phyllura was 10 months and still immature. Maximum reported sizes for G. phyllura and C. calyx exceed those of our examined specimens, and therefore their longevity likely exceeds 2 years, in particular if the females brood their eggs. Our study supports the hypothesis that deeper living squid exhibit reduced growth rates and an increased longevity compared to shallow living species. We discuss these traits in the context of a life in the deep pelagic ocean.

Long-term soil warming and Carbon Cycle Feedbacks to the Climate System

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

Melillo, Jerry M.

2014-04-30

The primary objective of the proposed research was to quantify and explain the effects of a sustained in situ 5oC soil temperature increase on net carbon (C) storage in a northeastern deciduous forest ecosystem. The research was done at an established soil warming experiment at the Harvard Forest in central Massachusetts – Barre Woods site established in 2001. In the field, a series of plant and soil measurements were made to quantify changes in C storage in the ecosystem and to provide insights into the possible relationships between C-storage changes and nitrogen (N) cycling changes in the warmed plots. Fieldmore » measurements included: 1) annual woody increment; 2) litterfall; 3) carbon dioxide (CO2) efflux from the soil surface; 4) root biomass and respiration; 5) microbial biomass; and 6) net N mineralization and net nitrification rates. This research was designed to increase our understanding of how global warming will affect the capacity of temperate forest ecosystems to store C. The work explored how soil warming changes the interactions between the C and N cycles, and how these changes affect land-atmosphere feedbacks. This core research question framed the project – What are the effects of a sustained in situ 5oC soil temperature increase on net carbon (C) storage in a northeastern deciduous forest ecosystem? A second critical question was addressed in this research – What are the effects of a sustained in situ 5{degrees}C soil temperature increase on nitrogen (N) cycling in a northeastern deciduous forest ecosystem?« less

Effects of the age class distributions of the temperate and boreal forests on the global CO2 source-sink function

NASA Astrophysics Data System (ADS)

Kohlmaier, G. H.; Häger, Ch.; Würth, G.; Lüdeke, M. K. B.; Ramge, P.; Badeck, F.-W.; Kindermann, J.; Lang, T.

1995-02-01

The rôle of the temperate and boreal forests as a global CO2 source or sink is examined, both for the present time and for the next hundred years. The results of the Forest Resource Assessment for 1990 of the Economic Comission for Europe and the Food and Agricultural Organisation of the United Nations (1992) serve as the main database in this study. Out of the estimated total area of approximately 20106 km2 of forests and wooded lands in the temperate and boreal zone only approximately fifty percent is documented within the category of exploitable forests, which are examined in detail here. In this study, a general formalism of the time evolution of an ensemble of forests within an ecological province is developed using the formalism of the Leslie matrix. This matrix can be formulated if the age class dependent mortalities which arise from the disturbances are known. A distinction is made between the natural disturbances by fire, wind throw and insect infestations and disturbances introduced through harvesting of timber. Through the use of Richards growth function each age class of a given biome is related to the corresponding biomass and annual increment. The data reported on the mean net annual increment and on the mean biomass serve to calibrate the model. The difference of the reported net annual increment and annual fellings of approximately 550 106 m3 roundwood correspond to a sink of 210-330 Mt of carbon per year excluding any changes in the soil balance. It could be shown that the present distribution of forest age classes for the United States, Canada, Europe, or the former Soviet Union does not correspond to a quasi-stationary state, in which biomass is accumulated only due to a stimulated growth under enhanced atmospheric CO2 levels. The present CO2 sink function will not persist in the next century, if harvesting rates increase with 0.5% annually or even less. The future state will also be influenced by the effect of the greenhouse climate, the impact of which may range from a stimulating effect on growth, which is calculated by the Frankfurt biosphere model, up to a transitional negative effect through a shift in vegetation zones.

A Monetarist View.

ERIC Educational Resources Information Center

Friedman, Milton

1983-01-01

Examined are the quantity theory of money and the recent application of monetary policy in Japan, the United Kingdom, and the United States. In all three countries, the reduction of monetary growth has reduced inflation. (Author/RM)

7 CFR 3560.452 - Monetary and non-monetary defaults.

Code of Federal Regulations, 2011 CFR

2011-01-01

... requirements, including requirements imposed on a borrower through a workout agreement developed in accordance... agreement, workout agreement, or other agreement remains due more than 30 days after the due date. (c...

7 CFR 3560.452 - Monetary and non-monetary defaults.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requirements, including requirements imposed on a borrower through a workout agreement developed in accordance... agreement, workout agreement, or other agreement remains due more than 30 days after the due date. (c...

Increasing the Value of an Alternative Monetary Reinforcer Reduces Cigarette Choice in Adolescents

PubMed Central

Tidey, Jennifer W.; Kahler, Christopher W.; Wray, Tyler B.; Colby, Suzanne M.

2015-01-01

Introduction: Smoking can be conceptualized as an operant behavior maintained by the reinforcing effects of cigarettes. Changing the magnitude and availability of alternative reinforcers should shift behavior away from smoking. Adults’ smoking behavior is sensitive to the magnitude and availability of alternative reinforcers; however, the extent to which the same is true for adolescents has not yet been shown in the laboratory. Methods: To test the sensitivity of adolescent smoking behavior to changes in the magnitude of alternative reinforcement, we gave adolescents who abstained overnight the opportunity to make 20 choices between receiving two puffs of their usual-brand cigarette or money. The magnitude of the monetary reinforcer was varied across sessions in counterbalanced order ($0.00, $0.10, and $0.50). Results: Results indicated that adolescents’ choices for puffs decreased as a function of increasing monetary reinforcer magnitude, while money choices increased. This effect was moderated by baseline smoking level and by gender, such that heavier-smoking participants and males made more cigarette choices when the alternative monetary value was zero, and decreased their choices more steeply in response to increasing monetary value. Conclusions: The current study validates a laboratory choice procedure for studying smoking in adolescents, and demonstrates that adolescent smoking behavior is sensitive to changes in the magnitude of concurrently available monetary reinforcers. The current paradigm can be adapted and applied to explore the effects of other variables that may affect cigarette choice in adolescents. PMID:25666814

Breaking the taboo: a history of monetary financing in Canada, 1930-1975.

PubMed

Ryan-Collins, Josh

2017-12-01

Monetary financing - the funding of state expenditure via the creation of new money rather than through taxation or borrowing - has become a taboo policy instrument in advanced economies. It is generally associated with dangerously high inflation and/or war. Relatedly, a key institutional feature of modern independent central banks is that they are not obligated to support government expenditure via money creation. Since the financial crisis of 2007-2008, however, unorthodox monetary policies, in particular quantitative easing, coupled with stagnant growth and high levels of public and private debt have led to questions over the monetary financing taboo. Debates on the topic have so far been mainly theoretical with little attention to the social and political dynamics of historical instances of monetary financing. This paper analyses one of the most significant twentieth-century cases: Canada from the period after the Great Depression up until the monetarist revolution of the 1970s. The period was a successful one for the Canadian economy, with high growth and employment and manageable inflation. It offers some interesting insights into the relationship between states and central banks and present-day discussions around the governance of money creation. © London School of Economics and Political Science 2017.

Independent functional connectivity networks underpin food and monetary reward sensitivity in excess weight.

PubMed

Verdejo-Román, Juan; Fornito, Alex; Soriano-Mas, Carles; Vilar-López, Raquel; Verdejo-García, Antonio

2017-02-01

Overvaluation of palatable food is a primary driver of obesity, and is associated with brain regions of the reward system. However, it remains unclear if this network is specialized in food reward, or generally involved in reward processing. We used functional magnetic resonance imaging (fMRI) to characterize functional connectivity during processing of food and monetary rewards. Thirty-nine adults with excess weight and 37 adults with normal weight performed the Willingness to Pay for Food task and the Monetary Incentive Delay task in the fMRI scanner. A data-driven graph approach was applied to compare whole-brain, task-related functional connectivity between groups. Excess weight was associated with decreased functional connectivity during the processing of food rewards in a network involving primarily frontal and striatal areas, and increased functional connectivity during the processing of monetary rewards in a network involving principally frontal and parietal areas. These two networks were topologically and anatomically distinct, and were independently associated with BMI. The processing of food and monetary rewards involve segregated neural networks, and both are altered in individuals with excess weight. Copyright © 2016 Elsevier Inc. All rights reserved.

The asymmetry of U.S. monetary policy: Evidence from a threshold Taylor rule with time-varying threshold values

NASA Astrophysics Data System (ADS)

Zhu, Yanli; Chen, Haiqiang

2017-05-01

In this paper, we revisit the issue whether U.S. monetary policy is asymmetric by estimating a forward-looking threshold Taylor rule with quarterly data from 1955 to 2015. In order to capture the potential heterogeneity for regime shift mechanism under different economic conditions, we modify the threshold model by assuming the threshold value as a latent variable following an autoregressive (AR) dynamic process. We use the unemployment rate as the threshold variable and separate the sample into two periods: expansion periods and recession periods. Our findings support that the U.S. monetary policy operations are asymmetric in these two regimes. More precisely, the monetary authority tends to implement an active Taylor rule with a weaker response to the inflation gap (the deviation of inflation from its target) and a stronger response to the output gap (the deviation of output from its potential level) in recession periods. The threshold value, interpreted as the targeted unemployment rate of monetary authorities, exhibits significant time-varying properties, confirming the conjecture that policy makers may adjust their reference point for the unemployment rate accordingly to reflect their attitude on the health of general economy.

A techno-economic analysis of aquaculture business in Ogun State, Nigeria

NASA Astrophysics Data System (ADS)

Kareem, R. O.; Williams, S. B.

2009-05-01

Fish supplies 25% of the total protein source in developing countries. A techno-economic analysis was performed for developing a good business proposal for aquaculture loans to enhance aquaculture development in Nigeria. A case study of catfish Clarias gariepinus framing was conducted in Abeokuta North Local Government of Ogun State, Nigeria. The results show that the fixed cost is N18 338 per year, and the variable cost is N459 700 per year, accounting for the largest amount of the total; therefore, a profit of N43 289 per month can be made. Sensitivity analysis was performed to assess any risk(s) that associated with unfavorable changes in government policy with particular reference to monetary policy. Positive net present value shows that the investment in fish farm is economically feasible and the net investment ratio is 3.52. Also, the benefit-cost ratio is 2.17. The internal rate of return (IRR) is 21% showing that the enterprise is able to offset the interest being charged on the loan. It is therefore worthwhile to invest into fish farm business in the study area. The study suggests that to better sustain the local aquaculture business, the government should create a good conducive environment to foster development of the fish farming. Government intervention is urgently needed to solve problems such as in traditional land tenure, grant credit facilities and subsidies, to enhance the aquacultural development in the country.

In-use product stocks link manufactured capital to natural capital.

PubMed

Chen, Wei-Qiang; Graedel, T E

2015-05-19

In-use stock of a product is the amount of the product in active use. In-use product stocks provide various functions or services on which we rely in our daily work and lives, and the concept of in-use product stock for industrial ecologists is similar to the concept of net manufactured capital stock for economists. This study estimates historical physical in-use stocks of 91 products and 9 product groups and uses monetary data on net capital stocks of 56 products to either approximate or compare with in-use stocks of the corresponding products in the United States. Findings include the following: (i) The development of new products and the buildup of their in-use stocks result in the increase in variety of in-use product stocks and of manufactured capital; (ii) substitution among products providing similar or identical functions reflects the improvement in quality of in-use product stocks and of manufactured capital; and (iii) the historical evolution of stocks of the 156 products or product groups in absolute, per capita, or per-household terms shows that stocks of most products have reached or are approaching an upper limit. Because the buildup, renewal, renovation, maintenance, and operation of in-use product stocks drive the anthropogenic cycles of materials that are used to produce products and that originate from natural capital, the determination of in-use product stocks together with modeling of anthropogenic material cycles provides an analytic perspective on the material linkage between manufactured capital and natural capital.

In-use product stocks link manufactured capital to natural capital

PubMed Central

Chen, Wei-Qiang; Graedel, T. E.

2015-01-01

In-use stock of a product is the amount of the product in active use. In-use product stocks provide various functions or services on which we rely in our daily work and lives, and the concept of in-use product stock for industrial ecologists is similar to the concept of net manufactured capital stock for economists. This study estimates historical physical in-use stocks of 91 products and 9 product groups and uses monetary data on net capital stocks of 56 products to either approximate or compare with in-use stocks of the corresponding products in the United States. Findings include the following: (i) The development of new products and the buildup of their in-use stocks result in the increase in variety of in-use product stocks and of manufactured capital; (ii) substitution among products providing similar or identical functions reflects the improvement in quality of in-use product stocks and of manufactured capital; and (iii) the historical evolution of stocks of the 156 products or product groups in absolute, per capita, or per-household terms shows that stocks of most products have reached or are approaching an upper limit. Because the buildup, renewal, renovation, maintenance, and operation of in-use product stocks drive the anthropogenic cycles of materials that are used to produce products and that originate from natural capital, the determination of in-use product stocks together with modeling of anthropogenic material cycles provides an analytic perspective on the material linkage between manufactured capital and natural capital. PMID:25733904

Real-Time Diffusion of Information on Twitter and the Financial Markets

PubMed Central

Tafti, Ali; Zotti, Ryan; Jank, Wolfgang

2016-01-01

Do spikes in Twitter chatter about a firm precede unusual stock market trading activity for that firm? If so, Twitter activity may provide useful information about impending financial market activity in real-time. We study the real-time relationship between chatter on Twitter and the stock trading volume of 96 firms listed on the Nasdaq 100, during 193 days of trading in the period from May 21, 2012 to September 18, 2013. We identify observations featuring firm-specific spikes in Twitter activity, and randomly assign each observation to a ten-minute increment matching on the firm and a number of repeating time indicators. We examine the extent that unusual levels of chatter on Twitter about a firm portend an oncoming surge of trading of its stock within the hour, over and above what would normally be expected for the stock for that time of day and day of week. We also compare the findings from our explanatory model to the predictive power of Tweets. Although we find a compelling and potentially informative real-time relationship between Twitter activity and trading volume, our forecasting exercise highlights how difficult it can be to make use of this information for monetary gain. PMID:27504639

Photodynamic Therapy for Actinic Keratoses: A Randomized Prospective Non-sponsored Cost-effectiveness Study of Daylight-mediated Treatment Compared with Light-emitting Diode Treatment.

PubMed

Neittaanmäki-Perttu, Noora; Grönroos, Mari; Karppinen, Toni; Snellman, Erna; Rissanen, Pekka

2016-02-01

Daylight-mediated photodynamic therapy (DL-PDT) is considered as effective as conventional PDT using artificial light (light-emitting diode (LED)-PDT) for treatment of actinic keratoses (AK). This randomized prospective non-sponsored study assessed the cost-effectiveness of DL-PDT compared with LED-PDT. Seventy patients with 210 AKs were randomized to DL-PDT or LED-PDT groups. Effectiveness was assessed at 6 months. The costs included societal costs and private costs, including the time patients spent in treatment. Results are presented as incremental cost-effectiveness ratio (ICER). The total costs per patient were significantly lower for DL-PDT (€132) compared with LED-PDT (€170), giving a cost saving of €38 (p = 0.022). The estimated probabilities for patients' complete response were 0.429 for DL-PDT and 0.686 for LED-PDT; a difference in probability of being healed of 0.257. ICER showed a monetary gain of €147 per unit of effectiveness lost. DL-PDT is less costly and less effective than LED-PDT. In terms of cost-effectiveness analysis, DL-PDT provides lower value for money compared with LED-PDT.

Real-Time Diffusion of Information on Twitter and the Financial Markets.

PubMed

Tafti, Ali; Zotti, Ryan; Jank, Wolfgang

2016-01-01

Do spikes in Twitter chatter about a firm precede unusual stock market trading activity for that firm? If so, Twitter activity may provide useful information about impending financial market activity in real-time. We study the real-time relationship between chatter on Twitter and the stock trading volume of 96 firms listed on the Nasdaq 100, during 193 days of trading in the period from May 21, 2012 to September 18, 2013. We identify observations featuring firm-specific spikes in Twitter activity, and randomly assign each observation to a ten-minute increment matching on the firm and a number of repeating time indicators. We examine the extent that unusual levels of chatter on Twitter about a firm portend an oncoming surge of trading of its stock within the hour, over and above what would normally be expected for the stock for that time of day and day of week. We also compare the findings from our explanatory model to the predictive power of Tweets. Although we find a compelling and potentially informative real-time relationship between Twitter activity and trading volume, our forecasting exercise highlights how difficult it can be to make use of this information for monetary gain.

A Behavioral Economic Reward Index Predicts Drinking Resolutions: Moderation Re-visited and Compared with Other Outcomes

PubMed Central

Tucker, Jalie A.; Roth, David L.; Vignolo, Mary J.; Westfall, Andrew O.

2014-01-01

Data were pooled from three studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes. Moderation over 1-2 year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes compared to abstinence or relapse and to be predicted by more balanced pre-resolution monetary allocations between short- and longer-term objectives (i.e., drinking and saving for the future). Standardized odds ratios (OR) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this “Alcohol-Savings Discretionary Expenditure” index predicted higher rates of both abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p < .0001) compared to moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors. The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of pre-resolution spending patterns aids in predicting moderation. PMID:19309182

Offender Diversion Into Substance Use Disorder Treatment: The Economic Impact of California’s Proposition 36

PubMed Central

Nosyk, Bohdan; Jaffe, Adi; Urada, Darren; Evans, Elizabeth

2013-01-01

Objectives. We determined the costs and savings attributable to the California Substance Abuse and Crime Prevention Act (SACPA), which mandated probation or continued parole with substance abuse treatment in lieu of incarceration for adult offenders convicted of nonviolent drug offenses and probation and parole violators. Methods. We used individually linked, population-level administrative data to define intervention and control cohorts of offenders meeting SACPA eligibility criteria. Using multivariate difference-in-differences analysis, we estimated the effect of SACPA implementation on the total and domain-specific costs to state and county governments, controlling for fixed individual and county characteristics and changes in crime at the county level. Results. The additional costs of treatment were more than offset by savings in other domains, primarily in the costs of incarceration. We estimated the statewide policy effect as an adjusted savings of $2317 (95% confidence interval = $1905, $2730) per offender over a 30-month postconviction period. SACPA implementation resulted in greater incremental cost savings for Blacks and Hispanics, who had markedly higher rates of conviction and incarceration. Conclusions. The monetary benefits to government exceeded the additional costs of SACPA implementation and provision of treatment. PMID:23597352

Offender diversion into substance use disorder treatment: the economic impact of California's proposition 36.

PubMed

Anglin, M Douglas; Nosyk, Bohdan; Jaffe, Adi; Urada, Darren; Evans, Elizabeth

2013-06-01

We determined the costs and savings attributable to the California Substance Abuse and Crime Prevention Act (SACPA), which mandated probation or continued parole with substance abuse treatment in lieu of incarceration for adult offenders convicted of nonviolent drug offenses and probation and parole violators. We used individually linked, population-level administrative data to define intervention and control cohorts of offenders meeting SACPA eligibility criteria. Using multivariate difference-in-differences analysis, we estimated the effect of SACPA implementation on the total and domain-specific costs to state and county governments, controlling for fixed individual and county characteristics and changes in crime at the county level. The additional costs of treatment were more than offset by savings in other domains, primarily in the costs of incarceration. We estimated the statewide policy effect as an adjusted savings of $2317 (95% confidence interval = $1905, $2730) per offender over a 30-month postconviction period. SACPA implementation resulted in greater incremental cost savings for Blacks and Hispanics, who had markedly higher rates of conviction and incarceration. The monetary benefits to government exceeded the additional costs of SACPA implementation and provision of treatment.

Beyond monetary benefits of restoring sight in Vietnam: Evaluating well-being gains from cataract surgery.

PubMed

Feeny, Simon; Posso, Alberto; McDonald, Lachlan; Chuyen, Truong Thi Kim; Tung, Son Thanh

2018-01-01

A more holistic understanding of the benefits of sight-restoring cataract surgery requires a focus that goes beyond income and employment, to include a wider array of well-being measures. The objective of this study is to examine the monetary and non-monetary benefits of cataract surgery on both patients as well as their caregivers in Vietnam. Participants were randomly recruited from a Ho-Chi-Minh City Hospital. A total of 82 cataract patients and 83 caregivers participated in the survey conducted for this study. Paired t-tests, Wilcoxon Signed Rank tests, and regression analysis are used to detect any statistically significant differences in various measures of well-being for patients and caregivers before and after surgery. There are statistically significant improvements in monetary and non-monetary measures of well-being for both patients and caregivers approximately three months after undergoing cataract surgery, compared with baseline assessments collected prior to surgery. Non-monetary measures of well-being include self-assessments of overall health, mental health, hope, self-efficacy, happiness and life satisfaction. For patients, the benefits included statistically significant improvements in earnings, mobility, self-care, the ability to undertake daily activities, self-assessed health and mental health, life satisfaction, hope, and self-efficacy (p<0.01). For caregivers, attendance at work improved alongside overall health, mental health, hope, self-efficacy, happiness and life satisfaction, three months post-surgery (p<0.01). Restoring sight has positive impacts for those suffering from cataracts and their caregivers. Sometimes the benefits are almost equal in their magnitude. The study has also demonstrated that many of these impacts are non-monetary in nature. It is clear that estimates of the rate of return to restoring sight that focus only on financial gains will underestimate the true returns to society of restoring sight from cataract surgeries.

Tropical rain forest tree growth and atmospheric carbon dynamics linked to interannual temperature variation during 1984–2000

PubMed Central

Clark, D. A.; Piper, S. C.; Keeling, C. D.; Clark, D. B.

2003-01-01

During 1984–2000, canopy tree growth in old-growth tropical rain forest at La Selva, Costa Rica, varied >2-fold among years. The trees' annual diameter increments in this 16-yr period were negatively correlated with annual means of daily minimum temperatures. The tree growth variations also negatively covaried with the net carbon exchange of the terrestrial tropics as a whole, as inferred from nearly pole-to-pole measurements of atmospheric carbon dioxide (CO2) interpreted by an inverse tracer–transport model. Strong reductions in tree growth and large inferred tropical releases of CO2 to the atmosphere occurred during the record-hot 1997–1998 El Niño. These and other recent findings are consistent with decreased net primary production in tropical forests in the warmer years of the last two decades. As has been projected by recent process model studies, such a sensitivity of tropical forest productivity to on-going climate change would accelerate the rate of atmospheric CO2 accumulation. PMID:12719545

Proposed International Aeronautical Monetary Fund - Legal and Practical Implications

DOT National Transportation Integrated Search

1998-01-01

The proposed international aeronautical monetary fund has its genesis in the Latin American Civil Aviation Commission (LACAC) which proposed the inauguration of the fund to finance air navigation services provided by the satellite based Communication...

The neural basis of academic achievement motivation.

PubMed

Mizuno, Kei; Tanaka, Masaaki; Ishii, Akira; Tanabe, Hiroki C; Onoe, Hirotaka; Sadato, Norihiro; Watanabe, Yasuyoshi

2008-08-01

We have used functional magnetic resonance imaging to study the neural correlates of motivation, concentrating on the motivation to learn and gain monetary rewards. We compared the activation in the brain obtained during reported high states of motivation for learning, with the ones observed when the motivation was based on monetary reward. Our results show that motivation to learn correlates with bilateral activity in the putamen, and that the higher the reported motivation, as derived from a questionnaire that each subject filled prior to scanning, the greater the change in the BOLD signals within the putamen. Monetary motivation also activated the putamen bilaterally, though the intensity of activity was not related to the monetary reward. We conclude that the putamen is critical for motivation in different domains and the extent of activity of the putamen may be pivotal to the motivation that drives academic achievement and thus academic successes.

Monetary Shocks in Models with Inattentive Producers.

PubMed

Alvarez, Fernando E; Lippi, Francesco; Paciello, Luigi

2016-04-01

We study models where prices respond slowly to shocks because firms are rationally inattentive. Producers must pay a cost to observe the determinants of the current profit maximizing price, and hence observe them infrequently. To generate large real effects of monetary shocks in such a model the time between observations must be long and/or highly volatile. Previous work on rational inattentiveness has allowed for observation intervals that are either constant-but-long ( e.g . Caballero, 1989 or Reis, 2006) or volatile-but-short ( e.g . Reis's, 2006 example where observation costs are negligible), but not both. In these models, the real effects of monetary policy are small for realistic values of the duration between observations. We show that non-negligible observation costs produce both of these effects: intervals between observations are infrequent and volatile. This generates large real effects of monetary policy for realistic values of the average time between observations.

Elevated Striatal Reactivity Across Monetary and Social Rewards in Bipolar I Disorder

PubMed Central

Dutra, Sunny J.; Cunningham, William A.; Kober, Hedy; Gruber, June

2016-01-01

Bipolar disorder (BD) is associated with increased reactivity to rewards and heightened positive affectivity. It is less clear to what extent this heightened reward sensitivity is evident across contexts and what the associated neural mechanisms might be. The present investigation employed both a monetary and social incentive delay task among adults with remitted BD type I (N=24) and a healthy non-psychiatric control group (HC; N=25) using fMRI. Both whole-brain and region-of-interest analyses revealed elevated ventral and dorsal striatal reactivity across monetary and social reward receipt, but not anticipation, in the BD group. Post-hoc analyses further suggested that greater striatal reactivity to reward receipt across monetary and social reward tasks predicted decreased self-reported positive affect when anticipating subsequent rewards in the HC, but not BD, group. Results point toward elevated striatal reactivity to reward receipt as a potential neural mechanism of reward reactivity. PMID:26390194

Processing of social and monetary rewards in the human striatum.

PubMed

Izuma, Keise; Saito, Daisuke N; Sadato, Norihiro

2008-04-24

Despite an increasing focus on the neural basis of human decision making in neuroscience, relatively little attention has been paid to decision making in social settings. Moreover, although human social decision making has been explored in a social psychology context, few neural explanations for the observed findings have been considered. To bridge this gap and improve models of human social decision making, we investigated whether acquiring a good reputation, which is an important incentive in human social behaviors, activates the same reward circuitry as monetary rewards. In total, 19 subjects participated in functional magnetic resonance imaging (fMRI) experiments involving monetary and social rewards. The acquisition of one's good reputation robustly activated reward-related brain areas, notably the striatum, and these overlapped with the areas activated by monetary rewards. Our findings support the idea of a "common neural currency" for rewards and represent an important first step toward a neural explanation for complex human social behaviors.

Monetary economics from econophysics perspective

NASA Astrophysics Data System (ADS)

Yakovenko, Victor M.

2016-12-01

This is an invited article for the Discussion and Debate special issue of The European Physical Journal Special Topics on the subject "Can Economics be a Physical Science?" The first part of the paper traces the personal path of the author from theoretical physics to economics. It briefly summarizes applications of statistical physics to monetary transactions in an ensemble of economic agents. It shows how a highly unequal probability distribution of money emerges due to irreversible increase of entropy in the system. The second part examines deep conceptual and controversial issues and fallacies in monetary economics from econophysics perspective. These issues include the nature of money, conservation (or not) of money, distinctions between money vs. wealth and money vs. debt, creation of money by the state and debt by the banks, the origins of monetary crises and capitalist profit. Presentation uses plain language understandable to laypeople and may be of interest to both specialists and general public.

Monetary Shocks in Models with Inattentive Producers

PubMed Central

Alvarez, Fernando E.; Lippi, Francesco; Paciello, Luigi

2016-01-01

We study models where prices respond slowly to shocks because firms are rationally inattentive. Producers must pay a cost to observe the determinants of the current profit maximizing price, and hence observe them infrequently. To generate large real effects of monetary shocks in such a model the time between observations must be long and/or highly volatile. Previous work on rational inattentiveness has allowed for observation intervals that are either constant-but-long (e.g. Caballero, 1989 or Reis, 2006) or volatile-but-short (e.g. Reis's, 2006 example where observation costs are negligible), but not both. In these models, the real effects of monetary policy are small for realistic values of the duration between observations. We show that non-negligible observation costs produce both of these effects: intervals between observations are infrequent and volatile. This generates large real effects of monetary policy for realistic values of the average time between observations. PMID:27516627

Increasing the Value of an Alternative Monetary Reinforcer Reduces Cigarette Choice in Adolescents.

PubMed

Cassidy, Rachel N; Tidey, Jennifer W; Kahler, Christopher W; Wray, Tyler B; Colby, Suzanne M

2015-12-01

Smoking can be conceptualized as an operant behavior maintained by the reinforcing effects of cigarettes. Changing the magnitude and availability of alternative reinforcers should shift behavior away from smoking. Adults' smoking behavior is sensitive to the magnitude and availability of alternative reinforcers; however, the extent to which the same is true for adolescents has not yet been shown in the laboratory. To test the sensitivity of adolescent smoking behavior to changes in the magnitude of alternative reinforcement, we gave adolescents who abstained overnight the opportunity to make 20 choices between receiving two puffs of their usual-brand cigarette or money. The magnitude of the monetary reinforcer was varied across sessions in counterbalanced order ($0.00, $0.10, and $0.50). Results indicated that adolescents' choices for puffs decreased as a function of increasing monetary reinforcer magnitude, while money choices increased. This effect was moderated by baseline smoking level and by gender, such that heavier-smoking participants and males made more cigarette choices when the alternative monetary value was zero, and decreased their choices more steeply in response to increasing monetary value. The current study validates a laboratory choice procedure for studying smoking in adolescents, and demonstrates that adolescent smoking behavior is sensitive to changes in the magnitude of concurrently available monetary reinforcers. The current paradigm can be adapted and applied to explore the effects of other variables that may affect cigarette choice in adolescents. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Impact of monetary incentives on cognitive performance and error monitoring following sleep deprivation.

PubMed

Hsieh, Shulan; Li, Tzu-Hsien; Tsai, Ling-Ling

2010-04-01

To examine whether monetary incentives attenuate the negative effects of sleep deprivation on cognitive performance in a flanker task that requires higher-level cognitive-control processes, including error monitoring. Twenty-four healthy adults aged 18 to 23 years were randomly divided into 2 subject groups: one received and the other did not receive monetary incentives for performance accuracy. Both subject groups performed a flanker task and underwent electroencephalographic recordings for event-related brain potentials after normal sleep and after 1 night of total sleep deprivation in a within-subject, counterbalanced, repeated-measures study design. Monetary incentives significantly enhanced the response accuracy and reaction time variability under both normal sleep and sleep-deprived conditions, and they reduced the effects of sleep deprivation on the subjective effort level, the amplitude of the error-related negativity (an error-related event-related potential component), and the latency of the P300 (an event-related potential variable related to attention processes). However, monetary incentives could not attenuate the effects of sleep deprivation on any measures of behavior performance, such as the response accuracy, reaction time variability, or posterror accuracy adjustments; nor could they reduce the effects of sleep deprivation on the amplitude of the Pe, another error-related event-related potential component. This study shows that motivation incentives selectively reduce the effects of total sleep deprivation on some brain activities, but they cannot attenuate the effects of sleep deprivation on performance decrements in tasks that require high-level cognitive-control processes. Thus, monetary incentives and sleep deprivation may act through both common and different mechanisms to affect cognitive performance.

A systematic worldwide review of the direct monetary losses in cattle due to bovine viral diarrhoea virus infection.

PubMed

Richter, Veronika; Lebl, Karin; Baumgartner, Walter; Obritzhauser, Walter; Käsbohrer, Annemarie; Pinior, Beate

2017-02-01

Bovine viral diarrhoea virus (BVDV) is an important infectious agent of cattle worldwide that affects herd productivity and reproduction. In this systematic review of the impact of BVDV, studies were analysed with a particular focus on the monetary implications and types of direct losses, the initial infection status of herds, production systems, time periods of assessment, calculation level, study types and whether or not country-specific assessments were published. A linear mixed model was applied to analyse factors that influence the level of monetary direct losses due to BVDV infection. The 44 studies included in this review covered 15 countries and assessed direct monetary losses due to BVDV incurred over the past 30 years. Direct losses between and within countries were largely heterogeneous with respect to the monetary level and types of direct losses, ranging from 0.50 to 687.80 US dollars (USD) per animal. 1 Average direct losses per naïve dairy cow were USD24.85 higher than per beef cow. Country-specific assessments of direct losses due to BVDV were provided in 38/44 (86.4%) studies. Mortality, morbidity, premature culling, stillbirths, abortion, reinfection, country and study type had a significant influence on the monetary level of direct losses (r 2  = 0.69). Countries recording direct losses were more likely to carry out voluntary or compulsory control and eradication programmes (odds ratio = 10.2; 95% confidence interval 1.7-81.9; P = 0.004). Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Kinky thresholds revisited: opportunity costs differ in the NE and SW quadrants.

PubMed

Eckermann, Simon

2015-02-01

Historically, a kinked threshold line on the cost-effectiveness plane at the origin was suggested due to differences in willingness to pay (WTP) for health gain with trade-offs in the north-east (NE) quadrant versus willingness to accept (WTA) cost reductions for health loss with trade-offs in the south-west (SW) quadrant. Empirically, WTA is greater than WTP for equivalent units of health, a finding supported by loss aversion under prospect theory. More recently, appropriate threshold values for health effects have been shown to require an endogenous consideration of the opportunity cost of alternative actions in budget-constrained health systems, but also allocative and displacement inefficiency observed in health system practice. Allocative and displacement inefficiency arise in health systems where the least cost-effective program in contraction has a higher incremental cost-effectiveness ratio (ICER = m) than the most cost-effective program in expansion (ICER = n) and displaced services (ICER = d), respectively. The health shadow price derived by Pekarsky, [Formula: see text] reflects the opportunity cost of best alternative adoption and financing actions in reimbursing new technology with expected incremental costs and net effect allowing for allocative (n < m), and displacement, inefficiency (d < m). This provides an appropriate threshold value for the NE quadrant. In this paper, I show that for trade-offs in the SW quadrant, where new strategies have lower expected net cost while lower expected net effect than current practice, the opportunity cost is contraction of the least cost-effective program, with threshold ICER m. That is, in the SW quadrant, the cost reduction per unit of decreased effect should be compared with the appropriate opportunity cost, best alternative generation of funding. Consequently, appropriate consideration of opportunity cost produces a kink in the threshold at the origin, with the health shadow price in the NE quadrant and ICER of the least cost-effective program in contraction (m) in the SW quadrant having the same general shape as that previously suggested by WTP versus WTA. The extent of this kink depends on the degree of allocative and displacement inefficiency, with no kink in the threshold line strictly only appropriate with complete allocative and displacement efficiency, that is n = d = m.

Cost effectiveness of herpes zoster vaccine in Canada.

PubMed

Najafzadeh, Mehdi; Marra, Carlo A; Galanis, Eleni; Patrick, David M

2009-01-01

Herpes zoster (HZ), or shingles, results from reactivation of latent varicella zoster virus in the sensory ganglia of adults, and results in significant morbidity in the elderly, including the development of post-herpetic neuralgia (PHN). The lifetime risk of HZ is about 20-30% and the incidence increases with age. The protective effect of the HZ vaccine has been shown in a large clinical trial; however, the effectiveness of the vaccine decreased with age of vaccination. We sought to compare the incremental cost and health benefits of HZ vaccine over status quo (no HZ vaccine) from the perspective of the Canadian healthcare payer. We developed a discrete-event simulation model comparing the costs and QALYs accrued to patients receiving HZ vaccine to those who did not. The effect of the vaccine on the (i) incidence of severe, moderate or mild HZ; (ii) severity and duration of HZ; (iii) incidence of PHN among patients with HZ; (iv) duration of PHN; and (v) costs associated with treating HZ and PHN were modelled. Data from published literature, including the Shingle Prevention Study, were used for transition probabilities. Health resource utilizations were estimated using administrative data retrieved from the British Columbia Medical Services Plan and hospital separation databases in British Columbia from 1994 to 2003. Utility estimates were obtained from various published sources. Canadian 2008 costs were used and both cost and QALYs were discounted at a 5% annual rate in the base-case analyses. On average, receiving the vaccination lowered mean direct medical costs (excluding the vaccine costs) by $Can35 per person. The incremental cost and QALYs per person receiving the vaccine versus no vaccination were $Can115 and 0.0028 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of $Can41 709 per QALY gained for a cohort of elderly subjects aged >or=60 years. Results were robust in probabilistic and univariate sensitivity analyses. Expected value of perfect information was estimated at $Can47.72 per person, reflecting the expected monetary losses that could be avoided by having perfect information on all model parameters. HZ vaccination of adults, especially for individuals aged 60-75 years, seems to be a cost-effective intervention and might be considered by Canadian decision makers.

[Effects of salt stress on physiological characters and salt-tolerance of Ulmus pumila in different habitats].

PubMed

Liu, Bing-Xiang; Wang, Zhi-Gang; Liang, Hai-Yong; Yang, Min-Sheng

2012-06-01

Taking the Ulmus pumila seedlings from three different habitats (medium-, mild-, and non-saline soils) as test materials, an experiment was conducted to study their salt-tolerance thresholds and physiological characteristic under different levels (0, 2, 4, 6, 8, and 10 g X kg(-1)) of salt stress. With increasing level of the salt stress, the seedlings taken from medium- and mild- saline habitats had a lower increment of leaf membrane permeability, Na+ content, and Na+/K+ but a higher increment of leaf proline, soluble sugar, and K+ contents, and a lower decrement of leaf starch content, net photosynthetic rate, transpiration rate, intercellular CO2 concentration, and stomatic conductance, as compared with the seedlings taken from non-saline habitat. The salt-tolerance thresholds of the seedlings taken from different habitats were in the order of medium- saline habitat (7.76 g X kg(-1)) > mild- saline habitat (7.37 g X kg(-1)) > non-saline habitat (6.95 g X kg(-1)). It was suggested that the U. pumila seedlings in medium- and mild-saline habitats had a stronger adaptability to saline soil environment than the U. pumila seedlings in non-saline soil environment.

Designing a new cropping system for high productivity and sustainable water usage under climate change

NASA Astrophysics Data System (ADS)

Meng, Qingfeng; Wang, Hongfei; Yan, Peng; Pan, Junxiao; Lu, Dianjun; Cui, Zhenling; Zhang, Fusuo; Chen, Xinping

2017-02-01

The food supply is being increasingly challenged by climate change and water scarcity. However, incremental changes in traditional cropping systems have achieved only limited success in meeting these multiple challenges. In this study, we applied a systematic approach, using model simulation and data from two groups of field studies conducted in the North China Plain, to develop a new cropping system that improves yield and uses water in a sustainable manner. Due to significant warming, we identified a double-maize (M-M; Zea mays L.) cropping system that replaced the traditional winter wheat (Triticum aestivum L.) -summer maize system. The M-M system improved yield by 14-31% compared with the conventionally managed wheat-maize system, and achieved similar yield compared with the incrementally adapted wheat-maize system with the optimized cultivars, planting dates, planting density and water management. More importantly, water usage was lower in the M-M system than in the wheat-maize system, and the rate of water usage was sustainable (net groundwater usage was ≤150 mm yr-1). Our study indicated that systematic assessment of adaptation and cropping system scale have great potential to address the multiple food supply challenges under changing climatic conditions.

Economics of influenza vaccine administration timing for children.

PubMed

Lee, Bruce Y; Tai, Julie H Y; Bailey, Rachel R; Smith, Kenneth J; Nowalk, Andrew J

2010-03-01

To determine how much should be invested each year to encourage and operationalize the administration of influenza vaccine to children before November and how late the vaccine should be offered each year. Monte Carlo decision analytic computer simulation models. The children's influenza vaccination timing model quantified the incremental economic value of vaccinating a child earlier in the influenza season and the incremental cost of delaying vaccination. The children's monthly influenza vaccination decision model evaluated the cost-effectiveness of vaccinating versus not vaccinating for every month of the influenza season. Getting children vaccinated by the end of October rather than when they are currently getting vaccinated could save society between $6.4 million and $9.2 million plus 653 and 926 quality-adjusted life-years (QALYs) and third-party payers between $4.1 million and $6.1 million plus 647 to 942 QALYs each year. Decision makers may want to continue offering influenza vaccination to children at least through the end of December. Vaccinating with trivalent inactivated virus vaccine was more cost-effective than vaccinating with live attenuated influenza vaccine for every month. Policymakers could invest up to $6 million to $9 million a year to get children vaccinated in September or October without expending any net costs.

CO2 sequestration in two mediterranean dune areas subjected to a different level of anthropogenic disturbance

NASA Astrophysics Data System (ADS)

Bonito, Andrea; Ricotta, Carlo; Iberite, Mauro; Gratani, Loretta; Varone, Laura

2017-09-01

Coastal sand dunes are among the most threatened habitats, especially in the Mediterranean Basin, where the high levels of human pressure impair the presence of plant species, putting at risk the maintenance of the ecosystem services, such as CO2 sequestration provided by these habitats. The aim of this study was to analyze how disturbance-induced changes in plant species abundance patterns account for variations in annual CO2 sequestration flow (CS) of Mediterranean sand dune areas. Two sites characterized by a high (site HAD) and a lower (site LAD) anthropogenic disturbance level were selected. At both sites, plant species number, cover, height and CS based on net photosynthesis measurements were sampled. At the plant species level, our results highlighted that Ammophila arenaria and Pancratium maritimum, had a key role in CS. Moreover, the results revealed a patchy species assemblage in both sites. In particular, HAD was characterized by a higher extension of the anthropogenic aphytoic zone (64% of the total transect length) than LAD. In spite of the observed differences in plant species composition, there were not significant differences between HAD and LAD in structural and functional traits, such as plant height and net photosynthesis. As a consequence, HAD and LAD had a similar CS (443 and 421 Mg CO2 ha-1 y-1, respectively). From a monetary point of view, our estimates based on the social costs of carbon revealed that the flow of sequestered CO2 valued on an average 3181 ± 114 ha-1 year-1 (mean value for the two sites). However, considering also the value of the CO2 negative flow related to loss of vegetated area, the annual net benefit arising from CO2 sequestration amounted to 1641 and 1772 for HAD and LAD, respectively. Overall, the results highlighted the importance to maximize the efforts to preserve dune habitats by applying an effective management policy, which could allow maintaining also a regulatory ecosystem service such as CO2 sequestration.

Operational and financial impact of physician screening in the ED.

PubMed

Soremekun, Olanrewaju A; Biddinger, Paul D; White, Benjamin A; Sinclair, Julia R; Chang, Yuchiao; Carignan, Sarah B; Brown, David F M

2012-05-01

Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. We aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center. We conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS. During the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%. In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact. Copyright © 2012 Elsevier Inc. All rights reserved.

46 CFR 506.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Definitions. 506.2 Section 506.2 Shipping FEDERAL MARITIME COMMISSION GENERAL AND ADMINISTRATIVE PROVISIONS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 506.2 Definitions. (a) Commission means the Federal Maritime Commission. (b) Civil Monetary Penalty...

The reductions in monetary cost and gains in productivity with methadone maintenance treatment: one year follow-up.

PubMed

Hsiao, Chih Yin; Chen, Kao Chin; Lee, Lan-Ting; Tsai, Hsin Chun; Chang, Wei Hung; Lee, I Hui; Chen, Po See; Lu, Ru-Band; Yang, Yen Kuang

2015-02-28

While methadone maintenance treatment (MMT) is beneficial for heroin dependence, there is little information regarding the reductions in monetary cost and gains in productivity following MMT. The aim of this study was to evaluate the changes in the monetary cost of heroin addiction and productivity after one year of MMT. Twenty-nine participants from an MMT clinic were included. The monetary cost, productivity, quality of life (QOL) and mental health status were assessed at both baseline and one year follow-up. The average annual total cost was approximately US$26,485 (1.43 GDP per capita in 2010) at baseline, and decreased by 59.3% to US$10,784 (0.58 GDP) at follow-up. The mean number of months of unemployment dropped from 6.03 to 2.79, the mean income increased to exceed the basic salary, but only reached 45.3% of the national average monthly earnings. The participants׳ mental health improved, but their QOL scores did not increase significantly. After one year of MMT, the monetary cost of heroin addiction fell, both the productivity and mental health of the participants׳ improved, but limited gains were seen with regard to their QOL. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Individual differences in sensitivity to reward and punishment and neural activity during reward and avoidance learning

PubMed Central

Yoon, HeungSik; Kim, Hackjin; Hamann, Stephan

2015-01-01

In this functional neuroimaging study, we investigated neural activations during the process of learning to gain monetary rewards and to avoid monetary loss, and how these activations are modulated by individual differences in reward and punishment sensitivity. Healthy young volunteers performed a reinforcement learning task where they chose one of two fractal stimuli associated with monetary gain (reward trials) or avoidance of monetary loss (avoidance trials). Trait sensitivity to reward and punishment was assessed using the behavioral inhibition/activation scales (BIS/BAS). Functional neuroimaging results showed activation of the striatum during the anticipation and reception periods of reward trials. During avoidance trials, activation of the dorsal striatum and prefrontal regions was found. As expected, individual differences in reward sensitivity were positively associated with activation in the left and right ventral striatum during reward reception. Individual differences in sensitivity to punishment were negatively associated with activation in the left dorsal striatum during avoidance anticipation and also with activation in the right lateral orbitofrontal cortex during receiving monetary loss. These results suggest that learning to attain reward and learning to avoid loss are dependent on separable sets of neural regions whose activity is modulated by trait sensitivity to reward or punishment. PMID:25680989

A Meta-Analysis of Single-Family Deep Energy Retrofit Performance in the U.S.

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

Less, Brennan; Walker, Iain

2014-03-01

The current state of Deep Energy Retrofit (DER) performance in the U.S. has been assessed in 116 homes in the United States (US), using actual and simulated data gathered from the available domestic literature. Substantial airtightness reductions averaging 63% (n=48) were reported (two- to three-times more than in conventional retrofits), with average post-retrofit airtightness of 4.7 Air Changes per House at 50 Pascal (ACH50) (n=94). Yet, mechanical ventilation was not installed consistently. In order to avoid indoor air quality (IAQ) issues, all future DERs should comply with ASHRAE 62.2-2013 requirements or equivalent. Projects generally achieved good energy results, with averagemore » annual net-site and net-source energy savings of 47%±20% and 45%±24% (n=57 and n=35), respectively, and carbon emission reductions of 47%±22% (n=23). Net-energy reductions did not vary reliably with house age, airtightness, or reported project costs, but pre-retrofit energy usage was correlated with total reductions (MMBtu). Annual energy costs were reduced $1,283±$804 (n=31), from a pre-retrofit average of $2,738±$1,065 to $1,588±$561 post-retrofit (n=25 and n=39). The average reported incremental project cost was $40,420±$30,358 (n=59). When financed on a 30-year term, the median change in net-homeownership cost was only $1.00 per month, ranging from $149 in savings to an increase of $212 (mean=$15.67±$87.74; n=28), and almost half of the projects resulted in reductions in net-cost. The economic value of a DER may be much greater than is suggested by these net-costs, because DERs entail substantial non-energy benefits (NEBs), and retrofit measures may add value to a home at resale similarly to general remodeling, PV panel installation, and green/energy efficient home labels. These results provide estimates of the potential of DERs to address energy use in existing homes across climate zones that can be used in future estimates of the technical potential to reduce household energy use and greenhouse gas emissions through DERs.« less

What Controls Ooid Grain Size?

NASA Astrophysics Data System (ADS)

Trower, L.; Lamb, M. P.; Fischer, W. W.

2015-12-01

Ooids are subspherical chemical sand grains composed of concentric layers of CaCO₃ surrounding a central nucleus. These grains represent a common mode of carbonate sedimentation, making them potentially powerful proxies for paleoenvironmental conditions, provided a mechanistic understanding of the physical, chemical, and perhaps biological conditions necessary for their formation. At a basic level, growth of an ooid reflects that precipitation has outpaced abrasion over the ooid's lifetime. We can describe change in ooid size over time (net growth rate) mechanistically as the sum of a growth rate (the rate of carbonate precipitation on the ooid surface) and an abrasion rate (the rate of removal of material through grain-grain and grain-bed collisions). Previous studies have addressed the growth rate, investigating the extent to which microbial activity affects and/or controls carbonate precipitation on ooid surfaces, and the net growth rate, using stepwise acid digestion and radiocarbon dating to determine the ages of cortical layers. We focused on the abrasion rate and designed an experimental study to measure abrasion rates of ooids as a function of grain size and sediment transport stage. Preliminary experiments with medium-sand-sized ooids at a Rouse number of ~1.2 yielded an abrasion rate of 0.04 g/hr (or ~40 ng/ooid/hr), which is four orders of magnitude greater than the fastest net growth rates reported in the recent high resolution ooid cortex radiocarbon dating study by Beaupre et al. (2015). This result requires that either: 1) ooids are essentially not moving and therefore not being abraded or 2) precipitation rates are also much more rapid than the net growth rates estimated by incremental radiocarbon dating. The former constraint is inconsistent with field observations that most marine ooids occur in high energy shoal environments, both in modern examples and in the rock record. Precipitation rates must therefore also be relatively rapid compared with net growth rates in order to offset the effects of abrasion. This disparity in magnitude between abrasion/precipitation rates and net growth rate implies that ooids spend much of their lifetime near a dynamic equilibrium in ooid size, perhaps explaining why ooid populations tend to be unimodal with relatively narrow distributions of grain size.

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

PubMed

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

2016-05-01

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

Incremental value of 99mTc-HYNIC-TOC SPECT/CT over whole-body planar scintigraphy and SPECT in patients with neuroendocrine tumours.

PubMed

Trogrlic, Mate; Težak, Stanko

2017-06-12

The aim of this study was to evaluate the additional value of 99m Tc-HYNIC-TOC SPECT/CT over planar whole-body (WB) scintigraphy and SPECT alone in the detection and accurate localisation of neuroendocrine tumour (NET) lesions. This study included 65 patients with a definitive histological diagnosis of NET prior to scintigraphy. Planar WB scintigraphy, SPECT, and SPECT/CT images were acquired at 4 h post-administration of 670 MBq 99m Tc-HYNIC-TOC. Additional SPECT images at 10 min after tracer administration were also acquired. Clinical and imaging follow-up findings were considered as the reference standards (minimum follow-up period, 15 months). Patient and lesion-based analyses of the efficacies of the imaging modalities were performed. While 38 patients exhibited metastasis of NETs, 27 presented no evidence of metastasis. Upon patient-based analysis, the sensitivity and specificity of SPECT/CT were found to be 88.9 and 79.3 %, respectively. The diagnostic accuracies of WB scintigraphy, 4h-SPECT, and SPECT/CT were 72.3, 73.8, and 84.6 %, respectively. The area under curve (AUC) value for SPECT/CT (0.84) was the highest, followed by those for 4h-SPECT (0.75) and WB scintigraphy (0.74). The accuracy and AUC values of SPECT/CT were significantly better compared to those of WB scintigraphy (p < 0.001), 10 min-SPECT (p < 0.001), and 4 h-SPECT (p = 0.001). The findings of SPECT/CT led to the change in treatment plan of 11 patients (16.9 %). The sensitivity and diagnostic accuracy of SPECT/CT in the evaluation of NET lesions outperforms planar WB imaging or SPECT alone.

14 CFR 1240.112 - Presentation of awards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CONTRIBUTIONS Awards for Scientific and Technical Contributions § 1240.112 Presentation of awards. (a) Monetary awards and accompanying written acknowledgments to employees of NASA will be presented in a formal... cognizant field installation or designee. (b) Monetary awards and accompanying written acknowledgments to...

20 CFR 10.519 - What action will OWCP take if an employee refuses to undergo vocational rehabilitation?

Code of Federal Regulations, 2011 CFR

2011-04-01

... monetary compensation based on the amount which would likely have been his or her wage-earning capacity had... monetary compensation accordingly (that is, to zero). This reduction will remain in effect until such time...

76 FR 74720 - Inflation Adjustment of Civil Monetary Penalties; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-01

... of Civil Monetary Penalties; Correction AGENCY: Federal Maritime Commission. ACTION: Correcting... maximum amount of each statutory civil penalty subject to Federal Maritime Commission jurisdiction, in accordance with the requirements of the Federal Civil Penalties Inflation Adjustment Act of 1990, as amended...

The economics (or lack thereof) of aerosol geoengineering

NASA Astrophysics Data System (ADS)

Goes, M.; Keller, K.; Tuana, N.

2009-04-01

Anthropogenic greenhouse gas emissions are changing the Earth's climate and impose substantial risks for current and future generations. What are scientifically sound, economically viable, and ethically defendable strategies to manage these climate risks? Ratified international agreements call for a reduction of greenhouse gas emissions to avoid dangerous anthropogenic interference with the climate system. Recent proposals, however, call for the deployment of a different approach: to geoengineer climate by injecting aerosol precursors into the stratosphere. Published economic studies typically suggest that substituting aerosol geoengineering for abatement of carbon dioxide emissions results in large net monetary benefits. However, these studies neglect the risks of aerosol geoengineering due to (i) the potential for future geoengineering failures and (ii) the negative impacts associated with the aerosol forcing. Here we use a simple integrated assessment model of climate change to analyze potential economic impacts of aerosol geoengineering strategies over a wide range of uncertain parameters such as climate sensitivity, the economic damages due to climate change, and the economic damages due to aerosol geoengineering forcing. The simplicity of the model provides the advantages of parsimony and transparency, but it also imposes severe caveats on the interpretation of the results. For example, the analysis is based on a globally aggregated model and is hence silent on the question of intragenerational distribution of costs and benefits. In addition, the analysis neglects the effects of endogenous learning about the climate system. We show that the risks associated with a future geoengineering failure and negative impacts of aerosol forcings can cause geoenginering strategies to fail an economic cost-benefit test. One key to this finding is that a geoengineering failure would lead to dramatic and abrupt climatic changes. The monetary damages due to this failure can dominate the cost-benefit analysis because the monetary damages of climate change are expected to increase with the rate of change. Substituting aerosol geoengineering for greenhouse gas emission abatement might fail not only an economic cost-benefit test but also an ethical test of distributional justice. Substituting aerosol geoengineering for greenhouse gas emissions abatements constitutes a conscious risk transfer to future generations. Intergenerational justice demands distributional justice, namely that present generations may not create benefits for themselves in exchange for burdens on future generations. We use the economic model to quantify this risk transfer to better inform the judgment of whether substituting aerosol geoengineering for carbon dioxide emission abatement fails this ethical test.

Dissociated effects of anticipating smoking versus monetary reward in the caudate as a function of smoking abstinence.

PubMed

Sweitzer, Maggie M; Geier, Charles F; Joel, Danielle L; McGurrin, Patrick; Denlinger, Rachel L; Forbes, Erika E; Donny, Eric C

2014-11-01

Theories of addiction suggest that chronic smoking may be associated with both hypersensitivity to smoking and related cues and hyposensitivity to alternative reinforcers. However, neural responses to smoking and nonsmoking rewards are rarely evaluated within the same paradigm, leaving the extent to which both processes operate simultaneously uncertain. Behavioral evidence and theoretical models suggest that dysregulated reward processing may be more pronounced during deprivation from nicotine, but neuroimaging evidence on the effects of deprivation on reward processing is limited. The current study examined the impact of deprivation from smoking on neural processing of both smoking and monetary rewards. Two separate functional magnetic resonance imaging scans were performed in 38 daily smokers, one after smoking without restriction and one following 24 hours of abstinence. A rewarded guessing task was conducted during each scan to evaluate striatal blood oxygen level-dependent response during anticipation of both smoking and monetary rewards. A significant reward type by abstinence interaction was observed in the bilateral caudate and medial prefrontal cortex during reward anticipation. The blood oxygen level-dependent response to anticipation of smoking reward was significantly higher and anticipation of monetary rewards was significantly lower during abstinence compared with nonabstinence. Attenuation of monetary reward-related activation during abstinence was significantly correlated with abstinence-induced increases in craving and withdrawal. These results provide the first direct evidence of dissociated effects of smoking versus monetary rewards as a function of abstinence. The findings suggest an important neural pathway that may underlie the choice to smoke in lieu of alternative reinforcement during a quit attempt. © 2013 Society of Biological Psychiatry Published by Society of Biological Psychiatry All rights reserved.

Differential effects of social and non-social reward on response inhibition in children and adolescents.

PubMed

Kohls, Gregor; Peltzer, Judith; Herpertz-Dahlmann, Beate; Konrad, Kerstin

2009-07-01

An important issue in the field of clinical and developmental psychopathology is whether cognitive control processes, such as response inhibition, can be specifically enhanced by motivation. To determine whether non-social (i.e. monetary) and social (i.e. positive facial expressions) rewards are able to differentially improve response inhibition accuracy in typically developing children and adolescents, an 'incentive' go/no-go task was applied with reward contingencies for successful inhibition. In addition, the impact of children's personality traits (such as reward seeking and empathy) on monetary and social reward responsiveness was assessed in 65 boys, ages 8 to 12 years. All subjects were tested twice: At baseline, inhibitory control was assessed without reward, and then subjects were pseudorandomly assigned to one of four experimental conditions, including (1) social reward only, (2) monetary reward only, (3) mixed social and monetary reward, or (4) a retest condition without reward. Both social and non-social reward significantly improved task performance, although larger effects were observed for monetary reward. The higher the children scored on reward seeking scales, the larger was their improvement in response inhibition, but only if monetary reward was used. In addition, there was a tendency for an association between empathic skills and benefits from social reward. These data suggest that social incentives do not have an equally strong reinforcing value as compared to financial incentives. However, different personality traits seem to determine to what extent a child profits from different types of reward. Clinical implications regarding probable hyposensitivity to social reward in subjects with autism and dysregulated reward-seeking behaviour in children with attention-deficit/hyperactivity disorder (ADHD) are discussed.

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission: A Systematic Review and Meta-analysis.

PubMed

Nuckols, Teryl K; Keeler, Emmett; Morton, Sally; Anderson, Laura; Doyle, Brian J; Pevnick, Joshua; Booth, Marika; Shanman, Roberta; Arifkhanova, Aziza; Shekelle, Paul

2017-07-01

Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. To systematically review economic evaluations of QI interventions designed to reduce readmissions. Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat (January 2004 to July 2016). Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs. Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs. We calculated the risk difference and net costs to the health system in 2015 US dollars. Weighted least-squares regression analyses tested predictors of the risk difference and net costs. Main outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Of 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95% CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3% among general populations (95% CI, 4.0%-8.7%; P < .001; 18 studies). The mean net savings to the health system per patient was $972 among patients with HF (95% CI, -$642 to $2586; P = .23; 24 studies), and the mean net loss was $169 among general populations (95% CI, -$2610 to $2949; P = .90; 21 studies), reflecting nonsignificant differences. Among general populations, interventions that engaged patients and caregivers were associated with greater net savings ($1714 vs -$6568; P = .006). Multicomponent QI interventions can be effective at reducing readmissions relative to the status quo, but net costs vary. Interventions that engage general populations of patients and their caregivers may offer greater value to the health system, but the implications for patients and caregivers are unknown.

38 CFR 3.21 - Monetary rates.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Compensation, and Dependency and Indemnity Compensation General § 3.21 Monetary rates. The rates of compensation, dependency and indemnity compensation for surviving spouses and children, and section 306 and old... limitations applicable to parents' dependency and indemnity compensation are set forth in § 3.25. Cross...

38 CFR 3.21 - Monetary rates.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., Compensation, and Dependency and Indemnity Compensation General § 3.21 Monetary rates. The rates of compensation, dependency and indemnity compensation for surviving spouses and children, and section 306 and old... limitations applicable to parents' dependency and indemnity compensation are set forth in § 3.25. Cross...

38 CFR 3.21 - Monetary rates.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., Compensation, and Dependency and Indemnity Compensation General § 3.21 Monetary rates. The rates of compensation, dependency and indemnity compensation for surviving spouses and children, and section 306 and old... limitations applicable to parents' dependency and indemnity compensation are set forth in § 3.25. Cross...

38 CFR 3.21 - Monetary rates.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Compensation, and Dependency and Indemnity Compensation General § 3.21 Monetary rates. The rates of compensation, dependency and indemnity compensation for surviving spouses and children, and section 306 and old... limitations applicable to parents' dependency and indemnity compensation are set forth in § 3.25. Cross...

38 CFR 3.21 - Monetary rates.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Compensation, and Dependency and Indemnity Compensation General § 3.21 Monetary rates. The rates of compensation, dependency and indemnity compensation for surviving spouses and children, and section 306 and old... limitations applicable to parents' dependency and indemnity compensation are set forth in § 3.25. Cross...

25 CFR 162.549 - How much monetary compensation must be paid under a WSR lease of tribal land?

Code of Federal Regulations, 2014 CFR

2014-04-01

... INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation... tribe may request, in writing, that we determine fair market rental, in which case we will use a...

25 CFR 162.549 - How much monetary compensation must be paid under a WSR lease of tribal land?

Code of Federal Regulations, 2013 CFR

2013-04-01

... INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Monetary Compensation... tribe may request, in writing, that we determine fair market rental, in which case we will use a...

77 FR 65100 - Adjustment of Civil Monetary Penalties for Inflation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

... Penalties for Inflation AGENCY: Commodity Futures Trading Commission ACTION: Final rule. SUMMARY: The... civil monetary penalties, to adjust for inflation. This rule sets forth the maximum, inflation-adjusted... Federal Civil Penalties Inflation Adjustment Act of 1990, as amended by the Debt Collection Improvement...

34 CFR 36.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Secretary, Department of Education ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION § 36.1 Purpose. The purpose of this part is to make inflation adjustments to the civil monetary penalties within the... at least once every 4 years in accordance with the Federal Civil Penalties Inflation Adjustment Act...

Estimating monetary damages from flooding in the United States under a changing climate

EPA Science Inventory

A national-scale analysis of potential changes in monetary damages from flooding under climate change. The approach uses empirically based statistical relationships between historical precipitation and flood damage records from 18 hydrologic regions of the United States, along w...

Operational Reserve: Costs and Considerations

DTIC Science & Technology

material way. Findings include relevant RC costs at approximately 132% of those of a hypothetical equivalent AC unit. The primary contributor to...the Deputy Commandant for Manpower and Reserve Affairs (DC, M and RA), should monitor the totality of relevant monetary and non -monetary costs for any

Health effects associated with passenger vehicles: monetary values of air pollution.

PubMed

Marzouk, Mohamed; Madany, Magdy

2012-01-01

Air pollution is regarded as one of the highest priorities in environmental protection in both developed and developing countries. High levels of air pollution have adverse effects on human health that might cause premature death. This study presents the monetary value estimates for the adverse human health effects resulted from ambient air pollution. It aids decision makers to set priorities in the public health relevance of pollution abatement. The main driver of policymaker is the need to reduce the avoidable cardiopulmonary morbidity and mortality from pollutant exposures. The monetary valuation involves 2 steps: (i) relate levels of pollutants to mortality and morbidity (concentration-response relationships) and (ii) apply unit economic values. Cost of air pollution associated with passenger vehicles running over a major traffic bridge (6th of October Elevated Highway) is presented as a case study to demonstrate the use of monetary value of air pollution. The study proves that the cost of air pollution is extremely high and should not be overlooked.

Impacts of monetary incentive measures on the acceptability for intelligent speed adaptation (ISA)

NASA Astrophysics Data System (ADS)

Matsuo, Kojiro; Sugihara, Mitsuru; Yamazaki, Motohiro; Mimura, Yasuhiro; Kanno, Komei; Sugiki, Nao

2017-10-01

In Japan, Mandatory Intelligent Speed Adaptation (ISA) or Voluntary ISA could be a new paradigm for urban driving speed management such as traffic calming in community streets, once it is widely disseminated. This study aims to analyze the impacts of various monetary incentive measures and individual attributes on the acceptability for several ISA installation. We conducted a stated preference (SP) surveys for the subjects who had attended in a 5-month Advisory ISA field experiment. Then we applied disaggregate model analyses to the response data. The main results were: that the acceptability for Advisory ISA is highest followed by Voluntary ISA and then Mandatory ISA; that the acceptability for ISA that operates only on community streets is high; that the acceptability becomes higher as the age of the subjects becomes higher; and that the acceptability becomes higher as the amount of the monetary incentive becomes greater, but the marginal effect becomes lower. In conclusions, the monetary incentive measures for disseminating Voluntary ISA seems to be practical.

Can beneficial ends justify lying? Neural responses to the passive reception of lies and truth-telling with beneficial and harmful monetary outcomes

PubMed Central

Weber, Bernd

2016-01-01

Can beneficial ends justify morally questionable means? To investigate how monetary outcomes influence the neural responses to lying, we used a modified, cheap talk sender–receiver game in which participants were the direct recipients of lies and truthful statements resulting in either beneficial or harmful monetary outcomes. Both truth-telling (vs lying) as well as beneficial (vs harmful) outcomes elicited higher activity in the nucleus accumbens. Lying (vs truth-telling) elicited higher activity in the supplementary motor area, right inferior frontal gyrus, superior temporal sulcus and left anterior insula. Moreover, the significant interaction effect was found in the left amygdala, which showed that the monetary outcomes modulated the neural activity in the left amygdala only when truth-telling rather than lying. Our study identified a neural network associated with the reception of lies and truth, including the regions linked to the reward process, recognition and emotional experiences of being treated (dis)honestly. PMID:26454816

No Evidence for Inhibitory Deficits or Altered Reward Processing in ADHD: Data From a New Integrated Monetary Incentive Delay Go/No-Go Task.

PubMed

Demurie, Ellen; Roeyers, Herbert; Wiersema, Jan R; Sonuga-Barke, Edmund

2016-04-01

Cognitive and motivational factors differentially affect individuals with mental health problems such as ADHD. Here we introduce a new task to disentangle the relative contribution of inhibitory control and reward anticipation on task performance in children with ADHD and/or autism spectrum disorders (ASD). Typically developing children, children with ADHD,  ASD, or both disorders worked during separate sessions for monetary or social rewards in go/no-go tasks with varying inhibitory load levels. Participants also completed a monetary temporal discounting (TD) task. As predicted, task performance was sensitive to both the effects of anticipated reward amount and inhibitory load. Reward amount had different effects depending on inhibitory load level. TD correlated with inhibitory control in the ADHD group. The integration of the monetary incentive delay and go/no-go paradigms was successful. Surprisingly, there was no evidence of inhibitory control deficits or altered reward anticipation in the clinical groups. © The Author(s) 2013.

Event-related EEG responses to anticipation and delivery of monetary and social reward.

PubMed

Flores, Amanda; Münte, Thomas F; Doñamayor, Nuria

2015-07-01

Monetary and a social incentive delay tasks were used to characterize reward anticipation and delivery with electroencephalography. During reward anticipation, N1, P2 and P3 components were modulated by both prospective reward value and incentive type (monetary or social), suggesting distinctive allocation of attentional and motivational resources depending not only on whether rewards or non-rewards were cued, but also on the monetary and social nature of the prospective outcomes. In the delivery phase, P2, FRN and P3 components were also modulated by levels of reward value and incentive type, illustrating how distinctive affective and cognitive processes were attached to the different outcomes. Our findings imply that neural processing of both reward anticipation and delivery can be specific to incentive type, which might have implications for basic as well as translational research. These results are discussed in the light of previous electrophysiological and neuroimaging work using similar tasks. Copyright © 2015 Elsevier B.V. All rights reserved.

Gender differences in reward and punishment for monetary and social feedback in children: An ERP study

PubMed Central

Zou, Yuchen; Song, Yan; Xiao, Xue; Huang, Wanyi; Li, Yanfang

2017-01-01

Gender differences in feedback processing have been observed among adolescents and adults through event-related potentials. However, information on whether and how this feedback processing is affected by feedback valence, feedback type, and individual sensitivity in reward/punishment among children remains minimal. In this study, we used a guessing game task coupled with electroencephalography to investigate gender differences in feedback processing, in which feedback to reward and punishment was presented in the context of monetary and social conditions. Results showed that boys were less likely to switch their response after punishment, had generally less feedback-related negativity (FRN) amplitude, and longer FRN latency in monetary and punishment conditions than girls. Moreover, FRN for monetary punishment, which is related to individual difference in reward sensitivity, was observed only in girls. The study provides gender-specific evidence for the neural processing of feedback, which may offer educational guidance for appropriate feedback for girls and boys. PMID:28346515

Monetary incentives in support of academic achievement: results of a randomized field trial involving high-achieving, low-resource, ethnically diverse urban adolescents.

PubMed

Spencer, Margaret Beale; Noll, Elizabeth; Cassidy, Elaine

2005-06-01

Significant resources have been directed at understanding and alleviating the achievement gap in education. Most programs focused on this aim rely on a top-down approach, including funding for infrastructure improvement, curriculum development, class size, and teacher salaries. This article presents findings from a randomized field trial that evaluates a bottom-up approach in which high-achieving students of diverse racial and ethnic backgrounds from poor families are given monetary incentives to maintain their academic standing. The evaluation was designed to explore the role of monetary incentives as a mechanism for promoting resiliency in the face of poverty-related challenge. Discussion of what motivates students to learn is framed as a function of normal cognitive and socioemotional development in challenging environments. Evaluation findings indicate that monetary incentives are effective in promoting academic success to different degrees and for different reasons depending on students' perception of the meaning of the incentive in relation to their emergent identity.

Estimating the monetary value of willingness to pay for E-book reader's attributes using partially confounded factorial conjoint choice experiment

NASA Astrophysics Data System (ADS)

Yong, Chin-Khian

2013-09-01

A partially confounded factorial conjoint choice experiments design was used to examine the monetary value of the willingness to pay for E-book Reader's attributes. Conjoint analysis is an efficient, cost-effective, and most widely used quantitative method in marketing research to understand consumer preferences and value trade-off. Value can be interpreted by customer or consumer as the received of multiple benefits from a price that was paid. The monetary value of willingness to pay for battery life, internal memory, external memory, screen size, text to Speech, touch screen, and converting handwriting to digital text of E-book reader were estimated in this study. Due to the significant interaction effect of the attributes with the price, the monetary values for the seven attributes were found to be different at different values of odds of purchasing versus not purchasing. The significant interactions effects were one of the main contribution of the partially confounded factorial conjoint choice experiment.

The convergence of gambling and digital media: implications for gambling in young people.

PubMed

King, Daniel; Delfabbro, Paul; Griffiths, Mark

2010-06-01

Adolescents' use of the Internet and other digital media for the purpose of gambling represents a serious concern in modern society. This paper overviews some of the available monetary and non-monetary forms of gambling within new digital and online media and monetary forms of games with gambling-like experiences. With reference to current psychological knowledge on the risk factors that promote adolescent gambling, it is suggested that new gambling technologies may: (a) make gambling more accessible and attractive to young people, (b) may promote factually incorrect information about gambling, (c) provide an easy escape from real world problems such as depression and social isolation, (d) create a gambling environment that easily facilitates peer pressures to gamble, (e) ease parental transmission of gambling attitudes and beliefs, and (f) make gambling more ubiquitous and socially acceptable. The unique risks of Internet gambling for young people are critically discussed, as well as the lack of restricted classification for video games and other media that feature interactive, non-monetary forms of gambling.

The need for monetary information within corporate water accounting.

PubMed

Burritt, Roger L; Christ, Katherine L

2017-10-01

A conceptual discussion is provided about the need to add monetary data to water accounting initiatives and how best to achieve this if companies are to become aware of the water crisis and to take actions to improve water management. Analysis of current water accounting initiatives reveals the monetary business case for companies to improve water management is rarely considered, there being a focus on physical information about water use. Three possibilities emerge for mainstreaming the integration of monetization into water accounting: add-on to existing water accounting frameworks and tools, develop new tools which include physical and monetary information from the start, and develop environmental management accounting (EMA) into a water-specific application and set of tools. The paper appraises these three alternatives and concludes that development of EMA would be the best way forward. Suggestions for further research include the need to examine the use of a transdisciplinary method to address the complexities of water accounting. Copyright © 2017 Elsevier Ltd. All rights reserved.

Left-right compatibility in the processing of trading verbs.

PubMed

Vicario, Carmelo M; Rumiati, Raffaella I

2014-01-01

The research investigating the nature of cognitive processes involved in the representation of economical outcomes is growing. Within this research, the mental accounting model proposes that individuals may well use cognitive operations to organize, evaluate, and keep track of their financial activities (Thaler, 1999). Here we wanted to test this hypothesis by asking to a group of participants to detect a syntax mistake of verbs indicating incoming and going out activities related to economical profit (trading verbs), swapping (swapping verbs) and thinking (thinking verbs). We reported a left-right compatibility for trading verbs (i.e., participants were faster with their right hand while detecting verb referring to a monetary gain with respect to a monetary loss; and faster with their left hand while detecting a monetary loss with respect to a monetary gain). However, this pattern of result was not reported while detecting swapping verbs. Results are discussed taking into account the mental accounting theory as well as to the spatial mapping of valence hypothesis.

Gender differences in reward and punishment for monetary and social feedback in children: An ERP study.

PubMed

Ding, Ying; Wang, Encong; Zou, Yuchen; Song, Yan; Xiao, Xue; Huang, Wanyi; Li, Yanfang

2017-01-01

Gender differences in feedback processing have been observed among adolescents and adults through event-related potentials. However, information on whether and how this feedback processing is affected by feedback valence, feedback type, and individual sensitivity in reward/punishment among children remains minimal. In this study, we used a guessing game task coupled with electroencephalography to investigate gender differences in feedback processing, in which feedback to reward and punishment was presented in the context of monetary and social conditions. Results showed that boys were less likely to switch their response after punishment, had generally less feedback-related negativity (FRN) amplitude, and longer FRN latency in monetary and punishment conditions than girls. Moreover, FRN for monetary punishment, which is related to individual difference in reward sensitivity, was observed only in girls. The study provides gender-specific evidence for the neural processing of feedback, which may offer educational guidance for appropriate feedback for girls and boys.

Prognostic Value of Quantitative Stress Perfusion Cardiac Magnetic Resonance.

PubMed

Sammut, Eva C; Villa, Adriana D M; Di Giovine, Gabriella; Dancy, Luke; Bosio, Filippo; Gibbs, Thomas; Jeyabraba, Swarna; Schwenke, Susanne; Williams, Steven E; Marber, Michael; Alfakih, Khaled; Ismail, Tevfik F; Razavi, Reza; Chiribiri, Amedeo

2018-05-01

This study sought to evaluate the prognostic usefulness of visual and quantitative perfusion cardiac magnetic resonance (CMR) ischemic burden in an unselected group of patients and to assess the validity of consensus-based ischemic burden thresholds extrapolated from nuclear studies. There are limited data on the prognostic value of assessing myocardial ischemic burden by CMR, and there are none using quantitative perfusion analysis. Patients with suspected coronary artery disease referred for adenosine-stress perfusion CMR were included (n = 395; 70% male; age 58 ± 13 years). The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, aborted sudden death, and revascularization after 90 days. Perfusion scans were assessed visually and with quantitative analysis. Cross-validated Cox regression analysis and net reclassification improvement were used to assess the incremental prognostic value of visual or quantitative perfusion analysis over a baseline clinical model, initially as continuous covariates, then using accepted thresholds of ≥2 segments or ≥10% myocardium. After a median 460 days (interquartile range: 190 to 869 days) follow-up, 52 patients reached the primary endpoint. At 2 years, the addition of ischemic burden was found to increase prognostic value over a baseline model of age, sex, and late gadolinium enhancement (baseline model area under the curve [AUC]: 0.75; visual AUC: 0.84; quantitative AUC: 0.85). Dichotomized quantitative ischemic burden performed better than visual assessment (net reclassification improvement 0.043 vs. 0.003 against baseline model). This study was the first to address the prognostic benefit of quantitative analysis of perfusion CMR and to support the use of consensus-based ischemic burden thresholds by perfusion CMR for prognostic evaluation of patients with suspected coronary artery disease. Quantitative analysis provided incremental prognostic value to visual assessment and established risk factors, potentially representing an important step forward in the translation of quantitative CMR perfusion analysis to the clinical setting. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Indian social safety net programs as platforms for introducing wheat flour fortification: a case study of Gujarat, India.

PubMed

Fiedler, John L; Babu, Sunil; Smitz, Marc-Francois; Lividini, Keith; Bermudez, Odilia

2012-03-01

Micronutrient deficiencies exact an enormous health burden on India. The release of the National Family Health Survey results--showing the relatively wealthy state of Gujarat having deficiency levels exceeding national averages--prompted Gujarat officials to introduce fortified wheat flour in their social safety net programs (SSNPs). To provide a case study of the introduction of fortified wheat flour in Gujarat's Public Distribution System (PDS), Integrated Child Development Scheme (ICDS), and Mid-Day Meal (MDM) Programme to assess the coverage, costs, impact, and cost-effectiveness of the initiative. India's 2004/05 National Sample Survey data were used to identify beneficiaries of each of Gujarat's three SSNPs and to estimate usual intake levels of vitamin A, iron, and zinc. Comparing age- and sex-specific usual intakes to Estimated Average Requirements, the proportion of the population with inadequate intakes was estimated. Postfortification intake levels and reductions in inadequate intake were estimated. The incremental cost of fortifying wheat flour and the cost-effectiveness of each program were estimated. When each program was assessed independently, the proportion of the population with inadequate vitamin A intakes was reduced by 34% and 74% among MDM and ICDS beneficiaries, respectively. Both programs effectively eliminated inadequate intakes of both iron and zinc. Among PDS beneficiaries, the proportion with inadequate iron intakes was reduced by 94%. CONCLUSIONS. Gujarat's substitution of fortified wheat flour for wheat grain is dramatically increasing the intake of micronutrients among its SSNP beneficiaries. The incremental cost of introducing fortification in each of the programs is low, and, according to World Health Organization criteria, each program is "highly cost-effective." The introduction of similar reforms throughout India would largely eliminate the inadequate iron intake among persons participating in any of the three SSNPs and would have a significant impact on the global prevalence rate of inadequate iron intake.

14 CFR 13.301 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.301 Scope and purpose. (a) This subpart provides a mechanism for the regular adjustment for inflation of civil monetary penalties in conformity with the Federal Civil Penalties Inflation Adjustment Act of 1990, 28 U.S.C. 2461...

46 CFR 506.1 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MARITIME COMMISSION GENERAL AND ADMINISTRATIVE PROVISIONS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 506... for inflation of civil monetary penalties and to adjust such penalties in conformity with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note), as amended by the Debt...

Non-Monetary Benefits Without Apology: The Economic Theory and Practice of Ecosystem Service Benefit Indicators.

EPA Science Inventory

Values for changes in ecosystem services (ES) are required or desired in many policy and management decision contexts, although appropriate monetary values often are not available or are infeasible to estimate. Fortunately, in many contexts—e.g., cost-effectiveness analysis...

Non-Monetary Benefits Without Apology: The Economic Theory and Practice of Ecosystem Service Benefit Indicators

EPA Science Inventory

Values for changes in ecosystem services (ES) are required or desired in many policy and management contexts. Often, appropriate monetary values are not available or are infeasible to estimate. Fortunately, in many contexts—e.g., cost-effectiveness analysis of programmatic ...

7 CFR 1980.470 - Defaults by borrower.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 14 2010-01-01 2009-01-01 true Defaults by borrower. 1980.470 Section 1980.470...) PROGRAM REGULATIONS (CONTINUED) GENERAL Business and Industrial Loan Program § 1980.470 Defaults by... property management. A. In case of any monetary or significant non-monetary default under the loan...

78 FR 49370 - Inflation Adjustment of Maximum Forfeiture Penalties

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... ``civil monetary penalties provided by law'' at least once every four years. DATES: Effective September 13... increases the maximum civil monetary forfeiture penalties available to the Commission under its rules... maximum civil penalties established in that section to account for inflation since the last adjustment to...

Sharing, Discounting, and Selfishness: A Japanese-American Comparison

ERIC Educational Resources Information Center

Ito, Masato; Saeki, Daisuke; Green, Leonard

2011-01-01

Social discounting rates were compared between Japanese and American college students. In a series of psychophysical questionnaire tasks, participants chose between a hypothetical unshared monetary reward and a hypothetical monetary reward to be shared with other people (relatives or strangers), to determine amounts of the unshared reward…

Modulation of working memory function by motivation through loss-aversion.

PubMed

Krawczyk, Daniel C; D'Esposito, Mark

2013-04-01

Cognitive performance is affected by motivation. Few studies, however, have investigated the neural mechanisms of the influence of motivation through potential monetary punishment on working memory. We employed functional MRI during a delayed recognition task that manipulated top-down control demands with added monetary incentives to some trials in the form of potential losses of bonus money. Behavioral performance on the task was influenced by loss-threatening incentives in the form of faster and more accurate performance. As shown previously, we found enhancement of activity for relevant stimuli occurs throughout all task periods (e.g., stimulus encoding, maintenance, and response) in both prefrontal and visual association cortex. Further, these activation patterns were enhanced for trials with possible monetary loss relative to nonincentive trials. During the incentive cue, the amygdala and striatum showed significantly greater activation when money was at a possible loss on the trial. We also evaluated patterns of functional connectivity between regions responsive to monetary consequences and prefrontal areas responsive to the task. This analysis revealed greater delay period connectivity between and the left insula and prefrontal cortex with possible monetary loss relative to nonincentive trials. Overall, these results reveal that incentive motivation can modulate performance on working memory tasks through top-down signals via amplification of activity within prefrontal and visual association regions selective to processing the perceptual inputs of the stimuli to be remembered. Copyright © 2011 Wiley Periodicals, Inc.

Modulation of working memory function by motivation through loss-aversion

PubMed Central

Krawczyk, Daniel C.; D’Esposito, Mark

2012-01-01

Cognitive performance is affected by motivation. Few studies, however, have investigated the neural mechanisms of the influence of motivation through potential monetary punishment on working memory. We employed functional MRI during a delayed recognition task that manipulated top-down control demands with added monetary incentives to some trials in the form of potential losses of bonus money. Behavioral performance on the task was influenced by loss-threatening incentives in the form of faster and more accurate performance. As shown previously, we found enhancement of activity for relevant stimuli occurs throughout all task periods (e.g. stimulus encoding, maintenance, and response) in both prefrontal and visual association cortex. Further, these activation patterns were enhanced for trials with possible monetary loss relative to non-incentive trials. During the incentive cue, the amygdala and striatum showed significantly greater activation when money was at a possible loss on the trial. We also evaluated patterns of functional connectivity between regions responsive to monetary consequences and prefrontal areas responsive to the task. This analysis revealed greater delay period connectivity between and the left insula and prefrontal cortex with possible monetary loss relative to non-incentive trials. Overall, these results reveal that incentive motivation can modulate performance on working memory tasks through top-down signals via amplification of activity within prefrontal and visual association regions selective to processing the perceptual inputs of the stimuli to be remembered. PMID:22113962

Individual differences in sensitivity to reward and punishment and neural activity during reward and avoidance learning.

PubMed

Kim, Sang Hee; Yoon, HeungSik; Kim, Hackjin; Hamann, Stephan

2015-09-01

In this functional neuroimaging study, we investigated neural activations during the process of learning to gain monetary rewards and to avoid monetary loss, and how these activations are modulated by individual differences in reward and punishment sensitivity. Healthy young volunteers performed a reinforcement learning task where they chose one of two fractal stimuli associated with monetary gain (reward trials) or avoidance of monetary loss (avoidance trials). Trait sensitivity to reward and punishment was assessed using the behavioral inhibition/activation scales (BIS/BAS). Functional neuroimaging results showed activation of the striatum during the anticipation and reception periods of reward trials. During avoidance trials, activation of the dorsal striatum and prefrontal regions was found. As expected, individual differences in reward sensitivity were positively associated with activation in the left and right ventral striatum during reward reception. Individual differences in sensitivity to punishment were negatively associated with activation in the left dorsal striatum during avoidance anticipation and also with activation in the right lateral orbitofrontal cortex during receiving monetary loss. These results suggest that learning to attain reward and learning to avoid loss are dependent on separable sets of neural regions whose activity is modulated by trait sensitivity to reward or punishment. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Health policy model: long-term predictive results associated with the management of hepatitis C virus-induced diseases in Italy.

PubMed

Mennini, Francesco Saverio; Marcellusi, Andrea; Andreoni, Massimo; Gasbarrini, Antonio; Salomone, Salvatore; Craxì, Antonio

2014-01-01

At present, there are no specific nationwide epidemiological studies representing the whole Italian population. This study is aimed at describing the epidemiological and economic burden that HCV will generate in the next few years in Italy. Furthermore, the impact that future anti-HCV treatments may have on the burden of disease was considered. This analysis was developed for the period 2012-2030 from the perspective of the Italian National Health Service (NHS). A published system dynamic model was adapted for Italy in order to quantify the HCV-infected population in terms of disease progression and the associated costs from 1950 to 2030. The model structure was based on transition probabilities reflecting the natural history of the disease. In order to estimate the efficacy of current anti-HCV treatment strategies for genotypes 1 and 4, the sustained virological response (SVR) rate in registration clinical trials for both boceprevir and telaprevir was estimated. It was assumed that the efficacy for patients treated with peginterferon + ribavirin was equal to the placebo arm of a randomized clinical trial (RCT) relating to boceprevir and telaprevir. For genotypes 2/3 patients it was assumed that treatment efficacy with dual therapy was equal to a SVR rate from the literature. According to the aim of this study, only direct health care costs (hospital admissions, drugs, treatment, and care of patients) incurred by the Italian NHS have been included in the model. Costs have been extrapolated using the published scientific literature available in Italy and actualized with the 2012 ISTAT (Istituto Nazionale di Statistica) Price Index system for monetary revaluation. Three different scenarios were assumed in order to evaluate the impact of future anti-HCV treatments on the burden of disease. Overall, in Italy, 1.2 million infected subjects were estimated in 2012. Of these, about 211,000 patients were diagnosed, while only about 11,800 subjects were actually being treated with anti-HCV drugs. A reduction of health care costs is associated with a prevalence decrease. Indeed, once the spending peak is reached during this decade (about €527 million), the model predicts a cost reduction in the following 18 years. In 2030, based on the more effective treatments currently available, the direct health care cost associated with the management of HCV patients may reach €346 million (-34.3% compared to 2012). The first scenario (new treatment in 2015 with SVR =90% and same number of treated patients) was associated with a significant reduction in HCV-induced clinical consequences (prevalence =-3%) and a decrease in direct health care expenses, corresponding to €11.1 million. The second scenario (increase in treated patients to 12,790) produced an incremental cost reduction of €7.3 million, reaching a net decrease equal to €18.4 million. In the third scenario (treated patients =16,770), a higher net direct health care cost decrease versus the base-case (€44.0 million) was estimated. Our model showed that the introduction of new treatments that are more effective could result in a quasi-eradication of HCV, with a very strong reduction in prevalence.

Cost Effectiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch Pharmacoeconomic Guidelines.

PubMed

Ramos, Isaac Corro; Versteegh, Matthijs M; de Boer, Rudolf A; Koenders, Jolanda M A; Linssen, Gerard C M; Meeder, Joan G; Rutten-van Mölken, Maureen P M H

2017-12-01

To describe the adaptation of a global health economic model to determine whether treatment with the angiotensin receptor neprilysin inhibitor LCZ696 is cost effective compared with the angiotensin-converting enzyme inhibitor enalapril in adult patients with chronic heart failure with reduced left ventricular ejection fraction in the Netherlands; and to explore the effect of performing the cost-effectiveness analyses according to the new pharmacoeconomic Dutch guidelines (updated during the submission process of LCZ696), which require a value-of-information analysis and the inclusion of indirect medical costs of life-years gained. We adapted a UK model to reflect the societal perspective in the Netherlands by including travel expenses, productivity loss, informal care costs, and indirect medical costs during the life-years gained and performed a preliminary value-of-information analysis. The incremental cost-effectiveness ratio obtained was €17,600 per quality-adjusted life-year (QALY) gained. This was robust to changes in most structural assumptions and across different subgroups of patients. Probability sensitivity analysis results showed that the probability that LCZ696 is cost-effective at a €50,000 per QALY threshold is 99.8%, with a population expected value of perfect information of €297,128. On including indirect medical costs of life-years gained, the incremental cost-effectiveness ratio was €26,491 per QALY gained, and LCZ696 was 99.46% cost effective at €50,000 per QALY, with a population expected value of perfect information of €2,849,647. LCZ696 is cost effective compared with enalapril under the former and current Dutch guidelines. However, the (monetary) consequences of making a wrong decision were considerably different in both scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain

PubMed Central

Christensen, Finn Bjarke; Christiansen, Terkel; Bünger, Cody

2006-01-01

Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator’s perspective, by means of Activity-Based-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental cost-effectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself—at least from an administrator’s perspective. PMID:16871387

Launch vehicle and power level impacts on electric GEO insertion

NASA Technical Reports Server (NTRS)

Oleson, Steven R.; Myers, Roger M.

1996-01-01

Solar Electric Propulsion (SEP) has been shown to increase net geosynchronous spacecraft mass when used for station keeping and final orbit insertion. The impact of launch vehicle selection and power level on the benefits of this approach were examined for 20 and 25 kW systems launched using the Ariane 5, Atlas IIAR, Long March, Proton, and Sea Launch vehicles. Two advanced on-board propulsion technologies, 5 kW ion and Hall thruster systems, were used to establish the relative merits of the technologies and launch vehicles. GaAs solar arrays were assumed. The analysis identifies the optimal starting orbits for the SEP orbit raising/plane changing while considering the impacts of radiation degradation in the Van Allen belts, shading, power degradation, and oblateness. This use of SEP to provide part of the orbit insertion results in net mass increases of 15 - 38% and 18 - 46% for one to two month trip times, respectively, over just using SEP for 15 years of north/south station keeping. SEP technology was shown to have a greater impact on net masses of launch vehicles with higher launch latitudes when avoidance of solar array and payload degradation is desired. This greater impact of SEP could help reduce the plane changing disadvantage of high latitude launch sites. Comparison with results for 10 and 15 kW systems show clear benefits of incremental increases in SEP power level, suggesting that an evolutionary approach to high power SEP for geosynchronous spacecraft is possible.

Consumption-based Total Suspended Particulate Matter Emissions in Jing-Jin-Ji Area of China

NASA Astrophysics Data System (ADS)

Yang, S.; Chen, S.; Chen, B.

2014-12-01

The highly-industrialized regions in China have been facing a serious problem of haze mainly consisted of total suspended particulate matter (TSPM), which has attracted great attention from the public since it directly impairs human health and clinically increases the risks of various respiratory and pulmonary diseases. In this paper, we set up a multi-regional input-output (MRIO) model to analyze the transferring routes of TSPM emissions between regions through trades. TSPM emission from particulate source regions and sectors are identified by analyzing the embodied TSPM flows through monetary flow and carbon footprint. The track of TSPM from origin to end via consumption activities are also revealed by tracing the product supply chain associated with the TSPM emissions. Beijing-Tianjin-Hebei (Jing-Jin-Ji) as the most industrialized area of China is selected for a case study. The result shows that over 70% of TSPM emissions associated with goods consumed in Beijing and Tianjin occurred outside of their own administrative boundaries, implying that Beijing and Tianjin are net embodied TSPM importers. Meanwhile, 63% of the total TSPM emissions in Hebei Province are resulted from the outside demand, indicating Hebei is a net exporter. In addition, nearly half of TSPM emissions are the by-products related to electricity and heating supply and non-metal mineral products in Jing-Jin-Ji Area. Based on the model results, we provided new insights into establishing systemic strategies and identifying mitigation priorities to stem TSPM emissions in China. Keywords: total suspended particulate matter (TSPM); urban ecosystem modeling; multi-regional input-output (MRIO); China

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

PubMed

Kornfeld, R; Rupp, K

2000-01-01

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

75 FR 43840 - Inflation Adjustment of the Ordinary Maximum and Aggravated Maximum Civil Monetary Penalties for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... Civil Monetary Penalties for a Violation of the Hazardous Material Transportation Laws and Regulations... violations of Federal hazardous material transportation law or a regulation, order, special permit or approval issued under that law. The hazardous material transportation regulations are issued by the...

19 CFR 111.94 - Decision on monetary penalty.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... If payment or arrangements for payment are not timely made, Customs will refer the matter to the... 19 Customs Duties 1 2014-04-01 2014-04-01 false Decision on monetary penalty. 111.94 Section 111.94 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF...

19 CFR 111.94 - Decision on monetary penalty.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... If payment or arrangements for payment are not timely made, Customs will refer the matter to the... 19 Customs Duties 1 2010-04-01 2010-04-01 false Decision on monetary penalty. 111.94 Section 111.94 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF...

19 CFR 111.94 - Decision on monetary penalty.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... If payment or arrangements for payment are not timely made, Customs will refer the matter to the... 19 Customs Duties 1 2011-04-01 2011-04-01 false Decision on monetary penalty. 111.94 Section 111.94 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF...